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Fatima TSD, Fathima ST, Kandadai RM, Borgohain R, Sreenu B, Kutala VK. Association of Catechol-O-Methyltransferase Gene Polymorphisms and Haplotypes in the Levodopa-Induced Adverse Events in Subjects with Parkinson's Disease. Indian J Clin Biochem 2023; 38:262-274. [PMID: 37025429 PMCID: PMC10070583 DOI: 10.1007/s12291-022-01046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
Abstract
The presence of dyskinesia is the most common side effect of chronic administration of levodopa in Parkinson's disease (PD) subjects. Genetic polymorphisms in levodopa metabolizing gene, catechol-O-methyl transferase (COMT), is shown to influence the inter-individual variability in drug response and adverse events. In the present study, the association of COMT rs6269, rs4633, rs4818, and rs4680 polymorphisms and haplotypes on pharmacokinetics and adverse events with levodopa was investigated in 150 PD patients. The age of onset of PD was 58.00 ± 10 yrs. The most common side effect faced by 78% of the subjects was dyskinesia. The AUC of levodopa was found to be significantly higher in subjects with dyskinesia (1695 ± 113 ng/ml/hr, p < 0.0001) than those without dyskinesia (1550 ± 122 ng/ml/hr). We found that the frequency of subjects presenting dyskinesia was significantly higher in subjects carrying variant genotype of COMT rs6269, rs4633, and rs4680 than that with wild genotype and these subjects presented higher AUC of levodopa. In addition, in subjects with dyskinesia, the AUC of levodopa was found to be significantly higher with low COMT (ACCG) haplotype. The association of COMT rs6269, COMT rs4633, COMT rs4818, and COMT rs4680 variant genotypes with the risk of dyskinesia due to levodopa therapy showed an ROC AUC of 0.67 indicating the moderate prediction of dyskinesia (p = 0.0021) with these COMT variants. In conclusion, PD subjects carrying the variant genotypes of COMT strongly influence high levodopa-induced dyskinesia. Hence the genotyping of COMT before the levodopa therapy will be useful to reduce the adverse events associated with the chronic levodopa treatment.
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Affiliation(s)
- Tasneem SD Fatima
- Department of Clinical Pharmacology and Therapeutics, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Syed Tazeem Fathima
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Rukmini Mridula Kandadai
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Rupam Borgohain
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Boddupally Sreenu
- Department of Clinical Pharmacology and Therapeutics, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
| | - Vijay Kumar Kutala
- Department of Biochemistry, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana 500082 India
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Gaurav R, Valabrègue R, Yahia-Chérif L, Mangone G, Narayanan S, Arnulf I, Vidailhet M, Corvol JC, Lehéricy S. NigraNet: An automatic framework to assess nigral neuromelanin content in early Parkinson's disease using convolutional neural network. Neuroimage Clin 2022; 36:103250. [PMID: 36451356 PMCID: PMC9668659 DOI: 10.1016/j.nicl.2022.103250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/15/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Parkinson's disease (PD) demonstrates neurodegenerative changes in the substantia nigra pars compacta (SNc) using neuromelanin-sensitive (NM)-MRI. As SNc manual segmentation is prone to substantial inter-individual variability across raters, development of a robust automatic segmentation framework is necessary to facilitate nigral neuromelanin quantification. Artificial intelligence (AI) is gaining traction in the neuroimaging community for automated brain region segmentation tasks using MRI. OBJECTIVE Developing and validating AI-based NigraNet, a fully automatic SNc segmentation framework allowing nigral neuromelanin quantification in patients with PD using NM-MRI. METHODS We prospectively included 199 participants comprising 144 early-stage idiopathic PD patients (disease duration = 1.5 ± 1.0 years) and 55 healthy volunteers (HV) scanned using a 3 Tesla MRI including whole brain T1-weighted anatomical imaging and NM-MRI. The regions of interest (ROI) were delineated in all participants automatically using NigraNet, a modified U-net, and compared to manual segmentations performed by two experienced raters. The SNc volumes (Vol), volumes corrected by total intracranial volume (Cvol), normalized signal intensity (NSI) and contrast-to-noise ratio (CNR) were computed. One-way GLM-ANCOVA was performed while adjusting for age and sex as covariates. Diagnostic performance measurement was assessed using the receiver operating characteristic (ROC) analysis. Inter and intra-observer variability were estimated using Dice similarity coefficient (DSC). The agreements between methods were tested using intraclass correlation coefficient (ICC) based on a mean-rating, two-way, mixed-effects model estimates for absolute agreement. Cronbach's alpha and Bland-Altman plots were estimated to assess inter-method consistency. RESULTS Using both methods, Vol, Cvol, NSI and CNR measurements differed between PD and HV with an effect of sex for Cvol and CNR. ICC values between the methods demonstrated optimal agreement for Cvol and CNR (ICC > 0.9) and high reproducibility (DSC: 0.80) was also