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Paulk AC, Salami P, Zelmann R, Cash SS. Electrode Development for Epilepsy Diagnosis and Treatment. Neurosurg Clin N Am 2024; 35:135-149. [PMID: 38000837 DOI: 10.1016/j.nec.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Recording neural activity has been a critical aspect in the diagnosis and treatment of patients with epilepsy. For those with intractable epilepsy, intracranial neural monitoring has been of substantial importance. Clinically, however, methods for recording neural information have remained essentially unchanged for decades. Over the last decade or so, rapid advances in electrode technology have begun to change this landscape. New systems allow for the observation of neural activity with high spatial resolution and, in some cases, at the level of the activity of individual neurons. These new tools have contributed greatly to our understanding of brain function and dysfunction. Here, the authors review the primary technologies currently in use in humans. The authors discuss other possible systems, some of the challenges which come along with these devices, and how they will become incorporated into the clinical workflow. Ultimately, the expectation is that these new, high-density, high-spatial-resolution recording systems will become a valuable part of the clinical arsenal used in the diagnosis and surgical management of epilepsy.
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Affiliation(s)
- Angelique C Paulk
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Pariya Salami
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Rina Zelmann
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Sydney S Cash
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Modern Gamma Knife radiosurgery for management of psychiatric disorders. PROGRESS IN BRAIN RESEARCH 2022; 270:171-183. [PMID: 35396026 DOI: 10.1016/bs.pbr.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Psychiatric disorders result in great suffering of affected patients, who often have rather limited treatment options. In cases refractory to standard medical and behavioral therapy, interventional procedures may be the only feasible solution. The authors experience with Gamma Knife bilateral cingulotomy for treatment-resistant major depression disorder (5 cases) and anorexia nervosa (6 cases), and bilateral anterior capsulotomy for severe obsessive-compulsive disorder (10 cases) shows that such radiosurgical techniques may be applied both effectively and safely. During post-treatment follow-up, the vast majority of patients demonstrated gradual reduction of psychiatric symptoms and improvement of the quality of life, which was confirmed by results of regular neuropsychological testing and imaging examinations. No major side effect was observed in any case. More active application of radiosurgery (using standardized technique) for management of mental illnesses in various Gamma Knife centers worldwide should be encouraged.
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Scullen T, Teja N, Song SH, Couldwell M, Carr C, Mathkour M, Lee DJ, Tubbs RS, Dallapiazza RF. Use of stereoelectroencephalography beyond epilepsy: a systematic review. World Neurosurg 2021; 155:96-108. [PMID: 34217862 DOI: 10.1016/j.wneu.2021.06.105] [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] [Received: 02/07/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Tyler Scullen
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Nikhil Teja
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA
| | - Seo Ho Song
- Geisel School of Medicine, Dartmouth University, Hanover, New Hampshire, USA
| | - Mitchell Couldwell
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Chris Carr
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Darrin J Lee
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - R Shane Tubbs
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, Grenada
| | - Robert F Dallapiazza
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA.
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Guerrero Alzola F, Casas Rivero J, Martínez-Álvarez R. Stereotactic surgery on a female patient with severe chronic anorexia nervosa: 10-year follow-up. Eat Weight Disord 2020; 25:1827-1831. [PMID: 31595460 DOI: 10.1007/s40519-019-00787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Anorexia nervosa (AN) is a serious disease with a high rate of chronification. In chronic and serious cases, psychotherapeutic and pharmacological treatments are not sufficient to control the disease. CASE REPORT We present the case of a female patient with severe chronic restrictive anorexia nervosa resistant to psychomedical treatment. During the 31 years the illness evolved, the patient required multiple hospital admissions. With a body mass index (BMI) of 12.8 kg/m2 and consequent risk of death, stereotactic cingulotomy was performed comprising bilateral blocking of the anterior cingulate cortex by stereotactic radiofrequency thermocoagulation, confirmed by tractography 5 years later. After 10 years of follow-up, the patient is clinically stable with an increased BMI and improved neuropsychological indicators. DISCUSSION Stereotactic surgery may be an option for patients with chronic anorexia nervosa where conventional treatments have proved insufficient.
