1
|
Scolding NJ. Worked up but not worked out: inconclusive cases. Pract Neurol 2024; 24:352-353. [PMID: 38960595 DOI: 10.1136/pn-2024-004207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 07/05/2024]
Affiliation(s)
- Neil J Scolding
- Neurology, Gloucestershire Royal Hospital Neurology Department, Gloucester, UK
- Clinical Neurosciences, University of Bristol, Bristol, UK
| |
Collapse
|
2
|
Elwood BW, Godwin CR, Anders JJ, Kardon RH, Gramlich OW. Correlation of Visual System Biomarkers With Motor Deficits in Experimental Autoimmune Encephalomyelitis-Optic Neuritis. Transl Vis Sci Technol 2024; 13:1. [PMID: 39087931 PMCID: PMC11305423 DOI: 10.1167/tvst.13.8.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/11/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose Experimental autoimmune encephalomyelitis (EAE) scoring, the most commonly used primary outcome metric for an in vivo model of multiple sclerosis (MS), is highly variable and subjective. Here we explored the use of visual biomarkers in EAE as more objective and clinically relevant primary outcomes. Methods Motor impairment in myelin oligodendrocyte glycoprotein-immunized C57BL/6J mice was quantified using a five-point EAE grading scale. Pattern electroretinography (pERG) and retinal ganglion cell/inner plexiform layer (RGC/IPL) complex thickness were measured 60 days after induction. Optic nerve histopathology was analyzed at endpoint. Results EAE mice displayed motor impairments ranging from mild to severe. Significant correlations were seen between pERG amplitude and last EAE score, mean EAE score, and cumulative EAE score. Optical coherence tomography (OCT) analysis demonstrated a significant correlation between thinning of the RGC/IPL complex and both EAE score and pERG amplitude. Optic nerve histopathology showed significant correlations between demyelination and cumulative EAE score, pERG amplitude, and RGC/IPL complex thickness, as well as between immune cell infiltration and cumulative EAE score, pERG amplitude, and RGC/IPL complex thickness in EAE mice. Conclusions Unlike EAE scoring, pERG and OCT show direct measurement of retinal structure and function. Therefore we conclude that visual outcomes are well suited as a direct assessment of optic nerve involvement in this EAE model of MS while also being indicative of motor impairment. Translational Relevance Standardizing directly translatable measurements as primary outcome parameters in the murine EAE model could lead to more rapid and relevant testing of new therapeutic approaches for mitigating MS.
Collapse
Affiliation(s)
- Benjamin W. Elwood
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Cheyanne R. Godwin
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Jeffrey J. Anders
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Neuroscience and Pharmacology, University of Iowa, Iowa City, IA, USA
| | - Randy H. Kardon
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Oliver W. Gramlich
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Center for the Prevention and Treatment of Visual Loss, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Neuroscience and Pharmacology, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
3
|
Steiner OL, Klostermann F. Central involvement in peripheral disease: melanopsin pathway impairment in chronic inflammatory demyelinating polyneuropathy. Brain Commun 2024; 6:fcae206. [PMID: 39015766 PMCID: PMC11249960 DOI: 10.1093/braincomms/fcae206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/26/2024] [Accepted: 06/18/2024] [Indexed: 07/18/2024] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) compromises functions of the peripheral nervous system (PNS). Recently, however, symptoms such as cognitive deficits, visual dysfunction and circadian disorders were reported, compatible with additional involvement of the central nervous system (CNS) in CIDP. Against this background, we were interested in the functional state of melanopsin-expressing retinal ganglion cells (mRGCs) as a potential biomarker for sleep-wake abnormalities and CNS involvement in CIDP. Based on a chromatic pupillometry protocol, we examined the integrity of the melanopsin system in a prospective case-control study in 20 persons with CIDP compared to 20 controls without CIDP. The results were referred to clinical measures of disease severity and sleep behaviour. Patients with CIDP had a significantly reduced melanopsin-mediated post-illumination pupil response (PIPR) compared to healthy controls (25% versus 36%; P < 0.01). This reduction correlated with disease severity (r = 0.478, P < 0.05). Further, patients with CIDP reported diminished sleep quality (P < 0.05); however, there was no significant correlation with the melanopsin-mediated PIPR. The results demonstrate an impairment of mRGC function related to CIDP. Since the PIPR reduction correlated with disease severity, it could be an easily available biomarker for CNS affection in CIDP, a condition defined as PNS disorder.
