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Denervaud S, Korff C, Fluss J, Kalser J, Roulet-Perez E, Hagmann P, Lebon S. Structural brain abnormalities in epilepsy with myoclonic atonic seizures. Epilepsy Res 2021; 177:106771. [PMID: 34562678 DOI: 10.1016/j.eplepsyres.2021.106771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/22/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Epilepsy with myoclonic atonic seizure (EMAS) occurs in young children with previously normal to subnormal development. The outcome ranges from seizure freedom with preserved cognitive abilities to refractory epilepsy with intellectual disability (ID). Routine brain imaging typically shows no abnormalities. We aimed to compare the brain morphometry of EMAS patients with healthy subjects several years after epilepsy onset, and to correlate it to epilepsy severity and cognitive findings. METHODS Fourteen EMAS patients (4 females, 5-14 years) and 14 matched healthy controls were included. Patients were classified into three outcome groups (good, intermediate, poor) according to seizure control and cognitive and behavioral functioning. Individual anatomical data (T1-weighted sequence) were processed using the FreeSurfer pipeline. Cortical volume (CV), cortical thickness (CT), local gyrification index (LGI), and subcortical volumes were used for group-comparison and linear regression analyses. RESULTS Morphometric comparison between EMAS patients and healthy controls revealed that patients have 1) reduced CV in frontal, temporal and parietal lobes (p = <.001; 0.009 and 0.024 respectively); 2) reduced CT and LGI in frontal lobes (p = 0.036 and 0.032 respectively); and 3) a neat cerebellar volume reduction (p = 0.011). Neither the number of anti-seizure medication nor the duration of epilepsy was related to cerebellar volume (both p > 0.62). Poor outcome group was associated with lower LGI. Patients in good and intermediate outcome groups had a comparable LGI to their matched healthy controls (p > 0.27 for all lobes). CONCLUSIONS Structural brain differences were detectable in our sample of children with EMAS, mainly located in the frontal lobes and cerebellum. These findings are similar to those found in patients with genetic/idiopathic generalized epilepsies. Outcome groups correlated best with LGI. Whether these anatomical changes reflect genetically determined abnormal neuronal networks or a consequence of sustained epilepsy remains to be solved with prospective longitudinal studies.
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Affiliation(s)
- Solange Denervaud
- Radiology Department, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Christian Korff
- Pediatric Neurology Unit, Geneva Children's Hospital, Geneva, Switzerland
| | - Joël Fluss
- Pediatric Neurology Unit, Geneva Children's Hospital, Geneva, Switzerland
| | - Judith Kalser
- Pediatric Neurology and Neurorehabilitation Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Eliane Roulet-Perez
- Pediatric Neurology and Neurorehabilitation Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Patric Hagmann
- Radiology Department, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland; Connectomics Lab, Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Sébastien Lebon
- Pediatric Neurology and Neurorehabilitation Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland.
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Nickels K, Kossoff EH, Eschbach K, Joshi C. Epilepsy with myoclonic-atonic seizures (Doose syndrome): Clarification of diagnosis and treatment options through a large retrospective multicenter cohort. Epilepsia 2020; 62:120-127. [PMID: 33190223 DOI: 10.1111/epi.16752] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Epilepsy with myoclonic-atonic seizures (EMAS) is a rare childhood onset epileptic encephalopathy. There is no clear consensus for recommended treatments, and pharmacoresistance is common. To better assess the clinical phenotype, most effective treatment, and determinants of cognitive and seizure outcomes, three major pediatric epilepsy centers combined data, creating the largest cohort of patients with EMAS ever studied to date. METHODS Authors performed a retrospective chart review of patients with EMAS who received care at the authors' institutions. RESULTS A total of 166 children were identified. Global developmental delay (>1 domain) was present in 2% of children at onset and 49% during the course of the disease. Afebrile seizures occurred after the age of 2 years in 88%, generalized tonic-clonic seizures in 60%, and drop attack or myoclonic seizures in 30%. At onset, electroencephalography (EEG) found 28% normal, background slowing in 20%, and epileptiform discharges or seizures in 69%. Subsequent EEG found slowing in 62% and discharges or seizures in 90%. Response (>50% seizure reduction) to the first three antiseizure drugs (ASDs) was 26% (levetiracetam, 17%; valproic acid, 31%; other ASDs combined, 26%). Diet therapy was used as a second or third therapy in 19% and ultimately used in 57%; response was 79%, significantly greater than the first three ASDs (P = .005, χ2 ). Seizure freedom occurred in 57% and was less likely in the case of persistent global developmental delays (P < .001), seizure recorded on subsequent EEGs (P = .027), and failure to respond to diet therapy (P = .005). Development was normal in 47%, and 12% had delays in one domain, which was less likely in the case of global developmental delay after epilepsy onset (P < .001) and failure to achieve seizure freedom (P < .001). SIGNIFICANCE This large cohort of children with EMAS clarifies areas of variability in practice. Diet therapy is by far the most effective treatment; failure to respond was associated with failure to attain seizure freedom. This therapy should be used early in the treatment in EMAS. This study also identified a bidirectional link between cognitive and seizure outcomes.
