1
|
Gannamani R, Castela Forte J, Folkertsma P, Hermans S, Kumaraswamy S, van Dam S, Chavannes N, van Os H, Pijl H, Wolffenbuttel BHR. A Digitally Enabled Combined Lifestyle Intervention for Weight Loss: Pilot Study in a Dutch General Population Cohort. JMIR Form Res 2024; 8:e38891. [PMID: 38329792 PMCID: PMC10884913 DOI: 10.2196/38891] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Overweight and obesity rates among the general population of the Netherlands keep increasing. Combined lifestyle interventions (CLIs) focused on physical activity, nutrition, sleep, and stress management can be effective in reducing weight and improving health behaviors. Currently available CLIs for weight loss (CLI-WLs) in the Netherlands consist of face-to-face and community-based sessions, which face scalability challenges. A digitally enabled CLI-WL with digital and human components may provide a solution for this challenge; however, the feasibility of such an intervention has not yet been assessed in the Netherlands. OBJECTIVE The aim of this study was two-fold: (1) to determine how weight and other secondary cardiometabolic outcomes (lipids and blood pressure) change over time in a Dutch population with overweight or obesity and cardiometabolic risk participating in a pilot digitally enabled CLI-WL and (2) to collect feedback from participants to guide the further development of future iterations of the intervention. METHODS Participants followed a 16-week digitally enabled lifestyle coaching program rooted in the Fogg Behavior Model, focused on nutrition, physical activity, and other health behaviors, from January 2020 to December 2021. Participants could access the digital app to register and track health behaviors, weight, and anthropometrics data at any time. We retrospectively analyzed changes in weight, blood pressure, and lipids for remeasured users. Surveys and semistructured interviews were conducted to assess critical positive and improvement points reported by participants and health care professionals. RESULTS Of the 420 participants evaluated at baseline, 53 participated in the pilot. Of these, 37 (70%) were classified as overweight and 16 (30%) had obesity. Mean weight loss of 4.2% occurred at a median of 10 months postintervention. The subpopulation with obesity (n=16) showed a 5.6% weight loss on average. Total cholesterol decreased by 10.2% and low-density lipoprotein cholesterol decreased by 12.9% on average. Systolic and diastolic blood pressure decreased by 3.5% and 7.5%, respectively. Participants identified the possibility of setting clear action plans to work toward and the multiple weekly touch points with coaches as two of the most positive and distinctive components of the digitally enabled intervention. Surveys and interviews demonstrated that the digital implementation of a CLI-WL is feasible and well-received by both participants and health care professionals. CONCLUSIONS Albeit preliminary, these findings suggest that a behavioral lifestyle program with a digital component can achieve greater weight loss than reported for currently available offline CLI-WLs. Thus, a digitally enabled CLI-WL is feasible and may be a scalable alternative to offline CLI-WL programs. Evidence from future studies in a Dutch population may help elucidate the mechanisms behind the effectiveness of a digitally enabled CLI-WL.
Collapse
Affiliation(s)
- Rahul Gannamani
- Ancora Health BV, Groningen, Netherlands
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - José Castela Forte
- Ancora Health BV, Groningen, Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Pytrik Folkertsma
- Ancora Health BV, Groningen, Netherlands
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Sipko van Dam
- Ancora Health BV, Groningen, Netherlands
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Hendrikus van Os
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Hanno Pijl
- Department of Endocrinology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| |
Collapse
|
2
|
Castela Forte J, Folkertsma P, Gannamani R, Kumaraswamy S, van Dam S, Hoogsteen J. Effect of a Digitally-Enabled, Preventive Health Program on Blood Pressure in an Adult, Dutch General Population Cohort: An Observational Pilot Study. Int J Environ Res Public Health 2022; 19:ijerph19074171. [PMID: 35409854 PMCID: PMC8998845 DOI: 10.3390/ijerph19074171] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023]
Abstract
Worldwide, it is estimated that at least one in four adults suffers from hypertension, and this number is expected to increase as populations grow and age. Blood pressure (BP) possesses substantial heritability, but is also heavily modulated by lifestyle factors. As such, digital, lifestyle-based interventions are a promising alternative to standard care for hypertension prevention and management. In this study, we assessed the prevalence of elevated and high BP in a Dutch general population cohort undergoing a health screening, and observed the effects of a subsequent self-initiated, digitally-enabled lifestyle program on BP regulation. Baseline data were available for 348 participants, of which 56 had partaken in a BP-focused lifestyle program and got remeasured 10 months after the intervention. Participants with elevated SBP and DBP at baseline showed a mean decrease of 7.2 mmHg and 5.4 mmHg, respectively. Additionally, 70% and 72.5% of participants showed an improvement in systolic and diastolic BP at remeasurement. These improvements in BP are superior to those seen in other recent studies. The long-term sustainability and the efficacy of this and similar digital lifestyle interventions will need to be established in additional, larger studies.