Collapse
Affiliation(s)
- Oliver L Steiner
- Department of Neurology, Motor and Cognition Group, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin (CBF), 12203 Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
- Institute of Psychology, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Fabian Klostermann
- Department of Neurology, Motor and Cognition Group, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin (CBF), 12203 Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| |
Collapse
|
4
|
Hamidi BL, Mirawati DK, Rahayu RF, Prabaningtyas HR, Hafizhan M, Putra SE. Chronic inflammatory demyelinating polyradiculoneuropathy associated with neuromyelitis optica spectrum disorder: A rare case report. Prev Med Rep 2024; 42:102702. [PMID: 38737449 PMCID: PMC11081793 DOI: 10.1016/j.pmedr.2024.102702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare disease that targets the myelin sheath, while neuromyelitis optica spectrum disorder (NMOSD) with anti-aquaporin-4 antibodies (AQP4-Ab) affects astrocytes. We report a unique case of CIDP associated with NMOSD. Case presentation A 49-year-old woman presented to the emergency department with recurrent episodes of vertigo and blurred vision. Brain magnetic resonance imaging (MRI) with contrast eight months before admission showed Dawson's finger, and follow-up brain MRI showed a new hyperintense lesion. Visual evoked potential showed bilateral pre-chiasma lesions, and somatosensory evoked potential indicated lesions between the medulla and cerebral cortex. The patient tested positive for AQP4-Ab, and had ascending lower motor neuron weakness for the past 10 weeks. Electromyography revealed multiple demyelinating lesions suggestive of CIDP. The patient was intravenously administered corticosteroids, methotrexate, and azathioprine, resulting in clinical improvement. Conclusion CIDP associated with NMOSD is a rare occurrence. In our patient, a combination of corticosteroids and immunosuppressants was effective. The mechanism of combined demyelination of the central and peripheral nervous systems is still not fully understood, and further immunological and pathological studies are needed.
Collapse
Affiliation(s)
- Baarid Luqman Hamidi
- Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret Ir. Sutami Street No. 36, Kentingan, Jebres, Surakarta, Central Java 57126, Indonesia
- Doctoral Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret Ir. Sutami Street No. 36, Kentingan, Jebres, Surakarta, Central Java 57126, Indonesia
- Dr. Moewardi General Hospital, Kolonel Sutarto 132 St, Jebres, Kec. Jebres, Kota Surakarta, Central Java 57126, Indonesia
| | - Diah Kurnia Mirawati
- Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret Ir. Sutami Street No. 36, Kentingan, Jebres, Surakarta, Central Java 57126, Indonesia
- Doctoral Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret Ir. Sutami Street No. 36, Kentingan, Jebres, Surakarta, Central Java 57126, Indonesia
| | - Rachmi Fauziah Rahayu
- Department of Radiology, Faculty of Medicine, Universitas Sebelas Maret Ir. Sutami Street No. 36, Kentingan, Jebres, Surakarta, Central Java 57126, Indonesia
- Doctoral Program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret Ir. Sutami Street No. 36, Kentingan, Jebres, Surakarta, Central Java 57126, Indonesia
| | - Hanindia Riani Prabaningtyas
- Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret Ir. Sutami Street No. 36, Kentingan, Jebres, Surakarta, Central Java 57126, Indonesia
| | - Muhammad Hafizhan
- Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret Ir. Sutami Street No. 36, Kentingan, Jebres, Surakarta, Central Java 57126, Indonesia
| | - Stefanus Erdana Putra
- Department of Neurology, Faculty of Medicine, Universitas Sebelas Maret Ir. Sutami Street No. 36, Kentingan, Jebres, Surakarta, Central Java 57126, Indonesia
| |
Collapse
|
5
|
Ingwersen J, Masanneck L, Pawlitzki M, Samadzadeh S, Weise M, Aktas O, Meuth SG, Albrecht P. Real-world evidence of ocrelizumab-treated relapsing multiple sclerosis cohort shows changes in progression independent of relapse activity mirroring phase 3 trials. Sci Rep 2023; 13:15003. [PMID: 37696848 PMCID: PMC10495413 DOI: 10.1038/s41598-023-40940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
