1
|
Spani F, Carducci F, Piervincenzi C, Ben-Soussan TD, Mallio CA, Quattrocchi CC. Assessing brain neuroplasticity: Surface morphometric analysis of cortical changes induced by Quadrato motor training. J Anat 2024. [PMID: 38924527 DOI: 10.1111/joa.14104] [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: 03/21/2024] [Revised: 05/27/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Morphological markers for brain plasticity are still lacking and their findings are challenged by the extreme variability of cortical brain surface. Trying to overcome the "correspondence problem," we applied a landmark-free method (the generalized procrustes surface analysis (GPSA)) for investigating the shape variation of cortical surface in a group of 40 healthy volunteers (i.e., the practice group) subjected to daily motor training known as Quadrato motor training (QMT). QMT is a sensorimotor walking meditation that aims at balancing body, cognition, and emotion. More specifically, QMT requires coordination and attention and consists of moving in one of three possible directions on corners of a 50 × 50 cm2. Brain magnetic resonance images (MRIs) of practice group (acquired at baseline, as well as after 6 and 12 weeks of QMT), were 3D reconstructed and here compared with brain MRIs of six more volunteers never practicing the QMT (naïve group). Cortical regions mostly affected by morphological variations were visualized on a 3D average color-scaled brain surface indicating from higher (red) to lower (blue) levels of variation. Cortical regions interested in most of the shape variations were as follows: (1) the supplementary motor cortex; (2) the inferior frontal gyrus (pars opercolaris) and the anterior insula; (3) the visual cortex; (4) the inferior parietal lobule (supramarginal gyrus and angular gyrus). Our results show that surface morphometric analysis (i.e., GPSA) can be applied to assess brain neuroplasticity processes, such as those stimulated by QMT.
Collapse
Affiliation(s)
- F Spani
- Department of Science and Technology for Sustainable Development and One Health, Università Campus Bio-Medico di Roma, Rome, Italy
| | - F Carducci
- Neuroimaging Laboratory, Department of Physiology and Pharmacology, Sapienza University of Rome (IT), Rome, Italy
| | - C Piervincenzi
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - T D Ben-Soussan
- Research Institute for Neuroscience, Education and Didactics (RINED), Patrizio Paoletti Foundation, Assisi, Italy
| | - C A Mallio
- Department of Medicine and Surgery, Research Unit of Diagnostic Imaging, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Rome, Italy
| | - C C Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Trento, Italy
| |
Collapse
|
2
|
Steendam-Oldekamp E, van Laar T. The Effectiveness of Inpatient Rehabilitation in Parkinson's Disease: A Systematic Review of Recent Studies. JOURNAL OF PARKINSON'S DISEASE 2024:JPD230271. [PMID: 38788087 DOI: 10.3233/jpd-230271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background Parkinson's disease (PD) is a progressive disease, which is associated with the loss of activities of daily living independency. Several rehabilitation options have been studied during the last years, to improve mobility and independency. Objective This systematic review will focus on inpatient multidisciplinary rehabilitation (MR) in people with Parkinson's disease (PwPD), based on recent studies from 2020 onwards. Methods Search strategy in three databases included: multidisciplinary rehabilitation, Parkinson's Disease, inpatient rehabilitation, motor-, functional- and cognitive performance, cost-effectiveness, Quality of Life, and medication changes/Levodopa equivalent daily doses. Results Twenty-two studies were included, consisting of 13 studies dealing with inpatient MR and 9 studies on inpatient non-MR interventions. Inpatient PD multidisciplinary rehabilitation proved to be effective, as well as non-MR rehabilitation. Conclusions This review confirms the efficacy of inpatient MR and non-MR in PD, but is skeptical about the past and current study designs. New study designs, including new physical training methods, more attention to medication and costs, new biomarkers, artificial intelligence, and the use of wearables, will hopefully change rehabilitation trials in PwPD in the future.
