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Lam HW, Patodia S, Zeicu C, Lim YM, Mrzyglod A, Scott C, Oliveira J, De Tisi J, Legouhy A, Zhang H, Koepp M, Diehl B, Thom M. Quantitative cellular pathology of the amygdala in temporal lobe epilepsy and correlation with magnetic resonance imaging volumetry, tissue microstructure, and sudden unexpected death in epilepsy risk factors. Epilepsia 2024; 65:2368-2385. [PMID: 38837385 DOI: 10.1111/epi.18033] [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: 02/19/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Amygdala enlargement can occur in temporal lobe epilepsy, and increased amygdala volume is also reported in sudden unexpected death in epilepsy (SUDEP). Apnea can be induced by amygdala stimulation, and postconvulsive central apnea (PCCA) and generalized seizures are both known SUDEP risk factors. Neurite orientation dispersion and density imaging (NODDI) has recently provided additional information on altered amygdala microstructure in SUDEP. In a series of 24 surgical temporal lobe epilepsy cases, our aim was to quantify amygdala cellular pathology parameters that could predict enlargement, NODDI changes, and ictal respiratory dysfunction. METHODS Using whole slide scanning automated quantitative image analysis methods, parallel evaluation of myelin, axons, dendrites, oligodendroglia, microglia, astroglia, neurons, serotonergic networks, mTOR-pathway activation (pS6) and phosphorylated tau (pTau; AT8, AT100, PHF) in amygdala, periamygdala cortex, and white matter regions of interest were compared with preoperative magnetic resonance imaging data on amygdala size, and in 13 cases with NODDI and evidence of ictal-associated apnea. RESULTS We observed significantly higher glial labeling (Iba1, glial fibrillary acidic protein, Olig2) in amygdala regions compared to cortex and a strong positive correlation between Olig2 and Iba1 in the amygdala. Larger amygdala volumes correlated with lower microtubule-associated protein (MAP2), whereas higher NODDI orientation dispersion index correlated with lower Olig2 cell densities. In the three cases with recorded PCCA, higher MAP2 and pS6-235 expression was noted than in those without. pTau did not correlate with SUDEP risk factors, including seizure frequency. SIGNIFICANCE Histological quantitation of amygdala microstructure can shed light on enlargement and diffusion imaging alterations in epilepsy to explore possible mechanisms of amygdala dysfunction, including mTOR pathway activation, that in turn may increase the risk for SUDEP.
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Affiliation(s)
- Hou Wang Lam
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Smriti Patodia
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Claudia Zeicu
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Yau Mun Lim
- Division of Neuropathology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK
| | - Alicja Mrzyglod
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Catherine Scott
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Queen Square Institute of Neurology, London, UK
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK
| | - Joana Oliveira
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Queen Square Institute of Neurology, London, UK
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK
| | - Jane De Tisi
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Antoine Legouhy
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Hui Zhang
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Matthias Koepp
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Queen Square Institute of Neurology, London, UK
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, University College London (UCL) Queen Square Institute of Neurology, London, UK
- Division of Neuropathology, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK
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2
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Milczarek O, Jarocha D, Starowicz-Filip A, Kasprzycki M, Kijowski J, Mordel A, Kwiatkowski S, Majka M. Bone Marrow Nucleated Cells and Bone Marrow-Derived CD271+ Mesenchymal Stem Cell in Treatment of Encephalopathy and Drug-Resistant Epilepsy. Stem Cell Rev Rep 2024; 20:1015-1025. [PMID: 38483743 DOI: 10.1007/s12015-023-10673-4] [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] [Accepted: 12/22/2023] [Indexed: 05/12/2024]
Abstract
The broad spectrum of brain injuries in preterm newborns and the plasticity of the central nervous system prompts us to seek solutions for neurodegeneration to prevent the consequences of prematurity and perinatal problems. The study aimed to evaluate the safety and efficacy of the implantation of autologous bone marrow nucleated cells and bone marrow mesenchymal stem cells in different schemes in patients with hypoxic-ischemic encephalopathy and immunological encephalopathy. Fourteen patients received single implantation of bone marrow nucleated cells administered intrathecally and intravenously, followed by multiple rounds of bone marrow mesenchymal stem cells implanted intrathecally, and five patients were treated only with repeated rounds of bone marrow mesenchymal stem cells. Seizure outcomes improved in most cases, including fewer seizures and status epilepticus and reduced doses of antiepileptic drugs compared to the period before treatment. The neuropsychological improvement was more frequent in patients with hypoxic-ischemic encephalopathy than in the immunological encephalopathy group. Changes in emotional functioning occurred with similar frequency in both groups of patients. In the hypoxic-ischemic encephalopathy group, motor improvement was observed in all patients and the majority in the immunological encephalopathy group. The treatment had manageable toxicity, mainly mild to moderate early-onset adverse events. The treatment was generally safe in the 4-year follow-up period, and the effects of the therapy were maintained after its termination.