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Affiliation(s)
| | | | - Roberto Martínez-Álvarez
- Department of Radiosurgery and Functional Neurosurgery, Rúber International Hospital, Madrid, Spain
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Harary M, Cosgrove GR. Jean Talairach: a cerebral cartographer. Neurosurg Focus 2020; 47:E12. [PMID: 31473671 DOI: 10.3171/2019.6.focus19320] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/06/2019] [Indexed: 11/06/2022]
Abstract
Although French psychiatrist-turned-neurosurgeon Jean Talairach (1911-2007) is perhaps best known for the stereotaxic atlas he produced with Pierre Tournoux and Gábor Szikla, he has left his mark on most aspects of modern stereotactic and functional neurosurgery. In the field of psychosurgery, he expressed critique of the practice of prefrontal lobotomy and subsequently was the first to describe the more selective approach using stereotactic bilateral anterior capsulotomy. Turning his attention to stereotaxy, Talairach spearheaded the team at Hôpital Sainte-Anne in the construction of novel stereotaxic apparatus. Cadaveric investigation using these tools and methods resulted in the first human stereotaxic atlas where the use of the anterior and posterior commissures as intracranial reference points was established. This work revolutionized the approach to cerebral localization as well as leading to the development of numerous novel stereotactic interventions by the Sainte-Anne team, including tumor biopsy, interstitial irradiation, thermal ablation, and endonasal procedures. Together with epileptologist Jean Bancaud, Talairach invented the field of stereo-electroencephalography and developed a robust scientific methodology for the assessment and treatment of epilepsy. In this article the authors review Talairach's career trajectory in its historical context and in view of its impact on modern stereotactic and functional neurosurgery.
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Affiliation(s)
- Maya Harary
- 2Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - G Rees Cosgrove
- 1Harvard Medical School and.,2Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
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Naser Moghadasi A. The role of the brain in the treatment of multiple sclerosis as a connectomopathy. Med Hypotheses 2020; 143:110090. [PMID: 32679428 DOI: 10.1016/j.mehy.2020.110090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 12/14/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) causing a variety of symptoms. Although MS is recognized by the demyelinating process, the axonal injury can occur from the start of the disease and lead to neurodegenerative process in the disease. Although MS appears to damage the brain locally, the progressive and neurodegenerative nature of the disease indicate the general and global brain damage. Various studies have indicated this global damage at all areas of white and gray matter. Moreover, the earlier stages of mentioned disease can affect the structural and functional brain connections. Demyelinating lesions, which are local at first glance, lead to a global damage to the functional connections of the brain. Therefore, it seems that the brain network or brain connectome are broadly affected by this disease; therefore, MS can be referred as a connectomopathy. The drugs used in this disease all seek to suppress or regulate the immune system, and the human brain has always been considered as a therapeutic target. However, if the brain is generally involved in the disease, so the treatment should be general. In fact, the treatment process should target the connectomopathy. One of the methods that can be used to achieve the mentioned goal is attending to the role of the brain in its treatment.
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Affiliation(s)
- Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Kinfe TM, Hurlemann R. [Brain stimulation for the selective treatment of schizophrenia symptom domains : Non-invasive and invasive concepts]. DER NERVENARZT 2019; 90:73-88. [PMID: 30430190 DOI: 10.1007/s00115-018-0640-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Given that one third of patients with schizophrenia (SZ) only show limited response to established treatments, alternative therapeutic strategies such as non-invasive/invasive brain stimulation approaches have emerged as an adjunctive treatment option for distinct SZ symptom domains (e.g. acoustic hallucinations, negative/positive symptoms and cognitive impairment). Taking comparative interventional studies and standardized technical parameters into consideration, current meta-analyses indicate that adjunctive electroconvulsive therapy, repetitive transcranial magnetic stimulation and transcranial direct current stimulation have a positive effect. Invasive deep brain stimulation and MR-guided ultrasound brain ablation procedures represent treatment modalities that are currently being clinically tested. Complementary pre-interventional screening approaches (e.g. electrophysiology, neuroimaging and molecular inflammatory profiling) have been recommended in order to identify symptom-tailored predictive measures for diagnosis and treatment.