Collapse
Affiliation(s)
- Elien Steendam-Oldekamp
- University of Groningen, Department of Neurology, University Medical Center Groningen, The Netherlands
| | - Teus van Laar
- University of Groningen, Department of Neurology, University Medical Center Groningen, The Netherlands
| |
Collapse
|
3
|
Isernia S, Di Tella S, Rossetto F, Borgnis F, Realdon O, Cabinio M, Pagliari C, Torchio A, Castagna A, Blasi V, Silveri MC, Baglio F. Exploring cognitive reserve's influence: unveiling the dynamics of digital telerehabilitation in Parkinson's Disease Resilience. NPJ Digit Med 2024; 7:116. [PMID: 38710915 DOI: 10.1038/s41746-024-01113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/12/2024] [Indexed: 05/08/2024] Open
Abstract
Telerehabilitation is emerging as a promising digital method for delivering rehabilitation to Parkinson's Disease (PD) patients, especially in the early stages to promote brain resilience. This study explores how cognitive reserve (CR), the brain's ability to withstand aging and disease, impacts the effectiveness of telerehabilitation. It specifically examines the influence of lifelong cognitive activities on the relationship between neural reserve and improved functional abilities following rehabilitation. In the study, 42 PD patients underwent a 4-month neuromotor telerehabilitation program. CR proxies were assessed using the Cognitive Reserve Index questionnaire (CRIq), brain changes via 3T-MRI, and functional response through changes in the 6-Minute Walk Distance (6MWD). Participants were divided into responders (n = 23) and non-responders (n = 19) based on their 6MWD improvement. A multiple regression model was run to test significant predictors of 6MWD after treatment in each group. The results revealed a significant correlation between 6MWD and CRIq scores, but only among responders. Notably, the CRIq Leisure-Time sub-index, along with baseline 6MWD, were predictors of post-treatment 6MWD. These findings highlight CR's role in enhancing the benefits of telerehabilitation on PD patients' neuromotor functions. Clinically, these results suggest that neurologists and clinicians should consider patients' lifestyles and cognitive engagement as important factors in predicting and enhancing the outcomes of telerehabilitation. The study underscores the potential of CR as both a predictor and booster of telerehabilitation's effects, advocating for a personalized approach to PD treatment that takes into account individual CR levels.
Collapse
Affiliation(s)
- Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
| | - Sonia Di Tella
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Olivia Realdon
- Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | - Anna Castagna
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | |
Collapse
|
4
|
Li T, Wang L, Piao Z, Chen K, Yu X, Wen Q, Suo D, Zhang C, Funahashi S, Pei G, Fang B, Yan T. Altered Neurovascular Coupling for Multidisciplinary Intensive Rehabilitation in Parkinson's Disease. J Neurosci 2023; 43:1256-1266. [PMID: 36609454 PMCID: PMC9962778 DOI: 10.1523/jneurosci.1204-22.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Effective rehabilitation in Parkinson's disease (PD) is related to brain reorganization with restoration of cortico-subcortical networks and compensation of frontoparietal networks; however, further neural rehabilitation evidence from a multidimensional perspective is needed. To investigate how multidisciplinary intensive rehabilitation treatment affects neurovascular coupling, 31 PD patients (20 female) before and after treatment and 30 healthy controls (17 female) underwent blood oxygenation level-dependent functional magnetic resonance imaging and arterial spin labeling scans. Cerebral blood flow (CBF) was used to measure perfusion, and fractional amplitude of low-frequency fluctuation (fALFF) was used to measure neural activity. The global CBF-fALFF correlation and regional CBF/fALFF ratio were calculated as neurovascular coupling. Dynamic causal modeling (DCM) was used to evaluate treatment-related alterations in the strength and directionality of information flow. Treatment reduced CBF-fALFF correlations. The altered CBF/fALFF exhibited increases in the left angular gyrus and the right inferior parietal gyrus and decreases in the bilateral thalamus and the right superior frontal gyrus. The CBF/fALFF alteration in right superior frontal gyrus showed correlations with motor improvement. Further, DCM indicated increases in connectivity from the superior frontal gyrus and decreases from the thalamus to the inferior parietal gyrus. The benefits of rehabilitation were reflected in the dual mechanism, with restoration of executive control occurring in the initial phase of motor learning and compensation of information integration occurring in the latter phase. These findings may yield multimodal insights into the role of rehabilitation in disease modification and identify the dorsolateral superior frontal gyrus as a potential target for noninvasive neuromodulation in PD.SIGNIFICANCE STATEMENT Although rehabilitation has been proposed as a promising supplemental treatment for PD as it results in brain reorganization, restoring cortico-subcortical networks and eliciting compensatory activation of frontoparietal networks, further multimodal evidence of the neural mechanisms underlying rehabilitation is needed. We measured the ratio of perfusion and neural activity derived from arterial spin labeling and blood oxygenation level-dependent fMRI data and found that benefits of rehabilitation seem to be related to the dual mechanism, restoring executive control in the initial phase of motor learning and compensating for information integration in the latter phase. We also identified the dorsolateral superior frontal gyrus as a potential target for noninvasive neuromodulation in PD patients.