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Affiliation(s)
- Olga Milczarek
- Faculty of Medicine, Department of Children's Neurosurgery, Jagiellonian University Medical College Institute of Pediatrics, Cracow, Poland.
| | - Danuta Jarocha
- Hematology Department, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anna Starowicz-Filip
- Faculty of Medicine, Department of Children's Neurosurgery, Jagiellonian University Medical College Institute of Pediatrics, Cracow, Poland
- Faculty of Medicine, Department of Psychology, Jagiellonian University Medicl College, Cracow, Poland
| | - Maciej Kasprzycki
- Students' Scientific Group at the Department of Pediatric Neurosurgery, Jagiellonian University Medical College Institute of Pediatrics, Cracow, Poland
| | - Jacek Kijowski
- Faculty of Medicine, Department of Transplantation, Jagiellonian University Medical College Institute of Pediatrics, Cracow, Poland
| | - Anna Mordel
- Faculty of Medicine, Department of Transplantation, Jagiellonian University Medical College Institute of Pediatrics, Cracow, Poland
| | - Stanisław Kwiatkowski
- Faculty of Medicine, Department of Children's Neurosurgery, Jagiellonian University Medical College Institute of Pediatrics, Cracow, Poland
| | - Marcin Majka
- Faculty of Medicine, Department of Transplantation, Jagiellonian University Medical College Institute of Pediatrics, Cracow, Poland
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3
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Modarres Mousavi SM, Alipour F, Noorbakhsh F, Jafarian M, Ghadipasha M, Gharehdaghi J, Kellinghaus C, Speckmann EJ, Stummer W, Khaleghi Ghadiri M, Gorji A. Clinical Correlation of Altered Molecular Signatures in Epileptic Human Hippocampus and Amygdala. Mol Neurobiol 2024; 61:725-752. [PMID: 37658249 PMCID: PMC10861640 DOI: 10.1007/s12035-023-03583-6] [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: 12/26/2022] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Abstract
Widespread alterations in the expression of various genes could contribute to the pathogenesis of epilepsy. The expression levels of various genes, including major inhibitory and excitatory receptors, ion channels, cell type-specific markers, and excitatory amino acid transporters, were assessed and compared between the human epileptic hippocampus and amygdala, and findings from autopsy controls. Moreover, the potential correlation between molecular alterations in epileptic brain tissues and the clinical characteristics of patients undergoing epilepsy surgery was evaluated. Our findings revealed significant and complex changes in the expression of several key regulatory genes in both the hippocampus and amygdala of patients with intractable epilepsy. The expression changes in various genes differed considerably between the epileptic hippocampus and amygdala. Different correlation patterns were observed between changes in gene expression and clinical characteristics, depending on whether the patients were considered as a whole or were subdivided. Altered molecular signatures in different groups of epileptic patients, defined within a given category, could be viewed as diagnostic biomarkers. Distinct patterns of molecular changes that distinguish these groups from each other appear to be associated with epilepsy-specific functional consequences.
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Affiliation(s)
| | - Fatemeh Alipour
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
| | - Farshid Noorbakhsh
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
| | - Maryam Jafarian
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
| | - Masoud Ghadipasha
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Jaber Gharehdaghi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | | | - Erwin-Josef Speckmann
- Department of Neurosurgery, Westfälische Wilhelms-Universität Münster, Münster, Germany
- Epilepsy Research Center, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | | | - Ali Gorji
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran.
