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Alkhachroum A, Aklepi G, Sarafraz A, Robayo LE, Manolovitz BM, Blandino CF, Arwari B, Sobczak E, Bass DH, Ghamasaee P, Samano D, Massad N, Kottapally M, Merenda A, Dib S, Jagid JR, Dietrich WD, Rundek T, O'Phelan K, Claassen J, Walker MF. Covert Tracking to Visual Stimuli in Comatose Patients With Traumatic Brain Injury. Neurology 2023; 101:489-494. [PMID: 37076304 PMCID: PMC10513885 DOI: 10.1212/wnl.0000000000207302] [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] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/02/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES This study investigated video eye tracking (VET) in comatose patients with traumatic brain injury (TBI). METHODS We recruited healthy participants and unresponsive patients with TBI. We surveyed the patients' clinicians on whether the patient was tracking and performed the Coma Recovery Scale-Revised (CRS-R). We recorded eye movements in response to motion of a finger, a face, a mirror, and an optokinetic stimulus using VET glasses. Patients were classified as covert tracking (tracking on VET alone) and overt tracking (VET and clinical examination). The ability to obey commands was evaluated at 6-month follow-up. RESULTS We recruited 20 healthy participants and 10 patients with TBI. The use of VET was feasible in all participants and patients. Two patients demonstrated covert tracking (CRS-R of 6 and 8), 2 demonstrated overt tracking (CRS-R of 22 and 11), and 6 patients had no tracking (CRS-R of 8, 6, 5, 7, 6, and 7). Five of 56 (9%) tracking assessments were missed on clinical examination. All patients with tracking recovered consciousness at follow-up, whereas only 2 of 6 patients without tracking recovered at follow-up. DISCUSSION VET is a feasible method to measure covert tracking. Future studies are needed to confirm the prognostic value of covert tracking.
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Affiliation(s)
- Ayham Alkhachroum
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH.
| | - Gabriela Aklepi
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Amin Sarafraz
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Linda E Robayo
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Brian M Manolovitz
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Carlos F Blandino
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Brian Arwari
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Evie Sobczak
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Danielle H Bass
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Pardis Ghamasaee
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Daniel Samano
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Nina Massad
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Mohan Kottapally
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Amedeo Merenda
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Salim Dib
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Jonathan R Jagid
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - W Dalton Dietrich
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Tatjana Rundek
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Kristine O'Phelan
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Jan Claassen
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Mark F Walker
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
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Sobczak E, Swafford EP, Samano D, Bass D, Ghamasaee P, Kottapally M, Merenda A, O'Phelan K, Romano JG, Sacco RL, Rundek T, Alkhachroum A. Posttraumatic Stress Symptoms Among COVID-19 Survivors After Hospitalization. J Neuropsychiatry Clin Neurosci 2023; 35:256-261. [PMID: 36710628 DOI: 10.1176/appi.neuropsych.20220126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Limited data are available on posttraumatic stress symptoms (PTSS) among COVID-19 survivors. This study aimed to contribute to this knowledge base. METHODS PTSS among COVID-19 survivors who had been hospitalized were investigated. Patients were identified as COVID-19 positive at hospital admission. COVID-19 survivors were surveyed with the Posttraumatic Stress Disorder Checklist (PCL-5) between March and October 2020 at 5- and 12-month postdischarge follow-up points. RESULTS Of 411 patients, 331 (81%) survived to hospital discharge. Of these survivors, 83 (25%) completed the PCL-5 at the 5-month follow-up. Of those patients, 12 (14%) screened positive for PTSS. At the 12-month follow-up, four of eight patients remained PTSS positive. Mean age of follow-up participants was 62±15 years; 47% were women, 65% were White, and 63% were Hispanic. PTSS-positive patients were predominantly non-White (67% vs. 30%, p=0.02), and although the differences were not statistically significant, these patients tended to be younger (56 vs. 63 years, p=0.08) and have shorter intensive care unit stays (2.0 vs. 12.5 days, p=0.06). PTSS-positive and PTSS-negative groups did not differ significantly in prehospitalization neurological diagnoses (11% vs. 8%), psychiatric diagnoses (17% vs. 21%), and intensive care admission status (25% vs. 25%). More patients in the PTSS-positive group had returned to the emergency department (50% vs. 14%, p<0.01) and reported fatigue at follow-up (100% vs. 42%, p<0.001). In the multivariate logistic regression model, non-White race (OR=11, 95% CI=2-91) and returning to the emergency department (OR=19, 95% CI=3-252) were associated with PTSS-positive status. CONCLUSION PTSS were twice as common among hospitalized COVID-19 survivors than among those in the general population.
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Affiliation(s)
- Evie Sobczak
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Emily P Swafford
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Daniel Samano
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Danielle Bass
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Pardis Ghamasaee
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Mohan Kottapally
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Amedeo Merenda
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Kristine O'Phelan
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Jose G Romano
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Ralph L Sacco
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Tatjana Rundek
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
| | - Ayham Alkhachroum
- Department of Neurology (all authors) and the Evelyn F. McKnight Brain Institute (Sacco, Rundek), University of Miami; Department of Neurology, Jackson Memorial Hospital, Miami (Sobczak, Swafford, Samano, Kottapally, Merenda, O'Phelan, Romano, Sacco, Rundek, Alkhachroum)
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