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Affiliation(s)
- Thomas M Kinfe
- Abteilung für Medizinische Psychologie, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland.
| | - René Hurlemann
- Abteilung für Medizinische Psychologie, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
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Mithani K, Meng Y, Abrahao A, Mikhail M, Hamani C, Giacobbe P, Lipsman N. Electroencephalography in Psychiatric Surgery: Past Use and Future Directions. Stereotact Funct Neurosurg 2019; 97:141-152. [PMID: 31412334 DOI: 10.1159/000500994] [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: 11/06/2018] [Accepted: 05/08/2019] [Indexed: 11/19/2022]
Abstract
The last two decades have seen a re-emergence of surgery for intractable psychiatric disease, in large part due to increased use of deep brain stimulation. The development of more precise, image-guided, less invasive interventions has improved the safety of these procedures, even though the relative merits of modulation at various targets remain under investigation. With an increase in the number and type of interventions for modulating mood/anxiety circuits, the need for biomarkers to guide surgeries and predict treatment response is as critical as ever. Electroencephalography (EEG) has a long history in clinical neurology, cognitive neuroscience, and functional neurosurgery, but has limited prior usage in psychiatric surgery. MEDLINE, Embase, and Psyc-INFO searches on the use of EEG in guiding psychiatric surgery yielded 611 articles, which were screened for relevance and quality. We synthesized three important themes. First, considerable evidence supports EEG as a biomarker for response to various surgical and non-surgical therapies, but large-scale investigations are lacking. Second, intraoperative EEG is likely more valuable than surface EEG for guiding target selection, but comes at the cost of greater invasiveness. Finally, EEG may be a promising tool for objective functional feedback in developing "closed-loop" psychosurgeries, but more systematic investigations are required.
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Affiliation(s)
- Karim Mithani
- Sunnybrook Research Institute, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ying Meng
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Mirriam Mikhail
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, Ontario, Canada,
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Bourdillon P, Hermann B, Sitt JD, Naccache L. Electromagnetic Brain Stimulation in Patients With Disorders of Consciousness. Front Neurosci 2019; 13:223. [PMID: 30936822 PMCID: PMC6432925 DOI: 10.3389/fnins.2019.00223] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/26/2019] [Indexed: 12/27/2022] Open
Abstract
Severe brain injury is a common cause of coma. In some cases, despite vigilance improvement, disorders of consciousness (DoC) persist. Several states of impaired consciousness have been defined, according to whether the patient exhibits only reflexive behaviors as in the vegetative state/unresponsive wakefulness syndrome (VS/UWS) or purposeful behaviors distinct from reflexes as in the minimally conscious state (MCS). Recently, this clinical distinction has been enriched by electrophysiological and neuroimaging data resulting from a better understanding of the physiopathology of DoC. However, therapeutic options, especially pharmacological ones, remain very limited. In this context, electroceuticals, a new category of therapeutic agents which act by targeting the neural circuits with electromagnetic stimulations, started to develop in the field of DoC. We performed a systematic review of the studies evaluating therapeutics relying on the direct or indirect electro-magnetic stimulation of the brain in DoC patients. Current evidence seems to support the efficacy of deep brain stimulation (DBS) and non-invasive brain stimulation (NIBS) on consciousness in some of these patients. However, while the latter is non-invasive and well tolerated, the former is associated with potential major side effects. We propose that all chronic DoC patients should be given the possibility to benefit from NIBS, and that transcranial direct current stimulation (tDCS) should be preferred over repetitive transcranial magnetic stimulation (rTMS), based on the literature and its simple use. Surgical techniques less invasive than DBS, such as vagus nerve stimulation (VNS) might represent a good compromise between efficacy and invasiveness but still need to be further investigated.