- Department of Neurosurgery, Westfälische Wilhelms-Universität Münster, Münster, Germany.
- Epilepsy Research Center, Westfälische Wilhelms-Universität Münster, Münster, Germany.
- Department of Neuroscience, Mashhad University of Medical Sciences, Mashhad, Iran.
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Nasarudeen R, Singh A, Rana ZS, Punnakkal P. Epileptiform activity induced metaplasticity impairs bidirectional plasticity in the hippocampal CA1 synapses via GluN2B NMDA receptors. Exp Brain Res 2022; 240:3339-3349. [DOI: 10.1007/s00221-022-06486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
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Gala D, Gurusamy V, Patel K, Damodar S, Swaminath G, Ullal G. Stem Cell Therapy for Post-Traumatic Stress Disorder: A Novel Therapeutic Approach. Diseases 2021; 9:diseases9040077. [PMID: 34842629 PMCID: PMC8628773 DOI: 10.3390/diseases9040077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/04/2022] Open
Abstract
Stem cell therapy is a rapidly evolving field of regenerative medicine being employed for the management of various central nervous system disorders. The ability to self-renew, differentiate into specialized cells, and integrate into neuronal networks has positioned stem cells as an ideal mechanism for the treatment of epilepsy. Epilepsy is characterized by repetitive seizures caused by imbalance in the GABA and glutamate neurotransmission following neuronal damage. Stem cells provide benefit by reducing the glutamate excitotoxicity and strengthening the GABAergic inter-neuron connections. Similar to the abnormal neuroanatomic location in epilepsy, post-traumatic stress disorder (PTSD) is caused by hyperarousal in the amygdala and decreased activity of the hippocampus and medial prefrontal cortex. Thus, stem cells could be used to modulate neuronal interconnectivity. In this review, we provide a rationale for the use of stem cell therapy in the treatment of PTSD.
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Revealing the Precise Role of Calretinin Neurons in Epilepsy: We Are on the Way. Neurosci Bull 2021; 38:209-222. [PMID: 34324145 PMCID: PMC8821741 DOI: 10.1007/s12264-021-00753-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/24/2021] [Indexed: 02/03/2023] Open
Abstract
Epilepsy is a common neurological disorder characterized by hyperexcitability in the brain. Its pathogenesis is classically associated with an imbalance of excitatory and inhibitory neurons. Calretinin (CR) is one of the three major types of calcium-binding proteins present in inhibitory GABAergic neurons. The functions of CR and its role in neural excitability are still unknown. Recent data suggest that CR neurons have diverse neurotransmitters, morphologies, distributions, and functions in different brain regions across various species. Notably, CR neurons in the hippocampus, amygdala, neocortex, and thalamus are extremely susceptible to excitotoxicity in the epileptic brain, but the causal relationship is unknown. In this review, we focus on the heterogeneous functions of CR neurons in different brain regions and their relationship with neural excitability and epilepsy. Importantly, we provide perspectives on future investigations of the role of CR neurons in epilepsy.
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Epileptic Mechanisms Shared by Alzheimer's Disease: Viewed via the Unique Lens of Genetic Epilepsy. Int J Mol Sci 2021; 22:ijms22137133. [PMID: 34281185 PMCID: PMC8268161 DOI: 10.3390/ijms22137133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/18/2022] Open
Abstract
Our recent work on genetic epilepsy (GE) has identified common mechanisms between GE and neurodegenerative diseases including Alzheimer's disease (AD). Although both disorders are seemingly unrelated and occur at opposite ends of the age spectrum, it is likely there are shared mechanisms and studies on GE could provide unique insights into AD pathogenesis. Neurodegenerative diseases are typically late-onset disorders, but the underlying pathology may have already occurred long before the clinical symptoms emerge. Pathophysiology in the early phase of these diseases is understudied but critical for developing mechanism-based treatment. In AD, increased seizure susceptibility and silent epileptiform activity due to disrupted excitatory/inhibitory (E/I) balance has been identified much earlier than cognition deficit. Increased epileptiform activity is likely a main pathology in the early phase that directly contributes to impaired cognition. It is an enormous challenge to model the early phase of pathology with conventional AD mouse models due to the chronic disease course, let alone the complex interplay between subclinical nonconvulsive epileptiform activity, AD pathology, and cognition deficit. We have extensively studied GE, especially with gene mutations that affect the GABA pathway such as mutations in GABAA receptors and GABA transporter 1. We believe that some mouse models developed for studying GE and insights gained from GE could provide unique opportunity to understand AD. These include the pathology in early phase of AD, endoplasmic reticulum (ER) stress, and E/I imbalance as well as the contribution to cognitive deficit. In this review, we will focus on the overlapping mechanisms between GE and AD, the insights from mutations affecting GABAA receptors, and GABA transporter 1. We will detail mechanisms of E/I imbalance and the toxic epileptiform generation in AD, and the complex interplay between ER stress, impaired membrane protein trafficking, and synaptic physiology in both GE and AD.