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Affiliation(s)
| | - Eric H Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Krista Eschbach
- Children's Hospital of Colorado, University of Colorado Denver Anschutz School of Medicine, Aurora, CO, USA
| | - Charuta Joshi
- Children's Hospital of Colorado, University of Colorado Denver Anschutz School of Medicine, Aurora, CO, USA
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Tang S, Addis L, Smith A, Topp SD, Pendziwiat M, Mei D, Parker A, Agrawal S, Hughes E, Lascelles K, Williams RE, Fallon P, Robinson R, Cross HJ, Hedderly T, Eltze C, Kerr T, Desurkar A, Hussain N, Kinali M, Bagnasco I, Vassallo G, Whitehouse W, Goyal S, Absoud M, Møller RS, Helbig I, Weber YG, Marini C, Guerrini R, Simpson MA, Pal DK. Phenotypic and genetic spectrum of epilepsy with myoclonic atonic seizures. Epilepsia 2020; 61:995-1007. [PMID: 32469098 DOI: 10.1111/epi.16508] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 02/24/2020] [Accepted: 03/27/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We aimed to describe the extent of neurodevelopmental impairments and identify the genetic etiologies in a large cohort of patients with epilepsy with myoclonic atonic seizures (MAE). METHODS We deeply phenotyped MAE patients for epilepsy features, intellectual disability, autism spectrum disorder, and attention-deficit/hyperactivity disorder using standardized neuropsychological instruments. We performed exome analysis (whole exome sequencing) filtered on epilepsy and neuropsychiatric gene sets to identify genetic etiologies. RESULTS We analyzed 101 patients with MAE (70% male). The median age of seizure onset was 34 months (range = 6-72 months). The main seizure types were myoclonic atonic or atonic in 100%, generalized tonic-clonic in 72%, myoclonic in 69%, absence in 60%, and tonic seizures in 19% of patients. We observed intellectual disability in 62% of patients, with extremely low adaptive behavioral scores in 69%. In addition, 24% exhibited symptoms of autism and 37% exhibited attention-deficit/hyperactivity symptoms. We discovered pathogenic variants in 12 (14%) of 85 patients, including five previously published patients. These were pathogenic genetic variants in SYNGAP1 (n = 3), KIAA2022 (n = 2), and SLC6A1 (n = 2), as well as KCNA2, SCN2A, STX1B, KCNB1, and MECP2 (n = 1 each). We also identified three new candidate genes, ASH1L, CHD4, and SMARCA2 in one patient each. SIGNIFICANCE MAE is associated with significant neurodevelopmental impairment. MAE is genetically heterogeneous, and we identified a pathogenic genetic etiology in 14% of this cohort by exome analysis. These findings suggest that MAE is a manifestation of several etiologies rather than a discrete syndromic entity.
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Affiliation(s)
- Shan Tang
- Evelina London Children's Hospital, London, UK
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Laura Addis
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Eli Lilly and Company, Erl Wood, Surrey, UK
| | - Anna Smith
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Simon D Topp
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Manuela Pendziwiat
- Clinic for Neuropediatrics, Schleswig-Holstein University Clinics, Kiel, Germany
| | - Davide Mei
- Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Shakti Agrawal
- Birmingham Children's Hospital National Health Service Foundation Trust, Birmingham, UK
| | - Elaine Hughes
- Evelina London Children's Hospital, London, UK
- King's College Hospital, London, UK
| | | | | | - Penny Fallon
- St George's National Health Service Health Care Trust, London, UK
| | - Robert Robinson
- Great Ormond Street Hospital for Children National Health Service Trust, London, UK
| | - Helen J Cross
- Great Ormond Street Hospital for Children National Health Service Trust, London, UK
- Clinical Neurosciences, UCL - Institute of Child Health, London, UK
| | | | - Christin Eltze
- Great Ormond Street Hospital for Children National Health Service Trust, London, UK
| | - Tim Kerr
- St George's National Health Service Health Care Trust, London, UK
| | - Archana Desurkar
- Sheffield Children's National Health Service Foundation Trust, Sheffield, UK
| | - Nahin Hussain