Collapse
Affiliation(s)
- Ting Li
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Li Wang
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Zhixin Piao
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Keke Chen
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Xin Yu
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Qiping Wen
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Dingjie Suo
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Chunyu Zhang
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Shintaro Funahashi
- Advanced Research Institute of Multidisciplinary Science, Beijing Institute of Technology, Beijing 100081, China
| | - Guangying Pei
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| | - Boyan Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Tianyi Yan
- School of Life Science, Beijing Institute of Technology, Beijing 100081, China
| |
Collapse
|
5
|
Bonilauri A, Sangiuliano Intra F, Baglio F, Baselli G. Impact of Anatomical Variability on Sensitivity Profile in fNIRS-MRI Integration. SENSORS (BASEL, SWITZERLAND) 2023; 23:2089. [PMID: 36850685 PMCID: PMC9962997 DOI: 10.3390/s23042089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Functional near-infrared spectroscopy (fNIRS) is an important non-invasive technique used to monitor cortical activity. However, a varying sensitivity of surface channels vs. cortical structures may suggest integrating the fNIRS with the subject-specific anatomy (SSA) obtained from routine MRI. Actual processing tools permit the computation of the SSA forward problem (i.e., cortex to channel sensitivity) and next, a regularized solution of the inverse problem to map the fNIRS signals onto the cortex. The focus of this study is on the analysis of the forward problem to quantify the effect of inter-subject variability. Thirteen young adults (six males, seven females, age 29.3 ± 4.3) underwent both an MRI scan and a motor grasping task with a continuous wave fNIRS system of 102 measurement channels with optodes placed according to a 10/5 system. The fNIRS sensitivity profile was estimated using Monte Carlo simulations on each SSA and on three major atlases (i.e., Colin27, ICBM152 and FSAverage) for comparison. In each SSA, the average sensitivity curves were obtained by aligning the 102 channels and segmenting them by depth quartiles. The first quartile (depth < 11.8 (0.7) mm, median (IQR)) covered 0.391 (0.087)% of the total sensitivity profile, while the second one (depth < 13.6 (0.7) mm) covered 0.292 (0.009)%, hence indicating that about 70% of the signal was from the gyri. The sensitivity bell-shape was broad in the source-detector direction (20.953 (5.379) mm FWHM, first depth quartile) and steeper in the transversal one (6.082 (2.086) mm). The sensitivity of channels vs. different cortical areas based on SSA were analyzed finding high dispersions among subjects and large differences with atlas-based evaluations. Moreover, the inverse cortical mapping for the grasping task showed differences between SSA and atlas based solutions. In conclusion, integration with MRI SSA can significantly improve fNIRS interpretation.
