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Young MJ, Awad A, Andreev A, Bonkhoff AK, Schirmer MD, Dmytriw AA, Vranic JE, Rabinov JD, Doron O, Stapleton CJ, Das AS, Edlow BL, Singhal AB, Rost NS, Patel AB, Regenhardt RW. Characterizing coma in large vessel occlusion stroke. J Neurol 2024; 271:2658-2661. [PMID: 38366071 DOI: 10.1007/s00415-024-12199-2] [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: 11/30/2023] [Revised: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Coma is an unresponsive state of disordered consciousness characterized by impaired arousal and awareness. The epidemiology and pathophysiology of coma in ischemic stroke has been underexplored. We sought to characterize the incidence and clinical features of coma as a presentation of large vessel occlusion (LVO) stroke. METHODS Individuals who presented with LVO were retrospectively identified from July 2018 to December 2020. Coma was defined as an unresponsive state of impaired arousal and awareness, operationalized as a score of 3 on NIHSS item 1a. RESULTS 28/637 (4.4%) patients with LVO stroke were identified as presenting with coma. The median NIHSS was 32 (IQR 29-34) for those with coma versus 11 (5-18) for those without (p < 0.0001). In coma, occlusion locations included basilar (13), vertebral (2), internal carotid (5), and middle cerebral (9) arteries. 8/28 were treated with endovascular thrombectomy (EVT), and 20/28 died during the admission. 65% of patients not treated with EVT had delayed presentations or large established infarcts. In models accounting for pre-stroke mRS, basilar occlusion location, intravenous thrombolysis, and EVT, coma independently increased the odds of transitioning to comfort care during admission (aOR 6.75; 95% CI 2.87,15.84; p < 0.001) and decreased the odds of 90-day mRS 0-2 (aOR 0.12; 95% CI 0.03,0.55; p = 0.007). CONCLUSIONS It is not uncommon for patients with LVO to present with coma, and delayed recognition of LVO can lead to poor outcomes, emphasizing the need for maintaining a high index of suspicion. While more commonly thought to result from posterior LVO, coma in our cohort was similarly likely to result from anterior LVO. Efforts to improve early diagnosis and care of patients with LVO presenting with coma are crucial.
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Affiliation(s)
- Michael J Young
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA.
| | - Amine Awad
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA
| | - Alexander Andreev
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Anna K Bonkhoff
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA
| | - Markus D Schirmer
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA
| | - Adam A Dmytriw
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Justin E Vranic
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - James D Rabinov
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Omer Doron
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Alvin S Das
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brian L Edlow
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 101 Merrimac Street, Suite 310, Boston, MA, 02114, USA
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Beylergil SB, Noecker AM, Kilbane C, McIntyre CC, Shaikh AG. Does Vestibular Motion Perception Correlate with Axonal Pathways Stimulated by Subthalamic Deep Brain Stimulation in Parkinson's Disease? Cerebellum 2024; 23:554-569. [PMID: 37308757 DOI: 10.1007/s12311-023-01576-8] [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] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
Perception of our linear motion - heading - is critical for postural control, gait, and locomotion, and it is impaired in Parkinson's disease (PD). Deep brain stimulation (DBS) has variable effects on vestibular heading perception, depending on the location of the electrodes within the subthalamic nucleus (STN). Here, we aimed to find the anatomical correlates of heading perception in PD. Fourteen PD participants with bilateral STN DBS performed a two-alternative forced-choice discrimination task where a motion platform delivered translational forward movements with a heading angle varying between 0 and 30° to the left or to the right with respect to the straight-ahead direction. Using psychometric curves, we derived the heading discrimination threshold angle of each patient from the response data. We created patient-specific DBS models and calculated the percentages of stimulated axonal pathways that are anatomically adjacent to the STN and known to play a major role in vestibular information processing. We performed correlation analyses to investigate the extent of these white matter tracts' involvement in heading perception. Significant positive correlations were identified between improved heading discrimination for rightward heading and the percentage of activated streamlines of the contralateral hyperdirect, pallido-subthalamic, and subthalamo-pallidal pathways. The hyperdirect pathways are thought to provide top-down control over STN connections to the cerebellum. In addition, STN may also antidromically activate collaterals of hyperdirect pathway that projects to the precerebellar pontine nuclei. In select cases, there was strong activation of the cerebello-thalamic projections, but it was not consistently present in all participants. Large volumetric overlap between the volume of tissue activation and the STN in the left hemisphere positively impacted rightward heading perception. Altogether, the results suggest heavy involvement of basal ganglia cerebellar network in STN-induced modulation of vestibular heading perception in PD.
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Affiliation(s)
- Sinem Balta Beylergil
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Angela M Noecker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Camilla Kilbane
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Aasef G Shaikh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
- National VA Parkinson Consortium Center, Neurology Service, Daroff-Dell'Osso Ocular Motility and Vestibular Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
- Department of Neurology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, OH, USA.
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Aamodt WW, Kluger BM, Mirham M, Job A, Lettenberger SE, Mosley PE, Seshadri S. Caregiver Burden in Parkinson Disease: A Scoping Review of the Literature from 2017-2022. J Geriatr Psychiatry Neurol 2024; 37:96-113. [PMID: 37551798 PMCID: PMC10802092 DOI: 10.1177/08919887231195219] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Caregiver burden is a term that refers to the adverse effect of caregiving on the physical, emotional, social, spiritual, and financial well-being of the caregiver. Caregiver burden is associated with providing care to an individual with a chronic illness or disability, and the unique symptoms of Parkinson disease (PD) can amplify a patient's needs and reliance on others, leading to adverse outcomes for patients and their caregivers. In this scoping review of the literature from January 2017 through April 2022 that included 114 studies, we provide an updated, evidence-based summary of patient and caregiver-related factors that contribute to caregiver burden in PD. We also describe the impact of caregiver stress and burden on caregivers based on qualitative research studies and review recent interventions to mitigate burden. By providing clinical updates for practitioners, this review is designed to improve recognition of caregiver burden in the post-pandemic era and foster the development of targeted interventions to reduce caregiver burden in PD.
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Affiliation(s)
- Whitley W. Aamodt
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Benzi M. Kluger
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Miray Mirham
- School of Medicine, University of Rochester, Rochester, NY, USA
| | - Anna Job
- University of Rochester, Rochester, NY, USA
| | | | - Philip E. Mosley
- School of Medicine, University of Queensland, Herston, QLD, Australia
| | - Sandhya Seshadri
- Department of Neurology, University of Rochester, Rochester, NY, USA
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Yoo A, Guterman EL, Hwang DY, Holloway RG, George BP. Impact of the COVID-19 Pandemic on Inpatient Utilization for Acute Neurologic Disease. Neurohospitalist 2024; 14:13-22. [PMID: 38235034 PMCID: PMC10790622 DOI: 10.1177/19418744231196984] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Background and Objective: The initial months of the Corona Virus 2019 (COVID-19) pandemic resulted in decreased hospitalizations. We aimed to describe differences in hospitalizations and related procedures across neurologic disease. Methods: In our retrospective observational study using the California State Inpatient Database and state-wide population-level estimates, we calculated neurologic hospitalization rates for a control period from January 2019 to February 2020 and a COVID-19 pandemic period from March to December 2020. We calculated incident rate ratios (IRR) for neurologic hospitalizations using negative binomial regression and compared relevant procedure rates over time. Results: Population-based neurologic hospitalization rates were 29.1 per 100,000 (95% CI 26.9-31.3) in April 2020 compared to 43.6 per 100,000 (95% CI 40.4-46.7) in January 2020. Overall, the pandemic period had 13% lower incidence of neurologic hospitalizations per month (IRR 0.87, 95% CI 0.86-0.89). The smallest decreases were in neurotrauma (IRR 0.92, 95% CI 0.89-0.95) and neuro-oncologic cases (IRR 0.93, 95% CI 0.87-0.99). Headache admissions experienced the greatest decline (IRR 0.62, 95% CI 0.58-0.66). For ischemic stroke, greater rates of endovascular thrombectomy (5.6% vs 5.0%; P < .001) were observed in the pandemic. Among all neurologic disease, greater rates of gastrostomy (4.0% vs 3.5%; P < .001), intubation/mechanical ventilation (14.3% vs 12.9%, P < .001), and tracheostomy (1.4 vs 1.2%; P < .001) were observed during the pandemic. Conclusions: During the first months of the COVID-19 pandemic there were fewer hospitalizations to varying degrees for all neurologic diagnoses. Rates of procedures indicating severe disease increased. Further study is needed to determine the impact on triage, patient outcomes, and cost consequences.