Ocrelizumab is a B cell-depleting drug widely used in relapsing-remitting multiple sclerosis (RRMS) and primary-progressive MS. In RRMS, it is becoming increasingly apparent that accumulation of disability not only manifests as relapse-associated worsening (RAW) but also as progression independent of relapse activity (PIRA) throughout the disease course. This study's objective was to investigate the role of PIRA in RRMS patients treated with ocrelizumab. We performed a single-center, retrospective, cross-sectional study of clinical data acquired at a German tertiary multiple sclerosis referral center from 2018 to 2022. All patients with RRMS treated with ocrelizumab for at least six months and complete datasets were analyzed. Confirmed disability accumulation (CDA) was defined as a ≥ 12-week confirmed increase from the previous expanded disability status scale (EDSS) score of ≥ 1.0 if the previous EDSS was ≤ 5.5 or a ≥ 0.5-point increase if the previous EDSS was > 5.5. PIRA was defined as CDA without relapse since the last EDSS measurement and at least for the preceding 12 weeks. RAW was defined as CDA in an interval of EDSS measurements with ≥ 1 relapses. Cox proportional hazard models were used to analyze the probability of developing PIRA depending on various factors, including disease duration, previous disease-modifying treatments (DMTs), and optical coherence tomography-assessed retinal degeneration parameters. 97 patients were included in the analysis. Mean follow-up time was 29 months (range 6 to 51 months). 23.5% developed CDA under ocrelizumab therapy (n = 23). Of those, the majority developed PIRA (87.0% of CDA, n = 20) rather than RAW (13.0% of CDA, n = 3). An exploratory investigation using Cox proportional hazards ratios revealed two possible factors associated with an increased probability of developing PIRA: a shorter disease duration prior to ocrelizumab (p = 0.02) and a lower number of previous DMTs prior to ocrelizumab (p = 0.04). Our data show that in ocrelizumab-treated RRMS patients, the main driver of disability accumulation is PIRA rather than RAW. Furthermore, these real-world data show remarkable consistency with data from phase 3 randomized controlled trials of ocrelizumab in RRMS, which may increase confidence in translating results from tightly controlled RCTs into the real-world clinical setting.
Collapse
Affiliation(s)
- J Ingwersen
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - L Masanneck
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - M Pawlitzki
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - S Samadzadeh
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark
| | - M Weise
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - O Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - S G Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - P Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- Department of Neurology, Maria Hilf Clinics, Moenchengladbach, Germany.
| |
Collapse
|
6
|
Kruszewski AM, Tauqeer Z, Meer EA, Bautista SA, Cherayil NR, Cimino ME, Khella SL, Lancaster E, Bird SJ, Scherer SS, Revere KE, Hamedani AG, Liu GT, Tamhankar MA. Vision Loss as a Presenting Feature of Chronic Inflammatory Demyelinating Polyneuropathy: A Case Series. J Neuroophthalmol 2023; 43:48-54. [PMID: 35921552 DOI: 10.1097/wno.0000000000001700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired, immune-mediated, and clinically heterogeneous demyelinating disease affecting the nerve roots and peripheral nerves. We report a series of 4 patients who presented with early and progressive vision loss in the context of new-onset CIDP: 3 due to papilledema and 1 due to optic neuropathy without papilledema. METHODS This was a retrospective case series of 4 patients with vision loss as a presenting feature of CIDP evaluated at the Hospital of the University of Pennsylvania from January 2016 to August 2021. Demographic, clinical, diagnostic, and treatment data were collected via retrospective medical record review. RESULTS Case 1 was a 51-year-old man with 2 months of progressive bilateral papilledema associated with reduced visual acuity (count fingers at 1 foot in each eye) and severely constricted visual fields. Case 2 was a 36-year-old man with 4 months of worsening headaches, reduced visual acuity (count fingers at 1 foot in each eye), severely constricted visual fields, and papilledema. Case 3 was a 39-year-old man with papilledema causing progressive vision loss (20/80 in both eyes), headaches, and relapsing limb sensorimotor deficits. Case 4 was a 19-year-old man with 3 months of progressive bilateral visual decline (20/400 in the right eye, 20/600 in the left eye), central scotoma, and optic disc pallor consistent with optic neuropathy without papilledema. All 4 patients met clinical and electrodiagnostic criteria of CIDP. Cases 3 and 4 each tested positive for serum neurofascin-155 IgG4 antibodies. All patients were managed with immunomodulatory therapy. Cases 1 and 2 also each required surgical intervention with bilateral optic nerve sheath fenestration and cerebrospinal fluid (CSF) shunting procedures. CONCLUSION Vision loss from optic neuropathy with or without papilledema has rarely been reported in CIDP, and typically has been described in the context of longstanding disease. Our cases highlight how CIDP can present with early vision loss that may be profound and challenging to manage if diagnosis is delayed. CIDP should be considered in any patient with new progressive vision loss when associated with peripheral sensorimotor symptoms and elevated CSF protein. The small subgroup of CIDP patients with neurofascin-155 antibodies may be at particular risk of optic nerve involvement.