obtained. The SNc measurements also showed good to excellent consistency values (Cronbach's alpha > 0.87). Bland-Altman plots of agreement demonstrated no association of SNc ROI measurement differences between the methods and ROI average measurements while confirming that 95 % of the data points were ranging between the limits of mean difference (d ± 1.96xSD). Percentage changes between PD and HV were -27.4 % and -17.7 % for Vol, -30.0 % and -22.2 % for Cvol, -15.8 % and -14.4 % for NSI, -17.1 % and -16.0 % for CNR for automatic and manual measurements respectively. Using automatic method, in the entire dataset, we obtained the areas under the ROC curve (AUC) of 0.83 for Vol, 0.85 for Cvol, 0.79 for NSI and 0.77 for CNR whereas in the training dataset of 0.96 for Vol, 0.95 for Cvol, 0.85 for NSI and 0.85 for CNR. Disease duration correlated negatively with NSI of the patients for both the automatic and manual measurements. CONCLUSIONS We presented an AI-based NigraNet framework that utilizes a small MRI training dataset to fully automatize the SNc segmentation procedure with an increased precision and more reproducible results. Considering the consistency, accuracy and speed of our approach, this study could be a crucial step towards the implementation of a time-saving non-rater dependent fully automatic method for studying neuromelanin changes in clinical settings and large-scale neuroimaging studies.
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Affiliation(s)
- Rahul Gaurav
- Paris Brain Institute - ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France; Movement Investigations and Therapeutics Team (MOV'IT), ICM, Paris, France; Center for NeuroImaging Research - CENIR, ICM, Paris, France.
| | - Romain Valabrègue
- Paris Brain Institute - ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France; Center for NeuroImaging Research - CENIR, ICM, Paris, France
| | - Lydia Yahia-Chérif
- Paris Brain Institute - ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France; Center for NeuroImaging Research - CENIR, ICM, Paris, France
| | - Graziella Mangone
- Paris Brain Institute - ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France; INSERM, Clinical Investigation Center for Neurosciences (CIC), Pitié-Salpêtrière Hospital, Paris, France
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec, H3A 2B4, Canada
| | - Isabelle Arnulf
- Paris Brain Institute - ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France; Movement Investigations and Therapeutics Team (MOV'IT), ICM, Paris, France; Sleep Disorders Unit, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Marie Vidailhet
- Paris Brain Institute - ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France; Movement Investigations and Therapeutics Team (MOV'IT), ICM, Paris, France; Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Jean-Christophe Corvol
- Paris Brain Institute - ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France; INSERM, Clinical Investigation Center for Neurosciences (CIC), Pitié-Salpêtrière Hospital, Paris, France; Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Stéphane Lehéricy
- Paris Brain Institute - ICM, Sorbonne University, UPMC Univ Paris 06, INSERM U1127, CNRS UMR 7225, Pitié-Salpêtrière Hospital, Paris, France; Movement Investigations and Therapeutics Team (MOV'IT), ICM, Paris, France; Center for NeuroImaging Research - CENIR, ICM, Paris, France; Department of Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
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Pak K, Lee MJ, Kim K, Kim IJ. No effect of Parkinson's disease-polygenic load on striatal density of dopaminergic neuron in healthy subjects. Ann Nucl Med 2021; 35:1187-1192. [PMID: 34287783 DOI: 10.1007/s12149-021-01657-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE There has been increasing evidence to support the role of genetic factors in Parkinson's disease (PD). 123I-FP-CIT single-photon emission computed tomography (SPECT) enables in vivo visualization of the striatal density of dopaminergic neuron. METHODS We investigated the association between PD-associated polygenic load and striatal density of dopaminergic neuron in healthy subjects. Data used in the preparation of this article were obtained from Parkinson's Progression Markers Initiative database. 123I-FP-CIT SPECT was performed for all subjects. Specific binding ratios (SBRs) were calculated from the ventral striatum, caudate nucleus, and putamen with reference to cerebellum. Singe nucleotide polymorphism (SNP) genotyping from the PPMI database was adopted in calculating genetic risk score (GRS). GRS was defined as the sum of the number of risk alleles weighted by log odds ratios for PD. We calculated three GRSs using three different sets of SNPs. RESULT A total of 151 subjects were included in this study (101 males, 50 females). GRS1, GRS2 and GRS3 were significantly different with the highest scores of GRS1. Multiple regression was done to investigate whether striatal SBRs are influenced by GRSs after adjusting for age and sex. However, none of GRSs were associated with SBRs of the ventral striatum, caudate nucleus and putamen. CONCLUSION PD risk SNPs weighted by odds ratio for PD were not associated with SBRs measured from SPECT in healthy subjects. Therefore, there is no effect of PD-associated polygenic load on striatal density of dopaminergic neuron in healthy subjects.