Collapse
Affiliation(s)
- Augusto Bonilauri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | | | - Francesca Baglio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| |
Collapse
|
6
|
Cao W, Zhang X, Qiu H. Rehabilomics: A state-of-the-art review of framework, application, and future considerations. Front Neurol 2023; 14:1103349. [PMID: 36970504 PMCID: PMC10032373 DOI: 10.3389/fneur.2023.1103349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Rehabilomics is an important research framework that allows omics research built upon rehabilitation practice, especially in function evaluation, outcome prediction, and individualized rehabilitation. In the field of rehabilomics, biomarkers can serve as objectively measured indicators for body functioning, so as to complement the International Classification of Functioning, Disability, and Health (ICF) assessment. Studies on traumatic brain injury (TBI), stroke, and Parkinson's disease have shown that biomarkers (such as serum markers, MRI, and digital signals derived from sensors) are correlated with diagnosis, disease severity, and prognosis. Rehabilomics also examines a wide range of individual biological characteristics in order to develop personalized rehabilitation programs. Secondary prevention and rehabilitation of stroke have already adopted a rehabilomic approach to individualize treatment programs. Mechanisms of non-pharmacological therapies are expected to be unveiled in light of rehabilomics research. When formulating the research plan, learning from established databases is recommended and a multidisciplinary collaborative team is warranted. Although still in its infancy, the advancement and incorporation of rehabilomics has the potential to make a significant impact on public health.
Collapse
Affiliation(s)
- Wenyue Cao
- Faculty of Rehabilitation Science, Nanjing Normal University of Special Education, Nanjing, China
| | - Xiuwei Zhang
- Faculty of Rehabilitation Science, Nanjing Normal University of Special Education, Nanjing, China
| | - Huaide Qiu
- Faculty of Rehabilitation Science, Nanjing Normal University of Special Education, Nanjing, China
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Huaide Qiu
| |
Collapse
|
7
|
Bonilauri A, Sangiuliano Intra F, Rossetto F, Borgnis F, Baselli G, Baglio F. Whole-Head Functional Near-Infrared Spectroscopy as an Ecological Monitoring Tool for Assessing Cortical Activity in Parkinson's Disease Patients at Different Stages. Int J Mol Sci 2022; 23:ijms232314897. [PMID: 36499223 PMCID: PMC9736501 DOI: 10.3390/ijms232314897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Functional near-infrared spectroscopy (fNIRS) is increasingly employed as an ecological neuroimaging technique in assessing age-related chronic neurological disorders, such as Parkinson's disease (PD), mainly providing a cross-sectional characterization of clinical phenotypes in ecological settings. Current fNIRS studies in PD have investigated the effects of motor and non-motor impairment on cortical activity during gait and postural stability tasks, but no study has employed fNIRS as an ecological neuroimaging tool to assess PD at different stages. Therefore, in this work, we sought to investigate the cortical activity of PD patients during a motor grasping task and its relationship with both the staging of the pathology and its clinical variables. This study considered 39 PD patients (age 69.0 ± 7.64, 38 right-handed), subdivided into two groups at different stages by the Hoehn and Yahr (HY) scale: early PD (ePD; N = 13, HY = [1; 1.5]) and moderate PD (mPD; N = 26, HY = [2; 2.5; 3]). We employed a whole-head fNIRS system with 102 measurement channels to monitor brain activity. Group-level activation maps and region of interest (ROI) analysis were computed for ePD, mPD, and ePD vs. mPD contrasts. A ROI-based correlation analysis was also performed with respect to contrasted subject-level fNIRS data, focusing on age, a Cognitive Reserve Index questionnaire (CRIQ), disease duration, the Unified Parkinson's Disease Rating Scale (UPDRS), and performances in the Stroop Color and Word (SCW) test. We observed group differences in age, disease duration, and the UPDRS, while no significant differences were found for CRIQ or SCW scores. Group-level activation maps revealed that the ePD group presented higher activation in motor and occipital areas than the mPD group, while the inverse trend was found in frontal areas. Significant correlations with CRIQ, disease duration, the UPDRS, and the SCW were mostly found in non-motor areas. The results are in line with current fNIRS and functional and anatomical MRI scientific literature suggesting that non-motor areas-primarily the prefrontal cortex area-provide a compensation mechanism for PD motor impairment. fNIRS may serve as a viable support for the longitudinal assessment of therapeutic and rehabilitation procedures, and define new prodromal, low-cost, and ecological biomarkers of disease progression.
