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Ji Y, Choi TY, Lee J, Yoon S, Won GH, Jeong H, Kang SW, Kim JW. Characteristics of Attention-Deficit/Hyperactivity Disorder Subtypes in Children Classified Using Quantitative Electroencephalography. Neuropsychiatr Dis Treat 2022; 18:2725-2736. [PMID: 36437880 PMCID: PMC9697401 DOI: 10.2147/ndt.s386774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE This study used quantitative electroencephalography (QEEG) to investigate the characteristics of attention-deficit/hyperactivity disorder (ADHD) subtypes in children. PATIENTS AND METHODS There were 69 subjects (42 with ADHD and 27 neurotypical (NT)) in this study. A semi-structured interview was conducted with each participant for psychiatric diagnostic evaluation. We measured the absolute and relative power in 19 channels and analyzed QEEG using the following frequency ranges: delta (1-4 Hz), theta (4-8 Hz), alpha 1 (8-10 Hz), alpha 2 (10-12 Hz), beta 1 (12-15 Hz), beta 2 (15-20 Hz), beta 3 (20-30 Hz), and gamma (30-45 Hz). Group analyses and EEG noise preprocessing were conducted using iSyncBrain, a cloud-based, artificial intelligence EEG analysis platform. Analysis of covariance adjusted for IQ, age, and sex was used. RESULTS QEEG analysis revealed three ADHD subtypes, characterized by (A) elevated relative fast alpha and beta power, (B) elevated absolute slow frequency (delta and theta power), or (C) elevated absolute and relative beta power. A significant difference was found in the Korean ADHD Rating Scale (K-ARS) among the four groups (df=3, F=8.004, p<0.001); group C had the highest score (25.31±11.16), followed by group A (21.67±13.18). The score of group B (12.64±7.84) was similar to that of the NT group (11.07±6.12) and did not reach the cut-off point of the K-ARS. In the Wender-Utah Rating Scale (WURS), group B score (55.82±23.17) was significantly higher than the NT group score (42.81±13.26). CONCLUSION These results indicate that children with ADHD do not constitute a neurophysiologically homogenous group. Children with QEEG subtype B (elevated slow frequency) may be difficult to distinguish from normal children using the K-ARS, which is the most common screening tool for ADHD. Moreover, parents of children with this subtype may be less sensitive to observing ADHD symptoms.
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Affiliation(s)
- Yoonmi Ji
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Tae Young Choi
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Jonghun Lee
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Seoyoung Yoon
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Geun Hui Won
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | | | - Seung Wan Kang
- iMediSync Inc, Seoul, Republic of Korea.,National Standard Reference Data Center for Korean EEG, Seoul National University College of Nursing, Seoul, Republic of Korea
| | - Jun Won Kim
- Department of Psychiatry, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
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Paul P, Bennett CN. Review of Neuropsychological and Electrophysiological Correlates of Callous-unemotional Traits in Children: Implications for EEG Neurofeedback Intervention. Clin EEG Neurosci 2021; 52:321-329. [PMID: 33709806 DOI: 10.1177/1550059421997129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Conduct disorder is a significant psychiatric disorder of childhood and adolescence. The Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-5), added the limited prosocial specifier to identify those individuals who exhibit a more severe pattern of behavior characterized by a callous and unemotional (CU) interpersonal style across multiple settings and relationships. This review has attempted to summarize the relevant research focusing on the significance of CU interpersonal style in the development of psychopathy. The primary focus was on the electrophysiological and neuropsychological correlates of CU traits and their implication on the treatment protocol using neurofeedback training for children with such traits. The source of the literature search was PubMed, which majorly uses the MEDLINE database. The keywords used included CU traits, conduct disorder, child psychopathy, empathy, electrophysiology, criminal behavior, neuropsychology, neurofeedback training, and so on. Studies from the last 15 years were considered for the review. This review revealed that children with conduct disorder and high-CU traits with a combination of reactive and proactive aggression are more likely to develop psychopathy. Evidence suggests that these children have distinct forms of electrophysiological and neuropsychological correlates. However, research in this area is still not conclusive as they yield variation in findings. Studies on the efficacy of neurofeedback training on reducing symptoms such as impulsivity, hostility, and psychopathy indicate that neurofeedback training can be a promising treatment alternative for children with severe conduct disorder.
