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Michel L, Molina P, Mameli M. The behavioral relevance of a modular organization in the lateral habenula. Neuron 2024:S0896-6273(24)00287-3. [PMID: 38772374 DOI: 10.1016/j.neuron.2024.04.026] [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: 02/23/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/23/2024]
Abstract
Behavioral strategies for survival rely on the updates the brain continuously makes based on the surrounding environment. External stimuli-neutral, positive, and negative-relay core information to the brain, where a complex anatomical network rapidly organizes actions, including approach or escape, and regulates emotions. Human neuroimaging and physiology in nonhuman primates, rodents, and teleosts suggest a pivotal role of the lateral habenula in translating external information into survival behaviors. Here, we review the literature describing how discrete habenular modules-reflecting the molecular signatures, anatomical connectivity, and functional components-are recruited by environmental stimuli and cooperate to prompt specific behavioral outcomes. We argue that integration of these findings in the context of valence processing for reinforcing or discouraging behaviors is necessary, offering a compelling model to guide future work.
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Affiliation(s)
- Leo Michel
- The Department of Fundamental Neuroscience, The University of Lausanne, 1005 Lausanne, Switzerland
| | - Patricia Molina
- The Department of Fundamental Neuroscience, The University of Lausanne, 1005 Lausanne, Switzerland
| | - Manuel Mameli
- The Department of Fundamental Neuroscience, The University of Lausanne, 1005 Lausanne, Switzerland; Inserm, UMR-S 839, 75005 Paris, France.
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2
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Groos D, Helmchen F. The lateral habenula: A hub for value-guided behavior. Cell Rep 2024; 43:113968. [PMID: 38522071 DOI: 10.1016/j.celrep.2024.113968] [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: 10/30/2023] [Revised: 01/20/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024] Open
Abstract
The habenula is an evolutionarily highly conserved diencephalic brain region divided into two major parts, medial and lateral. Over the past two decades, studies of the lateral habenula (LHb), in particular, have identified key functions in value-guided behavior in health and disease. In this review, we focus on recent insights into LHb connectivity and its functional relevance for different types of aversive and appetitive value-guided behavior. First, we give an overview of the anatomical organization of the LHb and its main cellular composition. Next, we elaborate on how distinct LHb neuronal subpopulations encode aversive and appetitive stimuli and on their involvement in more complex decision-making processes. Finally, we scrutinize the afferent and efferent connections of the LHb and discuss their functional implications for LHb-dependent behavior. A deepened understanding of distinct LHb circuit components will substantially contribute to our knowledge of value-guided behavior.
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Affiliation(s)
- Dominik Groos
- Laboratory of Neural Circuit Dynamics, Brain Research Institute, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.
| | - Fritjof Helmchen
- Laboratory of Neural Circuit Dynamics, Brain Research Institute, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland; University Research Priority Program (URPP), Adaptive Brain Circuits in Development and Learning, University of Zurich, Zurich, Switzerland
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3
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Benedict J, Cudmore RH, Oden D, Spruell A, Linden DJ. The lateral habenula is required for maternal behavior in the mouse dam. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.12.577842. [PMID: 38405910 PMCID: PMC10888914 DOI: 10.1101/2024.02.12.577842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Mammalian parenting is an unusually demanding commitment. How did evolution co-opt the reward system to ensure parental care? Previous work has implicated the lateral habenula (LHb), an epithalamic nucleus, as a potential intersection of parenting behavior and reward. Here, we examine the role of the LHb in the maternal behavior of naturally parturient mouse dams. We show that kainic acid lesions of the LHb induced a severe maternal neglect phenotype in dams towards their biological pups. Next, we demonstrate that through chronic chemogenetic inactivation of the LHb using DREADDs impaired acquisition and performance of various maternal behaviors, such as pup retrieval and nesting. We present a random intercepts model suggesting LHb-inactivation prevents the acquisition of the novel pup retrieval maternal behavior and decreases nest building performance, an already-established behavior, in primiparous mouse dams. Lastly, we examine the spatial histology of kainic-acid treated dams with a random intercepts model, which suggests that the role of LHb in maternal behavior may be preferentially localized at the posterior aspect of this structure. Together, these findings serve to establish the LHb as required for maternal behavior in the mouse dam, thereby complementing previous findings implicating the LHb in parental behavior using pup-sensitized virgin female mice.
