1
|
Abbas D, Ciricillo JA, Elom HA, Moon AM. Extrahepatic Health Effects of Alcohol Use and Alcohol-associated Liver Disease. Clin Ther 2023; 45:1201-1211. [PMID: 37806811 DOI: 10.1016/j.clinthera.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Alcohol use disorder (AUD) is a growing public health concern and an important contributor to global morbidity and mortality. While the hepatotoxic effects of alcohol are well known, the adverse effects of alcohol are manifested in almost every organ system. With the growing public health impact of AUD, the aim of this narrative review is to highlight the epidemiology and burden of AUD and its association with extrahepatic diseases including malignancy and disorders of the gastrointestinal (GI), cardiovascular, immunologic, neurologic, endocrine, and hematologic systems. METHODS A narrative review of the literature was performed to identify studies addressing the epidemiology, pathophysiology, clinical manifestations, and therapy of extrahepatic health manifestations of alcohol use. FINDINGS In the United States, an estimated 14.5 million people have AUD and approximately 88,000 adults die yearly due to alcohol-related causes. The consumption of alcohol and AUD is associated with injuries, violence, cancers, nonmalignant conditions of the GI system, infections, effects on the cardiovascular system, and neurodegenerative diseases. These conditions contribute to the increased mortality associated with AUD and are burdensome to patients and caregivers. IMPLICATIONS Increased awareness of the extrahepatic manifestations of AUD, screening for AUD using validated screening tools, such as the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score, and offering evidence-based interventions to patients with AUD is imperative to reduce the public health burden of AUD. Although historically controversial, recent evidence suggests that any level of alcohol consumption can have negative health consequences. Further research is warranted to determine if any amount of alcohol is safe for consumption. Public health efforts are warranted to help curtail the growing burden of AUD.
Collapse
Affiliation(s)
- Daniyal Abbas
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina
| | - Jacob A Ciricillo
- Department of Internal Medicine, University of Cincinnati Medicine Center, Cincinnati, Ohio
| | - Hilary A Elom
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Andrew M Moon
- Department of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
| |
Collapse
|
2
|
Sebalo I, Königová MP, Sebalo Vňuková M, Anders M, Ptáček R. The Associations of Adverse Childhood Experiences (ACEs) With Substance Use in Young Adults: A Systematic Review. Subst Abuse 2023; 17:11782218231193914. [PMID: 38025908 PMCID: PMC10631312 DOI: 10.1177/11782218231193914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/25/2023] [Indexed: 12/01/2023]
Abstract
Introduction Young adulthood is a transitional period between adolescence and adulthood. Due to the unique pressures of taking on a new social role and associated uncertainties, young adults are at heightened risk for drug and alcohol use. Furthermore, adverse childhood experiences (ACEs) increases the likelihood of using maladaptive coping strategies such as using substances to avoid or soothe negative emotions. The current review aimed to summarize the associations between exposure to ACEs before the age of 18 years and subsequent drug or alcohol use between the ages of 18 and 25 years. Methods The review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search of the Web of Science, PubMed, and PsycINFO databases was conducted in February 2022. Results The initial search yielded 7178 articles, with 777 duplicates. Consequently, 6401 titles were inspected for relevance. After reading the full text, 88 articles were included in the review. Conclusion This review provides clear evidence that exposure to multiple ACEs is a robust risk factor for the use of alcohol, cannabis and other drugs by young adults. Poor self-regulation and maladaptive coping strategies were identified as mechanisms explaining this link; however, further detailed research is needed.
Collapse
Affiliation(s)
- Ivan Sebalo
- Centre of Research and Education in Forensic Psychology, School of Psychology, University of Kent, Canterbury, UK
- Department of Psychiatry, Charles University and General University Hospital, Prague, Czechia
| | - Michaela Poslt Königová
- Department of Psychiatry, Charles University and General University Hospital, Prague, Czechia
| | - Martina Sebalo Vňuková
- Department of Psychiatry, Charles University and General University Hospital, Prague, Czechia
| | - Martin Anders
- Department of Psychiatry, Charles University and General University Hospital, Prague, Czechia
| | - Radek Ptáček
- Department of Psychiatry, Charles University and General University Hospital, Prague, Czechia
| |
Collapse
|
3
|
Brown S, Fite PJ, Bortolato M. The mediating role of impulsivity in the associations between child maltreatment types and past month substance use. CHILD ABUSE & NEGLECT 2022; 128:105591. [PMID: 35306342 PMCID: PMC9119917 DOI: 10.1016/j.chiabu.2022.105591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND Child maltreatment has emerged as an important risk factor for substance use. However, despite evidence consistently demonstrating that substance use peaks during emerging adulthood, less is known about the specificity of maltreatment effects on substance use during this critical developmental period. Further, the factors that might play a role in these associations are not well understood. OBJECTIVE The current study examined the associations between child maltreatment types (i.e., physical abuse, physical neglect, sexual abuse, emotional abuse, and emotional neglect) and past month marijuana, alcohol, and tobacco use among emerging adults, and tested whether impulsivity accounted for these associations. METHODS Participants were 500 emerging adults ranging in age between 18 and 25 years old (M = 18.96, SD = 1.22, 49.6% male) recruited from a large, public university in the Midwest United States. RESULTS Tests of indirect effects suggested that impulsivity accounted for associations between emotional abuse and past month marijuana, alcohol, and tobacco use. CONCLUSIONS Current findings provide support for impulsivity as a mechanism linking childhood emotional abuse to substance use among emerging adults, highlighting the need for targeted screening and intervention.
