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Vanegas-Arroyave N, Caroff SN, Citrome L, Crasta J, McIntyre RS, Meyer JM, Patel A, Smith JM, Farahmand K, Manahan R, Lundt L, Cicero SA. An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders. CNS Drugs 2024; 38:239-254. [PMID: 38502289 PMCID: PMC10980662 DOI: 10.1007/s40263-024-01078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
Drug-induced movement disorders (DIMDs) are associated with use of dopamine receptor blocking agents (DRBAs), including antipsychotics. The most common forms are drug-induced parkinsonism (DIP), dystonia, akathisia, and tardive dyskinesia (TD). Although rare, neuroleptic malignant syndrome (NMS) is a potentially life-threatening consequence of DRBA exposure. Recommendations for anticholinergic use in patients with DIMDs were developed on the basis of a roundtable discussion with healthcare professionals with extensive expertise in DIMD management, along with a comprehensive literature review. The roundtable agreed that "extrapyramidal symptoms" is a non-specific term that encompasses a range of abnormal movements. As such, it contributes to a misconception that all DIMDs can be treated in the same way, potentially leading to the misuse and overprescribing of anticholinergics. DIMDs are neurobiologically and clinically distinct, with different treatment paradigms and varying levels of evidence for anticholinergic use. Whereas evidence indicates anticholinergics can be effective for DIP and dystonia, they are not recommended for TD, akathisia, or NMS; nor are they supported for preventing DIMDs except in individuals at high risk for acute dystonia. Anticholinergics may induce serious peripheral adverse effects (e.g., urinary retention) and central effects (e.g., impaired cognition), all of which can be highly concerning especially in older adults. Appropriate use of anticholinergics therefore requires careful consideration of the evidence for efficacy (e.g., supportive for DIP but not TD) and the risks for serious adverse events. If used, anticholinergic medications should be prescribed at the lowest effective dose and for limited periods of time. When discontinued, they should be tapered gradually.
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Affiliation(s)
- Nora Vanegas-Arroyave
- Department of Neurology, Baylor College of Medicine, 7200 Cambridge Street, Suite 9A, Houston, TX, 77030, USA.
| | - Stanley N Caroff
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Jonathan M Meyer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Amita Patel
- Dayton Psychiatric Associations, Dayton, OH, USA
- Joint Township District Memorial Hospital, St. Marys, OH, USA
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Borders JC, Hegland KW, Vanegas-Arroyave N, Troche MS. Motor Performance During Sensorimotor Training for Airway Protection in Parkinson's Disease. Am J Speech Lang Pathol 2023; 32:2718-2733. [PMID: 37668552 DOI: 10.1044/2023_ajslp-23-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Cough dysfunction is highly prevalent in Parkinson's disease (PD) and associated with pneumonia, a leading cause of death. Although research suggests that cough can be volitionally upregulated, patterns of improvements that occur during cough skill training and potential correlates remain unexamined. Therefore, we sought to characterize changes to peak flow during cough skill training, examine whether early variability predicted motor performance trajectories during treatment, and explore the relationship between peak flow during cough skill training and motor learning on a similar but untrained task (i.e., reflex cough testing). METHOD This secondary analysis of treatment data from a randomized controlled trial included 28 individuals with PD who participated in five sessions of sensorimotor training for airway protection (smTAP). During this novel cough skill training, participants completed 25 repetitions of coughs targeting peak flow 25% above their baseline. Reflex and voluntary cough testing was performed pre- and posttreatment. Bayesian multilevel growth curve models provided group and individual-level estimates of peak flow during training. RESULTS The magnitude and consistency of peak flow increased during cough skill training. Variability in peak flow during the first treatment session was associated with greater improvements to peak flow in later sessions. There was no relationship between changes to peak flow during cough skill training and motor learning. CONCLUSIONS Individuals with PD improved the strength and variability of cough peak flow during cough skill training. These findings provide a clinically relevant characterization of motor performance during cough skill training and lend insight into potential correlates to guide future treatment paradigms.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York
| | - Karen W Hegland
- Laboratory for the Study of Upper Airway Dysfunction, College of Public Health and Health Professions, University of Florida, Gainesville
| | | | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York
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Borders JC, Sevitz JS, Curtis JA, Vanegas-Arroyave N, Troche MS. Quantifying Impairments in Swallowing Safety and Efficiency in Progressive Supranuclear Palsy and Parkinson's Disease. Dysphagia 2023; 38:1342-1352. [PMID: 36763187 DOI: 10.1007/s00455-023-10560-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
Dysphagia is a largely inevitable symptom in both progressive supranuclear palsy (PSP) and Parkinson's disease (PD). To date, comparative studies in these diseases have failed to detect differences in the severity of impairments in swallowing safety or efficiency, potentially due to small sample sizes and outcome measures with low sensitivity. Therefore, this study sought to address these limitations by using novel measurement methodology to comprehensively compare swallowing safety and efficiency impairments between these populations in order to better understand whether differences may exist and guide clinical management. Twenty-four participants with PSP and 24 with PD were matched for disease duration and completed flexible endoscopic evaluations of swallowing. A visual analog scale and penetration-aspiration scale quantified swallowing safety and efficiency. Bayesian multilevel models compared the frequency, severity, and variability of swallowing impairments. Individuals with PSP demonstrated greater impairments in swallowing safety, including deeper and more variable airway invasion and more frequent vocal fold and subglottic residue. Swallowing efficiency was also more impaired among individuals with PSP, including more frequent hypopharyngeal residue (with solids) and more severe residue in the oropharynx (with thin liquids and solids) and hypopharynx (with thin liquids). When airway or pharyngeal residue was present, similar within-subject variability of the amount of residue was appreciated across anatomic landmarks. This is the first study comparing the frequency, severity, and variability of swallowing impairments between PSP and PD populations. Our findings demonstrate more pronounced impairments in swallowing safety and efficiency for PSP compared to PD. These findings provide a clinically relevant characterization of swallowing measures using novel methodological and statistical approaches attempting to resolve some limitations of prior studies.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | | | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
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Vanegas-Arroyave N, Jankovic J. Spinal cord stimulation for gait disturbances in Parkinson's disease. Expert Rev Neurother 2023; 23:651-659. [PMID: 37345383 DOI: 10.1080/14737175.2023.2228492] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/18/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Gait disturbances are a major contributor to the disability associated with Parkinson's disease. Although pharmacologic therapies and deep brain stimulation improve most motor parkinsonian features, their effects on gait are highly variable. Spinal cord stimulation, typically used for the treatment of chronic pain, has emerged as a potential therapeutic approach to improve gait disturbances in Parkinson's disease. AREAS COVERED The authors review the available evidence on the effects of spinal cord stimulation in patients with Parkinson's disease, targeting primarily gait abnormalities. They also discuss possible mechanisms, safety, and methodological implications for future clinical trials. This systematic review of originally published articles in English language was performed using The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).
