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Obrenovic M, Mouthon M, Chavan C, Saj A, Dieguez S, Aellen J, Chabwine JN. Acute right opercular stroke-associated polyopic heautoscopy and hallucinations caused by disconnection to the inferior parietal lobule through the superior longitudinal fasciculus III: A single case study. Cortex 2024; 174:125-136. [PMID: 38520766 DOI: 10.1016/j.cortex.2023.12.020] [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: 07/07/2023] [Revised: 10/24/2023] [Accepted: 12/21/2023] [Indexed: 03/25/2024]
Abstract
Illusory neuropsychiatric symptoms such as hallucinations or the feeling of a presence (FOP) can occur in diffuse brain lesion or dysfunction, in psychiatric diseases as well as in healthy individuals. Their occurrence due to focal brain lesions is rare, most probably due to underreporting, which limits progress in understanding their underlying mechanisms and anatomical determinants. In this single case study, an 86-year-old patient experienced, in the context of an acute right central opercular ischemic stroke, visual hallucinatory symptoms (including palinopsia), differently lateralized auditory hallucinations and FOP. This unusual clinical constellation could be precisely documented and illustrated while still present, allowing a realistic and immersive visual experience validated by the patient. The acute stroke appeared to be their most plausible cause (after exclusion of other etiologies). Furthermore, accurate analysis of tractographic data suggested that disruption in the posterior bundle of the superior longitudinal fasciculus connecting the stroke lesion to the inferior parietal lobule was the anatomical substrate explaining the FOP and, indirectly, also hallucinations through whiter matter involvement, in coherence with existing literature. We could finally elaborate on symptoms taxonomy and phenomenology (e.g., polyopic heautoscopy, hallucinatory FOP, etc), and on patient's remarkable distancing from them (with some therapeutic implications supported by plausibly engaged mechanisms). This case not only authentically enriched the description of such rare combination of heterogenous illusory symptoms through this novel visualization-based reporting approach, but disclosed an unrevealed anatomo-clinical link relating all of them to the acute stroke lesion through an association fiber, thereby contributing to the understanding of these intriguing symptoms and their determinants.
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Affiliation(s)
- Mihailo Obrenovic
- Department of Neurorehabilitation, Clinique Romande de Réadaptation SUVA Care, Sion, Switzerland
| | - Michael Mouthon
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg Switzerland
| | - Camille Chavan
- Neuropsychology-Logopedy Unit, Fribourg Hospital, Switzerland
| | - Arnaud Saj
- Neuropsychology-Logopedy Unit, Fribourg Hospital, Switzerland
| | - Sebastian Dieguez
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg Switzerland
| | - Jerôme Aellen
- Department of Radiology, Fribourg Hospital, Riaz, Switzerland
| | - Joelle N Chabwine
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg Switzerland; Division of Neurology, Department of Internal Medicine, Fribourg Hospital, Cantonal Hospital Fribourg, Switzerland.
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Abstract
Palinopsia is an uncommon but important neuro-ophthalmic condition. It can present with a range of visual phenomena and may be misdiagnosed as migraine or a functional disorder. The list of possible causes is long and includes structural cerebral lesions. We present a clinical case to illustrate the condition before reviewing different palinoptic subtypes and discussing how these may help clinicians to narrow the differential diagnosis.
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Affiliation(s)
| | - Luke Bennetto
- Neurology, Southmead Hospital, Bristol, UK.,Neurology, University of Bristol, Bristol, UK
| | - Rhys Harrison
- Emergency Department, Bristol Eye Hospital, Bristol, UK
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3
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Klein A, Schankin CJ. Visual Snow Syndrome as a Network Disorder: A Systematic Review. Front Neurol 2021; 12:724072. [PMID: 34671311 PMCID: PMC8521005 DOI: 10.3389/fneur.2021.724072] [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: 06/11/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: By reviewing the existing clinical studies about visual snow (VS) as a symptom or as part of visual snow syndrome (VSS), we aim at improving our understanding of VSS being a network disorder. Background: Patients with VSS suffer from a continuous visual disturbance resembling the view of a badly tuned analog television (i.e., VS) and other visual, as well as non-visual symptoms. These symptoms can persist over years and often strongly impact the quality of life. The exact prevalence is still unknown, but up to 2.2% of the population could be affected. Presently, there is no established treatment, and the underlying pathophysiology is unknown. In recent years, there have been several approaches to identify the brain areas involved and their interplay to explain the complex presentation. Methods: We collected the clinical and paraclinical evidence from the currently published original studies on VS and its syndrome by searching PubMed and Google Scholar for the term visual snow. We included original studies in English or German and excluded all reviews, case reports that did not add new information to the topic of this review, and articles that were not retrievable in PubMed or Google Scholar. We grouped the studies according to the methods that were used. Results: Fifty-three studies were found for this review. In VSS, the clinical spectrum includes additional visual disturbances such as excessive floaters, palinopsia, nyctalopia, photophobia, and entoptic phenomena. There is also an association with other perceptual and affective disorders as well as cognitive symptoms. The studies that have been included in this review demonstrate structural, functional, and metabolic alterations in the primary and/or secondary visual areas of the brain. Beyond that, results indicate a disruption in the pre-cortical visual pathways and large-scale networks including the default mode network and the salience network. Discussion: The combination of the clinical picture and widespread functional and structural alterations in visual and extra-visual areas indicates that the VSS is a network disorder. The involvement of pre-cortical visual structures and attentional networks might result in an impairment of "filtering" and prioritizing stimuli as top-down process with subsequent excessive activation of the visual cortices when exposed to irrelevant external and internal stimuli. Limitations of the existing literature are that not all authors used the ICHD-3 definition of the VSS. Some were referring to the symptom VS, and in many cases, the control groups were not matched for migraine or migraine aura.