Collapse
Affiliation(s)
- Shaquanna Brown
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA; Consortium for Translational Research on Aggression and Drug Abuse (ConTRADA), University of Kansas, 2009 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045, USA.
| | - Paula J Fite
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA; Consortium for Translational Research on Aggression and Drug Abuse (ConTRADA), University of Kansas, 2009 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045, USA
| | - Marco Bortolato
- Consortium for Translational Research on Aggression and Drug Abuse (ConTRADA), University of Kansas, 2009 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045, USA; Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
4
|
Manto MU. Cerebellotoxic Agents. HANDBOOK OF THE CEREBELLUM AND CEREBELLAR DISORDERS 2022:2363-2408. [DOI: 10.1007/978-3-030-23810-0_96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
5
|
Manto MU. Cerebellotoxic Agents. HANDBOOK OF THE CEREBELLUM AND CEREBELLAR DISORDERS 2021:1-46. [DOI: 10.1007/978-3-319-97911-3_96-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/15/2020] [Indexed: 09/02/2023]
|
6
|
Li G, Le TM, Wang W, Zhornitsky S, Chen Y, Chaudhary S, Zhu T, Zhang S, Bi J, Tang X, Li CSR. Perceived stress, self-efficacy, and the cerebral morphometric markers in binge-drinking young adults. NEUROIMAGE: CLINICAL 2021; 32:102866. [PMID: 34749288 PMCID: PMC8569726 DOI: 10.1016/j.nicl.2021.102866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/12/2021] [Accepted: 10/24/2021] [Indexed: 11/18/2022] Open
Abstract
Self-efficacy is negatively correlated with perceived stress in young adult drinkers. Binge vs. non-binge drinking men show diminished PCC thickness and dmPFC GMV. The metrics are positively/negatively each correlated with self-efficacy/stress. Path analyses show daily drinks → neural metrics → low self-efficacy → high stress.
Studies have identified cerebral morphometric markers of binge drinking and implicated cortical regions in support of self-efficacy and stress regulation. However, it remains unclear how cortical structures of self-control play a role in ameliorating stress and alcohol consumption or how chronic alcohol exposure alters self-control and leads to emotional distress. We examined the data of 180 binge (131 men) and 256 non-binge (83 men) drinkers from the Human Connectome Project. We obtained data on regional cortical thickness from the HCP and derived gray matter volumes (GMVs) with voxel-based morphometry. At a corrected threshold, binge relative to non-binge drinking men showed diminished posterior cingulate cortex (PCC) thickness and dorsomedial prefrontal cortex (dmPFC) GMV. PCC thickness and dmPFC GMVs were positively and negatively correlated with self-efficacy and perceived stress, respectively, as assessed with the NIH Emotion Toolbox. Mediation and path analyses to query the inter-relationships between the neural markers and clinical variables showed a best fit of the model with daily drinks → lower PCC thickness and dmPFC GMV → lower self-efficacy → higher perceived stress in men. In contrast, binge and non-binge drinking women did not show significant differences in regional cortical thickness or GMVs. These findings suggest a pathway whereby chronic alcohol consumption alters cortical structures and self-efficacy mediates the effects of cortical structural deficits on perceived stress in men. The findings also suggest the need to investigate multimodal neural markers underlying the interplay between stress, self-control and alcohol use behavior in women.