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Affiliation(s)
- Nora Vanegas-Arroyave
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Rutherford BR, Choi J, Slifstein M, O'Boyle K, Abi-Dargham A, Brown PJ, Wall MW, Vanegas-Arroyave N, Sakhardande J, Stern Y, Roose SP. Retraction notice to "Neuroanatomical predictors of L-DOPA response in older adults with psychomotor slowing and depression: A pilot study" [J. Affect. Disord. 265 (2020) 439-444]. J Affect Disord 2023; 330:369. [PMID: 36966032 PMCID: PMC10830147 DOI: 10.1016/j.jad.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Affiliation(s)
- Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Jongwoo Choi
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Mark Slifstein
- Stony Brook University College of Medicine, New York, NY, United States
| | - Kaleigh O'Boyle
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Melanie W Wall
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Jayant Sakhardande
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Yaakov Stern
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
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Hitti FL, Widge AS, Riva-Posse P, Malone DA, Okun MS, Shanechi MM, Foote KD, Lisanby SH, Ankudowich E, Chivukula S, Chang EF, Gunduz A, Hamani C, Feinsinger A, Kubu CS, Chiong W, Chandler JA, Carbunaru R, Cheeran B, Raike RS, Davis RA, Halpern CH, Vanegas-Arroyave N, Markovic D, Bick SK, McIntyre CC, Richardson RM, Dougherty DD, Kopell BH, Sweet JA, Goodman WK, Sheth SA, Pouratian N. Future directions in psychiatric neurosurgery: Proceedings of the 2022 American Society for Stereotactic and Functional Neurosurgery meeting on surgical neuromodulation for psychiatric disorders. Brain Stimul 2023; 16:867-878. [PMID: 37217075 DOI: 10.1016/j.brs.2023.05.011] [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: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE Despite advances in the treatment of psychiatric diseases, currently available therapies do not provide sufficient and durable relief for as many as 30-40% of patients. Neuromodulation, including deep brain stimulation (DBS), has emerged as a potential therapy for persistent disabling disease, however it has not yet gained widespread adoption. In 2016, the American Society for Stereotactic and Functional Neurosurgery (ASSFN) convened a meeting with leaders in the field to discuss a roadmap for the path forward. A follow-up meeting in 2022 aimed to review the current state of the field and to identify critical barriers and milestones for progress. DESIGN The ASSFN convened a meeting on June 3, 2022 in Atlanta, Georgia and included leaders from the fields of neurology, neurosurgery, and psychiatry along with colleagues from industry, government, ethics, and law. The goal was to review the current state of the field, assess for advances or setbacks in the interim six years, and suggest a future path forward. The participants focused on five areas of interest: interdisciplinary engagement, regulatory pathways and trial design, disease biomarkers, ethics of psychiatric surgery, and resource allocation/prioritization. The proceedings are summarized here. CONCLUSION The field of surgical psychiatry has made significant progress since our last expert meeting. Although weakness and threats to the development of novel surgical therapies exist, the identified strengths and opportunities promise to move the field through methodically rigorous and biologically-based approaches. The experts agree that ethics, law, patient engagement, and multidisciplinary teams will be critical to any potential growth in this area.