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Affiliation(s)
- Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea.
| | - Myung Jun Lee
- Department of Neurology and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea.
| | - Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - In Joo Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea.
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Gaurav R, Yahia‐Cherif L, Pyatigorskaya N, Mangone G, Biondetti E, Valabrègue R, Ewenczyk C, Hutchison RM, Cedarbaum JM, Corvol J, Vidailhet M, Lehéricy S. Longitudinal Changes in Neuromelanin MRI Signal in Parkinson's Disease: A Progression Marker. Mov Disord 2021; 36:1592-1602. [PMID: 33751655 PMCID: PMC8359265 DOI: 10.1002/mds.28531] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/07/2021] [Accepted: 01/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Development of reliable and accurate imaging biomarkers of dopaminergic cell neurodegeneration is necessary to facilitate therapeutic drug trials in Parkinson's disease (PD). Neuromelanin-sensitive MRI techniques have been effective in detecting neurodegeneration in the substantia nigra pars compacta (SNpc). The objective of the current study was to investigate longitudinal neuromelanin signal changes in the SNpc in PD patients. METHODS In this prospective, longitudinal, observational case-control study, we included 140 PD patients and 64 healthy volunteers divided into 2 cohorts. Cohort I included 99 early PD patients (disease duration, 1.5 ± 1.0 years) and 41 healthy volunteers analyzed at baseline (V1), where 79 PD patients and 32 healthy volunteers were rescanned after 2.0 ± 0.2 years of follow-up (V2). Cohort II included 41 progressing PD patients (disease duration, 9.3 ± 3.7 years) and 23 healthy volunteers at V1, where 30 PD patients were rescanned after 2.4 ± 0.5 years of follow-up. Subjects were scanned at 3 T MRI using 3-dimensional T1-weighted and neuromelanin-sensitive imaging. Regions of interest were delineated manually to calculate SN volumes, volumes corrected by total intracranial volume, signal-to-noise ratio, and contrast-to-noise ratio. RESULTS Results showed (1) significant reduction in volume and volume corrected by total intracranial volume between visits, greater in progressing PD than nonsignificant changes in healthy volunteers; (2) no significant effects of visit for signal intensity (signal-to-noise ratio); (3) significant interaction in volume between group and visit; (4) greater volume corrected by total intracranial volume at baseline in female patients and greater decrease in volume and increase in the contrast-to-noise ratio in progressing female PD patients compared with male patients; and (5) correlations between neuromelanin SN changes and disease severity and duration. CONCLUSIONS We observed a progressive and measurable decrease in neuromelanin-based SN signal and volume in PD, which might allow a direct noninvasive assessment of progression of SN loss and could represent a target biomarker for disease-modifying treatments. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rahul Gaurav
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
| | - Lydia Yahia‐Cherif
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
| | - Nadya Pyatigorskaya
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
- Department of NeuroradiologyPitié‐Salpêtrière Hospital, AP‐HPParisFrance
| | - Graziella Mangone
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- INSERM, Clinical Investigation Center for Neurosciences, Pitié‐Salpêtrière HospitalParisFrance
| | - Emma Biondetti
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
| | - Romain Valabrègue
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
| | - Claire Ewenczyk
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
- Department of NeurologyPitié‐Salpêtrière Hospital, AP‐HPParisFrance
| | | | | | - Jean‐Christophe Corvol
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- INSERM, Clinical Investigation Center for Neurosciences, Pitié‐Salpêtrière HospitalParisFrance
- Department of NeurologyPitié‐Salpêtrière Hospital, AP‐HPParisFrance
| | - Marie Vidailhet
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
- Department of NeurologyPitié‐Salpêtrière Hospital, AP‐HPParisFrance
| | - Stéphane Lehéricy
- Paris Brain Institute– ICMCenter for NeuroImaging Research – CENIRParisFrance
- ICM, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMRParisFrance
- ICM Team “Movement Investigations and Therapeutics” (MOV'IT)ParisFrance
- Department of NeuroradiologyPitié‐Salpêtrière Hospital, AP‐HPParisFrance
