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Pino S, Vega E, Fragoso M, Salazar G. Nitrous Oxide as an Emerging Cause of Subacute Combined Degeneration and Polyneuropathy: A Two-Case Report. Cureus 2024; 16:e63003. [PMID: 38915835 PMCID: PMC11194535 DOI: 10.7759/cureus.63003] [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] [Accepted: 06/23/2024] [Indexed: 06/26/2024] Open
Abstract
Recreational use of nitrous oxide (N2O), commonly known as laughing gas, has increased in the last few years, bringing an increase in the number of reported cases of toxicity due to this gas. Subacute combined degeneration (SCD) of the spinal cord is the most frequently reported neurological disorder due to the use of N2O, as well as polyneuropathy and even psychiatric symptoms. All of these disorders are consequences of a functional deficit of vitamin B12. We are reporting the cases of two patients with a history of N2O abusive use presenting to the emergency department with progressive symptoms of paresthesia, ascending symmetric paraparesis, and gait ataxia, emulating the clinical characteristics of Guillain-Barré Syndrome (GBS). In both cases, magnetic resonance imaging (MRI) showed findings compatible with transverse myelitis of the cervical spinal cord, and electrodiagnosis studies reported the presence of polyneuropathy with a mixed mechanism. All these findings together pointed to the presence of myeloneuropathy due to a vitamin B12 deficit induced by the prolonged use of N2O. Symptoms improved gradually with vitamin B12 supplementation and abstinence from N2O. It is important to acknowledge the clinical characteristics of complications due to neurotoxicity induced by N2O. Such complications are potentially reversible if they are treated appropriately and quickly. Considering the increase in N2O abuse, it should be considered a probable cause when treating patients with myelopathy and/or neuropathy of an unusual etiology.
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Affiliation(s)
- Silvano Pino
- Neurology, Hospital Universitari de Terrassa, Consorci Sanitari de Terrassa, Barcelona, ESP
| | - Edison Vega
- Neurology, Hospital Universitari de Terrassa, Consorci Sanitari de Terrassa, Barcelona, ESP
| | - Marta Fragoso
- Neurology, Hospital Universitari de Terrassa, Consorci Sanitari de Terrassa, Barcelona, ESP
| | - Gabriel Salazar
- Neurology, Hospital Universitari de Terrassa, Consorci Sanitari de Terrassa, Barcelona, ESP
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2
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Paris A, Lake L, Joseph A, Workman A, Walton J, Hayton T, Evangelou N, Lilleker JB, Ayling RM, Nicholl D, Noyce AJ. Nitrous oxide-induced subacute combined degeneration of the cord: diagnosis and treatment. Pract Neurol 2023; 23:222-228. [PMID: 36813556 DOI: 10.1136/pn-2022-003631] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 02/24/2023]
Abstract
Recreational use of nitrous oxide (N2O) has increased rapidly in recent years and is now the second most commonly used recreational drug among young people in the UK. There has been a corresponding rise in cases of nitrous oxide-induced subacute combined degeneration of the cord (N2O-SACD), a pattern of myeloneuropathy usually associated with severe vitamin B12 deficiency. This can cause serious and permanent disability in young people but, if recognised early, may be effectively treated. All neurologists should be aware of N2O-SACD and its treatment; however, there are currently no agreed guidelines. Based on our experience in East London, an area of high N2O use, we provide practical advice on its recognition, investigation and treatment.