Collapse
Affiliation(s)
- José Castela Forte
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9711 LM Groningen, The Netherlands
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
- Correspondence:
| | - Pytrik Folkertsma
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, 9711 LM Groningen, The Netherlands
| | - Rahul Gannamani
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9711 LM Groningen, The Netherlands
| | - Sridhar Kumaraswamy
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
| | - Sipko van Dam
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, 9711 LM Groningen, The Netherlands
| | - Jan Hoogsteen
- Ancora Health B.V., 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.v.D.); (J.H.)
| |
Collapse
|
3
|
Castela Forte J, Gannamani R, Folkertsma P, Kumaraswamy S, Mount S, van Dam S, Hoogsteen J. Changes in blood lipid levels after a digitally-enabled, cardiometabolic preventive health program: a pre-post study in an adult, Dutch general population cohort (Preprint). JMIR Cardio 2021; 6:e34946. [PMID: 35319473 PMCID: PMC8987960 DOI: 10.2196/34946] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/12/2022] [Accepted: 03/05/2022] [Indexed: 01/17/2023] Open
Abstract
Background Despite widespread education, many individuals fail to follow basic health behaviors such as consuming a healthy diet and exercising. Positive changes in lifestyle habits are associated with improvements in multiple cardiometabolic health risk factors, including lipid levels. Digital lifestyle interventions have been suggested as a viable complement or potential alternative to conventional health behavior change strategies. However, the benefit of digital preventive interventions for lipid levels in a preventive health context remains unclear. Objective This observational study aimed to determine how the levels of lipids, namely total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, non-HDL cholesterol, and triglycerides, changed over time in a Dutch general population cohort undergoing a digital preventive health program. Moreover, we looked to establish associations between lifestyle factors at baseline and lipid levels. Methods We included 348 adults from the Dutch general population who underwent a digitally enabled preventive health program at Ancora Health between January 2020 and October 2021. Upon enrollment, participants underwent a baseline assessment involving a comprehensive lifestyle questionnaire, a blood biochemistry panel, physical measurements, and cardiopulmonary fitness measurements. Thereafter, users underwent a lifestyle coaching program and could access the digital application to register and track health behaviors, weight, and anthropometric data at any time. Lipid levels were categorized as normal, elevated, high, and clinical dyslipidemia according to accepted international standards. If at least one lipid marker was high or HDL was low, participants received specific coaching and advice for cardiometabolic health. We retrospectively analyzed the mean and percentage changes in lipid markers in users who were remeasured after a cardiometabolic health–focused intervention, and studied the association between baseline user lifestyle characteristics and having normal lipid levels. Results In our cohort, 199 (57.2%) participants had dyslipidemia at baseline, of which 104 participants were advised to follow a cardiometabolic health–focused intervention. Eating more amounts of favorable food groups and being more active were associated with normal lipid profiles. Among the participants who underwent remeasurement 9 months after intervention completion, 57% (17/30), 61% (19/31), 56% (15/27), 82% (9/11), and 100% (8/8) showed improvements at remeasurement for total, LDL, HDL, and non-HDL cholesterol, and triglycerides, respectively. Moreover, between 35.3% and 77.8% showed a return to normal levels. In those with high lipid levels at baseline, total cholesterol decreased by 0.5 mmol/L (7.5%), LDL cholesterol decreased by 0.39 mmol/L (10.0%), non-HDL cholesterol decreased by 0.44 mmol/L (8.3%), triglycerides decreased by 0.97 mmol/L (32.0%), and HDL increased by 0.17 mmol/L (15.6%), after the intervention. Conclusions A cardiometabolic screening program in a general population cohort identified a significant portion of individuals with subclinical and clinical lipid levels. Individuals who, after screening, actively engaged in a cardiometabolic health–focused lifestyle program improved their lipid levels.