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Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Adolphe de Rothschild Foundation, Paris, France.,Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France.,Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France.,Inserm U 1127, Paris, France.,CNRS, UMR 7225, Paris, France
| | - Bertrand Hermann
- Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France.,Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France.,Inserm U 1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Department of Neurology, Neuro ICU, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Jacobo D Sitt
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France.,Inserm U 1127, Paris, France.,CNRS, UMR 7225, Paris, France
| | - Lionel Naccache
- Sorbonne Université, Faculté de Médecine Pitié-Salpêtrière, Paris, France.,Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France.,Inserm U 1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Department of Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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Bourdillon P, Châtillon CE, Moles A, Rheims S, Catenoix H, Montavont A, Ostrowsky-Coste K, Boulogne S, Isnard J, Guénot M. Effective accuracy of stereoelectroencephalography: robotic 3D versus Talairach orthogonal approaches. J Neurosurg 2018; 131:1938-1946. [PMID: 30544338 DOI: 10.3171/2018.7.jns181164] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) was first developed in the 1950s by Jean Talairach using 2D angiography and a frame-based, orthogonal approach through a metallic grid. Since then, various other frame-based and frameless techniques have been described. In this study the authors sought to compare the traditional orthogonal Talairach 2D angiographic approach with a frame-based 3D robotic procedure that included 3D angiographic interoperative imaging guidance. MRI was used for both procedures during surgery, but MRI preplanning was done only in the robotic 3D technique. METHODS All study patients suffered from drug-resistant focal epilepsy and were treated at the same center by the same neurosurgical team. Fifty patients who underwent the 3D robotic procedure were compared to the same number of historical controls who had previously been successfully treated with the Talairach orthogonal procedure. The effectiveness and absolute accuracy, as well as safety, of the two procedures were compared. Moreover, in the 3D robotic group, the reliability of the preoperative MRI to avoid vascular structures was evaluated by studying the rate of trajectory modification following the coregistration of the intraoperative 3D angiographic data onto the preoperative MRI-based trajectory plans. RESULTS Effective accuracy (96.5% vs 13.7%) and absolute accuracy (1.15 mm vs 4.00 mm) were significantly higher in the 3D robotic group than in the Talairach orthogonal group. Both procedures showed excellent safety results (no major complications). The rate of electrode modification after 3D angiography was 43.8%, and it was highest for frontal and insular locations. CONCLUSIONS The frame-based, 3D angiographic, robotic procedure described here provided better accuracy for SEEG implantations than the traditional Talairach approach. This study also highlights the potential safety advantage of trajectory planning using intraoperative frame-based 3D angiography over preoperative MRI alone.
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Affiliation(s)
- Pierre Bourdillon
- 1Department of Neurosurgery, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 3Faculty of Science & Engineering, Sorbonne University, Paris, France
- 4Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France
| | - Claude-Edouard Châtillon
- 5Department of Surgery, Service of Neurosurgery, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivières Hospital, Trois-Rivières, Quebec, Canada
- 6Faculty of Medicine, Division of Neurosurgery, Université de Montréal, Montreal, Quebec, Canada
| | - Alexis Moles
- 1Department of Neurosurgery, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Sylvain Rheims
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 8TIGER, Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292, Université de Lyon, Lyon, France; and
| | - Hélène Catenoix
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Alexandra Montavont
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Karine Ostrowsky-Coste
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Sebastien Boulogne
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Jean Isnard
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Marc Guénot
- 1Department of Neurosurgery, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 9NEUROPAIN Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS 5292, Université de Lyon, Lyon, France
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