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8
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Li HH, Lin PJ, Wang WH, Tseng LH, Tung H, Liu WY, Lin CL, Liu CH, Liao WC, Hung CS, Ho YJ. Treatment effects of the combination of ceftriaxone and valproic acid on neuronal and behavioural functions in a rat model of epilepsy. Exp Physiol 2021; 106:1814-1828. [PMID: 34086374 DOI: 10.1113/ep089624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/03/2021] [Indexed: 01/29/2023]
Abstract
NEW FINDINGS What is the central question of this study? Imbalance of activities between GABAergic and glutamatergic systems is involved in epilepsy. It is not known whether simultaneously increasing GABAergic and decreasing glutamatergic activity using valproic acid and ceftriaxone, respectively, leads to better seizure control. What is the central question of this study? Ceftriaxone suppressed seizure and cognitive deficits and restored neuronal density and the number of newborn cells in the hippocampus in a rat model of epilepsy. Combined treatment with ceftriaxone and valproic acid showed additive effects in seizure suppression. ABSTRACT The pathophysiology of epilepsy is typically considered as an imbalance between inhibitory GABA and excitatory glutamate neurotransmission. Valproic acid (Val), a GABA agonist, is one of the first-line antiepileptic drugs in the treatment of epilepsy, but it exhibits adverse effects. Ceftriaxone (CEF) elevates expression of glutamate transporter-1, enhances the reuptake of synaptic glutamate, increases the number of newborn cells and exhibits neuroprotective effects in animal studies. In this study, we evaluated effects of the combination of CEF and Val on behavioural and neuronal measures in a rat epilepsy model. Male Wistar rats were injected i.p. with pentylenetetrazol (35 mg/kg, every other day for 13 days) to induce the epilepsy model. Ceftriaxone (10 or 50 mg/kg), Val (50 or 100 mg/kg) or the combination of CEF and Val were injected daily after the fourth pentylenetetrazol injection for seven consecutive days. Epileptic rats exhibited seizure and impairments in motor and cognitive functions. Treatment with CEF and Val reduced the seizure and enhanced motor and cognitive functions in a dose-dependent manner. The combination of CEF (10 mg/kg) and Val (50 mg/kg) improved behaviours considerably. Histologically, compared with control animals, epileptic rats exhibited lower neuronal density and a reduction in hippocampal newborn cells but higher apoptosis in the basolateral amygdala, all of which were restored by the treatment with CEF, Val or the combination of CEF and Val. The study findings demonstrated that the combination of low doses of CEF and Val has beneficial effects on seizure suppression, neuroprotection and improvement in motor and cognitive functions in epilepsy.