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Sergiou CS, Santarnecchi E, Romanella SM, Wieser MJ, Franken IHA, Rassin EGC, van Dongen JDM. Transcranial Direct Current Stimulation Targeting the Ventromedial Prefrontal Cortex Reduces Reactive Aggression and Modulates Electrophysiological Responses in a Forensic Population. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 7:95-107. [PMID: 34087482 DOI: 10.1016/j.bpsc.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies have shown that impairments in the ventromedial prefrontal cortex play a crucial role in violent behavior in forensic patients who also abuse cocaine and alcohol. Moreover, interventions that aimed to reduce violence risk in those patients are found not to be optimal. A promising intervention might be to modulate the ventromedial prefrontal cortex by high-definition (HD) transcranial direct current stimulation (tDCS). The current study aimed to examine HD-tDCS as an intervention to increase empathic abilities and reduce violent behavior in forensic substance dependent offenders. In addition, using electroencephalography, we examined the effects on the P3 and the late positive potential of the event-related potentials in reaction to situations that depict victims of aggression. METHODS Fifty male forensic patients with a substance dependence were tested in a double-blind, placebo-controlled randomized study. The patients received HD-tDCS 2 times a day for 20 minutes for 5 consecutive days. Before and after the intervention, the patients completed self-reports and performed the Point Subtraction Aggression Paradigm, and electroencephalography was recorded while patients performed an empathy task. RESULTS Results showed a decrease in aggressive responses on the Point Subtraction Aggression Paradigm and in self-reported reactive aggression in the active tDCS group. Additionally, we found a general increase in late positive potential amplitude after active tDCS. No effects on trait empathy and the P3 were found. CONCLUSIONS Current findings are the first to find positive effects of HD-tDCS in reducing aggression and modulating electrophysiological responses in forensic patients, showing the potential of using tDCS as an intervention to reduce aggression in forensic mental health care.
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Affiliation(s)
- Carmen S Sergiou
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sara M Romanella
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Matthias J Wieser
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Ingmar H A Franken
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Eric G C Rassin
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Josanne D M van Dongen
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands.
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Sergiou CS, Woods AJ, Franken IHA, van Dongen JDM. Transcranial direct current stimulation (tDCS) as an intervention to improve empathic abilities and reduce violent behavior in forensic offenders: study protocol for a randomized controlled trial. Trials 2020; 21:263. [PMID: 32169111 PMCID: PMC7069186 DOI: 10.1186/s13063-020-4074-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/13/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Recent studies show that changes in one of the brain areas related to empathic abilities (i.e. the ventromedial prefrontal cortex (vmPFC)) plays an important role in violent behavior in abusers of alcohol and cocaine. According to the models of James Blair, empathy is a potential inhibitor of violent behavior. Individuals with less empathic abilities may be less susceptible and motivated to inhibit violent behavior, which causes a higher risk of violence. Recent neuroscientific research shows that modulating (stimulation or inhibition) certain brain areas could be a promising new intervention for substance abuse and to reduce violent behavior, such as the neurostimulation technique transcranial direct current stimulation (tDCS). This study aims to investigate tDCS as an intervention to increase empathic abilities and reduce violent behavior in forensic substance use offenders. METHODS/DESIGN A total sample of 50 male forensic substance abuse patients (25 active and 25 sham stimulation) will be tested in a double-blind placebo-controlled study, from which half of the patients will receive an active stimulation plus treatment as usual (TAU) and the other half will receive sham stimulation (placebo) plus TAU. The patients in the active condition will receive multichannel tDCS targeting the bilateral vmPFC two times a day for 20 min for five consecutive days. Before and after the stimulation period, the patients will complete self-report measurements, perform the Point Subtraction Aggression Paradigm (PSAP) and a passive viewing empathy task. Resting state electroencephalography (rsEEG) will be performed before and after the treatment period. A follow up will be conducted after 6 months. The primary outcome is to investigate multichannel tDCS as a new intervention to increase empathic abilities and reduce violent behavior in offenders with substance abuse problems. In addition, we will determine whether electrophysiological responses in the brain are affected by the tDCS intervention. Finally, the effects of tDCS on reducing craving will be investigated. DISCUSSION This study is one of the first studies using multichannel tDCS targeting the vmPFC in a forensic sample. This study will explore the opportunities to introduce a new intervention to improve empathic abilities and reduce violence in forensic substance use offenders. Specifically, this study may give insight into how to implement the tDCS intervention in the setting of daily clinical practice in this complex, multiple-problem target group and with that contribute to reduction of recidivism. TRIAL REGISTRATION Dutch Trial Register, NTR7701. Registered on 12 January 2019. Prospectively registered before the recruitment phase. https://www.trialregister.nl/trial/7459. Recruitment started on the 1st of February 2019 and will be finished approximately in the winter of 2019. Protocol version 1. 22 May 2019.