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Affiliation(s)
| | - Christoph J. Schankin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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When Left is One and Right is Double: An Experimental Investigation of Visual Allesthesia after Right Parietal Damage. Vision (Basel) 2020; 4:vision4010016. [PMID: 32121533 PMCID: PMC7157701 DOI: 10.3390/vision4010016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 11/22/2022] Open
Abstract
Illusory visual phenomena, such as palinopsia, polyopsia or allesthesia, are rare manifestations of posterior cortical damage. Symptoms are characterized by illusory perceptions, ranging from isolated stationary objects to scenes and moving persons. Such illusions may appear while the original object is still in view, or become manifest with a delay and last for minutes, hours or even days. Some authors have suggested a disinhibited cortical response underlying visual illusions, but experimental studies supporting this hypothesis are lacking. Here, we examined a rare patient who after focal right parietal injury consistently reported a second stimulus on the left when briefly shown a target in his right hemifield. The patient perceived the illusory stimulus as less intense, and therefore concluded that it must have a different shape than the original stimulus. A masking experiment revealed that the frequency of the illusion was inversely related to the visibility of the original stimulus, suggesting that it depended on early, feedforward visual processing. We propose that illusory perceptions reflect the interplay of two physiological processes: a fast and automatic activation of contralateral, homotopic visual cortex after unilateral stimulation, and the lack of top-down inhibition following damage to the posterior parietal cortex.
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Edelman S, Moyal R. Fundamental computational constraints on the time course of perception and action. PROGRESS IN BRAIN RESEARCH 2018; 236:121-141. [PMID: 29157408 DOI: 10.1016/bs.pbr.2017.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A cognitive system faced with contingent events that cause rapid changes in sensory data may (i) incrementally incorporate new data into the ongoing perceptual and motor processing; or (ii) restart processing on each new event; or (iii) sample the data and hold onto the sample until its processing is complete, while disregarding any contingent changes. We offer a set of computational first-principles arguments for a hypothesis, according to which any system that contends with certain classes of perception and behavioral control tasks must include the sample-and-hold option (possibly alongside the other two, which may be useful in other tasks). This hypothesis has implications for understanding the dynamics of perception and action. In particular, a sample-and-hold channel necessarily processes sensory data on some kind of cycle (which does not imply precise periodicity). Further, being prepared to face the world at all times requires that the sampling that initiates each cycle be triggered by every significant action on part of the agent itself, such as saccades. We survey a range of evidence for the sample-and-hold functionality, touching upon diverse phenomena such as attentional blink and backward masking, the yoking of olfaction to respiration, thalamocortical interactions, and metastable brain dynamics in perception and consciousness.