- University Hospital of Leicester National Health Service Trust, Leicester, UK
| | - Maria Kinali
- Chelsea and Westminster Hospital National Health Service Foundation Trust, London, UK
| | - Irene Bagnasco
- Child Neurology and Psychiatry Unit, Martini Hospital, Turin, Italy
| | | | | | - Sushma Goyal
- Evelina London Children's Hospital, London, UK
- King's College Hospital, London, UK
| | | | | | - Ingo Helbig
- Clinic for Neuropediatrics, Schleswig-Holstein University Clinics, Kiel, Germany
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yvonne G Weber
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Carla Marini
- Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Renzo Guerrini
- Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Michael A Simpson
- Division of Genetics and Molecular Medicine, King's College London, London, UK
| | - Deb K Pal
- Evelina London Children's Hospital, London, UK
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- King's College Hospital, London, UK
- Medical Research Council Centre for Neurodevelopmental Disorders, King's College London, London, UK
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Breuillard D, Jambaqué I, Laschet J, Nabbout R. Usefulness of preschool and school versions of the Behavioral Rating Inventory of Executive Functions in the evaluation of the daily life executive function in myoclonic-atonic epilepsy. Epilepsy Behav 2019; 99:106482. [PMID: 31461681 DOI: 10.1016/j.yebeh.2019.106482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Executive functions (EF) are high-order cognitive skills that have a major influence on quality of life, social skills, and school achievement. We aimed to screen EF daily life abilities in young patients with myoclonic-atonic epilepsy (MAE) using an ecological questionnaire and to correlate EF to epilepsy characteristics. METHODS Behavioral Rating Inventory of Executive Functions - Preschool (BRIEF-P) and BRIEF - for school-aged patients - parental questionnaires were proposed to patients with MAE and typically developing children (TDC) including Inhibit, Shift, Emotional control, Working memory (WM), Plan/Organize, Initiate, Organization of materials, and Monitor subscales. We included prospectively 12 patients with MAE and 44 TDC aged 3 to 5 years and seven patients with MAE and 21 TDC aged 6-7 years. We performed in addition for all patients an intellectual efficiency evaluation using WPPSI-IV (Wechsler intelligence scale for preschool children version IV) and collected demographics, age at onset of epilepsy, epilepsy duration, response to treatment, number and type of treatments including AEDs (antiepileptic drugs), and ketogenic diet. RESULTS Four out of 12 patients for BRIEF-P and 6/7 patients for BRIEF had pathological scores for at least one domain. Behavioral Rating Inventory of Executive Functions' questionnaires showed higher pathological scores for WM, Plan/Organize, Initiate, Monitor, and Metacognition Index in patients with MAE compared to TDC suggesting higher problems reported by parents. Working memory scores were higher in the group with MAE than TDC for both BRIEF-P and BRIEF. Response to treatment is a predictor of multiple BRIEF-P domains. Epilepsy duration predicts Shift and WM domains while age at onset predicts WM domain on BRIEF in this syndrome. CONCLUSIONS This study is the first to assess prospectively EF in young patients with MAE. We show everyday deficits in EF reported by parents. Metacognition and more specifically WM, appear to be a core deficit. Early evaluation of EF using both questionnaires and standardized tools is necessary for early detection of EF deficit and initiating tailored rehabilitation. Given the normal development before seizure onset and the absence of cerebral lesion in MAE, these results are in favor of the impact of epilepsy on EF.
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Affiliation(s)
- Delphine Breuillard
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades Hospital, APHP, Paris Descartes University, Imagine Institute, Paris, France; Memory, Brain and Cognition (MC2Lab, EA 7536), Paris Descartes University, Paris, France; France Institute of Psychology, Paris Descartes University, Boulogne Billancourt, France.