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Interactions of COMT and ALDH2 Genetic Polymorphisms on Symptoms of Parkinson's Disease. Brain Sci 2021; 11:brainsci11030361. [PMID: 33808974 PMCID: PMC8001371 DOI: 10.3390/brainsci11030361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Monoamine neurotransmitters play essential roles in the normal functioning of our nervous system. However, the metabolism of monoamine neurotransmitters is accompanied by the production of neurotoxic metabolites, and inefficient removal of the metabolites has been suggested to cause neurodegeneration. (2) Methods: To examine the effect of reduced activity of catechol-O-methyltransferase (COMT) and aldehyde dehydrogenase 2 (ALDH2) conferred by single nucleotide polymorphisms COMT rs4680(A) and ALDH2 rs671(A) on the symptoms of patients with Parkinson’s disease (PD), a total of 114 PD patients were recruited cross-sectionally and received genotyping for rs4680 and rs671 along with MDS-UPDRS evaluation. (3) Results: We found that patients carrying rs4680(A) had more severe bradykinesia in the upper extremity and rest tremor. Besides, patients carrying rs671(A) had more difficulty maintaining personal hygiene, while patients with genotype rs671(GG) had higher scores in the item “depressed mood.” More importantly, we found the effect of rs4680 to be moderated by rs671 SNP for the symptom of “hand movements.” The detrimental impact of rs4680(A) is more pronounced in the presence of genotype rs671(GG). (4) Conclusions: This study facilitates a deeper understanding of the detrimental effect of reduced activity of COMT and ALDH2 conferred by genetic variation and provides novel insight into the interactions between enzymes metabolizing monoamine neurotransmitters in the pathogenesis of PD.
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Dos Santos EUD, da Silva IIFG, Asano AGC, Asano NMJ, De Mascena Diniz Maia M, de Souza PRE. Pharmacogenetic profile and the development of the dyskinesia induced by levodopa-therapy in Parkinson's disease patients: a population-based cohort study. Mol Biol Rep 2020; 47:8997-9004. [PMID: 33151475 DOI: 10.1007/s11033-020-05956-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/28/2020] [Indexed: 12/21/2022]
Abstract
Levodopa-induced dyskinesia (LID) is an adverse effect that negatively impacts the quality of life of patients with Parkinson's disease (PD). Studies report that genetic variations in the genes of the pharmacogenetic pathway of the levodopa (L-DOPA) might be associated with LID development. The goal of the present study was to investigate a possible influence of functional genetic variants in the DRD1 (rs4532), DRD2 (rs1800497), DAT1 (rs28363170), and COMT (rs4680) genes with LID development. A total of 220 patients with idiopathic PD were enrolled. The genotyping for DRD1 (rs4532), DRD2 (rs1800497), DAT1 (rs28363170), and COMT (rs4680) polymorphisms were performed using Restriction Fragment Length Polymorphism (PCR-RFLP). Univariate and multivariate analyses were performed to assess the association of these polymorphisms and risk factors with LID development. Multivariate Cox regression analysis showed increased risk to LID development for both Levodopa Dose Equivalency (LED) (Hazard ratios (HR) = 1.001; 95% CI 1.00-1.01; p = 0.009) and individuals carrying the COMT L/L genotype (HR = 2.974; 95% CI 1.12-7.83; p = 0.010). Furthermore, when performed a Cox regression analysis adjusted for a total LED, we observed that the genotype COMT L/L had a 3.84-fold increased risk for LID development (HR = 3.841; 95% CI 1.29-11.37; p = 0.012). Our results suggest that before treating LID in PD patients, it is important to take into consideration genetic variant in the COMT gene, since COMT LL genotype may increase the risk for LID development.
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Affiliation(s)
- Erinaldo Ubirajara Damasceno Dos Santos
- Graduate Program in Applied Cellular and Molecular Biology, University of Pernambuco (UPE), Rua Dom Manuel de Medeiros, S/N -Dois Irmãos, CEP:52171-900, Recife, PE, Brazil
| | | | - Amdore Guescel C Asano
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Pernambuco (UFPE), Recife, PE, Brazil.,Pro-Parkinson Program of the Clinical Hospital of the Federal University of Pernambuco Recife (HC/UFPE), Recife, PE, Brazil
| | - Nadja Maria Jorge Asano
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Pernambuco (UFPE), Recife, PE, Brazil.,Pro-Parkinson Program of the Clinical Hospital of the Federal University of Pernambuco Recife (HC/UFPE), Recife, PE, Brazil
| | | | - Paulo Roberto Eleutério de Souza
- Graduate Program in Applied Cellular and Molecular Biology, University of Pernambuco (UPE), Rua Dom Manuel de Medeiros, S/N -Dois Irmãos, CEP:52171-900, Recife, PE, Brazil. .,Graduate Program in Genetics, Federal University of Pernambuco (UFPE), Recife, PE, Brazil. .,Department of Biology, Federal Rural University of Pernambuco (UFRPE), Recife, PE, Brazil.