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Affiliation(s)
- Alvar Paris
- Preventive Neurology Unit, Centre for Prevention, Diagnosis and Detection, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK.,Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Luke Lake
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Albert Joseph
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Anna Workman
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Joseph Walton
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Tom Hayton
- Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Surgical Reconstruction and Microbiology Research Centre, National Institute for Health Research, Birmingham, UK
| | - Nikos Evangelou
- Academic Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - James B Lilleker
- Muscle Diseases Unit, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, Salford, UK.,Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Ruth M Ayling
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - David Nicholl
- Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Alastair J Noyce
- Preventive Neurology Unit, Centre for Prevention, Diagnosis and Detection, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK .,Royal London Hospital, Barts Health NHS Trust, London, UK
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3
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Qin X, Kang L, Liu X, Jin J, Hu F, Lu W, Deng Y, Chen QY, Dang J. Acute nitrous oxide-induced neuropathy mimicking Guillain-Barré Syndrome. J Peripher Nerv Syst 2022; 27:189-196. [PMID: 35611446 DOI: 10.1111/jns.12503] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The early clinical features of nitrous oxide (N2 O)-induced neuropathy were mimicking that of Guillain-Barré Syndrome (GBS). We aimed to explore clinical and laboratory characteristics of N2 O-induced neuropathy in comparison with GBS. METHODS We retrospectively reviewed data of 15 patients with N2 O-induced neuropathy and compared them with 15 GBS patients. RESULTS The age of the N2 O-induced neuropathy group was significantly younger than that in the GBS group (22 ± 5 vs 45 ± 17). Paresthesia was more common in N2 O-induced neuropathy group (100% vs 53.3%). The proportion of distal upper limbs weakness was lower than that in GBS group (20.0% vs 93.3%). There was no significant difference in distal weakness of the lower limbs (100% vs 80.0%). The incidence of motor conduction block and compound muscle action potential amplitude reduction in upper limbs was lower than that in GBS group (6.7% vs 60.0%; 26.7% vs 80.0%). The sensory nerve action potential amplitude drop in the lower limbs was more severe than that in GBS group (53.3% vs 0). The increase of Mean corpuscular volume (MCV) was more pronounced compared to GBS group (96.97 ± 6.00 vs 88.55 ± 5.41). High homocysteine levels were more common in N2 O-related group [29.80(11.60, 70.50) vs 14.35(9.22, 19.30)]. CONCLUSION Typical clinical features of the acute N2 O neuropathy appears to be a myeloneuropathy, affecting the lower limbs more than the upper limbs, mixed axonal-demyelinating electrophysiological performance, higher homocysteine level and larger MCV and common posterior spinal cord involvement in cervical segment. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xing Qin
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Li Kang
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Xiao Liu
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Jiaoting Jin
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Fangfang Hu
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Wenhui Lu
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Yongning Deng
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Qiao Yi Chen
- Department of Cell Biology and Genetics, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, PR China
| | - Jingxia Dang
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
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[Acute and chronic toxicities associated with the use and misuse of nitrous oxide: An update]. Rev Med Interne 2021; 43:170-177. [PMID: 34903366 DOI: 10.1016/j.revmed.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/07/2021] [Accepted: 10/09/2021] [Indexed: 11/22/2022]
Abstract
Nitrous oxide (N2O) is used since the eighteenth century as an anesthetic and analgesic but also for recreational use. If the labelled uses of N2O and their modalities are nowadays perfectly framed, the misuse of N2O takes very alarming proportions among teenagers and young adults. This misuse is the cause of acute (hypoxia, barotrauma, burns, neuropsychiatric disorders) and chronic complications if repeated (myeloneuropathy, anemia, thrombosis, inhalant use disorder). The main mechanism of the latter is mainly related to a functional deficit in vitamin B12 induced by N2O. The management of acute complications is symptomatic. The management of chronic complications is based on vitamin B12 supplementation. The best biomarker of chronic N2O exposure is the elevation of the plasmatic level of methylmalonic acid. In all cases of recreational misuses, addiction treatment is necessary to prevent complications or their worsening by providing information in order to stop consumption.
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Florian IA, Lupan I, Sur L, Samasca G, Timiș TL. To be, or not to be… Guillain-Barré Syndrome. Autoimmun Rev 2021; 20:102983. [PMID: 34718164 DOI: 10.1016/j.autrev.2021.102983] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023]
Abstract
Guillain-Barré Syndrome (GBS) is currently the most frequent cause of acute flaccid paralysis on a global scale, being an autoimmune disorder wherein demyelination of the peripheral nerves occurs. Its main clinical features are a symmetrical ascending muscle weakness with reduced osteotendinous reflexes and variable sensory involvement. GBS most commonly occurs after an infection, especially viral (including COVID-19), but may also transpire after immunization with certain vaccines or in the development of specific malignancies. Immunoglobulins, plasmapheresis, and glucocorticoids represent the principal treatment modalities, however patients with severe disease progression may require supportive therapy in an intensive care unit. Due to its symptomology, which overlaps with numerous neurological and infectious illnesses, the diagnosis of GBS may often be misattributed to pathologies that are essentially different from this syndrome. Moreover, many of these require specific treatment methods distinct to those recommended for GBS, in lack of which the prognosis of the patient is drastically affected. Such diseases include exposure to toxins either environmental or foodborne, central nervous system infections, metabolic or serum ion alterations, demyelinating pathologies, or even conditions amenable to neurosurgical intervention. This extensive narrative review aims to systematically and comprehensively tackle the most notable and challenging differential diagnoses of GBS, emphasizing on the clinical discrepancies between the diseases, the appropriate paraclinical investigations, and suitable management indications.