Collapse
|
7
|
Cardenas VA, Hough CM, Durazzo TC, Meyerhoff DJ. Cerebellar Morphometry and Cognition in the Context of Chronic Alcohol Consumption and Cigarette Smoking. Alcohol Clin Exp Res 2020; 44:102-113. [PMID: 31730240 PMCID: PMC6980879 DOI: 10.1111/acer.14222] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebellar atrophy (especially involving the superior-anterior cerebellar vermis) is among the most salient and clinically significant effects of chronic hazardous alcohol consumption on brain structure. Smaller cerebellar volumes are also associated with chronic cigarette smoking. The present study investigated effects of both chronic alcohol consumption and cigarette smoking on cerebellar structure and its relation to performance on select cognitive/behavioral tasks. METHODS Using T1-weighted Magnetic Resonance Images (MRIs), the Cerebellar Analysis Tool Kit segmented the cerebellum into bilateral hemispheres and 3 vermis parcels from 4 participant groups: smoking (s) and nonsmoking (ns) abstinent alcohol-dependent treatment seekers (ALC) and controls (CON) (i.e., sALC, nsALC, sCON, and nsCON). Cognitive and behavioral data were also obtained. RESULTS We found detrimental effects of chronic drinking on all cerebellar structural measures in ALC participants, with largest reductions seen in vermis areas. Furthermore, both smoking groups had smaller volumes of cerebellar hemispheres but not vermis areas compared to their nonsmoking counterparts. In exploratory analyses, smaller cerebellar volumes were related to lower measures of intelligence. In sCON, but not sALC, greater smoking severity was related to smaller cerebellar volume and smaller superior-anterior vermis area. In sALC, greater abstinence duration was associated with larger cerebellar and superior-anterior vermis areas, suggesting some recovery with abstinence. CONCLUSIONS Our results show that both smoking and alcohol status are associated with smaller cerebellar structural measurements, with vermal areas more vulnerable to chronic alcohol consumption and less affected by chronic smoking. These morphometric cerebellar deficits were also associated with lower intelligence and related to duration of abstinence in sALC only.
Collapse
Affiliation(s)
- Valerie A. Cardenas
- Center for Imaging of Neurodegenerative Diseases (CIND),
San Francisco VA Medical Center, San Francisco, CA, USA
| | - Christina M. Hough
- Center for Imaging of Neurodegenerative Diseases (CIND),
San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Psychiatry, UCSF Weill Institute for
Neurosciences, University of California, San Francisco, San Francisco, CA
- Department of Psychology, University of California, Los
Angeles, Los Angeles, CA
| | - Timothy C. Durazzo
- VA Palo Alto Health Care System, Mental Illness Research
and Education Clinical Centers, Sierra-Pacific War Related Illness and Injury Study
Center, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford
University School of Medicine, Stanford, CA, USA
| | - Dieter J. Meyerhoff
- Center for Imaging of Neurodegenerative Diseases (CIND),
San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University
of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
8
|
Roque A, Lajud N, Valdez JJ, Torner L. Early-life stress increases granule cell density in the cerebellum of male rats. Brain Res 2019; 1723:146358. [DOI: 10.1016/j.brainres.2019.146358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/14/2019] [Accepted: 07/29/2019] [Indexed: 01/10/2023]
|
9
|
Ports KA, Holman DM, Guinn AS, Pampati S, Dyer KE, Merrick MT, Lunsford NB, Metzler M. Adverse Childhood Experiences and the Presence of Cancer Risk Factors in Adulthood: A Scoping Review of the Literature From 2005 to 2015. J Pediatr Nurs 2019; 44:81-96. [PMID: 30683285 PMCID: PMC6355255 DOI: 10.1016/j.pedn.2018.10.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 02/07/2023]
Abstract
Exposure to Adverse Childhood Experiences (ACEs) is associated with a host of harmful outcomes, including increased risk for cancer. A scoping review was conducted to gain a better understanding of how ACEs have been studied in association with risk factors for cancer. This review includes 155 quantitative, peer-reviewed articles published between 2005 and 2015 that examined associations between ACEs and modifiable cancer risk factors, including alcohol, environmental carcinogens, chronic inflammation, sex hormones, immunosuppression, infectious agents, obesity, radiation, ultraviolet (UV) radiation, and tobacco, among U.S. adults. This review highlights the growing body of research connecting ACEs to cancer risk factors, particularly alcohol, obesity, and tobacco. Fewer studies investigated the links between ACEs and chronic inflammation or infectious agents. No included publications investigated associations between ACEs and environmental carcinogens, hormones, immunosuppression, radiation, or ultraviolet radiation. Mitigating the impact of ACEs may provide innovative ways to effect comprehensive, upstream cancer prevention.
