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Zhao YJ, Zhang Y, Wang Q, Manssuer L, Cui H, Ding Q, Sun B, Liu W, Voon V. Evidence Accumulation and Neural Correlates of Uncertainty in Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1058-1065. [PMID: 37343660 PMCID: PMC10555851 DOI: 10.1016/j.bpsc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Decision making is frequently associated with risk taking under uncertainty. Elevated intolerance of uncertainty is suggested to be a critical feature of obsessive-compulsive disorder (OCD). However, impairments of latent constructs of uncertainty processing and its neural correlates remain unclear in OCD. METHODS In 83 participants (24 OCD patients treated with capsulotomy, 28 OCD control participants, and 31 healthy control participants), we performed magnetic resonance imaging using a card gambling task in which participants made decisions whether to bet or not that the next card would be larger than the current one. A hierarchical drift diffusion model was used to dissociate speed and amount of evidence accumulated before a decisional threshold (i.e., betting or no betting) was reached. RESULTS High uncertainty was characterized by a smaller amount of evidence accumulation (lower thresholds), thus dissociating uncertainty from conflict tasks and highlighting the specificity of this task to test value-based uncertainty. OCD patients exhibited greater caution with poor performance and greater evidence accumulation overall along with slower speed of accumulation, particularly under low uncertainty. Bilateral dorsal anterior cingulate and anterior insula distinguished high- and low-uncertainty decision processes in healthy control participants but not in the OCD groups, indicating impairments in anticipation of differences in outcome variance and salience network activity. There were no behavioral or imaging differences relating to capsulotomy despite improvements in OCD symptoms. CONCLUSIONS Our findings highlight greater impairments particularly in more certain trials in the OCD groups along with impaired neural differentiation of high and low uncertainty and suggest uncertainty processing as a trait cognitive endophenotype rather than a state-specific factor.
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Affiliation(s)
- Yi-Jie Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; Zhangjiang Fudan International Innovation Center, Shanghai, China; Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingying Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Qianfeng Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Luis Manssuer
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Hailun Cui
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Qiong Ding
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Clinical Neuroscience Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjuan Liu
- Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Valerie Voon
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China; Zhangjiang Fudan International Innovation Center, Shanghai, China; Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
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Manssuer L, Wang L, Ding Q, Li J, Zhang Y, Zhang C, Hallett M, Li D, Sun B, Voon V. Subthalamic Oscillatory Activity of Reward and Loss Processing Using the Monetary Incentive Delay Task in Parkinson Disease. Neuromodulation 2023; 26:414-423. [PMID: 35570149 PMCID: PMC10385018 DOI: 10.1016/j.neurom.2022.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The subthalamic nucleus (STN) is an effective deep brain stimulation target for Parkinson disease (PD) and obsessive-compulsive disorder and has been implicated in reward and motivational processing. In this study, we assessed the STN and prefrontal oscillatory dynamics in the anticipation and receipt of reward and loss using a task commonly used in imaging. MATERIALS AND METHODS We recorded intracranial left subthalamic local field potentials from deep brain stimulation electrodes and prefrontal scalp electroencephalography in 17 patients with PD while they performed a monetary incentive delay task. RESULTS During the expectation phase, enhanced left STN delta-theta activity was observed in both reward and loss vs neutral anticipation, with greater STN delta-theta activity associated with greater motivation specifically to reward. In the consummatory outcome phase, greater left STN delta activity was associated with a rewarding vs neutral outcome, particularly with more ventral contacts along with greater delta-theta coherence with the prefrontal cortex. We highlight a differential activity in the left STN to loss vs reward anticipation, demonstrating a distinct STN high gamma activity. Patients with addiction-like behaviors show lower left STN delta-theta activity to loss vs neutral outcomes, emphasizing impaired sensitivity to negative outcomes. CONCLUSIONS Together, our findings highlight a role for the left STN in reward and loss processing and a potential role in addictive behaviors. These findings emphasize the cognitive-limbic function of the STN and its role as a physiologic target for neuropsychiatric disorders.
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Affiliation(s)
- Luis Manssuer
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Linbin Wang
- Neural and Intelligence Engineering Center, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Qiong Ding
- Neural and Intelligence Engineering Center, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Jun Li
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Dianyou Li
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Valerie Voon
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, UK; Neural and Intelligence Engineering Center, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
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3
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Skandali N, Majuri J, Joutsa J, Baek K, Arponen E, Forsback S, Kaasinen V, Voon V. The neural substrates of risky rewards and losses in healthy volunteers and patient groups: a PET imaging study. Psychol Med 2022; 52:3280-3288. [PMID: 33568248 PMCID: PMC9693671 DOI: 10.1017/s0033291720005450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 12/08/2020] [Accepted: 12/31/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Risk is an essential trait of most daily decisions. Our behaviour when faced with risks involves evaluation of many factors including the outcome probabilities, the valence (gains or losses) and past experiences. Several psychiatric disorders belonging to distinct diagnostic categories, including pathological gambling and addiction, show pathological risk-taking and implicate abnormal dopaminergic, opioidergic and serotonergic neurotransmission. In this study, we adopted a transdiagnostic approach to delineate the neurochemical substrates of decision making under risk. METHODS We recruited 39 participants, including 17 healthy controls, 15 patients with pathological gambling and seven binge eating disorder patients, who completed an anticipatory risk-taking task. Separately, participants underwent positron emission tomography (PET) imaging with three ligands, [18F]fluorodopa (FDOPA), [11C]MADAM and [11C]carfentanil to assess presynaptic dopamine synthesis capacity and serotonin transporter and mu-opioid receptor binding respectively. RESULTS Risk-taking behaviour when faced with gains positively correlated with dorsal cingulate [11C]carfentanil binding and risk-taking to losses positively correlated with [11C]MADAM binding in the caudate and putamen across all subjects. CONCLUSIONS We show distinct neurochemical substrates underlying risk-taking with the dorsal cingulate cortex mu-opioid receptor binding associated with rewards and dorsal striatal serotonin transporter binding associated with losses. Risk-taking and goal-directed control appear to dissociate between dorsal and ventral fronto-striatal systems. Our findings thus highlight the potential role of pharmacological agents or neuromodulation on modifying valence-specific risk-taking biases.