Collapse
Affiliation(s)
- Augusto Bonilauri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Francesca Sangiuliano Intra
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy
- Faculty of Education, Free University of Bolzano-Bozen, 39042 Brixen, Italy
- Correspondence:
| | - Federica Rossetto
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy
| | - Francesca Borgnis
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Francesca Baglio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy
| |
Collapse
|
8
|
Bacanoiu MV, Danoiu M. New Strategies to Improve the Quality of Life for Normal Aging versus Pathological Aging. J Clin Med 2022; 11:4207. [PMID: 35887969 PMCID: PMC9322909 DOI: 10.3390/jcm11144207] [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: 05/31/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 12/10/2022] Open
Abstract
In the context of the manifestation of the phenomenon of normal aging and functional decline at older adults with neurodegenerative pathology, the development of physical activities and healthy lifestyle has become a priority that involves many decisions and responsibilities. Therefore, the study of the quality of life of the elderly in terms of delaying early aging and improving the lifestyle of patients with neurodegenerative diseases is a scientific challenge representing research of great interest and relevance. By promoting physical activity based on telerehabilitation programs or performed according to coordinated training either in the community or at home for both study groups, significant improvements have been obtained. The aim of this paper was to evaluate the intervention suitable patterns, surveys delivered through variables online platforms and tools to reflect the stagnation of early aging and the evolution of patients with PD and dementia. Our study involved selected original studies, intensively processed, which demonstrated through intervention specific tools, such as quantitative, qualitative, socio-economics, physical, and cognitive indicators, that significant improvements can be achieved in the process of early aging, but also significant progress in patients with neurodegenerative diseases. By searching the last five years of papers, our review, presents the importance of intervention by telerehabilitation or by scheduled physical exercises quantified by specific indicators.
Collapse
Affiliation(s)
- Manuela Violeta Bacanoiu
- Department of Physical Therapy and Sports Medicine, University of Craiova, 200207 Craiova, Romania;
- Department of Laboratory Medicine, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Mircea Danoiu
- Department of Physical Therapy and Sports Medicine, University of Craiova, 200207 Craiova, Romania;
| |
Collapse
|
9
|
Müller T. Perspective: cell death mechanisms and early diagnosis as precondition for disease modification in Parkinson's disease: are we on the right track? Expert Rev Mol Diagn 2022; 22:403-409. [PMID: 35400295 DOI: 10.1080/14737159.2022.2065198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Current research paradigms on biomarkers for chronic neurodegenerative diseases, such as Parkinson's disease, focus on identification of reliable, easy-to-apply tools for diagnostic screening and progression assessment. AREAS COVERED This perspective discusses possible misconceptions of biomarker research in chronic neurodegeneration from a clinician's view based on a not systematic literature search. Multifactorial disease triggers, heterogeneity of symptom and their progression are main reasons for the still missing availability of biomarkers. EXPERT OPINION Onset of chronic neurodegenerative disease entities may probably result from a decompensated endogenous repair machinery in the central nervous system, for example the neogenin receptor associated repulsive guidance molecule pathway. Future clinical research is warranted on these repair structures and aim to identify markers for the imbalance between damage and repair, which hypothetically contributes to generation of disease. An assignment to a specific chronic neurodegenerative disease entity probably appears to be secondary. Decryption of probable molecular signals of an impaired repair potential will enable an earlier diagnosis, better monitoring of disease progress and of treatment response. This concept will hopefully provide better preconditions for prevention, cure or therapeutic beneficial disease modification. These unmet therapeutic needs may be achieved for example via antagonism of repulsive guidance molecule A.
Collapse
Affiliation(s)
- Thomas Müller
- Department of NeurologySt. Joseph Hospital Berlin-Weißensee, Gartenstr.1 Berlin, Germany
| |
Collapse
|