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Affiliation(s)
- Jessie Benedict
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Robert H Cudmore
- Department of Physiology and Membrane Biology, University of California -Davis School of Medicine, Davis, CA, United States
| | - Diarra Oden
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aleah Spruell
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David J Linden
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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4
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Kiral FR, Choe M, Park IH. Diencephalic organoids - A key to unraveling development, connectivity, and pathology of the human diencephalon. Front Cell Neurosci 2023; 17:1308479. [PMID: 38130869 PMCID: PMC10733522 DOI: 10.3389/fncel.2023.1308479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
The diencephalon, an integral component of the forebrain, governs a spectrum of crucial functions, ranging from sensory processing to emotional regulation. Yet, unraveling its unique development, intricate connectivity, and its role in neurodevelopmental disorders has long been hampered by the scarcity of human brain tissue and ethical constraints. Recent advancements in stem cell technology, particularly the emergence of brain organoids, have heralded a new era in neuroscience research. Although most brain organoid methodologies have hitherto concentrated on directing stem cells toward telencephalic fates, novel techniques now permit the generation of region-specific brain organoids that faithfully replicate precise diencephalic identities. These models mirror the complexity of the human diencephalon, providing unprecedented opportunities for investigating diencephalic development, functionality, connectivity, and pathophysiology in vitro. This review summarizes the development, function, and connectivity of diencephalic structures and touches upon developmental brain disorders linked to diencephalic abnormalities. Furthermore, it presents current diencephalic organoid models and their applications in unraveling the intricacies of diencephalic development, function, and pathology in humans. Lastly, it highlights thalamocortical assembloid models, adept at capturing human-specific aspects of thalamocortical connections, along with their relevance in neurodevelopmental disorders.
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Affiliation(s)
| | | | - In-Hyun Park
- Interdepartmental Neuroscience Program, Department of Genetics, Yale Stem Cell Center, Yale Child Study Center, Wu Tsai Institute, Yale School of Medicine, New Haven, CT, United States
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5
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Congiu M, Mondoloni S, Zouridis IS, Schmors L, Lecca S, Lalive AL, Ginggen K, Deng F, Berens P, Paolicelli RC, Li Y, Burgalossi A, Mameli M. Plasticity of neuronal dynamics in the lateral habenula for cue-punishment associative learning. Mol Psychiatry 2023; 28:5118-5127. [PMID: 37414924 PMCID: PMC11041652 DOI: 10.1038/s41380-023-02155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/30/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
The brain's ability to associate threats with external stimuli is vital to execute essential behaviours including avoidance. Disruption of this process contributes instead to the emergence of pathological traits which are common in addiction and depression. However, the mechanisms and neural dynamics at the single-cell resolution underlying the encoding of associative learning remain elusive. Here, employing a Pavlovian discrimination task in mice we investigate how neuronal populations in the lateral habenula (LHb), a subcortical nucleus whose excitation underlies negative affect, encode the association between conditioned stimuli and a punishment (unconditioned stimulus). Large population single-unit recordings in the LHb reveal both excitatory and inhibitory responses to aversive stimuli. Additionally, local optical inhibition prevents the formation of cue discrimination during associative learning, demonstrating a critical role of LHb activity in this process. Accordingly, longitudinal in vivo two-photon imaging tracking LHb calcium neuronal dynamics during conditioning reveals an upward or downward shift of individual neurons' CS-evoked responses. While recordings in acute slices indicate strengthening of synaptic excitation after conditioning, support vector machine algorithms suggest that postsynaptic dynamics to punishment-predictive cues represent behavioral cue discrimination. To examine the presynaptic signaling in LHb participating in learning we monitored neurotransmitter dynamics with genetically-encoded indicators in behaving mice. While glutamate, GABA, and serotonin release in LHb remain stable across associative learning, we observe enhanced acetylcholine signaling developing throughout conditioning. In summary, converging presynaptic and postsynaptic mechanisms in the LHb underlie the transformation of neutral cues in valued signals supporting cue discrimination during learning.