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Affiliation(s)
| | - Roy Moyal
- Cornell University, Ithaca, NY, United States
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6
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Murphy RR, Al Sawaf A, Rose DR, Goldstein LB, Smith CD. Clinical Reasoning: Two see or not two see—Is it really double vision? Neurology 2017; 89:e56-e60. [DOI: 10.1212/wnl.0000000000004196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kalita J, Uniyal R, Bhoi SK. Is palinopsia in migraineurs an enhanced physiological phenomenon? Cephalalgia 2016; 36:1248-1256. [DOI: 10.1177/0333102415625610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Background We report the occurrence of palinopsia in patients with migraine and its correlation with migraine characteristics, triggers and allodynia. Methods This study included 153 consecutive patients with migraine and recorded their clinical details, including allodynia and migraine triggers and characteristics. Palinopsia was evaluated in migraineurs and 101 controls by using a questionnaire and a novel method. Results According to the questionnaire assessment, 9.8% migraineurs had palinopsia. According to the novel method, 57.5% of migraineurs and 12% of controls had palinopsia. Migraineurs most frequently had palinopsia to red color (51.6%), followed by yellow (49.7%), blue (47.7%), green (46.4%) and the least to white (30.7%). A similar pattern with a lesser frequency was noted in controls. The duration of palinopsia was longer in migraineurs than in controls (32.68 ± 20.24 vs. 5.92 ± 4.55 seconds; p < 0.001). Migraineurs with palinopsia differed from those without in terms of noise as a migraine trigger ( p < 0.001) and allodynia as a migraine-associated phenomenon ( p = 0.03). In multivariable analysis, predictors of palinopsia were the frequency ( p = 0.003) and severity ( p = 0.04) of headache and the presence of headache during examination ( p = 0.0001). Conclusion Migraineurs had a pattern of palinopsia to different colors that was similar to the controls, but the palinopsia of migraineurs was more frequent and of longer duration, especially during headaches.
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Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ravi Uniyal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjeev K Bhoi
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Lumi X, Hawlina M, Glavač D, Facskó A, Moe MC, Kaarniranta K, Petrovski G. Ageing of the vitreous: From acute onset floaters and flashes to retinal detachment. Ageing Res Rev 2015; 21:71-7. [PMID: 25841656 DOI: 10.1016/j.arr.2015.03.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 01/29/2023]
Abstract
Floaters and flashes are most commonly symptoms of age-related degenerative changes in the vitreous body and posterior vitreous detachment. The etiology and pathogenesis of floaters' formation is still not well understood. Patients with acute-onset floaters, flashes and defects in their visual field, represent a medical emergency with the need for same day referral to an ophthalmologist. Indirect ophthalmoscopy with scleral indentation is needed in order to find possible retinal break(s), on-time treatment and prevention of retinal detachment. The molecular and genetic pathogenesis, as well as the epidemiology of the ageing changes of the vitreous is summarized here, with view on the several treatment modalities in relation to their success rate and side-effects.
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Affiliation(s)
- Xhevat Lumi
- Eye Hospital, University Medical Centre, Ljubljana, Slovenia.
| | - Marko Hawlina
- Eye Hospital, University Medical Centre, Ljubljana, Slovenia.
| | - Damjan Glavač
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia.
| | - Andrea Facskó
- Department of Ophthalmology, Faculty of Medicine, University of Szeged, Hungary.
| | - Morten C Moe
- Center for Eye Research, Department of Ophthalmology, Oslo University Hospital and University of Oslo, and Norwegian Center for Stem Cell Research, Norway.
| | - Kai Kaarniranta
- Department of Ophthalmology, Institute of Clinical Medicine and Kuopio University Hospital, University of Eastern Finland, Finland.
| | - Goran Petrovski
- Department of Ophthalmology, Faculty of Medicine, University of Szeged, Hungary; Center for Eye Research, Department of Ophthalmology, Oslo University Hospital and University of Oslo, and Norwegian Center for Stem Cell Research, Norway.
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9
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Palinopsia revamped: A systematic review of the literature. Surv Ophthalmol 2015; 60:1-35. [DOI: 10.1016/j.survophthal.2014.06.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/23/2014] [Accepted: 06/24/2014] [Indexed: 02/07/2023]
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Hallucinogen persisting perception disorder and the serotonergic system: a comprehensive review including new MDMA-related clinical cases. Eur Neuropsychopharmacol 2014; 24:1309-23. [PMID: 24933532 DOI: 10.1016/j.euroneuro.2014.05.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 04/30/2014] [Accepted: 05/07/2014] [Indexed: 01/16/2023]
Abstract
Hallucinogen persisting perception disorder (HPPD) is a drug-induced condition associated with inaccurate visual representations. Since the underlying mechanism(s) are largely unknown, this review aims to uncover aspects underlying its etiology. Available evidence on HPPD and drug-related altered visual processing was reviewed and the majority of HPPD cases were attributed to drugs with agonistic effects on serotonergic 5-HT₂A receptors. Moreover, we present 31 new HPPD cases that link HPPD to the use of ecstasy (MDMA), which is known to reverse serotonin reuptake and acts as agonist on 5-HT₂A receptors. The available evidence suggests that HPPD symptoms may be a result from a misbalance of inhibitory-excitatory activity in low-level visual processing and GABA-releasing inhibitory interneurons may be involved. However, high co-morbidities with anxiety, attention problems and derealization symptoms add complexity to the etiology of HPPD. Also, other perceptual disorders that show similarity to HPPD cannot be ruled out in presentations to clinical treatment. Taken together, evidence is still sparse, though low-level visual processing may play an important role. A novel finding of this review study, evidenced by our new cases, is that ecstasy (MDMA) use may also induce symptoms of HPPD.
