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Okun MS, Cagle J, Gomez J, Bowers D, Wong J, Foote KD, Gunduz A. Responsive deep brain stimulation for the treatment of Tourette syndrome. Sci Rep 2024; 14:6467. [PMID: 38499664 PMCID: PMC10948908 DOI: 10.1038/s41598-024-57071-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/14/2024] [Indexed: 03/20/2024] Open
Abstract
To report the results of 'responsive' deep brain stimulation (DBS) for Tourette syndrome (TS) in a National Institutes of Health funded experimental cohort. The use of 'brain derived physiology' as a method to trigger DBS devices to deliver trains of electrical stimulation is a proposed approach to address the paroxysmal motor and vocal tic symptoms which appear as part of TS. Ten subjects underwent bilateral staged DBS surgery and each was implanted with bilateral centromedian thalamic (CM) region DBS leads and bilateral M1 region cortical strips. A series of identical experiments and data collections were conducted on three groups of consecutively recruited subjects. Group 1 (n = 2) underwent acute responsive DBS using deep and superficial leads. Group 2 (n = 4) underwent chronic responsive DBS using deep and superficial leads. Group 3 (n = 4) underwent responsive DBS using only the deep leads. The primary outcome measure for each of the 8 subjects with chronic responsive DBS was calculated as the pre-operative baseline Yale Global Tic Severity Scale (YGTSS) motor subscore compared to the 6 month embedded responsive DBS setting. A responder for the study was defined as any subject manifesting a ≥ 30 points improvement on the YGTSS motor subscale. The videotaped Modified Rush Tic Rating Scale (MRVTRS) was a secondary outcome. Outcomes were collected at 6 months across three different device states: no stimulation, conventional open-loop stimulation, and embedded responsive stimulation. The experience programming each of the groups and the methods applied for programming were captured. There were 10 medication refractory TS subjects enrolled in the study (5 male and 5 female) and 4/8 (50%) in the chronic responsive eligible cohort met the primary outcome manifesting a reduction of the YGTSS motor scale of ≥ 30% when on responsive DBS settings. Proof of concept for the use of responsive stimulation was observed in all three groups (acute responsive, cortically triggered and deep DBS leads only). The responsive approach was safe and well tolerated. TS power spectral changes associated with tics occurred consistently in the low frequency 2-10 Hz delta-theta-low alpha oscillation range. The study highlighted the variety of programming strategies which were employed to achieve responsive DBS and those used to overcome stimulation induced artifacts. Proof of concept was also established for a single DBS lead triggering bi-hemispheric delivery of therapeutic stimulation. Responsive DBS was applied to treat TS related motor and vocal tics through the application of three different experimental paradigms. The approach was safe and effective in a subset of individuals. The use of different devices in this study was not aimed at making between device comparisons, but rather, the study was adapted to the current state of the art in technology. Overall, four of the chronic responsive eligible subjects met the primary outcome variable for clinical effectiveness. Cortical physiology was used to trigger responsive DBS when therapy was limited by stimulation induced artifacts.
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Affiliation(s)
- Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3011 SW Williston Rd, Gainesville, FL, 32608, USA.