Collapse
Affiliation(s)
- Katie A Ports
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Dawn M Holman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Angie S Guinn
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Sanjana Pampati
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Karen E Dyer
- Virginia Commonwealth University, School of Medicine, Department of Health Behavior and Policy, Richmond, VA, USA.
| | - Melissa T Merrick
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Natasha Buchanan Lunsford
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Marilyn Metzler
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| |
Collapse
|
10
|
Cassiers LLM, Sabbe BGC, Schmaal L, Veltman DJ, Penninx BWJH, Van Den Eede F. Structural and Functional Brain Abnormalities Associated With Exposure to Different Childhood Trauma Subtypes: A Systematic Review of Neuroimaging Findings. Front Psychiatry 2018; 9:329. [PMID: 30123142 PMCID: PMC6086138 DOI: 10.3389/fpsyt.2018.00329] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/29/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Childhood trauma subtypes sexual abuse, physical abuse, emotional maltreatment, and neglect may have differential effects on the brain that persist into adulthood. A systematic review of neuroimaging findings supporting these differential effects is as yet lacking. Objectives: The present systematic review aims to summarize the findings of controlled neuroimaging trials regarding long-term differential effects of trauma subtypes on the human brain. Methods: A systematic literature search was performed using the PubMed and PsycINFO databases from January 2017 up to and including January 2018. Additional papers were identified by a manual search in the reference lists of selected papers and of relevant review articles retrieved by the initial database search. Studies were then assessed for eligibility by the first author. Only original human studies directly comparing neuroimaging findings of exposed and unexposed individuals to well-defined emotional, physical or sexual childhood maltreatment while controlling for the effects of other subtypes were included. A visual summary of extracted data was made for neuroimaging modalities for which comparison between trauma subtypes was feasible, taking the studies' numbers and sample sizes into account. Results: The systematic literature search yielded 25 publications. Sexual abuse was associated with structural deficits in the reward circuit and genitosensory cortex and amygdalar hyperreactivity during sad autobiographic memory recall. Emotional maltreatment correlated with abnormalities in fronto-limbic socioemotional networks. In neglected individuals, white matter integrity and connectivity were disturbed in several brain networks involved in a variety of functions. Other abnormalities, such as reduced frontal cortical volume, were common to all maltreatment types. Conclusions: There is some evidence for long-term differential effects of trauma subtypes on the human brain. The observed alterations may result from both protective adaptation of and damage to the brain following exposure to threatening life events. Though promising, the current evidence is incomplete, with few brain regions and neuroimaging modalities having been investigated in all subtypes. The comparability of the available evidence is further limited by the heterogeneity of study populations regarding gender, age and comorbid psychopathology. Future neuroimaging studies should take this potentially differential role of childhood trauma subtypes into account.
Collapse
Affiliation(s)
- Laura L M Cassiers
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium.,University Department of Psychiatry, Campus Antwerp University Hospital, Antwerp, Belgium
| | - Bernard G C Sabbe
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium.,University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Antwerp, Belgium
| | - Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands.,Amsterdam Neuroscience, VU University Medical Center, Amsterdam, Netherlands
| | - Filip Van Den Eede
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium.,University Department of Psychiatry, Campus Antwerp University Hospital, Antwerp, Belgium
| |
Collapse
|
11
|
Shanmugarajah PD, Hoggard N, Currie S, Aeschlimann DP, Aeschlimann PC, Gleeson DC, Karajeh M, Woodroofe N, Grünewald RA, Hadjivassiliou M. Alcohol-related cerebellar degeneration: not all down to toxicity? CEREBELLUM & ATAXIAS 2016; 3:17. [PMID: 27729985 PMCID: PMC5048453 DOI: 10.1186/s40673-016-0055-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/29/2016] [Indexed: 12/04/2022]
