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Sun T, Zhao D, Zhang G, Huang Y, Guo J, Jiang W, Jia R, Maimaiti M, Liu J, Bu N, Li Z, Yan Y, Zhang X, Sun C, Zhao C, Jia X, Mao B, Tian H, Liu Y, Chen Z, Fan Z, Guo X, Lu J, Ren K, Li H, Guo J. Late-Onset Anti-GABA B Receptor Encephalitis: Clinical Characteristics and Outcomes Differing From Early-Onset Patients. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/4/e200131. [PMID: 37230544 DOI: 10.1212/nxi.0000000000200131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/13/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Existing evidence indicates anti-GABAB receptor encephalitis (GABABR-E) seems to occur more commonly later in life, yet the age-associated differences in clinical features and outcomes are not well determined. This study aims to explore the demographic, clinical characteristics, and prognostic differences between late-onset and early-onset GABABR-E and identify predictors of favorable long-term outcomes. METHODS This is an observational retrospective study conducted in 19 centers from China. Data from 62 patients with GABABR-E were compared between late-onset (aged 50 years or older) and early-onset (younger than 50 years) groups and between groups with favorable outcomes (modified Rankin scale (mRS) ≤ 2) and poor outcomes (mRS >2). Logistic regression analyses were applied to identify factors affecting long-term outcomes. RESULTS Forty-one (66.1%) patients experienced late-onset GABABR-E. A greater proportion of males, a higher mRS score at onset, higher frequencies of ICU admission and tumors, and a higher risk of death were demonstrated in the late-onset group than in the early-onset group. Compared with poor outcomes, patients with favorable outcomes had a younger onset age, a lower mRS score at onset, lower frequencies of ICU admission and tumors, and a greater proportion with immunotherapy maintenance for at least 6 months. On multivariate regression analysis, age at onset (OR, 0.849, 95% CI 0.739-0.974, p = 0.020) and the presence of underlying tumors (OR, 0.095, 95% CI 0.015-0.613, p = 0.013) were associated with poorer long-term outcomes, whereas immunotherapy maintenance for at least 6 months was associated with favorable outcomes (OR, 10.958, 95% CI 1.469-81.742, p = 0.020). DISCUSSION These results demonstrate the importance of risk stratification of GABABR-E according to age at onset. More attention should be paid to older patients especially with underlying tumors, and immunotherapy maintenance for at least 6 months is recommended to achieve a favorable outcome.
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Affiliation(s)
- Tangna Sun
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Daidi Zhao
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gejuan Zhang
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yue Huang
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jia Guo
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Wen Jiang
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Rui Jia
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Maynur Maimaiti
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianguo Liu
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ning Bu
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zunbo Li
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yaping Yan
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoyan Zhang
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chenjing Sun
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Cong Zhao
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaotao Jia
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Baoyi Mao
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hui Tian
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yan Liu
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zheng Chen
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zilian Fan
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoyan Guo
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Jiarui Lu
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kaixi Ren
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongzeng Li
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jun Guo
- From the Department of Neurology (T.S., D.Z., J. Lu, K.R., H.L., Jun Guo), Tangdu Hospital, Air Force Medical University; Department of Neurology (G.Z.), Xi'an No.3 Hospital; Department of Neurology (Y.H.), Henan Provincial People's Hospital, Zhengzhou; Department of Neurology (Jia Guo), Lanzhou University Second Hospital; Department of Neurology (W.J.), Xijing Hospital, Air Force Medical University; Department of Neurology (R.J.), The First Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (M.M.), People's Hospital of Xinjiang Uygur Autonomous Region; Department of Neurology (J. Liu, C.S.), The Sixth Medical Center of PLA General Hospital, Beijing; Department of Neurology (N.B.), The Second Affiliated Hospital of Xi'an Jiaotong University; Department of Neurology (Z.L.), Xi'an Gaoxin Hospital; College of Life Sciences (Y.Y.), Shaanxi Normal University, Xi'an; Department of Neurology (X.Z.), No. 940 Hospital of the PLA Joint Logistics Support Force, Lanzhou; Department of Neurology (C.Z.), Air Force Medical Center of PLA, Beijing; Department of Neurology (X.J.), Xi'an Central Hospital; Department of Neurology (B.M.), Yuncheng Central Hospital; Department of Neurology (H.T.), Xi'an North Hospital; Department of Neurology (Y.L.), Weinan Central Hospital; Department of Neurology (Z.C.), Hanzhong Central Hospital; Department of Neurology (Z.F.), The First People's Hospital of Guangyuan; and Department of Neurology (X.G.), The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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