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Affiliation(s)
- Mauro Congiu
- The Department of Fundamental Neuroscience, The University of Lausanne, 1005, Lausanne, Switzerland
| | - Sarah Mondoloni
- The Department of Fundamental Neuroscience, The University of Lausanne, 1005, Lausanne, Switzerland
| | - Ioannis S Zouridis
- Institute of Neurobiology and Werner Reichardt Centre for Integrative Neuroscience (CIN), University of Tübingen, 72076, Tübingen, Germany
- Graduate Training Centre of Neuroscience, International Max Planck Research School (IMPRS), University of Tübingen, Tübingen, Germany
| | - Lisa Schmors
- Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
- Hertie Institute for AI in Brain Health, University of Tübingen, Tübingen, Germany
| | - Salvatore Lecca
- The Department of Fundamental Neuroscience, The University of Lausanne, 1005, Lausanne, Switzerland
| | - Arnaud L Lalive
- The Department of Fundamental Neuroscience, The University of Lausanne, 1005, Lausanne, Switzerland
| | - Kyllian Ginggen
- The Department of Biomedical Sciences, The University of Lausanne, 1005, Lausanne, Switzerland
| | - Fei Deng
- School of Life Sciences, Peking University, Beijing, 100871, China
| | - Philipp Berens
- Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
- Tübingen AI Center, University of Tübingen, Tübingen, Germany
| | - Rosa Chiara Paolicelli
- The Department of Biomedical Sciences, The University of Lausanne, 1005, Lausanne, Switzerland
| | - Yulong Li
- School of Life Sciences, Peking University, Beijing, 100871, China
| | - Andrea Burgalossi
- Institute of Neurobiology and Werner Reichardt Centre for Integrative Neuroscience (CIN), University of Tübingen, 72076, Tübingen, Germany
| | - Manuel Mameli
- The Department of Fundamental Neuroscience, The University of Lausanne, 1005, Lausanne, Switzerland.
- Inserm, UMR-S 839, 75005, Paris, France.
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6
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Bech P, Crochet S, Dard R, Ghaderi P, Liu Y, Malekzadeh M, Petersen CCH, Pulin M, Renard A, Sourmpis C. Striatal Dopamine Signals and Reward Learning. FUNCTION 2023; 4:zqad056. [PMID: 37841525 PMCID: PMC10572094 DOI: 10.1093/function/zqad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
We are constantly bombarded by sensory information and constantly making decisions on how to act. In order to optimally adapt behavior, we must judge which sequences of sensory inputs and actions lead to successful outcomes in specific circumstances. Neuronal circuits of the basal ganglia have been strongly implicated in action selection, as well as the learning and execution of goal-directed behaviors, with accumulating evidence supporting the hypothesis that midbrain dopamine neurons might encode a reward signal useful for learning. Here, we review evidence suggesting that midbrain dopaminergic neurons signal reward prediction error, driving synaptic plasticity in the striatum underlying learning. We focus on phasic increases in action potential firing of midbrain dopamine neurons in response to unexpected rewards. These dopamine neurons prominently innervate the dorsal and ventral striatum. In the striatum, the released dopamine binds to dopamine receptors, where it regulates the plasticity of glutamatergic synapses. The increase of striatal dopamine accompanying an unexpected reward activates dopamine type 1 receptors (D1Rs) initiating a signaling cascade that promotes long-term potentiation of recently active glutamatergic input onto striatonigral neurons. Sensorimotor-evoked glutamatergic input, which is active immediately before reward delivery will thus be strengthened onto neurons in the striatum expressing D1Rs. In turn, these neurons cause disinhibition of brainstem motor centers and disinhibition of the motor thalamus, thus promoting motor output to reinforce rewarded stimulus-action outcomes. Although many details of the hypothesis need further investigation, altogether, it seems likely that dopamine signals in the striatum might underlie important aspects of goal-directed reward-based learning.
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Affiliation(s)
- Pol Bech
- Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Sylvain Crochet
- Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Robin Dard
- Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Parviz Ghaderi
- Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Yanqi Liu
- Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Meriam Malekzadeh
- Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Carl C H Petersen
- Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Mauro Pulin
- Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Anthony Renard
- Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Christos Sourmpis
- Laboratory of Sensory Processing, Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
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Webster JF, Beerens S, Wozny C. Effects of early life stress and subsequent re-exposure to stress on neuronal activity in the lateral habenula. Neuropsychopharmacology 2022; 48:745-753. [PMID: 36371544 PMCID: PMC10066304 DOI: 10.1038/s41386-022-01493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 11/15/2022]
Abstract
Early life stress can result in depression in humans and depressive-like behaviour in rodents. In various animal models of depression, the lateral habenula (LHb) has been shown to become hyperactive immediately after early life stress. However, whether these pathological changes persist into adulthood is less well understood. Hence, we utilised the maternal separation (MS) model of depression to study how early life stress alters LHb physiology and depressive behaviour in adult mice. We find that only a weak depressive phenotype persists into adulthood which surprisingly is underpinned by LHb hypoactivity in acute slices, accompanied by alterations in both excitatory and inhibitory signalling. However, while we find the LHb to be less active at rest, we report that the neurons reside in a sensitised state where they are more responsive to re-exposure to stress in adulthood in the form of acute restraint, thus priming them to respond to aversive events with an increase in neuronal activity mediated by changes in glutamatergic transmission. These findings thus suggest that in addition to LHb hyperactivity, hypoactivity likely also promotes an adverse phenotype. Re-exposure to stress results in the reappearance of LHb hyperactivity offering a possible mechanism to explain how depression relapses occur following previous depressive episodes.