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Affiliation(s)
- Ioan Alexandru Florian
- Department of Neurology, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania, Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Iulia Lupan
- Department of Molecular Biology, Babes Bolyai University, Cluj-Napoca, Romania.
| | - Lucia Sur
- Department of Pediatrics I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Gabriel Samasca
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Teodora Larisa Timiș
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Redmond J, Cruse B, Kiers L. Nitrous Oxide-Induced Neurological Disorders - an increasing public health concern. Intern Med J 2021; 52:740-744. [PMID: 34569693 DOI: 10.1111/imj.15544] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/06/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neurologic presentations resulting from nitrous oxide (N2 O) abuse are increasing in Australia and worldwide. Despite known neuropsychiatric sequelae nitrous oxide canisters remain readily available and its use unregulated. AIMS To examine the demographics, clinical and electrophysiological findings of patients presenting with neurological complications of N2 O abuse, and thus inform clinicians and public health decision makers of the significant public health concerns of this increasing practice. METHODS Consecutive patients presenting to a tertiary referral, metropolitan hospital were included in this series. Patients were identified by a search of discharge summaries of patients admitted with acute or subacute neuropathy or myelopathy and a history of N2 O abuse, and from the electrophysiology database. RESULTS Thirteen patients were identified, most presenting with subacute paraesthesia, sensory ataxia and lower limb weakness. Eleven had low serum vitamin B12 . Spinal magnetic resonance imaging was consistent with subacute combined degeneration (SACD) in 8. Nerve conduction studies revealed a motor or sensorimotor axonal neuropathy (3 with motor predominance). There was a bimodal demographic distribution consisting of socially isolated, international university students and local residents with a history of mental illness and polydrug abuse. CONCLUSIONS Recreational N2 O use is an emerging health problem in Australia. International university students and patients with pre-existing mental illness or polydrug use appear to be at increased risk. A severe motor neuropathy may emerge following Vitamin B12 replacement. Public health measures are required to limit the availability of N2 O and to educate adolescents and young adults about the potential for significant harm. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jessica Redmond
- Department of Neurology, Royal Melbourne Hospital, Parkville, Vic, Australia
| | - Belinda Cruse
- Department of Neurology, Royal Melbourne Hospital, Parkville, Vic, Australia.,Department of Medicine (RMH), Faculty of Medicine, Health and Dentistry, The University of Melbourne
| | - Lynette Kiers
- Department of Neurology, Royal Melbourne Hospital, Parkville, Vic, Australia.,Department of Medicine (RMH), Faculty of Medicine, Health and Dentistry, The University of Melbourne
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Einsiedler M, Voulleminot P, Demuth S, Kalaaji P, Bogdan T, Gauer L, Reschwein C, Nadaj-Pakleza A, de Sèze J, Kremer L, Schroder I, Bigaut K. A rise in cases of nitrous oxide abuse: neurological complications and biological findings. J Neurol 2021; 269:577-582. [PMID: 34245346 PMCID: PMC8272450 DOI: 10.1007/s00415-021-10702-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The recent lockdown due to the COVID-19 pandemic has been linked to a higher incidence of psychiatric manifestations and substance abuse. The recreative use of nitrous oxide is more and more widespread and neurological complications are frequent. METHODS We report clinical characteristics and biological findings of five consecutive patients presenting to our tertiary care center between April 2020 and February 2021 with various neurological symptoms occurring after recent nitrous oxide abuse. RESULTS Our patients presented with subacute combined degeneration of the spinal cord (4/5 patients) or with acute inflammatory demyelinating polyneuropathy (1/5 patients). No patient had reduced vitamin B-12 titer, but all had elevated blood levels of homocysteine and methylmalonic acid. This reflects the functional deficit in vitamin B-12 that can be linked to nitrous oxide consumption. After vitamin B-12 supplementation, clinical signs regressed at least partially in all 5 patients. CONCLUSION We report an elevated incidence of neurological complications of nitrous oxide abuse occurring during the recent COVID-19 lockdown. Nitrous oxide abuse should be tracked down in patients presenting with compatible neurological symptoms and elevated homocysteinemia. Vitamin B-12 should be supplemented as soon as the diagnosis is made.