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
| | - Jackson Cagle
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3011 SW Williston Rd, Gainesville, FL, 32608, USA
| | - Julieth Gomez
- Department of Biomedical Engineering, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Joshua Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3011 SW Williston Rd, Gainesville, FL, 32608, USA
| | - Kelly D Foote
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3011 SW Williston Rd, Gainesville, FL, 32608, USA
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3011 SW Williston Rd, Gainesville, FL, 32608, USA
- Department of Clinical and Health Psychology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Eisinger RS, Okun MS, Cernera S, Cagle J, Beke M, Ramirez-Zamora A, Kim BH, Barbosa DAN, Qiu L, Vaswani P, Aamodt WW, Halpern CH, Foote KD, Gunduz A, Almeida L. Weight and survival after deep brain stimulation for Parkinson's disease. Parkinsonism Relat Disord 2023; 115:105810. [PMID: 37660542 PMCID: PMC10664863 DOI: 10.1016/j.parkreldis.2023.105810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/05/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Weight loss in Parkinson's disease (PD) is common and associated with increased mortality. The clinical significance of weight changes following deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is unclear. OBJECTIVES To address (1) whether PD patients exhibit progressive weight loss, (2) whether staged DBS surgery is associated with weight changes, and (3) whether survival after DBS correlates with post-DBS weight. METHODS This is a single-center, longitudinal, retrospective cohort study of 1625 PD patients. We examined trends in weight over time and the relationship between weight and years survival after DBS using regression and mixed model analyses. RESULTS There was a decline in body weight predating motor symptom onset (n = 756, 0.70 ± 0.03% decrease per year, p < 0.001). Weight decline accelerated in the decade preceding death (n = 456, 2.18 ± 0.31% decrease per year, p < 0.001). DBS patients showed a weight increase of 2.0 ± 0.33% at 1 year following the first DBS lead implant (n = 455) and 2.68 ± 1.1% at 3 years if a contralateral DBS lead was placed (n = 249). The bilateral STN DBS group gained the most weight after surgery during 6 years of follow up (vs bilateral GPi, 3.03 ± 0.45% vs 1.89 ± 0.31%, p < 0.01). An analysis of the DBS cohort with date of death available (n = 72) revealed that post-DBS weight (0-12 months after the first or 0-36 months after the second surgery) was positively associated with survival (R2 = 0.14, p < 0.001). DISCUSSION Though PD is associated with significant weight loss, DBS patients gained weight following surgery. Higher post-operative weight was associated with increased survival. These results should be replicated in other cohorts.
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Affiliation(s)
- Robert S Eisinger
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, USA; Department of Neurology, Hospital of the University of Pennsylvania, USA.
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, USA; Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, USA
| | - Stephanie Cernera
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, USA; Department of Neurosurgery, University of California, San Francisco, USA
| | - Jackson Cagle
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, USA
| | - Matthew Beke
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, USA; Food Science and Human Nutrition Department, University of Florida, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, USA
| | - B Hope Kim
- Department of Neurology, Hospital of the University of Pennsylvania, USA
| | - Daniel A N Barbosa
- Department of Neurosurgery, Hospital of the University of Pennsylvania, USA
| | - Liming Qiu
- Department of Neurosurgery, Hospital of the University of Pennsylvania, USA
| | - Pavan Vaswani
- Department of Neurology, Hospital of the University of Pennsylvania, USA
| | - Whitley W Aamodt
- Department of Neurology, Hospital of the University of Pennsylvania, USA
| | - Casey H Halpern
- Department of Neurosurgery, Hospital of the University of Pennsylvania, USA; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, PA, Philadelphia, USA
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, USA
| | - Aysegul Gunduz
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, USA; Department of Biomedical Engineering, University of Florida, USA
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, USA; Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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Ortigoza EB, Cagle J, Brown LS, Mansi S, Gosser SP, Montgomery AD, Foresman Z, Boren ML, Pettit PS, Thompson TD, Vasil DM, Chien JH, Neu J, Koh AY, Sanghavi R, Mirpuri J. Tachygastria in Preterm Infants: A Longitudinal Cohort Study. J Pediatr Gastroenterol Nutr 2022; 75:564-571. [PMID: 36305880 PMCID: PMC9627630 DOI: 10.1097/mpg.0000000000003575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Tachygastria is a gastric dysrhythmia (>4 to ≤9 cycles per minute, cpm) associated with gastric hypomotility and gastrointestinal disorders. Healthy preterm infants spend more time in tachygastria than adults; however, normative values are not defined. We sought to determine the percent of time preterm infants spend in tachygastria. METHODS We conducted a longitudinal, prospective cohort study with weekly electrogastrography (EGG) recordings in 51 preterm <34 weeks' gestation and 5 term (reference) infants. We calculated percentage recording time in tachygastria (% tachygastria) and determined the mean ± standard deviation (SD) across EGG sessions. Mixed effects model was performed to test weekly variance in % tachygastria and gestational age effect. Successive pre- and post-prandial measurements were obtained to assess reproducibility of % tachygastria. We compared time to achieve full feeds between subjects with % tachygastria within 1 SD from the mean versus % tachygastria >1 SD from mean. RESULTS Three hundred seventy-six EGG sessions were completed (N = 56). Mean % tachygastria was 40% with SD ±5%. We demonstrated no change in % tachygastria across 9 postnatal weeks (P = 0.70) and no gestational age effect. No difference was demonstrated between successive pre- (P = 0.91) and post-prandial (P = 0.96) % tachygastria. Infants with 35%-45% tachygastria (within 1 SD from mean) had higher gestational age and less time to achieve full feeds than infants with <35% or >45% tachygastria. CONCLUSIONS EGG is a reproducible tool to assess % tachygastria in preterm infants. Clinical significance of increased or decreased % tachygastria needs further investigation to validate if 35%-45% tachygastria is safe for feeding.