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Affiliation(s)
- Alexander Yoo
- Department of Medicine, University of Pennsylvania Perlman School of Medicine, Philadelphia, PA, USA
| | - Elan L. Guterman
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - David Y. Hwang
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert G. Holloway
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Benjamin P. George
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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Harrison EI, Kirkpatrick LA, Harrison PW, Kazmerski TM, Sogawa Y, Hochheiser HS. Use of Natural Language Processing to Identify Sexual and Reproductive Health Information in Clinical Text. Methods Inf Med 2023; 62:193-201. [PMID: 38122815 DOI: 10.1055/a-2233-2736] [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] [Indexed: 12/23/2023]
Abstract
OBJECTIVES This study aimed to enable clinical researchers without expertise in natural language processing (NLP) to extract and analyze information about sexual and reproductive health (SRH), or other sensitive health topics, from large sets of clinical notes. METHODS (1) We retrieved text from the electronic health record as individual notes. (2) We segmented notes into sentences using one of scispaCy's NLP toolkits. (3) We exported sentences to the labeling application Watchful and annotated subsets of these as relevant or irrelevant to various SRH categories by applying a combination of regular expressions and manual annotation. (4) The labeled sentences served as training data to create machine learning models for classifying text; specifically, we used spaCy's default text classification ensemble, comprising a bag-of-words model and a neural network with attention. (5) We applied each model to unlabeled sentences to identify additional references to SRH with novel relevant vocabulary. We used this information and repeated steps 3 to 5 iteratively until the models identified no new relevant sentences for each topic. Finally, we aggregated the labeled data for analysis. RESULTS This methodology was applied to 3,663 Child Neurology notes for 971 female patients. Our search focused on six SRH categories. We validated the approach using two subject matter experts, who independently labeled a sample of 400 sentences. Cohen's kappa values were calculated for each category between the reviewers (menstruation: 1, sexual activity: 0.9499, contraception: 0.9887, folic acid: 1, teratogens: 0.8864, pregnancy: 0.9499). After removing the sentences on which reviewers did not agree, we compared the reviewers' labels to those produced via our methodology, again using Cohen's kappa (menstruation: 1, sexual activity: 1, contraception: 0.9885, folic acid: 1, teratogens: 0.9841, pregnancy: 0.9871). CONCLUSION Our methodology is reproducible, enables analysis of large amounts of text, and has produced results that are highly comparable to subject matter expert manual review.
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Affiliation(s)
- Elizabeth I Harrison
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Laura A Kirkpatrick
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Traci M Kazmerski
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Yoshimi Sogawa
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Harry S Hochheiser
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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Sedov A, Joshi P, Semenova U, Usova S, Asriyants S, Gamaleya A, Tomskiy A, Jinnah HA, Shaikh AG. Proprioceptive Modulation of Pallidal Physiology in Cervical Dystonia. Mov Disord 2023; 38:2094-2102. [PMID: 37702261 DOI: 10.1002/mds.29603] [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: 04/28/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND There is a growing body of evidence suggesting that botulinum toxin can alter proprioceptive feedback and modulate the muscle-spindle output for the treatment of dystonia. However, the mechanism for this modulation remains unclear. METHODS We conducted a study involving 17 patients with cervical dystonia (CD), seven of whom had prominent CD and 10 with generalized dystonia (GD) along with CD. We investigated the effects of neck vibration, a form of proprioceptive modulation, on spontaneous single-neuron responses and local field potentials (LFPs) recorded from the globus pallidum externus (GPe) and internus (GPi). RESULTS Our findings demonstrated that neck vibration notably increased the regularity of neck-sensitive GPi neurons in focal CD patients. Additionally, in patients with GD and CD, the vibration enhanced the firing regularity of non-neck-sensitive neurons. These effects on single-unit activity were also mirrored in ensemble responses measured through LFPs. Notably, the LFP modulation was particularly pronounced in areas populated with burst neurons compared to pause or tonic cells. CONCLUSION The results from our study emphasize the significance of burst neurons in the pathogenesis of dystonia and in the efficacy of proprioceptive modulation for its treatment. Moreover, we observed that the effects of vibration on focal CD were prominent in the α band LFP, indicating modulation of pallido-cerebellar connectivity. Moreover, the pallidal effects of vibration in GD with CD involved modulation of cerebro-pallidal θ band connectivity. Our analysis provides insight into how vibration-induced changes in pallidal activity are integrated into the downstream motor circuit. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alexey Sedov
- N.N. Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow, Russia
- Moscow Institute of Physics and Technology, Dolgoprudny, Moscow Region, Russia
| | - Prajakta Joshi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ulia Semenova
- N.N. Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Svetlana Usova
- N.N. Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - Svetlana Asriyants
- N.N. Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow, Russia
- Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Anna Gamaleya
- Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Alexey Tomskiy
- Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Hyder A Jinnah
- Department of Neurology, Pediatrics, and Genetics, Emory University, Atlanta, Georgia, USA
| | - Aasef G Shaikh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
- Neurological Institute, University Hospitals, Cleveland, Ohio, USA
- Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
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Agharazi H, Wang A, Guha A, Gupta P, Shaikh AG. Unraveling the Twist: Spatial Navigational Challenges in Cervical Dystonia. Mov Disord 2023; 38:2116-2121. [PMID: 37914913 DOI: 10.1002/mds.29612] [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: 05/24/2023] [Accepted: 09/05/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Cervical dystonia (CD) is an intricate neurological condition with motor and nonmotor symptoms. These include disruptions in visual perception, self-orientation, visual working memory, and vestibular functions. However, the specific impact of CD on perceiving self-motion direction, especially with isolated visual or vestibular stimuli, remains largely unexplored. OBJECTIVE This study aimed to examine the effects of CD on linear motion perception, hypothesizing impaired heading discrimination in both vestibular and visual tasks, and that such deficits correlate with the disease severity. METHODS We employed a cutting-edge motion platform to precisely control whole-body linear motion. Through repeated two-alternative forced-choice tasks, we assessed vestibular heading direction discrimination. Participants observed dynamic star clouds in immersive virtual reality and indicated their perceived self-motion direction, evaluating visual heading direction discrimination. Sensitivity to direction variations and response accuracy errors were analyzed using robust Gaussian cumulative distribution psychometric functions. RESULTS Heading perception is impaired in individuals with CD, particularly evident in vestibular heading discrimination. CD severity correlated with elevated thresholds for both vestibular and visual heading discrimination. Surprisingly, lateralized CD did not introduce bias in either system, suggesting widespread disruption over localized effects. CONCLUSIONS Contrary to previous beliefs, our findings challenge the idea that CD-related heading discrimination issues mainly arise from peripheral vestibular effects. Instead, abnormal proprioceptive input from dystonic neck muscles introduces noise into the central mechanism integrating visual, vestibular, and proprioceptive signals. These insights into spatial navigation deficits have implications for future CD research. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
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Affiliation(s)
- Hanieh Agharazi
- National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Alexander Wang
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, Ohio, USA
| | - Aratrik Guha
- National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Palak Gupta
- National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Aasef G Shaikh
- National VA Parkinson Consortium Center, Neurology Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, USA
- Movement Disorders Center, Neurological Institute, University Hospitals, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Funk AT, Hassan AAO, Brüggemann N, Sharma N, Breiter HC, Blood AJ, Waugh JL. In humans, striato-pallido-thalamic projections are largely segregated by their origin in either the striosome-like or matrix-like compartments. Front Neurosci 2023; 17:1178473. [PMID: 37954873 PMCID: PMC10634229 DOI: 10.3389/fnins.2023.1178473] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/04/2023] [Indexed: 11/14/2023] Open