Abstract
Background Alcohol-related cerebellar degeneration is one of the commonest acquired forms of cerebellar ataxia. The exact pathogenic mechanisms by which alcohol leads to cerebellar damage remain unknown. Possible autoreactive immune mediated mechanisms have not been explored previously. In this study, we aim to investigate the potential role of alcohol-induced immune mediated cerebellar degeneration. Methods Patients with ataxia and a history of alcohol misuse were recruited from the Ataxia and Hepatology tertiary clinics at Sheffield Teaching Hospitals NHS Trust. We determined the pattern of cerebellar involvement both on clinical (SARA score) and imaging (MRI volumetry and MR spectroscopy) parameters. In addition, HLA genotyping, serological markers for gluten-related disorders and serological reactivity on rat cerebellar tissue using indirect immunohistochemistry were assessed. Results Thirty-eight patients were included in the study all of whom had ataxia. The gait (97 %), stance (89 %) and heel-shin slide (89 %) were the predominant SARA elements affected. MRI volumetric and spectroscopy techniques demonstrated significant structural, volumetric and functional deficits of the cerebellum with particular involvement of the cerebellar vermis. Circulating anti-gliadin antibodies were detected in 34 % patients vs. 12 % in healthy controls. Antibodies to transglutaminase 6 (TG6) were detected in 39 % of patients and 4 % of healthy control subjects. Using immunohistochemistry, Purkinje cell and/or granular layer reactivity was demonstrated in 71 % of patient sera. Conclusions Alcohol induced tissue injury to the CNS leading to cerebellar degeneration may also involve immune mediated mechanisms, including sensitisation to gluten. Electronic supplementary material The online version of this article (doi:10.1186/s40673-016-0055-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Priya D Shanmugarajah
- Academic Department of Neurosciences, Royal Hallamshire Hospital, and University of Sheffield, Sheffield, UK
| | - Nigel Hoggard
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Stuart Currie
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Daniel P Aeschlimann
- Matrix Biology & Tissue Repair Research Unit, College of Biomedical and Life Sciences, School of Dentistry, Cardiff University, Cardiff, UK
| | - Pascale C Aeschlimann
- Matrix Biology & Tissue Repair Research Unit, College of Biomedical and Life Sciences, School of Dentistry, Cardiff University, Cardiff, UK
| | - Dermot C Gleeson
- Academic Department of Hepatology, Royal Hallamshire Hospital, and University of Sheffield, Sheffield, UK
| | - Mohammed Karajeh
- Academic Department of Hepatology, Royal Hallamshire Hospital, and University of Sheffield, Sheffield, UK
| | - Nicola Woodroofe
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Richard A Grünewald
- Academic Department of Neurosciences, Royal Hallamshire Hospital, and University of Sheffield, Sheffield, UK
| | - Marios Hadjivassiliou
- Academic Department of Neurosciences, Royal Hallamshire Hospital, and University of Sheffield, Sheffield, UK
| |
Collapse
|
12
|
Brooks SJ, Naidoo V, Roos A, Fouché JP, Lochner C, Stein DJ. Early-life adversity and orbitofrontal and cerebellar volumes in adults with obsessive-compulsive disorder: voxel-based morphometry study. Br J Psychiatry 2016; 208:34-41. [PMID: 26338992 DOI: 10.1192/bjp.bp.114.162610] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/26/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND Early-life adversity is a risk for obsessive-compulsive disorder (OCD), but the impact at the neural level is less clear. AIMS To investigate the association between brain volumes and early-life adversity in individuals with a diagnosis of OCD only. METHOD The Childhood Trauma Questionnaire (CTQ-28) was used to assess early-life adversity in 21 participants with OCD and 25 matched healthy controls. The relationship between global and regional brain volume and early-life adversity was measured using voxel-based morphometry (VBM). All data were corrected for multiple comparisons using family-wise error (FWE) at P<0.05. RESULTS In the OCD group, correlations with total CTQ scores were positively associated with a larger right orbitofrontal cortex volume. Physical neglect was higher in the OCD group than in controls and was positively associated with larger right cerebellum volume in the OCD group only. CONCLUSIONS Larger brain volumes may reflect underlying developmental neuropathology in adults with OCD who also have experience of childhood trauma.