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Affiliation(s)
- Nikolina Skandali
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Joonas Majuri
- Department of Neurology and Turku Brain and Mind Center, University of Turku, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Neurology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Juho Joutsa
- Department of Neurology and Turku Brain and Mind Center, University of Turku, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Kwangyeol Baek
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | - Valtteri Kaasinen
- Department of Neurology and Turku Brain and Mind Center, University of Turku, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK
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Polosan M, Figee M. Electrical deep neuromodulation in psychiatry. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 159:89-110. [PMID: 34446252 DOI: 10.1016/bs.irn.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Addressing treatment refractoriness in psychiatric diseases is an essential public health objective. The last two decades have seen an increasing interest for deep brain stimulation (DBS) of several brain targets. In this chapter, we have reviewed the main DBS clinical trials in psychiatric diseases, mainly obsessive compulsive disorders (OCD) and depression, but also emerging research in other psychiatric disorders. While its efficacy and safety are confirmed, DBS is still not considered as standard therapy in psychiatry. However, advances in neuroimaging research combined to behavioral and electrophysiological data uniquely provided by DBS studies improve knowledge on physiopathology in these brain diseases. This will help define the optimal brain targets according to specific phenotype dimensions. Revealing the mechanisms of action and effects of DBS will support that its impact goes beyond a loco-regional brain stimulation and confirms that electrical neuromodulation influences brain networks. Added to the progress in neuromodulation technology, these insights will hopefully facilitate a more widespread application of this promising treatment. Future development of a personalized multimodal assessment of underlying dysfunctional brain networks will open new circuit-specific treatment perspectives that may facilitate better patient outcomes.
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Affiliation(s)
- Mircea Polosan
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
| | - Martijn Figee
- Center for Advanced Circuit Therapeutics, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, United States
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Breysse E, Meffre J, Pelloux Y, Winstanley CA, Baunez C. Decreased risk‐taking and loss‐chasing after subthalamic nucleus lesion in rats. Eur J Neurosci 2020; 53:2362-2375. [DOI: 10.1111/ejn.14895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Emmanuel Breysse
- Institut de Neurosciences de la Timone UMR7289 CNRS & Aix‐Marseille Université Marseille France
| | - Julie Meffre
- Institut de Neurosciences de la Timone UMR7289 CNRS & Aix‐Marseille Université Marseille France
- Laboratoire de Neurosciences Cognitives UMR7289 CNRS & Aix‐Marseille Université Marseille France
| | - Yann Pelloux
- Institut de Neurosciences de la Timone UMR7289 CNRS & Aix‐Marseille Université Marseille France
- IIT Genoa Italy
| | - Catharine A. Winstanley
- Department of Psychology Djavad Mowafaghian Centre for Brain HealthUniversity of British Columbia Vancouver BC Canada
| | - Christelle Baunez
- Institut de Neurosciences de la Timone UMR7289 CNRS & Aix‐Marseille Université Marseille France
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Morein-Zamir S, Shapher S, Gasull-Camos J, Fineberg NA, Robbins TW. Avoid jumping to conclusions under uncertainty in Obsessive Compulsive Disorder. PLoS One 2020; 15:e0225970. [PMID: 31940308 PMCID: PMC6961894 DOI: 10.1371/journal.pone.0225970] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/15/2019] [Indexed: 12/13/2022] Open
Abstract
High levels of intolerance of uncertainty (IU) could contribute to abnormal decision making in uncertain situations. Patients with Obsessive Compulsive Disorder (OCD) often report high IU, indecisiveness and the need to seek greater certainty before making decisions. The Beads task is a commonly used task assessing the degree of information gathering prior to making a decision and so would be predicted to show impairments in OCD patients. Results to date have found mixed support for this, possibility due to methodological issues. Here, a group of OCD patients (n = 50) with no comorbidities was compared with age, gender, and verbal-IQ matched controls (n = 50) on the most commonly used version of the Beads task. An independent sample of healthy volunteers with high versus low OC symptoms, and high versus low IU were also assessed (n = 125). There was no evidence that patients with OCD differed from control volunteers in the degree of information gathering prior to making a decision. Medication status and age did not appear to mediate performance. Similarly, there were no association in healthy volunteers between task performance and OC or IU characteristics. Additional measures examining the degree of certainty initially showed support for greater uncertainty in patients, but this was due to deviations from task instructions in a subset of patients. We conclude that despite the large sample size and good matching between groups, the Beads task in its most widely used form is not a useful measure of IU or of information gathering in OCD. The results argue against a robust behavioural difference in OCD when compared to controls. Recommendations for future studies employing the task are discussed.