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Affiliation(s)
- Carmen S Sergiou
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Ingmar H A Franken
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - Josanne D M van Dongen
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands.
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McVoy M, Lytle S, Fulchiero E, Aebi ME, Adeleye O, Sajatovic M. A systematic review of quantitative EEG as a possible biomarker in child psychiatric disorders. Psychiatry Res 2019; 279:331-344. [PMID: 31300243 DOI: 10.1016/j.psychres.2019.07.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 11/15/2022]
Abstract
Quantitative EEG (qEEG) has emerged as a potential intermediate biomarker for diagnostic clarification in mental illness. This systematic review examines published studies that used qEEG in youth with psychiatric illness between 1996 and 2017. We conducted a comprehensive database search of CINAHL, PubMed, and Cochrane using the following keywords: "quantitative EEG" and depression (MDD), anxiety, attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), eating disorder, conduct, substance use, schizophrenia, post-traumatic stress disorder, and panic disorder. Our search yielded 516 titles; 33 met final inclusion criteria, producing a total of 2268 youth aged 4-18. qEEG was most frequently studied as a potential diagnostic tool in pediatric mental illness; few studies assessed treatment response. Studies show higher theta/beta ratio in ADHD vs healthy controls (HC). The most consistent finding in ASD was decreased coherence in ASD vs HC. Studies show MDD has lower temporal coherence and interhemispheric coherence in sleep EEGs than HC. Further research is needed in the areas of mood, anxiety, ASD, and relationship to treatment. It remains unknown if abnormalities in qEEG are nonspecific markers of pediatric psychiatric illness or if they have the potential to differentiate types of psychopathology.
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Affiliation(s)
- Molly McVoy
- Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States.
| | - Sarah Lytle
- Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Erin Fulchiero
- Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Michelle E Aebi
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, United States
| | - Olunfunke Adeleye
- Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, United States
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Wu Y, Chen M, Cui Y, He X, Niu J, Zhang Y, Zhou L. Viral encephalitis in quantitative EEG. J Integr Neurosci 2018; 17:493-501. [PMID: 29710730 DOI: 10.3233/jin-180084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Our aim was to study the character of quantitative EEG of viral encephalitis. METHOD Collect the EEG data of hospitalized children with viral encephalitis diagnosed by pediatricians from January 2013 to September 2016, and EEG data of normal cases at the same age were control group. Using quantitative EEG analysis technologies to obtain power spectrum value, power spectrum value, 1 power spectrum value, 12 power spectrum value, 21 power spectrum value, and 12 power spectrum value. Relative power spectrum values of 2 and were obtained by calculation. All the cases were divided into 5 groups according to the EEG character: age 3 group, age 4 group, age 5-6 group, age 7-9-year group, and age 10-14-year group. Viral encephalitis group and normal cases group were statistically compared to obtain characters of quantitative EEG with viral encephalitis. RESULTS Power spectrum values and power spectrum values of 3-14-year-old cases with encephalitis increased. 1 power spectrum values existed in age 3 group with viral encephalitis and declined at the post-head lead, while 11 and 12 power spectrum values existed in age 4-14 group with viral encephalitis declined at the post-head lead. The value of 2 Power spectrum values of age 3-9 group was limited in diagnosing viral encephalitis. 1 and 12 power spectrum values decrease in age 10-14 group with viral encephalitis. Relative power spectrum values of 2 and increased in age 3-14 group with viral encephalitis; Relative power spectrum values of decreased in age 3-14 group with viral encephalitis, most lead of relative power spectrum decreased in age 3-14 group with viral encephalitis. CONCLUSION The character of quantitative EEG of cases with viral encephalitis is similar to EEG, but more detailed, more precise, more intuitive and can be used for clinical diagnose of viral encephalitis.