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Affiliation(s)
- Frederick L Hitti
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Alik S Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Donald A Malone
- Department of Psychiatry, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Maryam M Shanechi
- Departments of Electrical and Computer Engineering and Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Sarah H Lisanby
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Elizabeth Ankudowich
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Srinivas Chivukula
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Aysegul Gunduz
- Department of Biomedical Engineering and Fixel Institute for Neurological Disorders, University of Florida, Gainesville, FL, USA
| | - Clement Hamani
- Sunnybrook Research Institute, Hurvitz Brain Sciences Centre, Harquail Centre for Neuromodulation, Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Ashley Feinsinger
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Cynthia S Kubu
- Department of Neurology, Cleveland Clinic and Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Winston Chiong
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer A Chandler
- Faculty of Law, University of Ottawa, Ottawa, ON, USA; Affiliate Investigator, Bruyère Research Institute, Ottawa, ON, USA
| | | | | | - Robert S Raike
- Global Research Organization, Medtronic Inc. Neuromodulation, Minneapolis, MN, USA
| | - Rachel A Davis
- Departments of Psychiatry and Neurosurgery, University of Colorado Anschutz, Aurora, CO, USA
| | - Casey H Halpern
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Cpl Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | | | - Dejan Markovic
- Department of Electrical Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah K Bick
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cameron C McIntyre
- Departments of Biomedical Engineering and Neurosurgery, Duke University, Durham, NC, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Brian H Kopell
- Department of Neurosurgery, Center for Neuromodulation, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer A Sweet
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Chepke C, Vanegas-Arroyave N, Cicero S, Bron M. Use of Anticholinergics for Drug-Induced Movement Disorders With Implications for Elderly Patients. The American Journal of Geriatric Psychiatry 2023. [DOI: 10.1016/j.jagp.2022.12.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Troche MS, Curtis JA, Sevitz JS, Dakin AE, Perry SE, Borders JC, Grande AA, Mou Y, Vanegas-Arroyave N, Hegland KW. Rehabilitating Cough Dysfunction in Parkinson's Disease: A Randomized Controlled Trial. Mov Disord 2023; 38:201-211. [PMID: 36345090 DOI: 10.1002/mds.29268] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Disorders of airway protection (cough and swallowing) are pervasive in Parkinson's disease (PD) resulting in a high incidence of aspiration pneumonia and death. However, there are no randomized controlled trials comparing strength and skill-based approaches to improve airway protection in PD. OBJECTIVES The aim of this study was to compare expiratory muscle strength training (EMST) and sensorimotor training for airway protection (smTAP) to improve cough-related outcomes in people with PD. METHODS Participants with PD and dysphagia were recruited for this prospective phase II randomized-blinded controlled clinical trial. Participants completed baseline assessment, 5 weeks of EMST or smTAP, and a post-training assessment. Primary outcome measures included maximum expiratory pressure (MEP) and voluntary cough peak expiratory flow rate (PEFR). Mixed effects models were used to assess the effects of EMST and smTAP on outcomes. RESULTS A total of 65 participants received either EMST (n = 34) or smTAP (n = 31). MEP improved from pre- to post-treatment for smTAP (P < 0.001, d = 0.19) and EMST (P < 0.001, d = 0.53). Voluntary PEFR increased from pre- to post-treatment for smTAP (P < 0.001, d = 0.19) and EMST (P < 0.001, d = 0.06). Moreover, reflex cough PEFR (P < 0.001, d = 0.64), reflex cough expired volume (P < 0.001, d = 0.74), and urge to cough (P = 0.018, OR = 2.70) improved for the smTAP group but not for the EMST group. CONCLUSIONS This clinical trial confirmed the efficacy of smTAP to improve reflex and voluntary cough function, above and beyond EMST, the current gold standard. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA.,Division of Movement Disorders, Department of Neurology, Columbia University Medical Center, New York, New York, USA
| | - James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Avery E Dakin
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Sarah E Perry
- University of Canterbury Rose Centre for Stroke Recovery and Research at St. George's Medical Centre, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | | | - Yuhan Mou
- Laboratory for the Study of Upper Airway Dysfunction, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA
| | | | - Karen W Hegland
- Laboratory for the Study of Upper Airway Dysfunction, Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, USA.,Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
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El-Mallakh RS, Belnap A, Iyer S, Schreiber J, Matthews D, Lefler L, Dees D, Bott A, Vanegas-Arroyave N, Wolff A, Pesce U, Farahmand K, Shah C, Lundt L. Telehealth for Assessing and Managing Tardive Dyskinesia: Expert Insights from a Cross-Disciplinary Virtual Treatment Panel. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Rif S. El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Amy Belnap
- Rocky Mountain Psychiatry, Pocatello, Idaho, USA
- Neurocrine Biosciences, Inc., San Diego, California, USA
| | - Sanjay Iyer
- Memory & Movement Charlotte, Charlotte, North Carolina, USA
| | | | | | - Linda Lefler
- St. Anthony's Hospital and Bayfront Health St. Petersburg, St. Petersburg, Florida, USA
| | - Daniel Dees
- Department of Neurology, University of South Alabama College of Medicine, Mobile, Alabama, USA
| | | | | | - Adam Wolff
- Denver Neurological Clinic, Denver, Colorado, USA
| | - Ulises Pesce
- Department of Psychiatry, University of South Dakota, Vermillion, South Dakota, USA
| | | | - Chirag Shah
- Neurocrine Biosciences, Inc., San Diego, California, USA
| | - Leslie Lundt
- Neurocrine Biosciences, Inc., San Diego, California, USA
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Wong SB, Wang YM, Lin CC, Geng SK, Vanegas-Arroyave N, Pullman SL, Kuo SH, Pan MK. Cerebellar Oscillations in Familial and Sporadic Essential Tremor. Cerebellum 2022; 21:425-431. [PMID: 34341893 PMCID: PMC8970339 DOI: 10.1007/s12311-021-01309-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Enhanced cerebellar oscillations have recently been identified in essential tremor (ET) patients as a key pathophysiological change. Since ET is considered a heterogeneous group of diseases, we investigated whether cerebellar oscillations differ in ET subtypes (familial vs. sporadic). This study aims to determine cerebellar physiology in familial and sporadic ET. Using surface electroencephalogram, we studied cerebellar physiology in 40 ET cases (n = 22 familial and n = 18 sporadic) and 20 age-matched controls. Both familial and sporadic ET cases had an increase in the intensity of cerebellar oscillations when compared to controls. Interestingly, cerebellar oscillations correlated with tremor severity in familial ET but not in sporadic ET. Our study demonstrated that ET cases have enhanced cerebellar oscillations, and the different relationships between cerebellar oscillations and tremor severity in familial and sporadic ET suggest diverse cerebellar pathophysiology.