Abstract
Cortico-striato-thalamo-cortical (CSTC) loops are fundamental organizing units in mammalian brains. CSTCs process limbic, associative, and sensorimotor information in largely separated but interacting networks. CTSC loops pass through paired striatal compartments, striosome (aka patch) and matrix, segregated pools of medium spiny projection neurons with distinct embryologic origins, cortical/subcortical structural connectivity, susceptibility to injury, and roles in behaviors and diseases. Similarly, striatal dopamine modulates activity in striosome and matrix in opposite directions. Routing CSTCs through one compartment may be an anatomical basis for regulating discrete functions. We used differential structural connectivity, identified through probabilistic diffusion tractography, to distinguish the striatal compartments (striosome-like and matrix-like voxels) in living humans. We then mapped compartment-specific projections and quantified structural connectivity between each striatal compartment, the globus pallidus interna (GPi), and 20 thalamic nuclei in 221 healthy adults. We found that striosome-originating and matrix-originating streamlines were segregated within the GPi: striosome-like connectivity was significantly more rostral, ventral, and medial. Striato-pallido-thalamic streamline bundles that were seeded from striosome-like and matrix-like voxels transited spatially distinct portions of the white matter. Matrix-like streamlines were 5.7-fold more likely to reach the GPi, replicating animal tract-tracing studies. Striosome-like connectivity dominated in six thalamic nuclei (anteroventral, central lateral, laterodorsal, lateral posterior, mediodorsal-medial, and medial geniculate). Matrix-like connectivity dominated in seven thalamic nuclei (centromedian, parafascicular, pulvinar-anterior, pulvinar-lateral, ventral lateral-anterior, ventral lateral-posterior, ventral posterolateral). Though we mapped all thalamic nuclei independently, functionally-related nuclei were matched for compartment-level bias. We validated these results with prior thalamostriate tract tracing studies in non-human primates and other species; where reliable data was available, all agreed with our measures of structural connectivity. Matrix-like connectivity was lateralized (left > right hemisphere) in 18 thalamic nuclei, independent of handedness, diffusion protocol, sex, or whether the nucleus was striosome-dominated or matrix-dominated. Compartment-specific biases in striato-pallido-thalamic structural connectivity suggest that routing CSTC loops through striosome-like or matrix-like voxels is a fundamental mechanism for organizing and regulating brain networks. Our MRI-based assessments of striato-thalamic connectivity in humans match and extend the results of prior tract tracing studies in animals. Compartment-level characterization may improve localization of human neuropathologies and improve neurosurgical targeting in the GPi and thalamus.
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Affiliation(s)
- Adrian T. Funk
- Division of Pediatric Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, United States
| | - Asim A. O. Hassan
- Department of Natural Sciences and Mathematics, University of Texas at Dallas, Richardson, TX, United States
| | - Norbert Brüggemann
- Department of Neurology and Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, United States
| | - Hans C. Breiter
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Anne J. Blood
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard University, Boston, MA, United States
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Jeff L. Waugh
- Division of Pediatric Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, United States
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
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Aamodt WW, Dahodwala N, Bilker WB, Farrar JT, Willis AW. Unique characteristics of end-of-life hospitalizations in Parkinson disease. Front Aging Neurosci 2023; 15:1254969. [PMID: 37901789 PMCID: PMC10600520 DOI: 10.3389/fnagi.2023.1254969] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Persons with Parkinson disease (PD) are hospitalized at higher rates, have longer lengths of stay, and are more likely to die in the hospital than age-matched peers. Although prior studies have compared inpatient outcomes between persons with and without PD, little is known about inpatient outcomes across the PD trajectory, or whether hospitalizations occurring in the last 6 months of life differ from earlier hospitalizations. Methods This cross-sectional study compared Medicare Part A and B beneficiaries aged 65 and older with a qualifying PD diagnosis who were hospitalized in 2017: decedents who died between 7/1/2017 and 12/31/2017 from all causes and were hospitalized at least once in their last 6 months of life, and non-decedents who were hospitalized between 1/1/2017 and 6/30/2017 and lived 6 or more months after discharge. End-of-life (EoL) hospitalizations were defined as those occurring in the last 6 months of life. Descriptive analyses compared patient-level variables (e.g., demographics, comorbidities, treatment intensity) and encounter-level variables (e.g., length of stay, total charges) between groups. Multivariable logistic regression models also compared rates of intensive care unit (ICU) admission and 30-day readmission between hospitalized decedents and hospitalized non-decedents, adjusting for age, sex, race/ethnicity, rural residence, and Charlson Comorbidity Index Score. Results Of 26,492 Medicare decedents with PD, 16,187 (61.1%) were hospitalized in their last 6 months of life. Of 347,512 non-decedents with PD, 62,851 (18.1%) were hospitalized in a 6-month period. Hospitalized decedents were slightly older than hospitalized non-decedents (82.3 [SD 7.40] vs. 79.5 [SD 7.54] years) and had significantly more comorbidities. Compared to non-EoL hospitalizations, EoL hospitalizations were slightly longer (5 [IQR 3-9] vs. 4 [IQR 3-7] days) and more expensive based on total charges per admission ($36,323 [IQR 20,091-69,048] vs. $32,309 [IQR 18,789-57,756]). In covariate-adjusted regression models using hospitalized non-decedents as the reference group, hospitalized decedents were more likely to experience an ICU admission (AOR 2.36; CI 2.28-2.45) and 30-day readmission (AOR 2.43; CI 2.34-2.54). Discussion Hospitalizations occurring in the last 6 months of life among persons with PD in the United States are longer, more costly, and more resource intensive than earlier hospitalizations and may stem from medical comorbidities. Once hospitalized, ICU admission and 30-day readmission may aid in prognostication and serve as markers of transition to the EoL period.
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Affiliation(s)
- Whitley W. Aamodt
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, PA, United States
| | - Nabila Dahodwala
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, PA, United States
| | - Warren B. Bilker
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - John T. Farrar
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Allison W. Willis
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, PA, United States
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States
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10
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Baxter BS, Mylonas D, Kwok KS, Talbot CE, Patel R, Zhu L, Vangel M, Stickgold R, Manoach DS. The effects of closed-loop auditory stimulation on sleep oscillatory dynamics in relation to motor procedural memory consolidation. Sleep 2023; 46:zsad206. [PMID: 37531587 PMCID: PMC11009689 DOI: 10.1093/sleep/zsad206] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/13/2023] [Indexed: 08/04/2023] Open
Abstract
STUDY OBJECTIVES Healthy aging and many disorders show reduced sleep-dependent memory consolidation and corresponding alterations in non-rapid eye movement sleep oscillations. Yet sleep physiology remains a relatively neglected target for improving memory. We evaluated the effects of closed-loop auditory stimulation during sleep (CLASS) on slow oscillations (SOs), sleep spindles, and their coupling, all in relation to motor procedural memory consolidation. METHODS Twenty healthy young adults had two afternoon naps: one with auditory stimulation during SO upstates and another with no stimulation. Twelve returned for a third nap with stimulation at variable times in relation to SO upstates. In all sessions, participants trained on the motor sequence task prior to napping and were tested afterward. RESULTS Relative to epochs with no stimulation, upstate stimuli disrupted sleep and evoked SOs, spindles, and SO-coupled spindles. Stimuli that successfully evoked oscillations were delivered closer to the peak of the SO upstate and when spindle power was lower than stimuli that failed to evoke oscillations. Across conditions, participants showed similar significant post-nap performance improvement that correlated with the density of SO-coupled spindles. CONCLUSIONS Despite its strong effects on sleep physiology, CLASS failed to enhance motor procedural memory. Our findings suggest methods to overcome this failure, including better sound calibration to preserve sleep continuity and the use of real-time predictive algorithms to more precisely target SO upstates and to avoid disrupting endogenous SO-coupled spindles and their mnemonic function. They motivate continued development of CLASS as an intervention to manipulate sleep oscillatory dynamics and improve memory.