Collapse
Affiliation(s)
- Samantha J Brooks
- Samantha J. Brooks, PhD, Vanesh Naidoo, BSc(Hons), Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Annerine Roos, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Jean-Paul Fouché, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Christine Lochner, MA, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Dan J. Stein, PhD, DPhil, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa and Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Vanesh Naidoo
- Samantha J. Brooks, PhD, Vanesh Naidoo, BSc(Hons), Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Annerine Roos, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Jean-Paul Fouché, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Christine Lochner, MA, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Dan J. Stein, PhD, DPhil, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa and Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Annerine Roos
- Samantha J. Brooks, PhD, Vanesh Naidoo, BSc(Hons), Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Annerine Roos, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Jean-Paul Fouché, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Christine Lochner, MA, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Dan J. Stein, PhD, DPhil, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa and Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Jean-Paul Fouché
- Samantha J. Brooks, PhD, Vanesh Naidoo, BSc(Hons), Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Annerine Roos, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Jean-Paul Fouché, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Christine Lochner, MA, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Dan J. Stein, PhD, DPhil, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa and Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Christine Lochner
- Samantha J. Brooks, PhD, Vanesh Naidoo, BSc(Hons), Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Annerine Roos, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Jean-Paul Fouché, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Christine Lochner, MA, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Dan J. Stein, PhD, DPhil, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa and Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Dan J Stein
- Samantha J. Brooks, PhD, Vanesh Naidoo, BSc(Hons), Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Annerine Roos, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Jean-Paul Fouché, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa; Christine Lochner, MA, PhD, Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa; Dan J. Stein, PhD, DPhil, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, Cape Town, South Africa and Department of Psychiatry, MRC Unit on Anxiety & Stress Disorders, Stellenbosch University, Tygerberg, Cape Town, South Africa
| |
Collapse
|
13
|
Manto M. Toxic Agents. ESSENTIALS OF CEREBELLUM AND CEREBELLAR DISORDERS 2016:601-611. [DOI: 10.1007/978-3-319-24551-5_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
14
|
Cservenka A, Jones SA, Nagel BJ. Reduced cerebellar brain activity during reward processing in adolescent binge drinkers. Dev Cogn Neurosci 2015; 16:110-120. [PMID: 26190276 PMCID: PMC4691369 DOI: 10.1016/j.dcn.2015.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/28/2015] [Accepted: 06/26/2015] [Indexed: 11/26/2022] Open
Abstract
Adolescent binge drinkers have reduced cerebellar activity during reward outcome. Average drinks consumed/drinking day was negatively related to brain activity. Salience of rewards may be blunted because of alcohol-induced neurotoxicity.
Due to ongoing development, adolescence may be a period of heightened vulnerability to the neurotoxic effects of alcohol. Binge drinking may alter reward-driven behavior and neurocircuitry, thereby increasing risk for escalating alcohol use. Therefore, we compared reward processing in adolescents with and without a history of recent binge drinking. At their baseline study visit, all participants (age = 14.86 ± 0.88) were free of heavy alcohol use and completed a modified version of the Wheel of Fortune (WOF) functional magnetic resonance imaging task. Following this visit, 17 youth reported binge drinking on ≥3 occasions within a 90 day period and were matched to 17 youth who remained alcohol and substance-naïve. All participants repeated the WOF task during a second visit (age = 16.83 ± 1.22). No significant effects were found in a region of interest analysis of the ventral striatum, but whole-brain analyses showed significant group differences in reward response at the second study visit in the left cerebellum, controlling for baseline visit brain activity (p/α < 0.05), which was negatively correlated with mean number of drinks consumed/drinking day in the last 90 days. These findings suggest that binge drinking during adolescence may alter brain activity during reward processing in a dose-dependent manner.
Collapse
Affiliation(s)
- Anita Cservenka
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Scott A Jones
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States
| | - Bonnie J Nagel
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States; Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States.
| |
Collapse
|
15
|
Khan A, McCormack HC, Bolger EA, McGreenery CE, Vitaliano G, Polcari A, Teicher MH. Childhood Maltreatment, Depression, and Suicidal Ideation: Critical Importance of Parental and Peer Emotional Abuse during Developmental Sensitive Periods in Males and Females. Front Psychiatry 2015; 6:42. [PMID: 25870565 PMCID: PMC4378368 DOI: 10.3389/fpsyt.2015.00042] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/09/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The adverse childhood experience (ACE) study found that risk for depression increased as a function of number of types of childhood maltreatment, and interpret this as a result of cumulative stress. An alternative hypothesis is that risk depends on type and timing of maltreatment. This will also present as a linear increase, since exposure to more types of abuse increases likelihood of experiencing a critical type of abuse at a critical age. METHODS 560 (223M/337F) young adults (18-25 years) were recruited from the community without regard to diagnosis and balanced to have equal exposure to 0-4 plus types of maltreatment. The Maltreatment and Abuse Chronology of Exposure Scale assessed severity of exposure to 10 types of maltreatment across each year of childhood. Major depressive disorder (MDD) and current symptoms were evaluated by SCID, interview, and self-report. Predictive analytics assessed importance of exposure at each age and evaluated whether exposure at one or two ages was a more important predictor than number, severity, or duration of maltreatment across childhood. RESULTS The most important predictors of lifetime history of MDD were non-verbal emotional abuse in males and peer emotional abuse (EA) in females at 14 years of age, and these were more important predictors across models than number of types of maltreatment (males: t 9 = 16.39, p < 10(-7); females t 9 = 5.78, p < 10(-4)). Suicidal ideation was predicted, in part, by NVEA and peer EA at age 14, but most importantly by parental verbal abuse at age 5 in males and sexual abuse at age 18 in females. CONCLUSION This study provides evidence for sensitive exposure periods when maltreatment maximally impacts risk for depression, and provides an alternative interpretation of the ACE study results. These findings fit with emerging neuroimaging evidence for regional sensitivity periods. The presence of sensitive exposure periods has important implications for prevention, preemption, and treatment of MDD.