Collapse
Affiliation(s)
- José Castela Forte
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Groningen, Netherlands
- Ancora Health BV, Groningen, Netherlands
| | - Rahul Gannamani
- Ancora Health BV, Groningen, Netherlands
- Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
| | | | | | | | | | | |
Collapse
|
4
|
Castela Forte J, Folkertsma P, Gannamani R, Kumaraswamy S, Mount S, de Koning TJ, van Dam S, Wolffenbuttel BHR. Development and Validation of Decision Rules Models to Stratify Coronary Artery Disease, Diabetes, and Hypertension Risk in Preventive Care: Cohort Study of Returning UK Biobank Participants. J Pers Med 2021; 11:1322. [PMID: 34945794 PMCID: PMC8707007 DOI: 10.3390/jpm11121322] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/23/2021] [Accepted: 11/20/2021] [Indexed: 12/25/2022] Open
Abstract
Many predictive models exist that predict risk of common cardiometabolic conditions. However, a vast majority of these models do not include genetic risk scores and do not distinguish between clinical risk requiring medical or pharmacological interventions and pre-clinical risk, where lifestyle interventions could be first-choice therapy. In this study, we developed, validated, and compared the performance of three decision rule algorithms including biomarkers, physical measurements, and genetic risk scores for incident coronary artery disease (CAD), diabetes (T2D), and hypertension against commonly used clinical risk scores in 60,782 UK Biobank participants. The rules models were tested for an association with incident CAD, T2D, and hypertension, and hazard ratios (with 95% confidence interval) were calculated from survival models. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), and Net Reclassification Index (NRI). The higher risk group in the decision rules model had a 40-, 40.9-, and 21.6-fold increased risk of CAD, T2D, and hypertension, respectively (p < 0.001 for all). Risk increased significantly between the three strata for all three conditions (p < 0.05). Based on genetic risk alone, we identified not only a high-risk group, but also a group at elevated risk for all health conditions. These decision rule models comprising blood biomarkers, physical measurements, and polygenic risk scores moderately improve commonly used clinical risk scores at identifying individuals likely to benefit from lifestyle intervention for three of the most common lifestyle-related chronic health conditions. Their utility as part of digital data or digital therapeutics platforms to support the implementation of lifestyle interventions in preventive and primary care should be further validated.
Collapse
Affiliation(s)
- José Castela Forte
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
| | - Pytrik Folkertsma
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Rahul Gannamani
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Sridhar Kumaraswamy
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
| | - Sarah Mount
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
| | - Tom J. de Koning
- Department of Neurology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Pediatrics, Department of Clinical Sciences, Lund University, Sölvegatan 19-BMC F12, 221 84 Lund, Sweden
| | - Sipko van Dam
- Ancora Health B.V., Herestraat 106, 9711 LM Groningen, The Netherlands; (P.F.); (R.G.); (S.K.); (S.M.); (S.v.D.)
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Bruce H. R. Wolffenbuttel
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| |
Collapse
|
5
|
van der Stouwe AMM, Tuitert I, Giotis I, Calon J, Gannamani R, Dalenberg JR, van der Veen S, Klamer MR, Telea AC, Tijssen MAJ. Next move in movement disorders (NEMO): developing a computer-aided classification tool for hyperkinetic movement disorders. BMJ Open 2021; 11:e055068. [PMID: 34635535 PMCID: PMC8506849 DOI: 10.1136/bmjopen-2021-055068] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/28/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Our aim is to develop a novel approach to hyperkinetic movement disorder classification, that combines clinical information, electromyography, accelerometry and video in a computer-aided classification tool. We see this as the next step towards rapid and accurate phenotype classification, the cornerstone of both the diagnostic and treatment process. METHODS AND ANALYSIS The Next Move in Movement Disorders (NEMO) study is a cross-sectional study at Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen. It comprises patients with single and mixed phenotype movement disorders. Single phenotype groups will first include dystonia, myoclonus and tremor, and then chorea, tics, ataxia and spasticity. Mixed phenotypes are myoclonus-dystonia, dystonic tremor, myoclonus ataxia and jerky/tremulous functional movement disorders. Groups will contain 20 patients, or 40 healthy participants. The gold standard for inclusion consists of interobserver agreement on the phenotype among three independent clinical experts. Electromyography, accelerometry and three-dimensional video data will be recorded during performance of a set of movement tasks, chosen by a team of specialists to elicit movement disorders. These data will serve as input for the machine learning algorithm. Labels for supervised learning are provided by the expert-based classification, allowing the algorithm to learn to predict what the output label should be when given new input data. Methods using manually engineered features based on existing clinical knowledge will be used, as well as deep learning methods which can detect relevant and possibly new features. Finally, we will employ visual analytics to visualise how the classification algorithm arrives at its decision. ETHICS AND DISSEMINATION Ethical approval has been obtained from the relevant local ethics committee. The NEMO study is designed to pioneer the application of machine learning of movement disorders. We expect to publish articles in multiple related fields of research and patients will be informed of important results via patient associations and press releases.