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Sampedro F, Marín-Lahoz J, Martínez-Horta S, Camacho V, Lopez-Mora DA, Pagonabarraga J, Kulisevsky J. Extrastriatal SPECT-DAT uptake correlates with clinical and biological features of de novo Parkinson's disease. Neurobiol Aging 2020; 97:120-128. [PMID: 33212336 DOI: 10.1016/j.neurobiolaging.2020.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/09/2020] [Accepted: 10/17/2020] [Indexed: 10/23/2022]
Abstract
Striatal dopamine transporter (DAT) uptake assessment through I123-Ioflupane Single-Pphoton Emission Computed Tomography (SPECT) provides valuable information about the dopaminergic denervation occurring in Parkinson's disease (PD). However, little is known about the clinical or biological relevance of extrastriatal DAT uptake in PD. Here, from the Parkinson's Progression Markers Initiative, we studied 623 participants (431 PD and 192 healthy controls) with available SPECT data. Even though striatal denervation was undoubtedly the imaging hallmark of PD, extrastriatal DAT uptake was also reduced in patients with PD. Topographically, widespread frontal but also temporal and posterior cortical regions showed lower DAT uptake in PD patients with respect to healthy controls. Importantly, a longitudinal voxelwise analysis confirmed an active one-year loss of extrastriatal DAT uptake within the PD group. Extrastriatal DAT uptake also correlated with the severity of motor symptoms, cognitive performance, and cerebrospinal fluid α-synuclein levels. In addition, we found an association between the Catechol-O-methyltransferase val158met genotype and extrastriatal DAT uptake. These results highlight the clinical and biological relevance of extrastriatal SPECT-DAT uptake in PD.
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Affiliation(s)
- Frederic Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Marín-Lahoz
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Saul Martínez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Valle Camacho
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaime Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Faculty of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
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Cengiz M, Cezayirli E, Bayoglu B, Asliyuksek H, Kocabasoglu N. Catechol-O-Methyltransferase Val158Met and brain-derived neurotrophic factor Val66Met gene polymorphisms in paraphilic sexual offenders. Indian J Psychiatry 2019; 61:253-257. [PMID: 31142902 PMCID: PMC6532468 DOI: 10.4103/psychiatry.indianjpsychiatry_194_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Child sexual abuse (CSA) is an important problem worldwide. The reason of sex abuse is considered as multifactorial. Genetic contribution reported by recent studies is a significant evidence for this pathologic behavior. Catechol-O-Methyltransferase (COMT) is an enzyme in the metabolic inactivation of catecholamine and substances containing catecholamines such as dopamine, epinephrine, and norepinephrine. COMT polymorphism causes functional changes in COMT enzyme activity. Brain-derived neurotrophic factor (BDNF) is a neurotrophic factor usually synthesized from central nervous system neurons. With the effect of BDNF, dopamine and serotonin play important roles on neurogenesis, survival, and synaptic plasticity. AIM This study aims to examine COMT Val158Met (rs4680) and BDNF Val66Met (rs6265) polymorphisms in CSA. SETTINGS AND DESIGN This was a case-control study. MATERIALS AND METHODS Seventy paraphilic child sexual abuser patients and seventy age- and gender-matched healthy controls participated in this study. COMT Val158Met and BDNF Val66Met polymorphisms were genotyped by real-time polymerase chain reaction assay. RESULTS COMT Val158Met genotype frequencies were determined as GG 31.4%, GA 45.7%, and AA 22.9% in patients; GG 24.3%, GA 45.7%, and AA 8.6% in controls; and exhibited a positive relationship between the groups (P = 0.018). BDNF Val66Met genotype frequencies were determined as GG 77.1%, GA 21.4%, and AA 1.4% in patients; GG 65.7%, GA 31.4%, AA 2.9% in controls; and no significant relationship was observed between the groups (P = 0.317). CONCLUSIONS This research investigated COMT (Val158Met) and BDNF (Val66Met) in paraphilic child sexual offenders. A positive relationship was found for COMT gene; however, no significant relation was observed for BDNF gene between paraphilic sexual offenders and controls.