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Affiliation(s)
- Jack F Webster
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK
| | - Sanne Beerens
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK
| | - Christian Wozny
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK. .,MSH Medical School Hamburg, Medical University, Institute for Molecular Medicine, 20457, Hamburg, Germany.
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8
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Post RJ, Bulkin DA, Ebitz RB, Lee V, Han K, Warden MR. Tonic activity in lateral habenula neurons acts as a neutral valence brake on reward-seeking behavior. Curr Biol 2022; 32:4325-4336.e5. [PMID: 36049479 PMCID: PMC9613558 DOI: 10.1016/j.cub.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 12/16/2021] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Abstract
Survival requires both the ability to persistently pursue goals and the ability to determine when it is time to stop, an adaptive balance of perseverance and disengagement. Neural activity in the lateral habenula (LHb) has been linked to negative valence, but its role in regulating the balance between engaged reward seeking and disengaged behavioral states remains unclear. Here, we show that LHb neural activity is tonically elevated during minutes-long periods of disengagement from reward-seeking behavior, both when due to repeated reward omission (negative valence) and when sufficient reward has been consumed (positive valence). Furthermore, we show that LHb inhibition extends ongoing reward-seeking behavioral states but does not prompt task re-engagement. We find no evidence for similar tonic activity changes in ventral tegmental area dopamine neurons. Our findings support a framework in which tonic activity in LHb neurons suppresses engagement in reward-seeking behavior in response to both negatively and positively valenced factors.
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Affiliation(s)
- Ryan J Post
- Department of Neurobiology and Behavior, Cornell University, Ithaca, NY 14853, USA; Cornell Neurotech, Cornell University, Ithaca, NY 14853, USA
| | - David A Bulkin
- Department of Neurobiology and Behavior, Cornell University, Ithaca, NY 14853, USA; Cornell Neurotech, Cornell University, Ithaca, NY 14853, USA
| | - R Becket Ebitz
- Department of Neuroscience, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Vladlena Lee
- Department of Neurobiology and Behavior, Cornell University, Ithaca, NY 14853, USA
| | - Kasey Han
- Department of Neurobiology and Behavior, Cornell University, Ithaca, NY 14853, USA
| | - Melissa R Warden
- Department of Neurobiology and Behavior, Cornell University, Ithaca, NY 14853, USA; Cornell Neurotech, Cornell University, Ithaca, NY 14853, USA.
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Gouveia FV, Baker PM, Mameli M, Germann J. Editorial: The Habenula and Its Role in Neuropsychiatric Symptoms. Front Behav Neurosci 2022; 16:929507. [PMID: 35685273 PMCID: PMC9172991 DOI: 10.3389/fnbeh.2022.929507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Flavia Venetucci Gouveia
- Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- *Correspondence: Flavia Venetucci Gouveia
| | | | - Manuel Mameli
- The Department of Fundamental Neuroscience, The University of Lausanne, Lausanne, Switzerland
- INSERM, UMR-S 839, Paris, France
| | - Jurgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
- Jurgen Germann
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Zhang GM, Wu HY, Cui WQ, Peng W. Multi-level variations of lateral habenula in depression: A comprehensive review of current evidence. Front Psychiatry 2022; 13:1043846. [PMID: 36386995 PMCID: PMC9649931 DOI: 10.3389/fpsyt.2022.1043846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022] Open
Abstract
Despite extensive research in recent decades, knowledge of the pathophysiology of depression in neural circuits remains limited. Recently, the lateral habenula (LHb) has been extensively reported to undergo a series of adaptive changes at multiple levels during the depression state. As a crucial relay in brain networks associated with emotion regulation, LHb receives excitatory or inhibitory projections from upstream brain regions related to stress and cognition and interacts with brain regions involved in emotion regulation. A series of pathological alterations induced by aberrant inputs cause abnormal function of the LHb, resulting in dysregulation of mood and motivation, which present with depressive-like phenotypes in rodents. Herein, we systematically combed advances from rodents, summarized changes in the LHb and related neural circuits in depression, and attempted to analyze the intrinsic logical relationship among these pathological alterations. We expect that this summary will greatly enhance our understanding of the pathological processes of depression. This is advantageous for fostering the understanding and screening of potential antidepressant targets against LHb.
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Affiliation(s)
- Guang-Ming Zhang
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hong-Yun Wu
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wen-Qiang Cui
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wei Peng
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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