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Affiliation(s)
- Shi-Bing Wong
- Department of Pediatrics, Taipei Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 23142, Taiwan
- School of Medicine, Tzu Chi University, Hualien, 97071, Taiwan
| | - Yi-Mei Wang
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taipei, Taiwan
- Department of Education and Medical Research, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taipei, Taiwan
| | - Chih-Chun Lin
- Department of Neurology, Columbia University, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, 10032, USA
| | - Scott Kun Geng
- Department of Computer Science, Columbia University, New York, NY, 10027, USA
| | | | - Seth L Pullman
- Department of Neurology, Columbia University, New York, NY, 10032, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, 10032, USA
| | - Ming-Kai Pan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, 64041, Taipei, Taiwan.
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, 10617, Taiwan.
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, 10617, Taiwan.
- Department of Medical Research, National Taiwan University Hospital, Taipei, 10002, Taiwan.
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 11529, Taiwan.
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11
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Vanegas-Arroyave N, Chen DF, Lauro PM, Norato G, Lungu C, Hallett M. Where Do Parkinson's Disease Patients Look while Walking? Mov Disord 2022; 37:864-869. [PMID: 34997620 DOI: 10.1002/mds.28917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is associated with gait and visuomotor abnormalities, but it is not clear where PD patients look during ambulation. OBJECTIVE We sought to characterize the visual areas of interest explored by PD patients, with and without freezing of gait (FOG), compared to healthy volunteers (HVs). METHODS Using an eye-tracking device, we compared visual fixation patterns in 17 HVs and 18 PD patients, with and without FOG, during an ambulatory and a nonambulatory, computer-based task. RESULTS During ambulation, PD patients with FOG fixated more on proximal areas of the ground and less on the target destination. PD patients without FOG displayed a fixation pattern more similar to that of HVs. Similar patterns were observed during the nonambulatory, computer-based task. CONCLUSIONS Our findings suggest increased dependence on visual feedback from nearby areas in the environment in PD patients with FOG, even in the absence of motor demands. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Denise F Chen
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter M Lauro
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Gina Norato
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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Radmard S, Ortega RA, Ford B, Vanegas-Arroyave N, McKhann GM, Sheth SA, Winfield L, Luciano MS, Saunders-Pullman R, Pullman SL. Using computerized spiral analysis to evaluate deep brain stimulation outcomes in Parkinson disease. Clin Neurol Neurosurg 2021; 208:106878. [PMID: 34418700 DOI: 10.1016/j.clineuro.2021.106878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether spiral analysis can monitor the effects of deep brain stimulation (DBS) in Parkinson disease (PD) and provide a window on clinical features that change post-operatively. Clinical evaluation after DBS is subjective and insensitive to small changes. Spiral analysis is a computerized test that quantifies kinematic, dynamic, and spatial aspects of spiral drawing. Validated computational indices are generated and correlate with a range of clinically relevant motor findings. These include measures of overall clinical severity (Severity), bradykinesia and rigidity (Smoothness), amount of tremor (Tremor), irregularity of drawing movements (Variability), and micrographia (Tightness). METHODS We retrospectively evaluated the effect of subthalamic nucleus (STN) (n = 66) and ventral intermediate thalamus (Vim) (n = 10) DBS on spiral drawing in PD subjects using spiral analysis. Subjects freely drew ten spirals on plain paper with an inking pen on a graphics tablet. Five spiral indices (Severity, Smoothness, Tremor, Variability, Tightness) were calculated and compared pre- and post-operatively using Wilcoxon-rank sum tests, adjusting for multiple comparisons. RESULTS Severity improved after STN and Vim DBS (p < 0.005). Smoothness (p < 0.01) and Tremor (p < 0.02) both improved after STN and Vim DBS. Variability improved only with Vim DBS. Neither STN nor Vim DBS significantly changed Tightness. CONCLUSIONS All major spiral indices, except Tightness, improved after DBS. This suggests spiral analysis monitors DBS effects in PD and provides an objective window on relevant clinical features that change post-operatively. It may thus have utilization in clinical trials or investigations into the neural pathways altered by DBS. The lack of change in Tightness supports the notion that DBS does not improve micrographia.
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Affiliation(s)
- Sara Radmard
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
| | | | - Blair Ford
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nora Vanegas-Arroyave
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Linda Winfield
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Marta San Luciano
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Seth L Pullman
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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Sharma VD, Safarpour D, Mehta SH, Vanegas-Arroyave N, Weiss D, Cooney JW, Mari Z, Fasano A. Telemedicine and Deep brain stimulation - Current practices and recommendations. Parkinsonism Relat Disord 2021; 89:199-205. [PMID: 34274215 DOI: 10.1016/j.parkreldis.2021.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022]
Abstract
The use of telemedicine in the management of chronic neurological conditions including movement disorders has expanded over time. In addition to enabling remote access to specialized care, telemedicine has also been shown to reduce caregiver burden and to improve patient satisfaction. With the COVID-19 pandemic, implementation of telehealth for patients with movement disorders, particularly those with more severe mobility issues, has increased rapidly. Although telemedicine care has been shown to be effective for patients with various movement disorders, its utilization for patients with device aided therapies such as deep brain stimulation (DBS) is limited due to challenges related to adjusting these devices remotely and to the lack of consensus recommendations for using telemedicine in this patient population. Thus, guidelines for telemedicine and DBS will assist clinicians on the appropriate implementation of telemedicine to provide care to DBS patients. Optimizing the use of telemedicine for DBS will expand this type of therapy to remote locations with limited access to programming expertise, and also reduce the need for patient travel. Telemedicine is particularly important during the ongoing pandemic due to infection risk and limited access to clinic visits. In this article we review the currently available and emerging strategies for telemedicine and remote care for DBS. We then outline common principles and recommendations for telemedicine care in patients with DBS, review patient selection and best practices. Finally, we briefly discuss the current state of reimbursement for DBS telemedicine visits.