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Affiliation(s)
- Mujgan Cengiz
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esma Cezayirli
- Department of Science, Institute of Forensic Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burcu Bayoglu
- Department of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hizir Asliyuksek
- Department of Medical Sciences, Institute of Forensic Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nese Kocabasoglu
- Department of Psychiatry, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Pak K, Nam HY, Shin S, Kim K, Lee MJ, Kim EJ, Lee JM, Kim SJ, Kim IJ. Effects of rs591323 on serotonin transporter availability in healthy male subjects. Ann Nucl Med 2018; 32:431-436. [PMID: 29774458 DOI: 10.1007/s12149-018-1262-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/13/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We aimed to investigate the association between genetic factors of SNPs dopamine transporter (DAT) and serotonin transporter (SERT) availabilities in healthy controls. METHODS The study population consisted of healthy controls with screening 123I-FP-CIT single-photon emission computed tomography. Specific binding of 123I-FP-CIT regarding DAT and SERT was calculated using a region of interest analysis. VOI template was applied to measure specific binding ratios (SBRs) of caudate nucleus, putamen, striatum, midbrain, and pons. RESULTS One hundred sixty healthy controls (male 106, female 54, 61.0 ± 11.5 years) were included in this study. Sex difference did not exist in DAT availabilities of caudate nucleus (p = 0.5344), putamen (p = 0.5006), and striatum (p = 0.5056). However, male subjects had higher SERT availabilities of both midbrain (p = 0.0436), and pons (p = 0.0061). Therefore, we analyzed the effect of SNP on DAT availabilities of subjects in all, and that on SERT availabilities of males and females separately. None of 19 SNPs included in this study showed the effect on DAT availabilities. However, rs591323 in Fibroblast Growth Factor 20 on chromosome 8 had a significant impact on SERT availability of both midbrain (p = 0.0056) and pons (p = 0.0007). CONCLUSION SNP rs591323 of risk loci for Parkinson's disease is associated with SERT availability of healthy male subjects.
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Affiliation(s)
- Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea.
| | - Hyun-Yeol Nam
- Department of Nuclear Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
| | - Seunghyeon Shin
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea
| | - Myung Jun Lee
- Department of Neurology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Eun-Joo Kim
- Department of Neurology and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jae Meen Lee
- Department of Neurosurgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| | - In Joo Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea.
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10
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Sampaio TF, Dos Santos EUD, de Lima GDC, Dos Anjos RSG, da Silva RC, Asano AGC, Asano NMJ, Crovella S, de Souza PRE. MAO-B and COMT Genetic Variations Associated With Levodopa Treatment Response in Patients With Parkinson's Disease. J Clin Pharmacol 2018; 58:920-926. [PMID: 29578580 DOI: 10.1002/jcph.1096] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/16/2018] [Indexed: 12/19/2022]
Abstract
The most commonly used Parkinson's disease (PD) treatment is the replacement of dopamine by its levodopa precursor (l-dopa). Monoamine oxidase-B (MAO-B) and catechol-o-methyl transferase (COMT) are enzymes involved in the metabolism and regulation of dopamine availability. In our study we investigated the possible relation among selected single-nucleotide polymorphisms (SNPs) in the MAO-B (rs1799836) and COMT (rs4680) genes and the therapeutic response to levodopa (l-dopa). A total of 162 Brazilian patients from the Pro-Parkinson service of Clinics Hospital of Pernambuco diagnosed with sporadic PD and treated with levodopa were enrolled. PD patients were stratified into 2 groups according to the daily levodopa dose. MAO-B and COMT SNP genotyping was conducted by polymerase chain reaction-restriction fragment length polymorphism. After multivariate analysis, we observed a significant difference between PD groups for the following variables: sex (P = .02), longer duration of disease (P = .02), longer levodopa therapy duration (P = .01), younger onset of PD (P = .01), and use of COMT inhibitor (P = .02). We observed that patients carrying MAO-B (rs1799836) A and AA genotypes and COMT (rs4680) LL genotype suffered more frequently from levodopa-induced-dyskinesia. In addition, we found an increased risk of 2.84-fold for male individuals carrying the MAO-B G allele to be treated with higher doses of levodopa (P = .04). We concluded that before beginning PD pharmacological treatment, it is important to consider the genetic variants of the MAO-B and COMT genes and the sex, reinforcing the evidence that sexual dimorphism in the genes related to dopamine metabolism might affect PD treatment.