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Affiliation(s)
- Eric Brum Ortigoza
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Jackson Cagle
- Department of Biomedical Engineering, University of Florida, Gainesville, FL
| | | | - Sherief Mansi
- Division of Pediatric Gastroenterology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | | | | | | | | | | | | | - Diana M. Vasil
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Jui-Hong Chien
- Department of Neurology and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Josef Neu
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL
| | - Andrew Young Koh
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
- Department of Microbiology, UT Southwestern Medical Center, Dallas, TX; and
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Rinarani Sanghavi
- Division of Pediatric Gastroenterology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Julie Mirpuri
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
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Johnson K, Cagle J, Melo Lobo Jofili Lopes JL, Okun M, Hilliard J, Foote K, De Hemptinne C. O032 / #633 PALLIDAL DEEP BRAIN STIMULATION EVOKES RESONANT NEURAL ACTIVITY IN PARKINSON’S DISEASE. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.08.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Frey J, Cagle J, Johnson KA, Wong JK, Hilliard JD, Butson CR, Okun MS, de Hemptinne C. Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches. Front Neurol 2022; 13:825178. [PMID: 35356461 PMCID: PMC8959612 DOI: 10.3389/fneur.2022.825178] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) has advanced treatment options for a variety of neurologic and neuropsychiatric conditions. As the technology for DBS continues to progress, treatment efficacy will continue to improve and disease indications will expand. Hardware advances such as longer-lasting batteries will reduce the frequency of battery replacement and segmented leads will facilitate improvements in the effectiveness of stimulation and have the potential to minimize stimulation side effects. Targeting advances such as specialized imaging sequences and “connectomics” will facilitate improved accuracy for lead positioning and trajectory planning. Software advances such as closed-loop stimulation and remote programming will enable DBS to be a more personalized and accessible technology. The future of DBS continues to be promising and holds the potential to further improve quality of life. In this review we will address the past, present and future of DBS.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jackson Cagle
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kara A. Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Justin D. Hilliard
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Christopher R. Butson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- *Correspondence: Coralie de Hemptinne
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Prosky J, Cagle J, Sellers KK, Gilron R, de Hemptinne C, Schmitgen A, Starr PA, Chang EF, Shirvalkar P. Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain. Front Neurosci 2022; 15:762097. [PMID: 34975374 PMCID: PMC8716790 DOI: 10.3389/fnins.2021.762097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022] Open
Abstract
Deep brain stimulation (DBS) is a plausible therapy for various neuropsychiatric disorders, though continuous tonic stimulation without regard to underlying physiology (open-loop) has had variable success. Recently available DBS devices can sense neural signals which, in turn, can be used to control stimulation in a closed-loop mode. Closed-loop DBS strategies may mitigate many drawbacks of open-loop stimulation and provide more personalized therapy. These devices contain many adjustable parameters that control how the closed-loop system operates, which need to be optimized using a combination of empirically and clinically informed decision making. We offer a practical guide for the implementation of a closed-loop DBS system, using examples from patients with chronic pain. Focusing on two research devices from Medtronic, the Activa PC+S and Summit RC+S, we provide pragmatic details on implementing closed- loop programming from a clinician’s perspective. Specifically, by combining our understanding of chronic pain with data-driven heuristics, we describe how to tune key parameters to handle feature selection, state thresholding, and stimulation artifacts. Finally, we discuss logistical and practical considerations that clinicians must be aware of when programming closed-loop devices.