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Affiliation(s)
- Vibhash D Sharma
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Delaram Safarpour
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | | | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Disease, and Hertie-Institute for Clinical Brain Research, Tübingen, Germany
| | - Jeffrey W Cooney
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada. Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
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Borders JC, Sevitz JS, Curtis JA, Vanegas-Arroyave N, Troche MS. Sensorimotor Cough Dysfunction Is Prevalent and Pervasive in Progressive Supranuclear Palsy. Mov Disord 2021; 36:2624-2633. [PMID: 34173683 DOI: 10.1002/mds.28707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/31/2021] [Accepted: 06/04/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pneumonia, a leading cause of death in progressive supranuclear palsy (PSP), results from progressive and pervasive deficits of airway protection, including both cough and swallowing dysfunction. Cough protects the airway by expelling aspirate and may be an important therapeutic target to protect against pneumonia in the presence of dysphagia. However, cough has not been objectively characterized in PSP or compared to other common forms of parkinsonism, such as Parkinson's disease (PD). OBJECTIVE The purpose of this study was to examine voluntary and reflex cough function in PSP, as compared to patients with PD matched for disease duration. METHODS Twenty-six patients with PSP and 26 with PD completed voluntary and reflex cough testing via spirometry. Linear mixed effects models examined comparisons between groups and within cough types across cough sensory and motor outcomes. RESULTS Patients with PSP demonstrated significantly reduced cough motor function compared to PD, specifically reduced peak expiratory flow rate (P < 0.001), cough expiratory volume (P < 0.001), and cough inspiratory volume (P = 0.008). Both groups showed similar reflex cough thresholds (P = 0.694), but PSP demonstrated an increased perception of cough stimuli (P = 0.041). CONCLUSIONS These findings suggest that sensorimotor cough dysfunction is prevalent in PSP, and cough motor deficits, in particular, are worse in PSP than in PD. These deficits likely contribute to the pathogenesis of pneumonia in PSP. Therefore, cough should be integrated into assessments of airway protection and considered as a therapeutic target to potentially reduce adverse health events and improve quality of life in this population. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | | | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
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Borders JC, Curtis JA, Sevitz JS, Vanegas-Arroyave N, Troche MS. Immediate Effects of Sensorimotor Training in Airway Protection (smTAP) on Cough Outcomes in Progressive Supranuclear Palsy: A Feasibility Study. Dysphagia 2021; 37:74-83. [PMID: 33515312 DOI: 10.1007/s00455-021-10251-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by a high prevalence of dysphagia, cough dysfunction, and resultant aspiration pneumonia. Sensorimotor cough function is important for airway clearance in people with dysphagia. Upregulation of cough has been demonstrated in healthy adults and Parkinson's disease; however, the feasibility of cough rehabilitation in PSP is unknown. We sought to assess feasibility by examining the immediate effects of a novel sensorimotor training in airway protection (smTAP) on upregulation of cough function in PSP. Fifteen individuals with PSP enrolled in this study. Baseline voluntary and reflex cough testing were completed. During smTAP, participants were presented with subthreshold capsaicin and instructed to cough with sufficient intensity to hit a target line (set 25% above baseline reflex peak cough flow) via cough airflow visual biofeedback. Twenty-five repetitions were targeted within a single session. Wilcoxon signed-rank tests compared cough airflow measures between baseline voluntary cough testing, the initial five trials of smTAP, and final five trials. Mean peak expiratory flow rate (PEFR) significantly increased from initial to final smTAP trials (p < 0.001). Fourteen participants increased PEFR, with gains of more than 10% in 11 participants. Variability of PEFR (p = 0.01) and cough expired volume (p = 0.01) significantly decreased across smTAP trials. This study is the first to demonstrate the ability of people with PSP to immediately upregulate cough function, providing preliminary support for the feasibility of cough rehabilitation in this population with this novel treatment approach. Future research examining the effects of multiple sessions of smTAP on cough outcomes is warranted.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
| | - James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Jordanna S Sevitz
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Nora Vanegas-Arroyave
- Division of Movement Disorders, Department of Neurology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
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Enver N, Borders JC, Curtis JA, Sevitz JS, Vanegas-Arroyave N, Troche MS. The Role of Vocal Fold Bowing on Cough and Swallowing Dysfunction in Progressive Supranuclear Palsy. Laryngoscope 2020; 131:1217-1222. [PMID: 32687232 DOI: 10.1002/lary.28885] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Progressive supranuclear palsy (PSP) is a neurodegenerative disease which results in cough and swallowing dysfunction and aspiration pneumonia. Relationships among vocal fold atrophy, cough, and swallowing have been identified in related diseases, but remain unknown in PSP. This study examined: 1) the prevalence of vocal fold bowing in PSP, and 2) the influence of vocal fold bowing on cough and swallowing in PSP. STUDY DESIGN Prospective Cohort Study. METHODS Twenty-three participants with PSP completed instrumental assessments of cough and swallowing. Vocal fold bowing (BI) and swallowing safety (PAS) was assessed using flexible laryngoscopy. Measures of cough effectiveness were obtained using spirometry. Statistical analyses were used to determine the frequency of mild-moderate (BI > 0) and severe (BI > 12.2) bowing, and to assess the influence of BI on PAS and cough effectiveness in PSP. RESULTS Fifty-two percent (n = 12) of participants exhibited severe bowing while 48% (n = 11) exhibited mild-to-moderate bowing. Voluntary cough peak expiratory flow rate (P = .01), as well as reflex (P = .02) and voluntary (P = .005) cough volume acceleration were lower for participants with severe BI when compared to mild-to-moderate BI. However, BI did not influence PAS (P > .05). CONCLUSIONS Findings from this study suggest that vocal fold bowing is highly prevalent in PSP and associated with reduced reflex and voluntary cough effectiveness. These findings provide insight into the pathophysiology of compromised airway protection in this patient population. Future studies should examine vocal fold atrophy as a treatment target for behavioral and medical intervention in PSP. LEVEL OF EVIDENCE 3 (Prospective Observational Study) Laryngoscope, 131:1217-1222, 2021.