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Affiliation(s)
- Hsin-Hua Li
- Department of Medical Research, Institute of Medicine, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Pin-Jiun Lin
- Department of Psychology, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Wei-Han Wang
- Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Li-Ho Tseng
- Graduate School of Environmental Management, Tajen University, Pingtung, Taiwan, Republic of China
| | - Hsin Tung
- Division of Epilepsy, Center of Faculty Development, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Wen-Yuan Liu
- Department of Psychology, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Chih-Li Lin
- Department of Medical Research, Institute of Medicine, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Chiung-Hui Liu
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Wen-Chieh Liao
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Ching-Sui Hung
- Occupational Safety and Health Office, Taipei City Hospital, Taipei, Taiwan, Republic of China
| | - Ying-Jui Ho
- Department of Psychology, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung, Taiwan, Republic of China
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Synaptic Reshaping and Neuronal Outcomes in the Temporal Lobe Epilepsy. Int J Mol Sci 2021; 22:ijms22083860. [PMID: 33917911 PMCID: PMC8068229 DOI: 10.3390/ijms22083860] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 12/11/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is one of the most common types of focal epilepsy, characterized by recurrent spontaneous seizures originating in the temporal lobe(s), with mesial TLE (mTLE) as the worst form of TLE, often associated with hippocampal sclerosis. Abnormal epileptiform discharges are the result, among others, of altered cell-to-cell communication in both chemical and electrical transmissions. Current knowledge about the neurobiology of TLE in human patients emerges from pathological studies of biopsy specimens isolated from the epileptogenic zone or, in a few more recent investigations, from living subjects using positron emission tomography (PET). To overcome limitations related to the use of human tissue, animal models are of great help as they allow the selection of homogeneous samples still presenting a more various scenario of the epileptic syndrome, the presence of a comparable control group, and the availability of a greater amount of tissue for in vitro/ex vivo investigations. This review provides an overview of the structural and functional alterations of synaptic connections in the brain of TLE/mTLE patients and animal models.
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Sadanandan N, Saft M, Gonzales-Portillo B, Borlongan CV. Multipronged Attack of Stem Cell Therapy in Treating the Neurological and Neuropsychiatric Symptoms of Epilepsy. Front Pharmacol 2021; 12:596287. [PMID: 33815100 PMCID: PMC8010689 DOI: 10.3389/fphar.2021.596287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
Epilepsy stands as a life-threatening disease that is characterized by unprovoked seizures. However, an important characteristic of epilepsy that needs to be examined is the neuropsychiatric aspect. Epileptic patients endure aggression, depression, and other psychiatric illnesses. Therapies for epilepsy can be divided into two categories: antiepileptic medications and surgical resection. Antiepileptic drugs are used to attenuate heightened neuronal firing and to lessen seizure frequency. Alternatively, surgery can also be conducted to physically cut out the area of the brain that is assumed to be the root cause for the anomalous firing that triggers seizures. While both treatments serve as viable approaches that aim to regulate seizures and ameliorate the neurological detriments spurred by epilepsy, they do not serve to directly counteract epilepsy's neuropsychiatric traits. To address this concern, a potential new treatment involves the use of stem cells. Stem cell therapy has been employed in experimental models of neurological maladies, such as Parkinson's disease, and neuropsychiatric illnesses like depression. Cell-based treatments for epilepsy utilizing stem cells such as neural stem cells (NSCs), mesenchymal stem cells (MSCs), and interneuron grafts have been explored in preclinical and clinical settings, highlighting both the acute and chronic stages of epilepsy. However, it is difficult to create an animal model to capitalize on all the components of epilepsy due to the challenges in delineating the neuropsychiatric aspect. Therefore, further preclinical investigation into the safety and efficacy of stem cell therapy in addressing both the neurological and the neuropsychiatric components of epilepsy is warranted in order to optimize cell dosage, delivery, and timing of cell transplantation.