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Affiliation(s)
- Bryan S Baxter
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Dimitrios Mylonas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Kristi S Kwok
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christine E Talbot
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rudra Patel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lin Zhu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Vangel
- Department of Biostatistics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Stickgold
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dara S Manoach
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
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11
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Kolson DL. Can immunological imprinting drive neurological dysfunction in long COVID? Brain 2023; 146:3960-3962. [PMID: 37681523 PMCID: PMC11004940 DOI: 10.1093/brain/awad307] [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: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/09/2023] Open
Abstract
This scientific commentary refers to ‘Neurologic sequelae of COVID-19 are determined by immunologic imprinting from previous coronaviruses’ by Spatola et al. (https://doi.org/10.1093/brain/awad155).
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Affiliation(s)
- Dennis L Kolson
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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12
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Spatola M, Nziza N, Jung W, Deng Y, Yuan D, Dinoto A, Bozzetti S, Chiodega V, Ferrari S, Lauffenburger DA, Mariotto S, Alter G. Neurologic sequelae of COVID-19 are determined by immunologic imprinting from previous coronaviruses. Brain 2023; 146:4292-4305. [PMID: 37161609 PMCID: PMC11004923 DOI: 10.1093/brain/awad155] [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: 11/07/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/11/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a global public health emergency. Although SARS-CoV-2 is primarily a respiratory pathogen, extra-respiratory organs, including the CNS, can also be affected. Neurologic symptoms have been observed not only during acute SARS-CoV-2 infection, but also at distance from respiratory disease, also known as long-COVID or neurological post-acute sequelae of COVID-19 (neuroPASC). The pathogenesis of neuroPASC is not well understood, but hypotheses include SARS-CoV-2-induced immune dysfunctions, hormonal dysregulations and persistence of SARS-CoV-2 reservoirs. In this prospective cohort study, we used a high throughput systems serology approach to dissect the humoral response to SARS-CoV-2 (and other common coronaviruses: 229E, HKU1, NL63 and OC43) in the serum and CSF from 112 infected individuals who developed (n = 18) or did not develop (n = 94) neuroPASC. Unique SARS-CoV-2 humoral profiles were observed in the CSF of neuroPASC compared with serum responses. All antibody isotypes (IgG, IgM, IgA) and subclasses (IgA1-2, IgG1-4) were detected in serum, whereas CSF was characterized by focused IgG1 (and absence of IgM). These data argue in favour of compartmentalized brain-specific responses against SARS-CoV-2 through selective transfer of antibodies from the serum to the CSF across the blood-brain barrier, rather than intrathecal synthesis, where more diversity in antibody classes/subclasses would be expected. Compared to individuals who did not develop post-acute complications following infection, individuals with neuroPASC had similar demographic features (median age 65 versus 66.5 years, respectively, P = 0.55; females 33% versus 44%, P = 0.52) but exhibited attenuated systemic antibody responses against SARS-CoV-2, characterized by decreased capacity to activate antibody-dependent complement deposition (ADCD), NK cell activation (ADNKA) and to bind Fcγ receptors. However, surprisingly, neuroPASC individuals showed significantly expanded antibody responses to other common coronaviruses, including 229E, HKU1, NL63 and OC43. This biased humoral activation across coronaviruses was particularly enriched in neuroPASC individuals with poor outcome, suggesting an 'original antigenic sin' (or immunologic imprinting), where pre-existing immune responses against related viruses shape the response to the current infection, as a key prognostic marker of neuroPASC disease. Overall, these findings point to a pathogenic role for compromised anti-SARS-CoV-2 responses in the CSF, likely resulting in incomplete virus clearance from the brain and persistent neuroinflammation, in the development of post-acute neurologic complications of SARS-CoV-2 infection.
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Affiliation(s)
- Marianna Spatola
- Ragon Institute of MGH, MIT and Harvard Medical School, Cambridge, MA 02139, USA
| | - Nadège Nziza
- Ragon Institute of MGH, MIT and Harvard Medical School, Cambridge, MA 02139, USA
| | - Wonyeong Jung
- Ragon Institute of MGH, MIT and Harvard Medical School, Cambridge, MA 02139, USA
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Yixiang Deng
- Ragon Institute of MGH, MIT and Harvard Medical School, Cambridge, MA 02139, USA
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Dansu Yuan
- Ragon Institute of MGH, MIT and Harvard Medical School, Cambridge, MA 02139, USA
| | - Alessandro Dinoto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37131 Verona, Italy
| | - Silvia Bozzetti
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37131 Verona, Italy
| | - Vanessa Chiodega
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37131 Verona, Italy
- Department of Neurology/Stroke Unit, San Maurizio Hospital, 39100 Bolzano, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37131 Verona, Italy
| | | | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37131 Verona, Italy
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard Medical School, Cambridge, MA 02139, USA
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13
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Lee I, Stingone JA, Chan RB, Mitsumoto H. Utilizing machine learning and lipidomics to distinguish primary lateral sclerosis from amyotrophic lateral sclerosis. Muscle Nerve 2023; 67:306-310. [PMID: 36747323 DOI: 10.1002/mus.27797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/01/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION/AIMS There are currently no imaging or blood diagnostic biomarkers that can differentiate amyotrophic lateral sclerosis (ALS) from primary lateral sclerosis (PLS) patients early in their disease courses. Our objective is to examine whether patients with PLS can be differentiated from ALS reliably by using plasma lipidome profile and supervised machine learning. METHODS 40 ALS and 28 PLS patients derived from the Multicenter Cohort study of Oxidative Stress (COSMOS) and 28 healthy control volunteers (CTR) were included. ALS, PLS, and CTR were matched by age and sex. Plasma samples were obtained after overnight fasting. Lipids were extracted from the plasma samples and analyzed using liquid chromatography/mass spectrometry to obtain relative concentrations of 392 lipid species. The lipid data were partitioned into training and testing datasets randomly. An elastic net algorithm was trained using cross-validation to classify PLS vs ALS and PLS vs CTR. Final accuracy was evaluated in the testing dataset. RESULTS The elastic net model trained with labeled PLS and ALS training lipid dataset demonstrated accuracy (number classified correctly/total number), sensitivity, and specificity of 100% in classifying PLS vs ALS in the unlabeled testing lipid dataset. Similarly, the elastic net model trained with labeled PLS and CTR training lipid datasets demonstrated accuracy, sensitivity, and specificity of 88% in classifying PLS vs CTR in the unlabeled testing lipid dataset. DISCUSSION Our study suggests PLS patients can be accurately distinguished from ALS and CTR by combining lipidome profile and supervised machine learning without clinical information.
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Affiliation(s)
- Ikjae Lee
- Department of Neurology, Columbia University, New York, New York, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Robin Barry Chan
- Department of Pathology and Cell Biology, Columbia University, New York, New York, USA
| | - Hiroshi Mitsumoto
- Department of Neurology, Columbia University, New York, New York, USA
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14
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Elafros MA, Bwalya C, Muchanga G, Mwale M, Namukanga N, Birbeck GL, Chomba M, Mugala-Mulenga A, Kvalsund MP, Sikazwe I, Saylor DR, Winch PJ. A qualitative study of factors resulting in care delays for adults with meningitis in Zambia. Trans R Soc Trop Med Hyg 2022; 116:1138-1144. [PMID: 35653707 PMCID: PMC9717355 DOI: 10.1093/trstmh/trac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/27/2022] [Accepted: 05/11/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Meningitis causes significant mortality in regions with high comorbid HIV and TB. Improved outcomes are hindered by limited understanding of factors that delay adequate care. METHODS In-depth interviews of patients admitted to the University Teaching Hospital with suspected meningitis, their caregivers, doctors and nurses were conducted. Patient/caregiver interviews explored meningitis understanding, treatment prior to admission and experiences since admission. Provider interviews addressed current and prior experiences with meningitis patients and hospital barriers to care. A conceptual framework based on the Three Delays Model identified factors that delayed care. RESULTS Twenty-six patient/caregiver, eight doctor and eight nurse interviews occurred. Four delays were identified: in-home care; transportation to a health facility; clinic/first-level hospital care; and third-level hospital. Overcrowding and costly diagnostic testing delayed outpatient care; 23% of patients began with treatment inside the home due to prior negative experiences with biomedical care. Admission occurred after multiple clinic visits, where subsequent delays occurred during testing and treatment. CONCLUSIONS Delays in care from home to hospital impair quality meningitis care in Zambia. Interventions to improve outcomes must address patient, community and health systems factors. Patient/caregiver education regarding signs of meningitis and indications for care-seeking are warranted to reduce treatment delays.