Collapse
Affiliation(s)
- Alaptagin Khan
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
| | - Hannah C. McCormack
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
| | - Elizabeth A. Bolger
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
| | | | - Gordana Vitaliano
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
| | - Ann Polcari
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
- School of Nursing, Northeastern University, Belmont, MA, USA
| | - Martin H. Teicher
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
| |
Collapse
|
16
|
Magnetic resonance imaging biomarkers in patients with progressive ataxia: current status and future direction. THE CEREBELLUM 2013; 12:245-66. [PMID: 22828959 DOI: 10.1007/s12311-012-0405-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A diagnostic challenge commonly encountered in neurology is that of an adult patient presenting with ataxia. The differential is vast and clinical assessment alone may not be sufficient due to considerable overlap between different causes of ataxia. Magnetic resonance (MR)-based biomarkers such as voxel-based morphometry, MR spectroscopy, diffusion-weighted and diffusion-tensor imaging and functional MR imaging are gaining great attention for their potential as indicators of disease. A number of studies have reported correlation with clinical severity and underlying pathophysiology, and in some cases, MR imaging has been shown to allow differentiation of conditions causing ataxia. However, despite recent advances, their sensitivity and specificity vary. In addition, questions remain over their validity and reproducibility, especially when applied in routine clinical practice. This article extensively reviews the current literature regarding MR-based biomarkers for the patient with predominantly adult-onset ataxia. Imaging features characteristic of a particular ataxia are provided and features differentiating ataxia groups and subgroups are discussed. Finally, discussion will turn to the feasibility of applying these biomarkers in routine clinical practice.
Collapse
|
17
|
Manto M. Cerebellotoxic Agents. HANDBOOK OF THE CEREBELLUM AND CEREBELLAR DISORDERS 2013:2079-2117. [DOI: 10.1007/978-94-007-1333-8_96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
18
|
Teicher MH, Vitaliano GD. Witnessing violence toward siblings: an understudied but potent form of early adversity. PLoS One 2011; 6:e28852. [PMID: 22216127 PMCID: PMC3244412 DOI: 10.1371/journal.pone.0028852] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 11/16/2011] [Indexed: 11/18/2022] Open
Abstract
Research on the consequences of witnessing domestic violence has focused on inter-adult violence and most specifically on violence toward mothers. The potential consequences of witnessing violence to siblings have been almost entirely overlooked. Based on clinical experience we sought to test the hypothesis that witnessing violence toward siblings would be as consequential as witnessing violence toward mothers. The community sample consisted of unmedicated, right-handed, young adults who had siblings (n = 1,412; 62.7% female; 21.8±2.1 years of age). History of witnessing threats or assaults to mothers, fathers and siblings, exposure to parental and sibling verbal abuse and physical abuse, sexual abuse and sociodemographic factors were assessed by self-report. Symptoms of depression, anxiety, somatization, anger-hostility, dissociation and ‘limbic irritability’ were assessed by rating scales. Data were analyzed by multiple regression, with techniques to gauge relative importance; logistic regression to assess adjusted odds ratios for clinically-significant ratings; and random forest regression using conditional trees. Subjects reported witnessing violence to siblings slightly more often than witnessing violence to mothers (22% vs 21%), which overlapped by 51–54%. Witnessing violence toward siblings was associated with significant effects on all ratings. Witnessing violence toward mother was not associated with significant effects on any scale in these models. Measures of the relative importance of witnessing violence to siblings were many fold greater than measures of importance for witnessing violence towards mothers or fathers. Mediation and structural equation models showed that effects of witnessing violence toward mothers or fathers were predominantly indirect and mediated by changes in maternal behavior. The effects of witnessing violence toward siblings were more direct. These findings suggest that greater attention be given to the effects of witnessing aggression toward siblings in studies of domestic violence, abuse and early adversity.