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Affiliation(s)
- Tiago Furtado Sampaio
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco (UFPE), Recife, Brazil
| | | | | | | | - Ronaldo Celerino da Silva
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Amdore Guescel C Asano
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Pernambuco (UFPE), Recife, Brazil.,Pro-Parkinson Program of Clinical Hospital of Federal University of Pernambuco e Recife (HC/UFPE), Recife, Brazil
| | - Nadja Maria Jorge Asano
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Pernambuco (UFPE), Recife, Brazil.,Pro-Parkinson Program of Clinical Hospital of Federal University of Pernambuco e Recife (HC/UFPE), Recife, Brazil
| | - Sergio Crovella
- Department of Genetics, Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Paulo Roberto Eleutério de Souza
- Postgraduate Program of Biology Applied to Health, Federal University of Pernambuco (UFPE), Recife, Brazil.,Postgraduate Program of Applied Cellular and Molecular Biology, University of Pernambuco (UPE), Recife, Brazil.,Department of Biology, Federal Rural University of Pernambuco (UFRPE), Recife, Brazil
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11
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Marinho V, Oliveira T, Rocha K, Ribeiro J, Magalhães F, Bento T, Pinto GR, Velasques B, Ribeiro P, Di Giorgio L, Orsini M, Gupta DS, Bittencourt J, Bastos VH, Teixeira S. The dopaminergic system dynamic in the time perception: a review of the evidence. Int J Neurosci 2017; 128:262-282. [PMID: 28950734 DOI: 10.1080/00207454.2017.1385614] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Dopaminergic system plays a key role in perception, which is an important executive function of the brain. Modulation in dopaminergic system forms an important biochemical underpinning of neural mechanisms of time perception in a very wide range, from milliseconds to seconds to longer daily rhythms. Distinct types of temporal experience are poorly understood, and the relationship between processing of different intervals by the brain has received little attention. A comprehensive understanding of interval timing functions should be sought within a wider context of temporal processing, involving genetic aspects, pharmacological models, cognitive aspects, motor control and the neurological diseases with impaired dopaminergic system. Particularly, an unexplored question is whether the role of dopamine in interval timing can be integrated with the role of dopamine in non-interval timing temporal components. In this review, we explore a wider perspective of dopaminergic system, involving genetic polymorphisms, pharmacological models, executive functions and neurological diseases on the time perception. We conclude that the dopaminergic system has great participation in impact on time perception and neurobiological basis of the executive functions and neurological diseases.
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Affiliation(s)
- Victor Marinho
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil.,b Genetics and Molecular Biology Laboratory, Federal University of Piauí , Parnaíba , Brazil
| | - Thomaz Oliveira
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil.,b Genetics and Molecular Biology Laboratory, Federal University of Piauí , Parnaíba , Brazil
| | - Kaline Rocha
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
| | - Jéssica Ribeiro
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
| | - Francisco Magalhães
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
| | - Thalys Bento
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
| | - Giovanny R Pinto
- b Genetics and Molecular Biology Laboratory, Federal University of Piauí , Parnaíba , Brazil
| | - Bruna Velasques
- c Brain Mapping and Sensory Motor Integration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , Brazil
| | - Pedro Ribeiro
- c Brain Mapping and Sensory Motor Integration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , Brazil
| | - Luiza Di Giorgio
- c Brain Mapping and Sensory Motor Integration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , Brazil
| | - Marco Orsini
- c Brain Mapping and Sensory Motor Integration Laboratory, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) , Rio de Janeiro , Brazil.,d Rehabilitation Science Program, Analysis of Human Movement Laboratory, Augusto Motta University Center (UNISUAM) , Rio de Janeiro , Brazil
| | - Daya S Gupta
- e Department of Biology , Camden County College , Blackwood , NJ , USA
| | - Juliana Bittencourt
- f Biomedical Engineering Program (COPPE), Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brazil
| | - Victor Hugo Bastos
- g Brain Mapping and Functionality Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
| | - Silmar Teixeira
- a Brain Mapping and Plasticity Laboratory, Federal University of Piauí (UFPI) , Parnaíba , Brazil
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Lin JY, Xie CL, Zhang SF, Yuan W, Liu ZG. Current Experimental Studies of Gene Therapy in Parkinson's Disease. Front Aging Neurosci 2017; 9:126. [PMID: 28515689 PMCID: PMC5413509 DOI: 10.3389/fnagi.2017.00126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/13/2017] [Indexed: 12/21/2022] Open
Abstract
Parkinson's disease (PD) was characterized by late-onset, progressive dopamine neuron loss and movement disorders. The progresses of PD affected the neural function and integrity. To date, most researches had largely addressed the dopamine replacement therapies, but the appearance of L-dopa-induced dyskinesia hampered the use of the drug. And the mechanism of PD is so complicated that it's hard to solve the problem by just add drugs. Researchers began to focus on the genetic underpinnings of Parkinson's disease, searching for new method that may affect the neurodegeneration processes in it. In this paper, we reviewed current delivery methods used in gene therapies for PD, we also summarized the primary target of the gene therapy in the treatment of PD, such like neurotrophic factor (for regeneration), the synthesis of neurotransmitter (for prolong the duration of L-dopa), and the potential proteins that might be a target to modulate via gene therapy. Finally, we discussed RNA interference therapies used in Parkinson's disease, it might act as a new class of drug. We mainly focus on the efficiency and tooling features of different gene therapies in the treatment of PD.