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Affiliation(s)
- Maximilian Einsiedler
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France.
| | - Paul Voulleminot
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France
| | - Stanislas Demuth
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France
| | - Pauline Kalaaji
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France
| | - Thomas Bogdan
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France
| | - Lucas Gauer
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France
| | - Cécile Reschwein
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France
| | - Aleksandra Nadaj-Pakleza
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France
| | - Jérôme de Sèze
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France.,Neuroprotection et Stratégies Thérapeutiques, Unité INSERM 1119 Biopathologie de la Myéline, Strasbourg, France.,Centre D'Investigation Clinique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Kremer
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France.,Neuroprotection et Stratégies Thérapeutiques, Unité INSERM 1119 Biopathologie de la Myéline, Strasbourg, France.,Centre D'Investigation Clinique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Ivana Schroder
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France
| | - Kévin Bigaut
- Service de Neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67000, Strasbourg, France.,Neuroprotection et Stratégies Thérapeutiques, Unité INSERM 1119 Biopathologie de la Myéline, Strasbourg, France.,Centre D'Investigation Clinique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Zhang J, Xie D, Zou Y, Yu X, Ji Y, Wang C, Lv X, Zhou N, Jiang X, Wang K, Tian Y. Key Characteristics of Nitrous Oxide-Induced Neurological Disorders and Differences Between Populations. Front Neurol 2021; 12:627183. [PMID: 33986715 PMCID: PMC8110825 DOI: 10.3389/fneur.2021.627183] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nitrous oxide (N2O), commonly known as laughing gas, is inhaled recreationally because it produces the feelings of euphoria and freedom from pain. The risk of neurological dysfunction secondary to N2O abuse and its clinical diagnosis are, however, not yet sufficiently recognized, especially in China. Here, we have summarized the key clinical characteristics of N2O-induced neurological disorders. Materials and Methods: We recruited 20 patients with N2O-induced neurological disorders and analyzed their clinical features, laboratory data, magnetic resonance imaging and electromyography. We also carried out a literature review and compared 99 previously reported patients with our case series to confirm our results. Subgroup analysis was performed to explore the difference in demographical and clinical characteristics of N2O abuse between Asian and non-Asian patients. Results: The most common initial symptoms of N2O-induced neurological disorders were weakness and/or paresthesia. Most patients presented with myelopathy and/or peripheral neuropathy. The most commonly involved segment of the spinal cord was the cervical spinal cord, extending over 4–6 vertebral levels, but more than half of the patients with myelopathy had no sensory change at the corresponding spinal level. Homocysteine was found to be the most sensitive and practical indicator for diagnosis. Subgroup analysis showed that the Asian patients (median: 22.0 years old, Q1–Q3:19.0–26.0 years old) with N2O abuse were younger than non-Asian patients [26.0 (22.3–31.0) years old, P = 2.8 × 10−4]. The incidence of myelopathy combined with peripheral neuropathy was significantly higher in Asian patients than in non-Asian patients, who had myelopathy or peripheral neuropathy (P = 2 × 10−5). Conclusions: Key clinical characteristics of N2O abuse are longitudinally extensive cervical myelopathy and peripheral neuropathy. Recognition of these traits in young people in the age group of 20–30 years will provide important guidance for accurate diagnosis of neurological disease associated with N2O abuse. The clinical manifestations differ in Asian patients and non-Asian patients.
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Affiliation(s)
- Juanjuan Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dandan Xie
- Department of Neurology, The Affiliated Anqing Hospital of Anhui Medical University, Anqing, China
| | - Yanfeng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Xuen Yu
- Department of Neurology, The Institute of Neurology of Anhui University of Chinese Medicine, Hefei, China
| | - Yang Ji
- Anhui Medical University, Hefei, China
| | - Chengyou Wang
- Department of Neurology, The Affiliated Tongling Hospital of Anhui Medical University, Tongling, China
| | - Xinyi Lv
- Department of Neurology, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Nong Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiao Jiang
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.,Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Hefei, China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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