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Affiliation(s)
- Jordan Prosky
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
| | - Jackson Cagle
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Kristin K Sellers
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
| | - Ro'ee Gilron
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Cora de Hemptinne
- Department of Neurology, University of Florida, Gainesville, FL, United States.,Normal Fixel Institute for Neurological Diseases, Gainesville, FL, United States
| | - Ashlyn Schmitgen
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States.,UCSF Department of Physiology, San Francisco, CA, United States
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States.,UCSF Department of Physiology, San Francisco, CA, United States
| | - Prasad Shirvalkar
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,UCSF Weill Institute for Neurosciences, San Francisco, CA, United States.,Division of Pain Medicine, UCSF Department of Anesthesiology and Perioperative Care, San Francisco, CA, United States.,UCSF Department of Neurology, San Francisco, CA, United States
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Burke SE, Babu Henry Samuel I, Zhao Q, Cagle J, Cohen RA, Kluger B, Ding M. Task-Based Cognitive Fatigability for Older Adults and Validation of Mental Fatigability Subscore of Pittsburgh Fatigability Scale. Front Aging Neurosci 2018; 10:327. [PMID: 30405396 PMCID: PMC6202947 DOI: 10.3389/fnagi.2018.00327] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/27/2018] [Indexed: 11/23/2022] Open
Abstract
Cognitive fatigue and cognitive fatigability are distinct constructs. Cognitive fatigue reflects perception of cognitive fatigue outside of the context of activity level and duration and can be reliably assessed via established instruments such as the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). In contrast, cognitive fatigability reflects change in fatigue levels quantified within the context of the level and duration of cognitive activity, and currently there are no reliable measures of cognitive fatigability. A recently published scale, the Pittsburgh Fatigability Scale (PFS), attempts to remedy this problem with a focus on the aged population. While the physical fatigability subscore of PFS has been validated using physical activity derived measures, the mental fatigability subscore of PFS remains to be tested against equivalent measures derived from cognitive activities. To this end, we recruited 35 older, healthy adult participants (mean age 73.77 ± 5.9) to complete the PFS as well as a prolonged continuous performance of a Stroop task (>2 h). Task-based assessments included time-on-task changes in self-reported fatigue scores (every 20 min), reaction time, and pupil diameter. Defining subjective fatigability, behavioral fatigability, and physiologic/autonomic fatigability to be the slope of change over time-on-task in the above three assessed variables, we found that the PFS mental subscore was not correlated with any of the three task-based fatigability measures. Instead, the PFS mental subscore was correlated with trait level fatigue measures FSS (ρ = 0.63, p < 0.001), and MFIS cognitive subsection (ρ = 0.36, p = 0.03). This finding suggested that the PFS mental fatigability subscore may not be an adequate measure of how fatigued one becomes after a given amount of mental work. Further development efforts are needed to create a self-report scale that reliably captures cognitive fatigability in older adults.
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Affiliation(s)
- Sarah E. Burke
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Immanuel Babu Henry Samuel
- J. Crayton Pruitt Family Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, United States
| | - Qing Zhao
- J. Crayton Pruitt Family Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, United States
| | - Jackson Cagle
- J. Crayton Pruitt Family Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, United States
| | - Ronald A. Cohen
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Benzi Kluger
- Departments of Neurology and Psychiatry, Anschutz School of Medicine, University of Colorado, Aurora, CO, United States
| | - Mingzhou Ding
- J. Crayton Pruitt Family Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, United States
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Kelemen A, Groninger J, Cagle J, Walker K. Bringing Sexy Back: Sexuality and Intimacy Concerns in an Advanced Heart Failure Population Receiving Palliative Care Consultation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Krusz J, Cagle J. IV Baclofen for Treating Migraines Accompanied by Severe Muscle Spasm in Outpatient Setting (P03.235). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cagle J, Cammarata D, Scott-Krusz V, Krusz J. 249 IV TRAMADOL FOR TREATMENT OF REFRACTORY MIGRAINES IN THE CLINIC. Eur J Pain 2007. [DOI: 10.1016/j.ejpain.2007.03.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- J Cagle
- Nightly Home Hemodialysis Group, Lynchburg, Virginia, USA
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Cagle J. Conversions of mutual savings institutions: Do initial returns from these IPOS provide investors with windfall profits? ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s1057-0810(97)90024-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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