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Affiliation(s)
| | | | | | - Cesar V. Borlongan
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, United States
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11
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Valian N, Sorayya M, Asadi S, Sherafati F, Ershad A, Savaheli S, Ahmadiani A. Preconditioning by ultra-low dose of tramadol reduces the severity of tramadol-induced seizure: Contribution of glutamate receptors. Biomed Pharmacother 2021; 133:111031. [PMID: 33249277 DOI: 10.1016/j.biopha.2020.111031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/07/2020] [Accepted: 11/15/2020] [Indexed: 12/15/2022] Open
Abstract
Tramadol, a weak agonist of mu-opioid receptors, causes seizure via several mechanisms. Preconditioning has been purposed to reduce the epileptic seizures in animal models of epilepsy. The preconditioning effect of tramadol on seizure is not studied yet. This study was designed to evaluate the preconditioning effect of ultra-low dose of tramadol on the seizures induced by tramadol at high dose. Furthermore, regarding the critical role of glutamate signaling in the pathogenesis of epilepsy, the effect of preconditioning on some glutamate signaling elements was also examined. Male Wistar rats received tramadol (2 mg/kg, i.p) or normal saline (1 mL/kg, i.p) in preconditioning and control groups, respectively. After 4 days, the challenging tramadol dose (150 mg/kg) was injected to all rats. Epileptic behaviors were recorded during 50 min. The expression of Norbin (as a regulator of metabotropic glutamate receptor 5), Calponin3 (as a regulator of excitatory synaptic markers), NR1 (NMDA receptor subunit 1) and GluR1 (AMPA receptor subunit 1) was measured in hippocampus, prefrontal cortex (PFC) and amygdala. Preconditioning decreased the number and duration of tremors and tonic-clonic seizures. Norbin, Calponin3, NR1 and GluR1 expression were decreased in hippocampus, and preconditioning had no effect on them. In contrast, it increased Norbin expression in PFC and amygdala, and attenuated NR1 and GluR1 upregulation following tramadol at high dose. These findings indicated that preconditioning by ultra-low dose of tramadol protected the animals against seizures following high dose of tramadol mediated, at least in part, by Norbin up regulation, and NR1 and GluR1 down regulation.
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Affiliation(s)
- Neda Valian
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marziyeh Sorayya
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sareh Asadi
- Neurobiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sherafati
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Ershad
- Department of Clinical Toxicology, Loghman Hakim Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Savaheli
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abolhassan Ahmadiani
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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12
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Aligholi H, Safahani M, Asadi-Pooya AA. Stem cell therapy in patients with epilepsy: A systematic review. Clin Neurol Neurosurg 2020; 200:106416. [PMID: 33338823 DOI: 10.1016/j.clineuro.2020.106416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE The existing evidence of the potential applications and benefits of stem cell transplantation (SCT) in people with epilepsy and also its adverse effects in humans were systematically reviewed. METHODS MEDLINE (accessed from PubMed), Google Scholar, and Scopus from inception to August 17, 2020 were systematically reviewed for related published manuscripts. The following key words (in the title) were used: "stem cell" AND "epilepsy" OR "seizure". Articles written in English that were human studies on stem cell transplantation in people with epilepsy were all included. RESULTS We could identify six related articles. Because of their different methodologies, performing a meta-analysis was not feasible; they included 38 adults and 81 pediatric patients together. Five studies were single-arm human studies; there were no serious adverse events in any of the studies. CONCLUSION While stem cell transplantation seems like a promising therapeutic option for patients with drug-resistant epilepsy, data on its application is scarce and of low quality. For now, clinical stem cell-based interventions are not justified. Perhaps, in the future, there will be a rigorous and intensely scrutinized clinical trial protocol with informed consent that could provide enough scientific merit and could meet the required ethical standards.
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Affiliation(s)
- Hadi Aligholi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Iran.
| | - Maryam Safahani
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA.
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13
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Revisiting the role of neurotransmitters in epilepsy: An updated review. Life Sci 2020; 265:118826. [PMID: 33259863 DOI: 10.1016/j.lfs.2020.118826] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
Epilepsy is a neurologicaldisorder characterized by persistent predisposition to recurrent seizurescaused by abnormal neuronal activity in the brain. Epileptic seizures maydevelop due to a relative imbalance of excitatory and inhibitory neurotransmitters. Expressional alterations of receptors and ion channelsactivated by neurotransmitters can lead to epilepsy pathogenesis. AIMS In this updated comprehensive review, we discuss the emerging implication of mutations in neurotransmitter-mediated receptors and ion channels. We aim to provide critical findings of the current literature about the role of neurotransmitters in epilepsy. MATERIALS AND METHODS A comprehensive literature review was conducted to identify and critically evaluate studies analyzing the possible relationship between epilepsy and neurotransmitters. The PubMed database was searched for related research articles. KEY FINDINGS Glutamate and gamma-aminobutyric acid (GABA) are the main neurotransmitters playing a critical role in the pathophysiology of this balance, and irreversible neuronal damage may occur as a result of abnormal changes in these molecules. Acetylcholine (ACh), the main stimulant of the autonomic nervous system, mediates signal transmission through cholinergic and nicotinic receptors. Accumulating evidence indicates that dysfunction of nicotinic ACh receptors, which are widely expressed in hippocampal and cortical neurons, may be significantly implicated in the pathogenesis of epilepsy. The dopamine-norepinephrine-epinephrine cycle activates hormonal and neuronal pathways; serotonin, norepinephrine, histamine, and melatonin can act as both hormones and neurotransmitters. Recent reports have demonstrated that nitric oxide mediates cognitive and memory-related functions via stimulating neuronal transmission. SIGNIFICANCE The elucidation of the role of the main mediators and receptors in epilepsy is crucial for developing new diagnostic and therapeutic approaches.