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Affiliation(s)
- Necati Enver
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, U.S.A.,Department of Otolaryngology Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey.,The Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - James C Borders
- The Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - James A Curtis
- The Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Jordanna S Sevitz
- The Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Nora Vanegas-Arroyave
- Department of Neurology, Division of Movement Disorders, Columbia University Medical Center, New York, New York, U.S.A
| | - Michelle S Troche
- The Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A
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Rutherford BR, Choi J, Slifstein M, O'Boyle K, Abi-Dargham A, Brown PJ, Wall MW, Vanegas-Arroyave N, Sakhardande J, Stern Y, Roose SP. Neuroanatomical predictors of L-DOPA response in older adults with psychomotor slowing and depression: A pilot study. J Affect Disord 2020; 265:439-444. [PMID: 32090770 PMCID: PMC7042346 DOI: 10.1016/j.jad.2020.01.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/11/2019] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Declining function in dopamine circuits is implicated in normal aging and late-life depression (LLD). Dopamine augmentation recently has shown therapeutic promise, but predictors of response are unknown. METHODS Depressed elders with slowed gait underwent baseline magnetic resonance imaging (MRI) and [11C]raclopride positron emission tomography (PET). Subjects then received open treatment with carbidopa/levodopa (L-DOPA) for three weeks. Linear regressions examined relationships between baseline MRI measures, [11C]raclopride binding, and behavioral outcomes. RESULTS Among N = 16 participants aged 72.5 ± 6.8 years, higher left superior temporal gyrus volume was associated with higher processing speed at baseline, while cortical thinning in a processing speed network was associated with greater improvement following L-DOPA. Greater volume and cortical thickness in brain regions associated with mobility were associated with higher baseline gait speed. Higher baseline white matter hyperintensity volume predicted less post-L-DOPA improvement on dual task gait speed and IDS-SR scores. Higher [11C]raclopride binding in the associative striatum was associated with cortical thickness in some, but not all, processing speed brain regions, while higher binding in sensorimotor striatum was significantly associated with left caudate volume. LIMITATIONS Limiting the conclusions drawn from this pilot study are the small sample size and open administration of L-DOPA. CONCLUSIONS Greater baseline brain volumes and cortical thickness in regions supporting cognition and gait were associated with higher behavioral performance, while lower structural integrity was associated with increased responsivity to L-DOPA. If substantiated in larger studies, these findings could facilitate the targeting of dopaminergic treatments to those LLD patients most likely to respond.
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Affiliation(s)
- Bret R Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States.
| | - Jongwoo Choi
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Mark Slifstein
- Stony Brook University College of Medicine, New York, NY, United States
| | - Kaleigh O'Boyle
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Patrick J Brown
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Melanie W Wall
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | | | - Jayant Sakhardande
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Yaakov Stern
- Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Steven P Roose
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
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Pretegiani E, Vanegas-Arroyave N, FitzGibbon EJ, Hallett M, Optican LM. Evidence From Parkinson's Disease That the Superior Colliculus Couples Action and Perception. Mov Disord 2019; 34:1680-1689. [PMID: 31633242 DOI: 10.1002/mds.27861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/12/2019] [Accepted: 08/12/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Action and perception should be coordinated for good visual-motor performance. The mechanism coupling action and perception may be a prominence map in the intermediate layer of the superior colliculus that modulates motor and attentional/perceptual processes. This coordination comes with a cost: the misperception that briefly overlapping stimuli are separated in time. Our model predicts that abnormal intermediate layer of the superior colliculus inhibition, such as that arising from increased basal ganglia output, would affect the action and perception coupling, and it would worsen the misperception. OBJECTIVE To test the prominence map model by measuring reaction times and perceptions in human intermediate layer of the superior colliculus dysfunction. METHODS We measured the saccadic and perceptual reaction time changes and the percept for different temporal asynchronies between fixation point offset and peripheral target onset in Parkinson's disease (PD). RESULTS We found that increased basal ganglia inhibitory output to the intermediate layer of the superior colliculus prominence map disrupted the normal coupling of action and perception. With increasing temporal asynchronies, the PD perceptual reaction times increased approximately 3 times more than the increase of the saccadic reaction times. Also, PD subjects misperceive small overlaps as gaps for temporal asynchronies up to 3 times longer than controls. The results can be reproduced by an intermediate layer of the superior colliculus rostral-caudal gradient of inhibition. CONCLUSION These findings support the hypothesis that a prominence map in the intermediate layer of the superior colliculus couples action and perception through modulation of attention. A dysfunction of this network quantifies abnormal basal ganglia output and could underlie visual deficits, including common, yet poorly understood, misperceptions and visual-motor deficits of PD. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Elena Pretegiani