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Affiliation(s)
- Melissa A Elafros
- Department of Neurology, University of Michigan, Ann Arbor, 48109 Michigan, USA
| | - Chiti Bwalya
- Maryland Global Initiatives Corporation (MGIC), Lusaka, Zambia
| | | | - Mwangala Mwale
- Maryland Global Initiatives Corporation (MGIC), Lusaka, Zambia
| | | | - Gretchen L Birbeck
- Department of Neurology, University of Rochester, Rochester, 14642 New York, USA
- University Teaching Hospitals Children's Hospital, 10101 Lusaka, Zambia
| | - Mashina Chomba
- Department of Internal Medicine, University of Zambia, School of Medicine, 10101 Lusaka, Zambia
| | | | - Michelle P Kvalsund
- Department of Neurology, University of Rochester, Rochester, 14642 New York, USA
- Department of Internal Medicine, University of Zambia, School of Medicine, 10101 Lusaka, Zambia
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, 10101 Lusaka, Zambia
| | - Deanna R Saylor
- Department of Internal Medicine, University of Zambia, School of Medicine, 10101 Lusaka, Zambia
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205 Maryland, USA
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15
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Keenan KJ, Smith WS, Cole SB, Martin C, Hemphill JC, Madhok DY. Large vessel occlusion prediction scales provide high negative but low positive predictive values in prehospital suspected stroke patients. BMJ Neurol Open 2022; 4:e000272. [PMID: 35910334 PMCID: PMC9274523 DOI: 10.1136/bmjno-2022-000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction We studied a registry of Emergency Medical Systems (EMS) identified prehospital suspected stroke patients brought to an academic endovascular capable hospital over 1 year to assess the prevalence of disease and externally validate large vessel occlusion (LVO) stroke prediction scales with a focus on predictive values. Methods All patients had last known well times within 6 hours and a positive prehospital Cincinnati Prehospital Stroke Scale. LVO prediction scale scores were retrospectively calculated from emergency department arrival National Institutes of Health Stroke Scale scores. Final diagnoses were determined by chart review. Prevalence and diagnostic performance statistics were calculated. We prespecified analyses to identify scale thresholds with positive predictive values (PPVs) ≥80% and negative predictive values (NPVs) ≥95%. A secondary analysis identified thresholds with PPVs ≥50%. Results Of 220 EMS transported patients, 13.6% had LVO stroke, 15.9% had intracranial haemorrhage, 20.5% had non-LVO stroke and 50% had stroke mimic diagnoses. LVO stroke prevalence was 15.8% among the 184 diagnostic performance study eligible patients. Only Field Assessment Stroke Triage for Emergency Destination (FAST-ED) ≥7 had a PPV ≥80%, but this threshold missed 83% of LVO strokes. FAST-ED ≥6, Prehospital Acute Severity Scale =3 and Rapid Arterial oCclusion Evaluation ≥7 had PPVs ≥50% but sensitivities were <50%. Several standard and lower alternative scale thresholds achieved NPVs ≥95%, but false positives were common. Conclusions Diagnostic performance tradeoffs of LVO prediction scales limited their ability to achieve high PPVs without missing most LVO strokes. Multiple scales provided high NPV thresholds, but these were associated with many false positives.
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Affiliation(s)
- Kevin J Keenan
- Department of Neurology, University of California Davis, Sacramento, California, USA
- Department of Neurology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Wade S Smith
- Department of Neurology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Sara B Cole
- Department of Neurology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Christine Martin
- Department of Neurology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - J Claude Hemphill
- Department of Neurology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Debbie Y Madhok
- Department of Neurology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
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16
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McCray BA, Scherer SS. Axonal Charcot-Marie-Tooth Disease: from Common Pathogenic Mechanisms to Emerging Treatment Opportunities. Neurotherapeutics 2021; 18:2269-2285. [PMID: 34606075 PMCID: PMC8804038 DOI: 10.1007/s13311-021-01099-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Accepted: 07/28/2021] [Indexed: 01/12/2023] Open
Abstract
Inherited peripheral neuropathies are a genetically and phenotypically diverse group of disorders that lead to degeneration of peripheral neurons with resulting sensory and motor dysfunction. Genetic neuropathies that primarily cause axonal degeneration, as opposed to demyelination, are most often classified as Charcot-Marie-Tooth disease type 2 (CMT2) and are the focus of this review. Gene identification efforts over the past three decades have dramatically expanded the genetic landscape of CMT and revealed several common pathological mechanisms among various forms of the disease. In some cases, identification of the precise genetic defect and/or the downstream pathological consequences of disease mutations have yielded promising therapeutic opportunities. In this review, we discuss evidence for pathogenic overlap among multiple forms of inherited neuropathy, highlighting genetic defects in axonal transport, mitochondrial dynamics, organelle-organelle contacts, and local axonal protein translation as recurrent pathological processes in inherited axonal neuropathies. We also discuss how these insights have informed emerging treatment strategies, including specific approaches for single forms of neuropathy, as well as more general approaches that have the potential to treat multiple types of neuropathy. Such therapeutic opportunities, made possible by improved understanding of molecular and cellular pathogenesis and advances in gene therapy technologies, herald a new and exciting phase in inherited peripheral neuropathy.
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Affiliation(s)
- Brett A. McCray
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Steven S. Scherer
- Department of Neurology, The University of Pennsylvania, Philadelphia, PA 19104 USA
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17
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Calame DG, Fatih JM, Herman I, Coban‐Akdemir Z, Du H, Mitani T, Jhangiani SN, Marafi D, Gibbs RA, Posey JE, Mehta VP, Mohila CA, Abid F, Lotze TE, Pehlivan D, Adesina AM, Lupski JR. Deep clinicopathological phenotyping identifies a previously unrecognized pathogenic EMD splice variant. Ann Clin Transl Neurol 2021; 8:2052-2058. [PMID: 34524739 PMCID: PMC8528454 DOI: 10.1002/acn3.51454] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/12/2021] [Accepted: 09/02/2021] [Indexed: 12/05/2022] Open
Abstract
Exome sequencing (ES) has revolutionized rare disease management, yet only ~25%-30% of patients receive a molecular diagnosis. A limiting factor is the quality of available phenotypic data. Here, we describe how deep clinicopathological phenotyping yielded a molecular diagnosis for a 19-year-old proband with muscular dystrophy and negative clinical ES. Deep phenotypic analysis identified two critical data points: (1) the absence of emerin protein in muscle biopsy and (2) clinical features consistent with Emery-Dreifuss muscular dystrophy. Sequencing data analysis uncovered an ultra-rare, intronic variant in EMD, the gene encoding emerin. The variant, NM_000117.3: c.188-6A > G, is predicted to impact splicing by in silico tools. This case thus illustrates how better integration of clinicopathologic data into ES analysis can enhance diagnostic yield with implications for clinical practice.