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Eor JY, Tan PL, Son YJ, Kwak MJ, Kim SH. Gut microbiota modulation by both Lactobacillus fermentum MSK 408 and ketogenic diet in a murine model of pentylenetetrazole-induced acute seizure. Epilepsy Res 2020; 169:106506. [PMID: 33276243 DOI: 10.1016/j.eplepsyres.2020.106506] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE Seizures are a threat to the host brain and body and can even cause death in epileptic children. Ketogenic diet (KD) is suggested for children suffering from epileptic seizures and has been investigated for its anti-seizure effect. However, the relationships between KD and gut microbiota (GM) is not yet been deeply understood. Herein, we investigated the anti-seizure effect by administering KD and a lactic acid bacteria (LAB) in murine model of chemically induced seizures. We hypothesized that a single Lactobacillus fermentum MSK 408 (MSK 408) strain with or without KD may exert a neuroprotection by modulating host gut microbiota. METHOD We performed animal study using pentylenetetrazole (PTZ) to induce seizure. Thirty 3-week-old male Institute of Cancer research (ICR) mice were divided in six groups, Normal diet (ND), ND + PTZ, ND + PTZ + LAB, KD, KD + PTZ, and KD + PTZ. Based on our previous study, 4:1 KD and selected MSK 408 strain was orally gavaged (4 × 109 CFU/mL) with both diets for 4 weeks. PTZ (40 mg/kg) was injected intraperitoneally 30 min before euthanization. RESULTS Compared to ND, KD significantly reduced the seizure frequency. Administration of MSK 408 with both ND and KD for 4 weeks restored serum lipid profile and tight junction protein mRNA expression of the gut and brain. Additionally, PCoA revealed that MSK 408 independently affected fecal short chain fatty acid (SCFA) content via gut microbiota (GM) modulation. PICRUSt suggested that the modulation of microbiota by KD and MSK 408 led to increased GABA (gamma-aminobutyric acid) metabolism. SIGNIFICANCE Our findings suggest that MSK 408 strain can be consumed with KD as supplement without interfering the anti-seizure action of KD, and may improve the serum lipid profile, and brain barrier function via gut microbiota and SCFA modulation.
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Affiliation(s)
- Ju Young Eor
- College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, South Korea; Institute of Life Sciences and Natural Resources, Korea University, Seoul, 02841, South Korea
| | - Pei Lei Tan
- College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, South Korea
| | - Yoon Ji Son
- College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, South Korea; Institute of Life Sciences and Natural Resources, Korea University, Seoul, 02841, South Korea
| | - Min Jin Kwak
- College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, South Korea
| | - Sae Hun Kim
- College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, South Korea; Institute of Life Sciences and Natural Resources, Korea University, Seoul, 02841, South Korea.