Collapse
Affiliation(s)
- A M Madelein van der Stouwe
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge Tuitert
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ioannis Giotis
- ZiuZ Visual Intelligence BV, Gorredijk, Groningen, The Netherlands
| | - Joost Calon
- ZiuZ Visual Intelligence BV, Gorredijk, Groningen, The Netherlands
| | - Rahul Gannamani
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jelle R Dalenberg
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sterre van der Veen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marrit R Klamer
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
- ZiuZ Visual Intelligence BV, Gorredijk, Groningen, The Netherlands
| | - Alex C Telea
- Department of Information and Computing Sciences, University of Utrecht, Utrecht, The Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Expertise Centre Movement Disorders Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
6
|
Gannamani R, van der Veen S, van Egmond M, de Koning TJ, Tijssen MAJ. Challenges in Clinicogenetic Correlations: One Phenotype - Many Genes. Mov Disord Clin Pract 2021; 8:311-321. [PMID: 33816658 PMCID: PMC8015914 DOI: 10.1002/mdc3.13163] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 12/11/2022] Open
Abstract
Background In the field of movement disorders, what you see (phenotype) is seldom what you get (genotype). Whereas 1 phenotype was previously associated to 1 gene, the advent of next‐generation sequencing (NGS) has facilitated an exponential increase in disease‐causing genes and genotype–phenotype correlations, and the “one‐phenotype‐many‐genes” paradigm has become prominent. Objectives To highlight the “one‐phenotype‐many‐genes” paradigm by discussing the main challenges, perspectives on how to address them, and future directions. Methods We performed a scoping review of the various aspects involved in identifying the underlying molecular cause of a movement disorder phenotype. Results The notable challenges are (1) the lack of gold standards, overlap in clinical spectrum of different movement disorders, and variability in the interpretation of classification systems; (2) selecting which patients benefit from genetic tests and the choice of genetic testing; (3) problems in the variant interpretation guidelines; (4) the filtering of variants associated with disease; and (5) the lack of standardized, complete, and up‐to‐date gene lists. Perspectives to address these include (1) deep phenotyping and genotype–phenotype integration, (2) adherence to phenotype‐specific diagnostic algorithms, (3) implementation of current and complementary bioinformatic tools, (4) a clinical‐molecular diagnosis through close collaboration between clinicians and genetic laboratories, and (5) ongoing curation of gene lists and periodic reanalysis of genetic sequencing data. Conclusions Despite the rapidly emerging possibilities of NGS, there are still many steps to take to improve the genetic diagnostic yield. Future directions, including post‐NGS phenotyping and cohort analyses enriched by genotype–phenotype integration and gene networks, ought to be pursued to accelerate identification of disease‐causing genes and further improve our understanding of disease biology.
Collapse
Affiliation(s)
- Rahul Gannamani
- Department of Neurology University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Department of Genetics University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Expertise Centre Movement Disorders Groningen University Medical Centre Groningen Groningen The Netherlands
| | - Sterre van der Veen
- Department of Neurology University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Expertise Centre Movement Disorders Groningen University Medical Centre Groningen Groningen The Netherlands
| | - Martje van Egmond
- Department of Neurology University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Expertise Centre Movement Disorders Groningen University Medical Centre Groningen Groningen The Netherlands
| | - Tom J de Koning
- Department of Genetics University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Expertise Centre Movement Disorders Groningen University Medical Centre Groningen Groningen The Netherlands.,Pediatrics, Department of Clinical Sciences Lund University Lund Sweden
| | - Marina A J Tijssen
- Department of Neurology University of Groningen, University Medical Centre Groningen Groningen The Netherlands.,Expertise Centre Movement Disorders Groningen University Medical Centre Groningen Groningen The Netherlands
| |
Collapse
|
7
|
Gannamani R, Timmers ER, Tijssen MAJ. The use of next-generation sequencing to unravel new genes: overcoming challenges posed by rare neurological disorders such as myoclonus-dystonia. Eur J Neurol 2020; 27:1459-1460. [PMID: 32365425 DOI: 10.1111/ene.14296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R Gannamani
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Department of Genetics, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - E R Timmers
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| |
Collapse
|
8
|
|