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Affiliation(s)
- Daniel G. Calame
- Division of Neurology and Developmental NeuroscienceDepartment of PediatricsBaylor College of MedicineHoustonTexas77030USA
- Texas Children’s HospitalHoustonTexas77030USA
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
| | - Jawid M. Fatih
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
| | - Isabella Herman
- Division of Neurology and Developmental NeuroscienceDepartment of PediatricsBaylor College of MedicineHoustonTexas77030USA
- Texas Children’s HospitalHoustonTexas77030USA
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
| | - Zeynep Coban‐Akdemir
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
| | - Haowei Du
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
| | - Tadahiro Mitani
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
| | | | - Dana Marafi
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
- Department of PediatricsFaculty of MedicineKuwait UniversitySafat13110Kuwait
| | - Richard A. Gibbs
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
- Human Genome Sequencing CenterBaylor College of MedicineHoustonTexas77030USA
| | - Jennifer E. Posey
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
| | - Vidya P. Mehta
- Department of PathologyTexas Children's HospitalBaylor College of MedicineHoustonTexas77030USA
| | - Carrie A. Mohila
- Department of PathologyTexas Children's HospitalBaylor College of MedicineHoustonTexas77030USA
| | - Farida Abid
- Division of Neurology and Developmental NeuroscienceDepartment of PediatricsBaylor College of MedicineHoustonTexas77030USA
- Texas Children’s HospitalHoustonTexas77030USA
| | - Timothy E. Lotze
- Division of Neurology and Developmental NeuroscienceDepartment of PediatricsBaylor College of MedicineHoustonTexas77030USA
- Texas Children’s HospitalHoustonTexas77030USA
| | - Davut Pehlivan
- Division of Neurology and Developmental NeuroscienceDepartment of PediatricsBaylor College of MedicineHoustonTexas77030USA
- Texas Children’s HospitalHoustonTexas77030USA
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
| | - Adekunle M. Adesina
- Department of PathologyTexas Children's HospitalBaylor College of MedicineHoustonTexas77030USA
| | - James R. Lupski
- Texas Children’s HospitalHoustonTexas77030USA
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas77030USA
- Human Genome Sequencing CenterBaylor College of MedicineHoustonTexas77030USA
- Department of PediatricsBaylor College of MedicineHoustonTexas77030USA
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18
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Dalal JS, Winden KD, Salussolia CL, Sundberg M, Singh A, Pham TT, Zhou P, Pu WT, Miller MT, Sahin M. Loss of Tsc1 in cerebellar Purkinje cells induces transcriptional and translation changes in FMRP target transcripts. eLife 2021; 10:e67399. [PMID: 34259631 PMCID: PMC8279760 DOI: 10.7554/elife.67399] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/29/2021] [Indexed: 12/19/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a genetic disorder that is associated with multiple neurological manifestations. Previously, we demonstrated that Tsc1 loss in cerebellar Purkinje cells (PCs) can cause altered social behavior in mice. Here, we performed detailed transcriptional and translational analyses of Tsc1-deficient PCs to understand the molecular alterations in these cells. We found that target transcripts of the Fragile X Mental Retardation Protein (FMRP) are reduced in mutant PCs with evidence of increased degradation. Surprisingly, we observed unchanged ribosomal binding for many of these genes using translating ribosome affinity purification. Finally, we found that multiple FMRP targets, including SHANK2, were reduced, suggesting that compensatory increases in ribosomal binding efficiency may be unable to overcome reduced transcript levels. These data further implicate dysfunction of FMRP and its targets in TSC and suggest that treatments aimed at restoring the function of these pathways may be beneficial.
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Affiliation(s)
- Jasbir Singh Dalal
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Kirby Neurobiology Center, Boston Children’s HospitalBostonUnited States
| | - Kellen Diamond Winden
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Kirby Neurobiology Center, Boston Children’s HospitalBostonUnited States
| | - Catherine Lourdes Salussolia
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Kirby Neurobiology Center, Boston Children’s HospitalBostonUnited States
| | - Maria Sundberg
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Kirby Neurobiology Center, Boston Children’s HospitalBostonUnited States
| | - Achint Singh
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Kirby Neurobiology Center, Boston Children’s HospitalBostonUnited States
| | - Truc Thanh Pham
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Kirby Neurobiology Center, Boston Children’s HospitalBostonUnited States
| | - Pingzhu Zhou
- Department of Cardiology, Boston Children’s HospitalBostonUnited States
| | - William T Pu
- Department of Cardiology, Boston Children’s HospitalBostonUnited States
- Harvard Medical SchoolBostonUnited States
| | - Meghan T Miller
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center BaselBaselSwitzerland
| | - Mustafa Sahin
- Department of Neurology, Rosamund Stone Zander Translational Neuroscience Center, Kirby Neurobiology Center, Boston Children’s HospitalBostonUnited States
- Harvard Medical SchoolBostonUnited States
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Koch M, Acharjee A, Ament Z, Schleicher R, Bevers M, Stapleton C, Patel A, Kimberly WT. Machine Learning-Driven Metabolomic Evaluation of Cerebrospinal Fluid: Insights Into Poor Outcomes After Aneurysmal Subarachnoid Hemorrhage. Neurosurgery 2021; 88:1003-1011. [PMID: 33469656 PMCID: PMC8046589 DOI: 10.1093/neuros/nyaa557] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 07/04/2020] [Accepted: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is associated with a high mortality and poor neurologic outcomes. The biologic underpinnings of the morbidity and mortality associated with aSAH remain poorly understood. OBJECTIVE To ascertain potential insights into pathological mechanisms of injury after aSAH using an approach of metabolomics coupled with machine learning methods. METHODS Using cerebrospinal fluid (CSF) samples from 81 aSAH enrolled in a retrospective cohort biorepository, samples collected during the peak of delayed cerebral ischemia were analyzed using liquid chromatography-tandem mass spectrometry. A total of 138 metabolites were measured and quantified in each sample. Data were analyzed using elastic net (EN) machine learning and orthogonal partial least squares-discriminant analysis (OPLS-DA) to identify the leading CSF metabolites associated with poor outcome, as determined by the modified Rankin Scale (mRS) at discharge and at 90 d. Repeated measures analysis determined the effect size for each metabolite on poor outcome. RESULTS EN machine learning and OPLS-DA analysis identified 8 and 10 metabolites, respectively, that predicted poor mRS (mRS 3-6) at discharge and at 90 d. Of these candidates, symmetric dimethylarginine (SDMA), dimethylguanidine valeric acid (DMGV), and ornithine were consistent markers, with an association with poor mRS at discharge (P = .0005, .002, and .0001, respectively) and at 90 d (P = .0036, .0001, and .004, respectively). SDMA also demonstrated a significantly elevated CSF concentration compared with nonaneurysmal subarachnoid hemorrhage controls (P = .0087). CONCLUSION SDMA, DMGV, and ornithine are vasoactive molecules linked to the nitric oxide pathway that predicts poor outcome after severe aSAH. Further study of dimethylarginine metabolites in brain injury after aSAH is warranted.
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Affiliation(s)
- Matthew Koch
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Animesh Acharjee
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, Centre for Computational Biology and NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham, Birmingham, United Kingdom
| | - Zsuzsanna Ament
- Division of Neurocritical Care and Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Riana Schleicher
- Division of Neurocritical Care and Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew Bevers
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Aman Patel
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - W Taylor Kimberly
- Division of Neurocritical Care and Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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20
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Ament Z, Bevers MB, Wolcott Z, Kimberly WT, Acharjee A. Uric Acid and Gluconic Acid as Predictors of Hyperglycemia and Cytotoxic Injury after Stroke. Transl Stroke Res 2021; 12:293-302. [PMID: 33067777 PMCID: PMC7933067 DOI: 10.1007/s12975-020-00862-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 05/13/2020] [Revised: 08/31/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
Abstract
Hyperglycemia is a feature of worse brain injury after acute ischemic stroke, but the underlying metabolic changes and the link to cytotoxic brain injury are not fully understood. In this observational study, we applied regression and machine learning classification analyses to identify metabolites associated with hyperglycemia and a neuroimaging proxy for cytotoxic brain injury. Metabolomics and lipidomics were carried out using liquid chromatography-tandem mass spectrometry in admission plasma samples from 381 patients presenting with an acute stroke. Glucose was measured by a central clinical laboratory, and a subgroup of patients (n = 201) had apparent diffusion coefficient (ADC) imaging quantified on magnetic resonance imaging (MRI) to estimate cytotoxic injury. Uric acid was the leading metabolite in univariate analysis of both hyperglycemia (OR 19.6, 95% CI 8.6-44.7, P = 1.44 × 10-12) and ADC (OR 5.3, 95% CI 2.2-13.0, P = 2.42 × 10-4). To further prioritize model features and account for non-linear correlation structure, a random forest machine learning algorithm was applied to separately model hyperglycemia and ADC. The statistical techniques used have identified uric acid and gluconic acids as leading candidate markers common to all models (R2 = 68%, P = 2.2 × 10-10 for uric acid; R2 = 15%, P = 8.09 × 10-10 for gluconic acid). Both uric acid and gluconic acid were associated with hyperglycemia and cytotoxic brain injury. Both metabolites are linked to oxidative stress, which highlights two candidate targets for limiting brain injury after stroke.