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Affiliation(s)
- Yuepeng Wu
- Neurology Department, The Affiliated Hospital, Taishan Medical University, Taian, Shandong, China
| | - Meihua Chen
- Taishan Medical University, Taian, Shandong, China
| | - Yu Cui
- Neurosurgery Department, The Affiliated Hospital, Taishan Medical University, Taian, Shandong, China
| | - Xiying He
- Neurology Department, The Affiliated Hospital, Taishan Medical University, Taian, Shandong, China
| | - Jingzhong Niu
- Neurology Department, The Affiliated Hospital, Taishan Medical University, Taian, Shandong, China
| | - Yanbo Zhang
- Neurology Department, The Affiliated Hospital, Taishan Medical University, Taian, Shandong, China
| | - Li Zhou
- Pediatrics Department, The Affiliated Hospital, Taishan Medical University, Taian, Shandong, China
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Keune PM, Mayer SV, Jusyte A, Schönenberg M. Frontal alpha asymmetry and callous-unemotional traits in imprisoned violent offenders: A pilot study. Psychophysiology 2017; 55. [PMID: 28833272 DOI: 10.1111/psyp.12981] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 12/17/2022]
Abstract
Based on the approach-withdrawal model of hemispheric asymmetry, anger and aggression have been linked to an approach-related pattern, characterized by stronger relative left-hemispheric anterior cortical activity. Recent work suggests that also in individuals with extremely violent tendencies, such as imprisoned offenders, approach-related asymmetry may be associated with self-reported trait anger and aggression. A putative association between alpha asymmetry and further characteristics relevant for aggression, such as callous-unemotional (CU) traits, remains to be explored. CU traits may increase the probability of aggressive behavior; nevertheless, they may also enable individuals to inhibit and postpone the overt display of aggression until circumstances grant its strongest impact. In the current exploratory study, we measured trait aggression, CU traits, and resting-state EEG asymmetry in the alpha band (8-13 Hz) in imprisoned violent offenders in a German high security prison. Results revealed that particularly trait callousness was associated with stronger relative right-hemispheric anterior cortical activity (i.e., a withdrawal-related pattern). An association between alpha asymmetry and aggression was not replicated. These preliminary findings suggest that, due to the involved emotional and interpersonal detachment, callousness might be withdrawal related, despite its potential to bring about aggressive behavior. They also imply that the identification of putative clinical subtypes in prisoners is required, as varying psychopathology might undermine an association between alpha asymmetry and aggression.
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Affiliation(s)
- Philipp M Keune
- Klinikum Bayreuth GmbH, Department of Neurology, Bayreuth, Germany.,Department of Physiological Psychology, University of Bamberg, Bamberg, Germany
| | - Sarah V Mayer
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Tübingen, Germany
| | - Aiste Jusyte
- LEAD Graduate School and Research Network, University of Tübingen, Tübingen, Germany
| | - Michael Schönenberg
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
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Bodranghien FCAA, Langlois Mahe M, Clément S, Manto MU. A Pilot Study on the Effects of Transcranial Direct Current Stimulation on Brain Rhythms and Entropy during Self-Paced Finger Movement using the Epoc Helmet. Front Hum Neurosci 2017; 11:201. [PMID: 28503139 PMCID: PMC5408787 DOI: 10.3389/fnhum.2017.00201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/06/2017] [Indexed: 11/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) of the cerebellum is emerging as a novel non-invasive tool to modulate the activity of the cerebellar circuitry. In a single blinded study, we applied anodal tDCS (atDCS) of the cerebellum to assess its effects on brain entropy and brain rhythms during self-paced sequential finger movements in a group of healthy volunteers. Although wearable electroencephalogram (EEG) systems cannot compete with traditional clinical/laboratory set-ups in terms of accuracy and channel density, they have now reached a sufficient maturity to envision daily life applications. Therefore, the EEG was recorded with a comfortable and easy to wear 14 channels wireless helmet (Epoc headset; electrode location was based on the 10-20 system). Cerebellar neurostimulation modified brain rhythmicity with a decrease in the delta band (electrode F3 and T8, p < 0.05). By contrast, our study did not show any significant change in entropy ratios and laterality coefficients (LC) after atDCS of the cerebellum in the 14 channels. The cerebellum is heavily connected with the cerebral cortex including the frontal lobes and parietal lobes via the cerebello-thalamo-cortical pathway. We propose that the effects of anodal stimulation of the cerebellar cortex upon cerebral cortical rhythms are mediated by this key-pathway. Additional studies using high-density EEG recordings and behavioral correlates are now required to confirm our findings, especially given the limited coverage of Epoc headset.
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Affiliation(s)
- Florian C. A. A. Bodranghien
- Unité d’Etude du Mouvement (UEM-GRIM), Fonds de la Recherche Scientifique, Université Libre De BruxellesBruxelles, Belgium
| | | | - Serge Clément
- Haute Ecole Libre de Bruxelles Ilya Prigogine (HELB)Bruxelles, Belgium
| | - Mario U. Manto
- Unité d’Etude du Mouvement (UEM-GRIM), Fonds de la Recherche Scientifique, Université Libre De BruxellesBruxelles, Belgium
- Haute Ecole Libre de Bruxelles Ilya Prigogine (HELB)Bruxelles, Belgium
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