Collapse
Affiliation(s)
- Martin H Teicher
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
| | | |
Collapse
|
19
|
Teicher MH, Samson JA, Sheu YS, Polcari A, McGreenery CE. Hurtful words: association of exposure to peer verbal abuse with elevated psychiatric symptom scores and corpus callosum abnormalities. Am J Psychiatry 2010; 167:1464-71. [PMID: 20634370 PMCID: PMC3246683 DOI: 10.1176/appi.ajp.2010.10010030] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Previous studies have shown that exposure to parental verbal abuse in childhood is associated with higher rates of adult psychopathology and alterations in brain structure. In this study the authors sought to examine the symptomatic and neuroanatomic effects, in young adulthood, of exposure to peer verbal abuse during childhood. METHOD A total of 848 young adults (ages 18-25 years) with no history of exposure to domestic violence, sexual abuse, or parental physical abuse rated their childhood exposure to parental and peer verbal abuse and completed a self-report packet that included the Kellner Symptom Questionnaire, the Limbic Symptom Checklist-33, and the Dissociative Experiences Scale. Diffusion tensor images were collected for a subset of 63 young adults with no history of abuse or exposure to parental verbal abuse selected for varying degrees of exposure to peer verbal abuse. Images were analyzed using tract-based spatial statistics. RESULTS Analysis of covariance revealed dose-dependent effects of peer verbal abuse on anxiety, depression, anger-hostility, dissociation, "limbic irritability," and drug use. Peer and parental verbal abuse were essentially equivalent in effect size on these ratings. Path analysis indicated that peer verbal abuse during the middle school years had the most significant effect on symptom scores. Degree of exposure to peer verbal abuse correlated with increased mean and radial diffusivity and decreased fractional anisotropy in the corpus callosum and the corona radiata. CONCLUSIONS These findings parallel results of previous reports of psychopathology associated with childhood exposure to parental verbal abuse and support the hypothesis that exposure to peer verbal abuse is an aversive stimulus associated with greater symptom ratings and meaningful alterations in brain structure.
Collapse
Affiliation(s)
- Martin H. Teicher
- Developmental Biopsychiatry Research Program McLean Hospital Belmont MA 02478,Department of Psychiatry Harvard Medical School
| | - Jacqueline A. Samson
- Developmental Biopsychiatry Research Program McLean Hospital Belmont MA 02478,Department of Psychiatry Harvard Medical School
| | - Yi-Shin Sheu
- Developmental Biopsychiatry Research Program McLean Hospital Belmont MA 02478,Department of Psychiatry Harvard Medical School
| | - Ann Polcari
- Developmental Biopsychiatry Research Program McLean Hospital Belmont MA 02478,Department of Psychiatry Harvard Medical School
| | | |
Collapse
|
20
|
Harsh corporal punishment is associated with increased T2 relaxation time in dopamine-rich regions. Neuroimage 2010; 53:412-9. [PMID: 20600981 DOI: 10.1016/j.neuroimage.2010.06.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 06/11/2010] [Accepted: 06/15/2010] [Indexed: 01/18/2023] Open
Abstract
Harsh corporal punishment (HCP) was defined as frequent parental administration of corporal punishment (CP) for discipline, with occasional use of objects such as straps, or paddles. CP is linked to increased risk for depression and substance abuse. We examine whether long-term exposure to HCP acts as sub-traumatic stressor that contributes to brain alterations, particularly in dopaminergic pathways, which may mediate their increased vulnerability to drug and alcohol abuse. Nineteen young adults who experienced early HCP but no other forms of maltreatment and twenty-three comparable controls were studied. T2 relaxation time (T2-RT) measurements were performed with an echo planar imaging TE stepping technique and T2 maps were calculated and analyzed voxel-by-voxel to locate regional T2-RT differences between groups. Previous studies indicated that T2-RT provides an indirect index of resting cerebral blood volume. Region of interest (ROI) analyses were also conducted in caudate, putamen, nucleus accumbens, anterior cingulate cortex, dorsolateral prefrontal cortex, thalamus, globus pallidus and cerebellar hemispheres. Voxel-based relaxometry showed that HCP was associated with increased T2-RT in right caudate and putamen. ROI analyses also revealed increased T2-RT in dorsolateral prefrontal cortex, substantia nigra, thalamus and accumbens but not globus pallidus or cerebellum. There were significant associations between T2-RT measures in dopamine target regions and use of drugs and alcohol, and memory performance. Alteration in the paramagnetic or hemodynamic properties of dopaminergic cell body and projection regions were observed in subjects with HCP, and these findings may relate to their increased risk for drug and alcohol abuse.
Collapse
|
21
|
Cerebellar lingula thickness as a novel risk factor for alcohol and drug abuse. THE CEREBELLUM 2010; 9:145-7. [PMID: 20405261 DOI: 10.1007/s12311-010-0173-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|