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Canafoglia L, Morbin M, Scaioli V, Pareyson D, D'Incerti L, Fugnanesi V, Tagliavini F, Berkovic SF, Franceschetti S. Recurrent generalized seizures, visual loss, and palinopsia as phenotypic features of neuronal ceroid lipofuscinosis due to progranulin gene mutation. Epilepsia 2014; 55:e56-9. [PMID: 24779634 DOI: 10.1111/epi.12632] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/28/2022]
Abstract
We detail the phenotype of a novel form of neuronal ceroid lipofuscinosis due to a homozygous progranulin gene mutation (c.813_816del; CLN11 MIM #614706). The symptoms appeared in two young adult siblings, and included progressive retinopathy, recurrent generalized seizures, moderate ataxia, and subtle cognitive dysfunction. Long-lasting episodes of palinopsia were a recurring symptom and associated with polyphasic visual-evoked potential waveform that suggested hyperexcitability of the occipital cortex. Electroencephalography showed rare spike-wave paroxysms, and magnetic resonance imaging revealed selective cerebellar atrophy. Skin biopsy revealed fingerprint storage and the absence of progranulin protein. Electron microscopy of peripheral blood leukocytes showed fingerprint profiles in 1/100 lymphocytes. These findings define a novel phenotype and provide clues for better understanding of progranulin function. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.
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Affiliation(s)
- Laura Canafoglia
- Neurophysiopathology and Epilepsy Center, IRCCS Foundation C. Besta Neurological Institute, Milan, Italy
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12
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Hashemi N, Scranton RA, Hashemi M, Lee AG. Visual hallucinations: a review for ophthalmologists. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sierra-Hidalgo F, de Pablo-Fernández E. Palinopsia Induced by Topiramate and Zonisamide in a Patient With Migraine. Clin Neuropharmacol 2013; 36:63-4. [DOI: 10.1097/wnf.0b013e3182849208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ziaei M, Elgohary MA, Bremner FD. Palinopsia as the initial manifestation of non-hodgkin's lymphoma. Int Ophthalmol 2012. [PMID: 23188189 DOI: 10.1007/s10792-012-9682-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 37-year old general practitioner thought to be in good health presented to the ophthalmology department with palinopsia, headaches and transient visual obscurations. A CT scan revealed a large destructive lesion centred on the occiput and stealth guided excisional biopsy of the occipital lesion showed diffuse large B cell, Non-Hodgkin's lymphoma (NHL) infiltration. To the best of our knowledge this is only the second report of a patient with NHL presenting with palinopsia.
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Affiliation(s)
- Mohammed Ziaei
- Department of Eye, University College London Hospital, Third Floor, Central Wing, 250 Euston Road, London, NW1 2PQ, United Kingdom,
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Van der Stigchel S, Nijboer TCW, Bergsma DP, Barton JJS, Paffen CLE. Measuring palinopsia: characteristics of a persevering visual sensation from cerebral pathology. J Neurol Sci 2012; 316:184-8. [PMID: 22285276 DOI: 10.1016/j.jns.2012.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 12/24/2011] [Accepted: 01/06/2012] [Indexed: 11/25/2022]
Abstract
Palinopsia is an abnormal perseverative visual phenomenon, whose relation to normal afterimages is unknown. We measured palinoptic positive visual afterimages in a patient with a cerebral lesion. Positive afterimages were confined to the left inferior quadrant, which allowed a comparison between afterimages in the intact and the affected part of his visual field. Results showed that negative afterimages in the affected quadrant were no different from those in the unaffected quadrant. The positive afterimage in his affected field, however, differed both qualitatively and quantitatively from normal afterimages, being weaker but much more persistent, and displaced from the location of the inducing stimulus. These findings reveal distinctions between pathological afterimages of cerebral origin and physiological afterimages of retinal origin.
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Affiliation(s)
- S Van der Stigchel
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
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Affiliation(s)
- Julien Dubois
- Université de Toulouse, Centre de Recherche Cerveau et Cognition, Université Paul Sabatier, Toulouse, France.
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