| | - Isabelle Jambaqué
- Memory, Brain and Cognition (MC2Lab, EA 7536), Paris Descartes University, Paris, France; France Institute of Psychology, Paris Descartes University, Boulogne Billancourt, France
| | - Jacques Laschet
- INSERM U1129 "Child Epilepsies & Brain Plasticity", University Paris Descartes, Sorbonne Paris Cité, CEA, Gif sur Yvette, France; University Paris Descartes, Sorbonne Paris Cité, CEA, Gif sur Yvette, France
| | - Rima Nabbout
- Memory, Brain and Cognition (MC2Lab, EA 7536), Paris Descartes University, Paris, France; France Institute of Psychology, Paris Descartes University, Boulogne Billancourt, France; Inserm UMR 1163, Paris, France
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Eschbach K, Moss A, Joshi C, Angione K, Smith G, Dempsey A, Juarez-Colunga E, Demarest ST. Diagnosis switching and outcomes in a cohort of patients with potential epilepsy with myoclonic-atonic seizures. Epilepsy Res 2018; 147:95-101. [PMID: 30286391 DOI: 10.1016/j.eplepsyres.2018.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/06/2018] [Accepted: 09/21/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION There is overlap in the electroclinical features of many childhood epilepsy syndromes, especially those presenting with multiple seizure types, such as epilepsy with myoclonic-atonic seizures (EMAS) and Lennox-Gastaut syndrome (LGS). This study aimed to determine the frequency of diagnosis switching and the factors influencing epilepsy syndrome diagnosis in a cohort of children with possible EMAS, as well as to explore the relationship between epilepsy syndrome diagnoses, key electroclinical features, and clinically relevant outcomes. METHODS This is a cross-sectional retrospective chart review of children treated at the Children's Hospital of Colorado with a potential diagnosis of EMAS. RESULTS There were 77 patients that met eligibility criteria, including 39% (n = 30) with an initial diagnosis of EMAS and 74% (n = 57) with a final diagnosis of EMAS. On average, for the 65% of patients who received more than one epilepsy diagnosis, the first, second, and third diagnoses were received within one year, three years, and ten years after epilepsy onset, respectively. Final diagnosis was significantly related to obtaining at least a six-month period of seizure freedom, p = 0.03. Classic LGS traits, including paroxysmal fast activity, slow spike-and-wave, and tonic seizures were present in 50% of the overall cohort, although a minority of these patients had a final diagnosis of LGS. However, the presence of more LGS traits was associated with a higher likelihood of ongoing seizures. Adjusted for age of epilepsy onset, seizure freedom was half as likely for every additional LGS trait observed (0.49[0.31, 0.77], p = 0.002). CONCLUSION Current epilepsy syndrome classification has reduced applicability due to overlapping features. This results in diagnosis switching and limited prognostic value for patients with an overlapping clinical phenotype. Future studies should attempt to stratify patients based not only on epilepsy syndrome diagnosis, but also on the presence of various electroclinical traits to more accurately predict outcome.
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Affiliation(s)
- Krista Eschbach
- Department of Pediatrics, Section of Neurology, Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Angela Moss
- Adult and Child Center for Health Outcomes and Delivery Science, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO, USA.
| | - Charuta Joshi
- Department of Pediatrics, Section of Neurology, Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Katie Angione
- Department of Pediatrics, Section of Neurology, Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Garnett Smith
- Department of Pediatrics, Section of Neurology, Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Amanda Dempsey
- Adult and Child Center for Health Outcomes and Delivery Science, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO, USA; Department of Pediatrics, Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Elizabeth Juarez-Colunga
- Adult and Child Center for Health Outcomes and Delivery Science, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO, USA.
| | - Scott T Demarest
- Department of Pediatrics, Section of Neurology, Children's Hospital of Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Cao K, Liu M, Wang C, Liu Q, Yang K, Tao L, Guo X. Five-Year Long-Term Prognosis of Epileptic Children After Hemispheric Surgery: A Systematic Review and Meta-analysis. Medicine (Baltimore) 2016; 95:e3743. [PMID: 27281073 PMCID: PMC4907651 DOI: 10.1097/md.0000000000003743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/13/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022] Open
Abstract
To estimate children's long-term seizure outcomes after hemispheric surgery and the associated predictors.A systematic review of 4 databases and a meta-analysis were performed from January 1, 1995 to August 31, 2015. The databases included PubMed, Embase, Science Direct, and Web of Science; patients were classified into the Engel Class I group and the Engel Class II to IV group, according to their seizure outcomes. Nine potential predictors were then stratified across the groups and estimated using the Wilcoxon rank-sum test for continuous variables and the Chi-squared test for categorical variables.The search yielded 15 retrospective studies, with a total sample size of 380. Five years after surgery, 268 (0.71, 95% confidence interval [CI]: 0.64-0.78) children were seizure free; the seizure onset age in the Engel Class I group was significantly higher than that of the Engel Class II to IV group (standardized mean difference [SMD] = 0.26, 95% CI: 0.03-0.49, P = 0.028); specifically, when predicting the positive long-term outcomes, the odds ratio for late onset age (≥3.6 months, median value of the Engel Class II-IV group) versus early onset age was 2.65 (95% CI: 1.454-4.836, z = 3.18, P = 0.001). The abnormal magnetic resonance imaging (MRI) findings were more predictive for positive seizure outcomes than the normal findings (odds ratio [OR] = 4.60, 95% CI: 1.27-16.62, P = 0.02).Following hemispheric surgery, the long-term prognosis of children with epilepsy was good. Late seizure onset (age ≥ 3.6 months) and abnormal MRI findings were positive predictors for long-term seizure control in children.
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Affiliation(s)
- Kai Cao
- From the Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University (KC, CW, QL, KY, LT, XG); Beijing Municipal Key Laboratory of Clinical Epidemiology (KC, CW, QL, KY, LT, XG); Beijing Key Laboratory of Environment Toxicology (ML); School of Public Health, Capital Medical University (ML); and Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Laboratory (KC), Beijing, China
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