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Affiliation(s)
- Jing-Ya Lin
- Department of Neurology, Xinhua Hospital Affiliated to the Medical School of Shanghai JiaoTong UniversityShanghai, China
| | - Cheng-Long Xie
- Department of Neurology, The first Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical UniversityWenzhou, China
| | - Su-Fang Zhang
- Department of Neurology, Xinhua Hospital Affiliated to the Medical School of Shanghai JiaoTong UniversityShanghai, China
| | - Weien Yuan
- School of Pharmacy, Shanghai JiaoTong UniversityShanghai, China
| | - Zhen-Guo Liu
- Department of Neurology, Xinhua Hospital Affiliated to the Medical School of Shanghai JiaoTong UniversityShanghai, China
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13
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Bastos P, Gomes T, Ribeiro L. Catechol-O-Methyltransferase (COMT): An Update on Its Role in Cancer, Neurological and Cardiovascular Diseases. Rev Physiol Biochem Pharmacol 2017; 173:1-39. [DOI: 10.1007/112_2017_2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Genetic factors influencing frontostriatal dysfunction and the development of dementia in Parkinson's disease. PLoS One 2017; 12:e0175560. [PMID: 28399184 PMCID: PMC5388496 DOI: 10.1371/journal.pone.0175560] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/28/2017] [Indexed: 02/07/2023] Open
Abstract
The dual syndrome hypothesis for cognitive impairment in Parkinson's disease (PD) establishes a dichotomy between a frontrostriatal dopamine-mediated syndrome, which leads to executive deficits, and a posterior cortical syndrome, which leads to dementia. Certain genes have been linked to these syndromes although the exact contribution is still controversial. The study's objective was to investigate the role of APOE, MAPT, COMT, SNCA and GBA genes in the dual syndromes. We genotyped APOE (rs429358 and rs7412), MAPT (rs9468), COMT (rs4680) and SNCA (rs356219) risk polymorphisms and sequenced GBA in a cohort of 298 PD patients. The degree of dopaminergic depletion was investigated with [123I]FP-CIT SPECTs and the presence of dementia was ascertained with a long-term review based on established criteria. The association between genetic and imaging parameters was studied with linear regression, and the relationship with dementia onset with Cox regression. We found that APOE2 allele (Pput = 0.002; Pcau = 0.01), the minor allele 'G' in SNCA polymorphism (Pput = 0.02; Pcau = 0.006) and GBA deleterious variants in (Pput = 0.01; Pcau = 0.001) had a detrimental effect on striatal [123I]FP-CIT uptake in PD. Conversely, Met/Met carriers in COMT polymorphism had increased caudate uptake (Pcau = 0.03). The development of dementia was influenced by APOE4 allele (HR = 1.90; P = 0.03) and GBA deleterious variants (HR = 2.44; P = 0.01). Finally, we observed no role of MAPT locus in any of the syndromes. As a conclusion, APOE2, SNCA, COMT and GBA influence frontostriatal dysfunction whereas APOE4 and GBA influence the development of dementia, suggesting a double-edged role of GBA. The dichotomy of the dual syndromes may be driven by a broad dichotomy in these genetic factors.
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Zhang Y, Feng S, Nie K, Zhao X, Gan R, Wang L, Zhao J, Tang H, Gao L, Zhu R, Wang L, Zhang Y. Catechol-O-methyltransferase Val158Met polymorphism influences prefrontal executive function in early Parkinson's disease. J Neurol Sci 2016; 369:347-353. [DOI: 10.1016/j.jns.2016.08.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
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