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Affiliation(s)
- Sharon Morein-Zamir
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute; Department of Psychology, Cambridge University, Cambridge, United Kingdom
| | - Sonia Shapher
- Hertfordshire Partnership University NHS Foundation Trust, NHS; University of Hertfordshire, Hatfield, United Kingdom
| | - Julia Gasull-Camos
- Behavioural and Clinical Neuroscience Institute; Department of Psychology, Cambridge University, Cambridge, United Kingdom
| | - Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, NHS; University of Hertfordshire, Hatfield, United Kingdom
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute; Department of Psychology, Cambridge University, Cambridge, United Kingdom
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Affective modulation of the associative-limbic subthalamic nucleus: deep brain stimulation in obsessive-compulsive disorder. Transl Psychiatry 2019; 9:73. [PMID: 30718450 PMCID: PMC6361948 DOI: 10.1038/s41398-019-0404-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 09/23/2018] [Accepted: 01/01/2019] [Indexed: 12/11/2022] Open
Abstract
Affective states underlie daily decision-making and pathological behaviours relevant to obsessive-compulsive disorders (OCD), mood disorders and addictions. Deep brain stimulation targeting the motor and associative-limbic subthalamic nucleus (STN) has been shown to be effective for Parkinson's disease (PD) and OCD, respectively. Cognitive and electrophysiological studies in PD showed responses of the motor STN to emotional stimuli, impairments in recognition of negative affective states and modulation of the intensity of subjective emotion. Here we studied whether the stimulation of the associative-limbic STN in OCD influences the subjective emotion to low-intensity positive and negative images and how this relates to clinical symptoms. We assessed 10 OCD patients with on and off STN DBS in a double-blind randomized manner by recording ratings of valence and arousal to low- and high-intensity positive and negative emotional images. STN stimulation increased positive ratings and decreased negative ratings to low-intensity positive and negative stimuli, respectively, relative to off stimulation. We also show that the change in severity of obsessive-compulsive symptoms pre- versus post-operatively interacts with both DBS and valence ratings. We show that stimulation of the associative-limbic STN might influence the negative cognitive bias in OCD and decreasing the negative appraisal of emotional stimuli with a possible relationship with clinical outcomes. That the effect is specific to low intensity might suggest a role of uncertainty or conflict related to competing interpretations of image intensity. These findings may have implications for the therapeutic efficacy of DBS.
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Calzà J, Gürsel DA, Schmitz-Koep B, Bremer B, Reinholz L, Berberich G, Koch K. Altered Cortico-Striatal Functional Connectivity During Resting State in Obsessive-Compulsive Disorder. Front Psychiatry 2019; 10:319. [PMID: 31133898 PMCID: PMC6524661 DOI: 10.3389/fpsyt.2019.00319] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/24/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Neuroimaging studies show that obsessive-compulsive disorder (OCD) is characterized by an alteration of the cortico-striato-thalamo-cortical (CSTC) system in terms of an imbalance of activity between the direct and the indirect loop of the CSTC. As resting-state functional connectivity (FC) studies investigated only specific parts of the CSTC in patients with OCD up to now, the present study aimed at exploring FC in the CSTC as a whole. Methods: We investigated potential alterations in resting-state FC within the CSTC system in 44 OCD patients and 40 healthy controls by taking into consideration all relevant nodes of the direct and indirect CSTC loop. Results: Compared to healthy controls, OCD patients showed an increased FC between the left subthalamic nucleus (STN) and the left external globus pallidus (GPe), as well as an increased FC between the left GPe and the left internal globus pallidus (GPi). Conclusion: These findings may contribute to a better understanding of the OCD pathophysiology by providing further information on the connectivity alterations within specific regions of the CSTC system. In particular, increased FC between the STN and the left GPe may play a major role in OCD pathology. This assumption is consistent with the fact that these regions are also the main target sites of therapeutic deep brain stimulation in OCD.
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Affiliation(s)
- Jessica Calzà
- Department of Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.,TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Deniz A Gürsel
- Department of Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.,TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Benita Schmitz-Koep
- Department of Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Benno Bremer
- Department of Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Lena Reinholz
- Department of Psychology, Ludwigs-Maximilians-Universität, Munich, Germany
| | - Götz Berberich
- Windach Institute and Hospital of Neurobehavioural Research and Therapy (WINTR), Windach, Germany
| | - Kathrin Koch
- Department of Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.,TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany.,Graduate School of Systemic Neurosciences GSN, Ludwig-Maximilians-Universität, Biocenter, Munich, Germany
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