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Association of cortical spreading depression and seizures in patients with medically intractable epilepsy. Clin Neurophysiol 2020; 131:2861-2874. [PMID: 33152524 DOI: 10.1016/j.clinph.2020.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/14/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Monitoring of the ultra-low frequency potentials, particularly cortical spreading depression (CSD), is excluded in epilepsy monitoring due to technical barriers imposed by the scalp ultra-low frequency electroencephalogram (EEG). As a result, clinical studies of CSD have been limited to invasive EEG. Therefore, the occurrence of CSD and its interaction with epileptiform field potentials (EFP) require investigation in epilepsy monitoring. METHODS Using a novel AC/DC-EEG approach, the occurrence of DC potentials in patients with intractable epilepsy presenting different symptoms of aura was investigated during long-term video-EEG monitoring. RESULTS Various forms of slow potentials, including simultaneous negative direct current (DC) potentials and prolonged EFP, propagated negative DC potentials, and non-propagated single negative DC potentials were recorded from the scalp of the epileptic patients. The propagated and single negative DC potentials preceded the prolonged EFP with a time lag and seizure appeared at the final shoulder of some instances of the propagated negative DC potentials. The slow potential deflections had a high amplitude and prolonged duration and propagated slowly through the brain. The high-frequency EEG was suppressed in the vicinity of the negative DC potential propagations. CONCLUSIONS The study is the first to report the recording of the propagated and single negative DC potentials with EFP at the scalp of patients with intractable epilepsy. The negative DC potentials preceded the prolonged EFP and may trigger seizures. The propagated and single negative DC potentials may be considered as CSD. SIGNIFICANCE Recordings of CSD may serve as diagnostic and prognostic monitoring tools in epilepsy.
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Stefanits H, Milenkovic I, Mahr N, Pataraia E, Baumgartner C, Hainfellner JA, Kovacs GG, Kasprian G, Sieghart W, Yilmazer-Hanke D, Czech T. Alterations in GABAA Receptor Subunit Expression in the Amygdala and Entorhinal Cortex in Human Temporal Lobe Epilepsy. J Neuropathol Exp Neurol 2020; 78:1022-1048. [PMID: 31631219 DOI: 10.1093/jnen/nlz085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/06/2019] [Indexed: 12/14/2022] Open
Abstract
The amygdala has long been implicated in the pathophysiology of human temporal lobe epilepsy (TLE). The different nuclei of this complex structure are interconnected and share reciprocal connections with the hippocampus and other brain structures, partly via the entorhinal cortex. Expression of GABAA receptor subunits α1, α2, α3, α5, β2, β2/3, and γ2 was evaluated by immunohistochemistry in amygdala specimens and the entorhinal cortex of 12 TLE patients and 12 autopsy controls. A substantial decrease in the expression of α1, α2, α3, and β2/3 subunits was found in TLE cases, accompanied by an increase of γ2 subunit expression in many nuclei. In the entorhinal cortex, the expression of all GABAA receptor subunits was decreased except for the α1 subunit, which was increased on cellular somata. The overall reduction in α subunit expression may lead to decreased sensitivity to GABA and its ligands and compromise phasic inhibition, whereas upregulation of the γ2 subunit might influence clustering and kinetics of receptors and impair tonic inhibition. The description of these alterations in the human amygdala is important for the understanding of network changes in TLE as well as the development of subunit-specific therapeutic agents for the treatment of this disease.
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Affiliation(s)
- Harald Stefanits
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
| | - Ivan Milenkovic
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
| | - Nina Mahr
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
| | - Ekaterina Pataraia
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
| | - Christoph Baumgartner
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
| | - Johannes A Hainfellner
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
| | - Gabor G Kovacs
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
| | - Gregor Kasprian
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
| | - Werner Sieghart
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
| | - Deniz Yilmazer-Hanke
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
| | - Thomas Czech
- Department of Neurosurgery, Institute of Neurology, Department of Neurology, Department of Biomedical Imaging and Image Guided Therapy, Center for Brain Research, Department of Molecular Neurosciences, Medical University of Vienna, Vienna, Austria; Second Neurological Department, General Hospital Hietzing, Vienna, Austria; and Clinical Neuroanatomy, Neurology Department, Medical Faculty, Ulm University, Ulm, Germany
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Xenon exerts anti-seizure and neuroprotective effects in kainic acid-induced status epilepticus and neonatal hypoxia-induced seizure. Exp Neurol 2019; 322:113054. [DOI: 10.1016/j.expneurol.2019.113054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/27/2019] [Accepted: 09/01/2019] [Indexed: 12/16/2022]
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Wang Z, Du X, Yang Y, Zhang G. Study on miR-384-5p activates TGF-β signaling pathway to promote neuronal damage in abutment nucleus of rats based on deep learning. Artif Intell Med 2019; 101:101740. [DOI: 10.1016/j.artmed.2019.101740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/18/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
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