- Laboratory of Sensorimotor Research, National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Nora Vanegas-Arroyave
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Edmond J FitzGibbon
- Laboratory of Sensorimotor Research, National Eye Institute, NIH, Bethesda, Maryland, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Lance M Optican
- Laboratory of Sensorimotor Research, National Eye Institute, NIH, Bethesda, Maryland, USA
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Rutherford BR, Slifstein M, Chen C, Abi-Dargham A, Brown PJ, Wall MW, Vanegas-Arroyave N, Stern Y, Bailey V, Valente E, Roose SP. RETRACTED: Effects of L-DOPA Monotherapy on Psychomotor Speed and [ 11C]Raclopride Binding in High-Risk Older Adults With Depression. Biol Psychiatry 2019; 86:221-229. [PMID: 31178096 PMCID: PMC6641997 DOI: 10.1016/j.biopsych.2019.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 01/02/2019] [Revised: 03/22/2019] [Accepted: 04/04/2019] [Indexed: 01/28/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of Biological Psychiatry Editor John H. Krystal, M.D., with agreement from all authors except Chen Chen and Emily Valente. These two co-authors moved and, with no forwarding information that was available or could be found, they were therefore unable to be contacted. The authors have uncovered irregularities and deviations from the approved protocol related to the work reported in this article. Treatment with antidepressant medications within the past 28 days was an exclusion criterion: “Subjects were excluded for… current treatment or treatment within the past 4 weeks with psychotropic or other medications known to affect dopamine.” Individuals taking an ineffective antidepressant medication who otherwise met study criteria were to undergo a study-supervised medication taper to discontinue their medication for the required period prior to study participation. The published article does not describe that a subgroup of participants (15 out of the 47 consented subjects) enrolled in the study while taking an ineffective antidepressant medication. Of this subgroup, 10 individuals were successfully tapered off their medication and were among the 36 subjects contributing data to the analyses described. In addition, the authors have found that 8 participants did not complete the required 28-day washout prior to beginning the study. For these 8 participants, the medication-free period ranged from 1 to 21 days, with a mean of 10.1 days. Separately, an inclusion criterion was that eligible subjects “had Center for Epidemiologic Studies—Depression Rating scale score ≤ 10.” However, the authors have found that 3 ineligible participants were included, each of whom had depressive symptom scores 1 point out of range for eligibility. Lastly, the CONSORT diagram in Figure S1 states that 11 participants were lost to follow-up. However, this is incorrect. Instead, 9 participants were lost to follow up and 2 participants were screen failures. The authors voluntarily informed the Journal of these honest errors upon discovery. Because of the extent of these issues, the editors and authors concluded that the only course of action was to retract this paper. However, the authors are revising the paper, which the Journal will consider further for publication.
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Affiliation(s)
- Bret R Rutherford
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York.
| | - Mark Slifstein
- Stony Brook University Renaissance College of Medicine, Stony Brook, New York
| | - Chen Chen
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Anissa Abi-Dargham
- Stony Brook University Renaissance College of Medicine, Stony Brook, New York
| | - Patrick J Brown
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | - Melanie W Wall
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | | | - Yaakov Stern
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Emily Valente
- New York State Psychiatric Institute, New York, New York
| | - Steven P Roose
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
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Vanegas-Arroyave N, Panyakaew P, Lamichhane D, Shulman L, Hallett M. Possible Functional Moving Toes Syndrome. Tremor Other Hyperkinet Mov (N Y) 2016; 6:352. [PMID: 27144090 PMCID: PMC4850742 DOI: 10.7916/d8cz36xt] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/22/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Moving toes syndrome has been classically described as an organic movement disorder, on occasion related to peripheral nerve injuries. The association between nerve trauma and movement disorders has become a controversial topic, and the functional etiology of moving toes syndrome has recently been proposed. CASE REPORT We describe two cases of moving toes syndrome with clinical features typically suggestive of a functional movement disorder. DISCUSSION The presence of entrainability and distractibility in the described patients is an indication of attentional influences on their involuntary movements. However, it is possible that if there is a subcortical origin, the toe movements could be influenced by voluntary commands.