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Affiliation(s)
- Zsuzsanna Ament
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, MA, 02114, USA
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Lunder 644, Boston, MA, 02114, USA
| | - Matthew B Bevers
- Division of Stroke, Cerebrovascular and Crital Care Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Zoe Wolcott
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, MA, 02114, USA
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Lunder 644, Boston, MA, 02114, USA
| | - W Taylor Kimberly
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, MA, 02114, USA.
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Lunder 644, Boston, MA, 02114, USA.
| | - Animesh Acharjee
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, Centre for Computational Biology, University of Birmingham, Birmingham, UK.
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK.
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21
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Jankovic MJ, Kapadia PP, Krishnan V. Home-cage monitoring ascertains signatures of ictal and interictal behavior in mouse models of generalized seizures. PLoS One 2019; 14:e0224856. [PMID: 31697745 PMCID: PMC6837443 DOI: 10.1371/journal.pone.0224856] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022] Open
Abstract
Epilepsy is a significant contributor to worldwide disability. In epilepsy, disability can be broadly divided into two components: ictal (pertaining to the burden of unpredictable seizures and associated medical complications including death) and interictal (pertaining to more pervasive debilitating changes in cognitive and emotional behavior). In this study, we objectively and noninvasively appraise aspects of ictal and interictal behavior in mice using instrumented home-cage chambers designed to assay kinematic and appetitive behavioral measures. Through daily intraperitoneal injections of the chemoconvulsant pentylenetetrazole (PTZ) applied to C57BL/6J mice, we coordinately measure how “behavioral severity” (complex dynamic changes in movement and sheltering behavior) and convulsive severity (latency and occurrence of convulsive seizures) evolve or kindle with repeated injections. By closely studying long epochs between PTZ injections, we identify an interictal syndrome of nocturnal hypoactivity and increased sheltering behavior which remits with the cessation of seizure induction. We observe elements of this interictal behavioral syndrome in seizure-prone DBA/2J mice and in mice with a pathogenic Scn1a mutation (modeling Dravet syndrome). Through analyzing their responses to PTZ, we illustrate how convulsive severity and “behavioral” severity are distinct and independent aspects of the overall severity of a PTZ-induced seizure. Our results illustrate the utility of an ethologically centered automated approach to quantitatively appraise murine expressions of disability in mouse models of seizures and epilepsy. In doing so, this study highlights the very unique psychopharmacological profile of PTZ.
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Affiliation(s)
- Miranda J. Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States of America
| | - Paarth P. Kapadia
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States of America
| | - Vaishnav Krishnan
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States of America
- * E-mail:
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22
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Abstract
Ataxia-telangiectasia is the second most common autosomal recessive hereditary ataxia, with an estimated incidence of 1 in 100,000 births. Besides ataxia and ocular telangiectasias, eye movement abnormalities have long been associated with this disorder and is frequently present in almost all patients. A handful of studies have described the phenomenology of ocular motor deficits in ataxia-telangiectasia. Contemporary literature linked their physiology to cerebellar dysfunction and secondary abnormalities at the level of brainstem. These studies, while providing a proof of concept of ocular motor physiology in disease, i.e., ataxia-telangiectasia, also advanced our understanding of how the cerebellum works. Here, we will summarize the clinical abnormalities seen with ataxia-telangiectasia in each subtype of eye movements and subsequently describe the underlying pathophysiology. Finally, we will review how these deficits are linked to abnormal cerebellar function and how it allows better understanding of the cerebellar physiology.
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Affiliation(s)
- Sherry Y Tang
- Department of Neurology, Neurology Service, Cleveland VA Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA
| | - Aasef G Shaikh
- Department of Neurology, Neurology Service, Cleveland VA Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44110, USA.
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23
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Hemond CC, Glanz BI, Bakshi R, Chitnis T, Healy BC. The neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios are independently associated with neurological disability and brain atrophy in multiple sclerosis. BMC Neurol 2019; 19:23. [PMID: 30755165 PMCID: PMC6371437 DOI: 10.1186/s12883-019-1245-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Serum hematological indices such as the neutrophil-lymphocyte ratio (NLR) or monocyte-lymphocyte ratio (MLR) have been used as biomarkers of pathogenic inflammation and prognostication in multiple areas of medicine; recent evidence shows correlation with psychological parameters as well. OBJECTIVES/AIMS To characterize clinical, neuroimaging, and psycho-neuro-immunological associations with NLR and MLR in persons with multiple sclerosis (MS). METHODS We identified a large cohort of clinically well-defined patients from our longitudinal database that included MS-related outcomes, disease-modifying therapy, patient-reported outcome (PRO) measures, and quantified cerebral MRI at 1.5 T. We queried hospital records for complete blood counts within 2 months of each clinic visit and excluded those obtained during clinical relapses. Four hundred eighty-three patients, with a mean of 3 longitudinal observations each, were identified who met these criteria. Initial analyses assessed the association between NLR and MLR as the outcomes, and psychological and demographic predictors in univariable and multivariable models controlling for age, gender and treatment. The second set of analyses assessed the association between clinical and MRI outcomes including whole brain atrophy and T2-hyperintense lesion volume, with NLR and MLR as predictors in univariable and multivariable models. All analyses used a mixed effects linear or logistic regression model with repeated measures. RESULTS Unadjusted analyses demonstrated significant associations between higher (log-transformed) NLR (but not MLR) and PRO measures including increasing depression (p = 0.01), fatigue (p < 0.01), and decreased physical quality of life (p < 0.01). Higher NLR and MLR strongly predicted increased MS-related disability as assessed by the Expanded Disability Status Scale, independent of all demographic, clinical, treatment-related, and psychosocial variables (p < 0.001). Lastly, higher NLR and MLR significantly discriminated progressive from relapsing status (p ≤ 0.01 for both), and higher MLR correlated with increased whole-brain atrophy (p < 0.05) but not T2 hyperintense lesion volume (p > 0.05) even after controlling for all clinical and demographic covariates. Sensitivity analyses using a subset of untreated patients (N = 146) corroborated these results. CONCLUSIONS Elevated NLR and MLR may represent hematopoetic bias toward increased production and pro-inflammatory priming of the myeloid innate immune system (numerator) in conjunction with dysregulated adaptive immune processes (denominator), and consequently reflect a complementary and independent marker for severity of MS-related neurological disability and MRI outcomes.