Collapse
Affiliation(s)
- Adam M Kruszewski
- Departments of Ophthalmology (AMK, ZT, SAB, GTL, MAT), and Neurology (AMK, MEC, SLK, EL, SJB, SSS, AGH, GTL, MAT), University of Pennsylvania, Philadelphia, PA; Division of Ophthalmology (ZT, SAB, KER, GTL), The Children's Hospital of Philadelphia, Philadelphia, PA; The Perelman School of Medicine (EAM, SLK, EL, SJB, SSS, KER, AGH, GTL, MAT), University of Pennsylvania, Philadelphia, PA; and Departments of Neurology and Ophthalmology (NRC), Feinberg School of Medicine, Northwestern Medicine, Chicago, IL
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Costru-Tasnic E, Manole E, Lisnic V. Combined central and peripheral demyelination: a case report. J Med Life 2022; 15:1442-1448. [PMID: 36567843 PMCID: PMC9762372 DOI: 10.25122/jml-2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/07/2022] [Indexed: 12/27/2022] Open
Abstract
Overlapping central nervous system (CNS) and peripheral nervous system (PNS) demyelination is a rare clinical entity, more frequently seen in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multiple sclerosis (MS). This case report showcases a patient with atypical CIDP and CNS demyelination lesions. Demographic data, disease course, treatment responsiveness, neurological examination, laboratory tests, nerve conduction studies (NCS), and brain and spinal cord MRI were registered. The case highlights the difficulty of diagnosis establishment and treatment selection, given the atypical course of the disease and limited answers to the indicated therapies. The data from our report suggest that specific and widely available immunological targets are necessary for diagnosing combined central and peripheral demyelination cases appropriately. The association of different immunotherapeutic agents may be necessary to induce and maintain disease remission.
Collapse
Affiliation(s)
- Elena Costru-Tasnic
- Neurology Department No. 1, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova,Corresponding Author: Elena Costru-Tasnic, Neurology Department No. 1, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova. E-mail:
| | - Elena Manole
- Neurology Department No. 1, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Vitalie Lisnic
- Neurology Department No. 1, Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| |
Collapse
|
8
|
Radomski KL, Zi X, Lischka FW, Noble MD, Galdzicki Z, Armstrong RC. Acute axon damage and demyelination are mitigated by 4-aminopyridine (4-AP) therapy after experimental traumatic brain injury. Acta Neuropathol Commun 2022; 10:67. [PMID: 35501931 PMCID: PMC9059462 DOI: 10.1186/s40478-022-01366-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Damage to long axons in white matter tracts is a major pathology in closed head traumatic brain injury (TBI). Acute TBI treatments are needed that protect against axon damage and promote recovery of axon function to prevent long term symptoms and neurodegeneration. Our prior characterization of axon damage and demyelination after TBI led us to examine repurposing of 4-aminopyridine (4-AP), an FDA-approved inhibitor of voltage-gated potassium (Kv) channels. 4-AP is currently indicated to provide symptomatic relief for patients with chronic stage multiple sclerosis, which involves axon damage and demyelination. We tested clinically relevant dosage of 4-AP as an acute treatment for experimental TBI and found multiple benefits in corpus callosum axons. This randomized, controlled pre-clinical study focused on the first week after TBI, when axons are particularly vulnerable. 4-AP treatment initiated one day post-injury dramatically reduced axon damage detected by intra-axonal fluorescence accumulations in Thy1-YFP mice of both sexes. Detailed electron microscopy in C57BL/6 mice showed that 4-AP reduced pathological features of mitochondrial swelling, cytoskeletal disruption, and demyelination at 7 days post-injury. Furthermore, 4-AP improved the molecular organization of axon nodal regions by restoring disrupted paranode domains and reducing Kv1.2 channel dispersion. 4-AP treatment did not resolve deficits in action potential conduction across the corpus callosum, based on ex vivo electrophysiological recordings at 7 days post-TBI. Thus, this first study of 4-AP effects on axon damage in the acute period demonstrates a significant decrease in multiple pathological hallmarks of axon damage after experimental TBI.
Collapse
Affiliation(s)
- Kryslaine L. Radomski
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Xiaomei Zi
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Fritz W. Lischka
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Biomedical Instrumentation Center, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Mark D. Noble
- Department of Biomedical Genetics, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Box 633, Rochester, NY 14642 USA
| | - Zygmunt Galdzicki
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Regina C. Armstrong
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| |
Collapse
|