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Affiliation(s)
- Nora Vanegas-Arroyave
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Human Motor Control Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA,*To whom correspondence should be addressed. E-mail:
| | - Pattamon Panyakaew
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA,Department of Medicine, Faculty of Medicine, Chulalongkorn Center of Excellence on Parkinson Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Dronacharya Lamichhane
- Illinois Neurological Institute, University of Illinois College of Medicine-Peoria, Peoria, IL, USA
| | - Lisa Shulman
- Parkinson Disease and Movement Disorders Center, University of Maryland, Baltimore, MD, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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Park JE, Vanegas-Arroyave N, Hallett M, Lungu C. A Woman With a Novel Mutation of THAP1 With a Prominent Response to Deep Brain Stimulation of the Globus Pallidus Internus. JAMA Neurol 2016; 72:1369. [PMID: 26415042 DOI: 10.1001/jamaneurol.2015.1954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jung E Park
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Nora Vanegas-Arroyave
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland2Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Codrin Lungu
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Vanegas-Arroyave N, Lauro PM, Huang L, Hallett M, Horovitz SG, Zaghloul KA, Lungu C. Tractography patterns of subthalamic nucleus deep brain stimulation. Brain 2016; 139:1200-10. [PMID: 26921616 DOI: 10.1093/brain/aww020] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/05/2016] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation therapy is an effective symptomatic treatment for Parkinson's disease, yet the precise mechanisms responsible for its therapeutic effects remain unclear. Although the targets of deep brain stimulation are grey matter structures, axonal modulation is known to play an important role in deep brain stimulation's therapeutic mechanism. Several white matter structures in proximity to the subthalamic nucleus have been implicated in the clinical benefits of deep brain stimulation for Parkinson's disease. We assessed the connectivity patterns that characterize clinically beneficial electrodes in Parkinson's disease patients, after deep brain stimulation of the subthalamic nucleus. We evaluated 22 patients with Parkinson's disease (11 females, age 57 ± 9.1 years, disease duration 13.3 ± 6.3 years) who received bilateral deep brain stimulation of the subthalamic nucleus at the National Institutes of Health. During an initial electrode screening session, one month after deep brain stimulation implantation, the clinical benefits of each contact were determined. The electrode was localized by coregistering preoperative magnetic resonance imaging and postoperative computer tomography images and the volume of tissue activated was estimated from stimulation voltage and impedance. Brain connectivity for the volume of tissue activated of deep brain stimulation contacts was assessed using probabilistic tractography with diffusion-tensor data. Areas most frequently connected to clinically effective contacts included the thalamus, substantia nigra, brainstem and superior frontal gyrus. A series of discriminant analyses demonstrated that the strength of connectivity to the superior frontal gyrus and the thalamus were positively associated with clinical effectiveness. The connectivity patterns observed in our study suggest that the modulation of white matter tracts directed to the superior frontal gyrus and the thalamus is associated with favourable clinical outcomes and may contribute to the therapeutic effects of deep brain stimulation. Our method can be further developed to reliably identify effective deep brain stimulation contacts and aid in the programming process.
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Affiliation(s)
- Nora Vanegas-Arroyave
- Department of Neurology, Columbia University College of Physicians and Surgeons New York, NY, USA
| | - Peter M Lauro
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ling Huang
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Silvina G Horovitz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Codrin Lungu
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Lauro PM, Vanegas-Arroyave N, Huang L, Taylor PA, Zaghloul KA, Lungu C, Saad ZS, Horovitz SG. DBSproc: An open source process for DBS electrode localization and tractographic analysis. Hum Brain Mapp 2015; 37:422-33. [PMID: 26523416 DOI: 10.1002/hbm.23039] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/18/2015] [Accepted: 10/18/2015] [Indexed: 01/01/2023] Open
Abstract
Deep brain stimulation (DBS) is an effective surgical treatment for movement disorders. Although stimulation sites for movement disorders such as Parkinson's disease are established, the therapeutic mechanisms of DBS remain controversial. Recent research suggests that specific white-matter tract and circuit activation mediates symptom relief. To investigate these questions, we have developed a patient-specific open-source software pipeline called 'DBSproc' for (1) localizing DBS electrodes and contacts from postoperative CT images, (2) processing structural and diffusion MRI data, (3) registering all images to a common space, (4) estimating DBS activation volume from patient-specific voltage and impedance, and (5) understanding the DBS contact-brain connectivity through probabilistic tractography. In this paper, we explain our methodology and provide validation with anatomical and tractographic data. This method can be used to help investigate mechanisms of action of DBS, inform surgical and clinical assessments, and define new therapeutic targets.
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Affiliation(s)
- Peter M Lauro
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Nora Vanegas-Arroyave
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Ling Huang
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Paul A Taylor
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, MRC/UCT Medical Imaging Research Unit, Cape Town, South Africa.,African Institute for Mathematical Sciences, Muizenberg, Western Cape, South Africa
| | - Kareem A Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Codrin Lungu
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Ziad S Saad
- Statistical and Scientific Computing Core, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Silvina G Horovitz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Hoyos-Orrego A, Massaro-Ceballos M, Ospina-Ospina M, Gómez-Builes C, Vanegas-Arroyave N, Tobón-Pereira J, Jaramillo-Hurtado J, Rugeles-López MT. Serological markers and risk factors for hepatitis B and C viruses in patients infected with human immunodeficiency virus. Rev Inst Med Trop Sao Paulo 2007; 48:321-6. [PMID: 17221128 DOI: 10.1590/s0036-46652006000600004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 06/26/2006] [Indexed: 11/22/2022] Open
Abstract
Both hepatitis B and hepatitis C viruses (HBV and HCV) infection are common in HIV-infected individuals as a result of shared risk factors for acquisition. A serological study for HBV and HCV was performed in 251 HIV-positive individuals from Medellín, Colombia. A qualitative RT-PCR for HCV was done in 90 patients with CD4+ T-cell count < 150 per mm(3). Serological markers for HBV infection were present in 97 (38.6%) patients. Thirty six of them (37.1%) had isolated anti-HBc. A multivariate analysis indicated that the following risk factors were significantly associated with the presence of these markers: age (OR = 1.05, 95% CI: 1.01-1.08), pediculosis pubis (OR = 1.83, 95% CI: 1.01-3.33), men who have sex with men and women (OR = 3.23, 95% CI: 1.46-7.13) and men who have sex only with men (OR = 3.73, 95% CI: 1.58-8.78). The same analysis restricted to women showed syphilis as the only significant risk factor. Thus, HBV infection was considerably associated with high risk sexual behavior. HCV was present in only two (0.8%) of HIV patients. Both of them were positive by RT-PCR and anti-HCV. This low frequency of HIV/HCV coinfection was probably due to the uncommon intravenous drug abuse in this population. The frequent finding of isolated anti-HBc warrants molecular approaches to rule out the presence of cryptic HBV infection.
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Affiliation(s)
- Alvaro Hoyos-Orrego
- Grupo de Inmunovirología, Biogénesis, Universidad de Antioquia, Calle 62 #52-59, Medellín, Colombia.
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