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Affiliation(s)
- Christopher C. Hemond
- Department of Neurology, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA 01655 USA
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA USA
| | - Bonnie I. Glanz
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA USA
| | - Rohit Bakshi
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA USA
- Department of Radiology, Harvard Medical School, Boston, MA USA
| | - Tanuja Chitnis
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA USA
| | - Brian C. Healy
- Department of Neurology, Harvard Medical School, Boston, MA USA
- Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Brigham & Women’s Hospital, Boston, MA USA
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24
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Olney NT, Bischof A, Rosen H, Caverzasi E, Stern WA, Lomen-Hoerth C, Miller BL, Henry RG, Papinutto N. Measurement of spinal cord atrophy using phase sensitive inversion recovery (PSIR) imaging in motor neuron disease. PLoS One 2018; 13:e0208255. [PMID: 30496320 PMCID: PMC6264489 DOI: 10.1371/journal.pone.0208255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/14/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The spectrum of motor neuron disease (MND) includes numerous phenotypes with various life expectancies. The degree of upper and lower motor neuron involvement can impact prognosis. Phase sensitive inversion recovery (PSIR) imaging has been shown to detect in vivo gray matter (GM) and white matter (WM) atrophy in the spinal cord of other patient populations but has not been explored in MND. METHODS In this study, total cord, WM and GM areas of ten patients with a diagnosis within the MND spectrum were compared to those of ten healthy controls (HC). Patients' diagnosis included amyotrophic lateral sclerosis (ALS), primary lateral sclerosis, primary muscular atrophy, facial onset sensory and motor neuronopathy and ALS-Frontotemporal dementia. Axial 2D PSIR images were acquired at four cervical disc levels (C2-C3, C3-C4, C5-C6 and C7-T1) with a short acquisition time (2 minutes) protocol. Total cross-sectional areas (TCA), GM and WM areas were measured using a combination of highly reliable manual and semi-automated methods. Cord areas in MND patients were compared with HC using linear regression analyses adjusted for age and sex. Correlation of WM and GM areas in MND patients was explored to gain insights into underlying atrophy patterns. RESULTS MND patients as a group had significantly smaller cervical cord GM area compared to HC at all four levels (C2-C3: p = .009; C3-C4: p = .001; C5-C6: p = .006; C7-T1: p = .002). WM area at C5-C6 level was significantly smaller (p = .001). TCA was significantly smaller at C3-C4 (p = .018) and C5-C6 (p = .002). No significant GM and WM atrophy was detected in the two patients with predominantly bulbar phenotype. Concomitant GM and WM atrophy was detected in solely upper or lower motor neuron level phenotypes. There was a significant correlation between GM and WM areas at all four levels in this diverse population of MND. CONCLUSION Spinal cord GM and WM atrophy can be detected in vivo in patients within the MND spectrum using a short acquisition time 2D PSIR imaging protocol. PSIR imaging shows promise as a method for quantifying spinal cord involvement and thus may be useful for diagnosis, prognosis and for monitoring disease progression.
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Affiliation(s)
- Nicholas T. Olney
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, United States of America
- Department of Neurology, University of California San Francisco Amyotrophic Lateral Sclerosis Center, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Antje Bischof
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
- Department of Neurology and Immunology Clinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Howard Rosen
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, United States of America
| | - Eduardo Caverzasi
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - William A. Stern
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Catherine Lomen-Hoerth
- Department of Neurology, University of California San Francisco Amyotrophic Lateral Sclerosis Center, University of California San Francisco, San Francisco, California, United States of America
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, United States of America
| | - Roland G. Henry
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Nico Papinutto
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
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Gourisankar A, Eisenstein SA, Trapp NT, Koller JM, Campbell MC, Ushe M, Perlmutter JS, Hershey T, Black KJ. Mapping movement, mood, motivation and mentation in the subthalamic nucleus. R Soc Open Sci 2018; 5:171177. [PMID: 30109035 PMCID: PMC6083651 DOI: 10.1098/rsos.171177] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 06/14/2018] [Indexed: 05/26/2023]
Abstract
The anatomical connections of the subthalamic nucleus (STN) have driven hypotheses about its functional anatomy, including the hypothesis that the precise anatomical location of STN deep brain stimulation (DBS) contributes to the variability of motor and non-motor responses across patients with Parkinson's disease (PD). We previously tested the hypothesis using a three-dimensional (3D) statistical method to interpret the acute effects of unilateral DBS at each patient's clinically optimized DBS settings and active contact. Here, we report a similar analysis from a new study in which DBS parameters were standardized and DBS locations were chosen blind to clinical response. In 74 individuals with PD and STN DBS, STN contacts were selected near the dorsal and ventral borders of the STN contralateral to the more affected side of the body. Participants were tested off PD medications in each of three unilateral DBS conditions (ventral STN DBS, dorsal STN DBS and DBS off) for acute effects on mood, apathy, working memory, response inhibition and motor function. Voltage, frequency and pulse width were standardized, and participants and raters were blind to condition. In a categorical analysis, both dorsal and ventral STN DBS improved mean motor function without affecting cognitive measures. Ventral STN DBS induced greater improvement in rigidity and anxiety than dorsal STN DBS. In the 3D analysis, contact location was significant for body hypokinesia, rigidity and resting tremor, with the greatest improvement occurring with DBS in dorsal STN and zona incerta. The 3D results provide new, direct functional evidence for the anatomically derived model of STN, in which motor function is best represented in dorsal STN. However, our data suggest that functional segregation between motor and non-motor areas of the STN is limited, because locations that induced improvements in motor function and mood overlapped substantially.
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Affiliation(s)
- Amritha Gourisankar
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Sarah A. Eisenstein
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nicholas T. Trapp
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Meghan C. Campbell
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mwiza Ushe
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joel S. Perlmutter
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
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26
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Waugh JL, Kuster JK, Levenstein JM, Makris N, Multhaupt-Buell TJ, Sudarsky LR, Breiter HC, Sharma N, Blood AJ. Thalamic Volume Is Reduced in Cervical and Laryngeal Dystonias. PLoS One 2016; 11:e0155302. [PMID: 27171035 PMCID: PMC4865047 DOI: 10.1371/journal.pone.0155302] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 04/27/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Dystonia, a debilitating movement disorder characterized by abnormal fixed positions and/or twisting postures, is associated with dysfunction of motor control networks. While gross brain lesions can produce secondary dystonias, advanced neuroimaging techniques have been required to identify network abnormalities in primary dystonias. Prior neuroimaging studies have provided valuable insights into the pathophysiology of dystonia, but few directly assessed the gross volume of motor control regions, and to our knowledge, none identified abnormalities common to multiple types of idiopathic focal dystonia. METHODS We used two gross volumetric segmentation techniques and one voxelwise volumetric technique (voxel based morphometry, VBM) to compare regional volume between matched healthy controls and patients with idiopathic primary focal dystonia (cervical, n = 17, laryngeal, n = 7). We used (1) automated gross volume measures of eight motor control regions using the FreeSurfer analysis package; (2) blinded, anatomist-supervised manual segmentation of the whole thalamus (also gross volume); and (3) voxel based morphometry, which measures local T1-weighted signal intensity and estimates gray matter density or volume at the level of single voxels, for both whole-brain and thalamus. RESULTS Using both automated and manual gross volumetry, we found a significant volume decrease only in the thalamus in two focal dystonias. Decreases in whole-thalamic volume were independent of head and brain size, laterality of symptoms, and duration. VBM measures did not differ between dystonia and control groups in any motor control region. CONCLUSIONS Reduced thalamic gross volume, detected in two independent analyses, suggests a common anatomical abnormality in cervical dystonia and spasmodic dysphonia. Defining the structural underpinnings of dystonia may require such complementary approaches.
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Affiliation(s)
- Jeff L. Waugh
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Division of Child Neurology, Boston Children’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
- * E-mail:
| | - John K. Kuster
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | - Jacob M. Levenstein
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | - Nikos Makris
- Center for Morphometric Analysis, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Psychiatry Neuroimaging Laboratory, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | | | - Lewis R. Sudarsky
- Department of Neurology, Brigham and Women’s Hospital, Boston MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Hans C. Breiter
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Neurology, Brigham and Women’s Hospital, Boston MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Anne J. Blood
- Mood and Motor Control Laboratory, Massachusetts General Hospital, Charlestown, MA, United States of America
- Laboratory of Neuroimaging and Genetics, Massachusetts General Hospital, Charlestown, MA, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Athinoula A. Martinos Center for Biomedical Imaging, MGH, Charlestown, MA, United States of America
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