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Turner S, Dress C, Misra VK. A 3'-truncating FTL mutation associated with hypoferritinemia without neuroferritinopathy. Eur J Med Genet 2021; 64:104159. [PMID: 33548513 DOI: 10.1016/j.ejmg.2021.104159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/16/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
Mutations in the gene for the ferritin light chain (FTL) often present with hypoferritinemia associated with progressive, late onset extrapyramidal dysfunction. However, it has been suggested that some FTL mutations may impact ferritin levels without any neurological manifestations. We report on a FTL mutation in a three generation family with autosomal dominant hypoferritinemia without neurodegeneration. The 4 year old proband was identified with longstanding history of hypoferritinemia without evidence of anemia. Brain MRI did not show any evidence of iron deposition. It was found that the patient's 19 month old sister, 30 year old mother and 58 year old maternal grandmother also had hypoferritinemia and normal iron levels. Over the next nine years, none of these persons had any evidence of neurological dysfunction, including movement disorders, gait disturbances, behavioral or psychiatric dysfunction. Whole exome sequencing revealed a heterozygous interstitial deletion of at least 5 kb within cytogenic band 19q13.33 involving exons 3 and 4 of FTL in all affected family members. This 3' FTL deletion is predicted to create a significantly truncated protein product. We conclude that haploinsufficiency of FTL may be associated with hypoferritinemia without neurological dysfunction.
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Zhang N, Yu X, Xie J, Xu H. New Insights into the Role of Ferritin in Iron Homeostasis and Neurodegenerative Diseases. Mol Neurobiol 2021; 58:2812-2823. [PMID: 33507490 DOI: 10.1007/s12035-020-02277-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/28/2020] [Indexed: 12/11/2022]
Abstract
Growing evidence has indicated that iron deposition is one of the key factors leading to neuronal death in the neurodegenerative diseases. Ferritin is a hollow iron storage protein composed of 24 subunits of two types, ferritin heavy chain (FTH) and ferritin light chain (FTL), which plays an important role in maintaining iron homeostasis. Recently, the discovery of extracellular ferritin and ferritin in exosomes indicates that ferritin might be not only an iron storage protein within the cell, but might also be an important factor in the regulation of tissue and body iron homeostasis. In this review, we first described the structural characteristics, regulation and the physiological functions of ferritin. Secondly, we reviewed the current evidence concerning the mechanisms underlying the secretion of ferritin and the possible role of secreted ferritin in the brain. Then, we summarized the relationship between ferritin and the neurodegenerative diseases including Parkinson's disease (PD), Alzheimer's disease (AD) and neuroferritinopathy (NF). Given the importance and relationship between iron and neurodegenerative diseases, understanding the role of ferritin in the brain can be expected to contribute to our knowledge of iron dysfunction and neurodegenerative diseases.
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Affiliation(s)
- Na Zhang
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, School of Basic Medicine, Qingdao University, Qingdao, 266071, China.,Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China
| | - Xiaoqi Yu
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, School of Basic Medicine, Qingdao University, Qingdao, 266071, China.,Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China
| | - Junxia Xie
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, School of Basic Medicine, Qingdao University, Qingdao, 266071, China. .,Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China.
| | - Huamin Xu
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders, School of Basic Medicine, Qingdao University, Qingdao, 266071, China. .,Institute of Brain Science and Disease, Qingdao University, Qingdao, 266071, China.
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Kumar N, Rizek P, Jog M. Neuroferritinopathy: Pathophysiology, Presentation, Differential Diagnoses and Management. Tremor Other Hyperkinet Mov (N Y) 2016; 6:355. [PMID: 27022507 PMCID: PMC4795517 DOI: 10.7916/d8kk9bhf] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/14/2016] [Indexed: 12/20/2022]
Abstract
Background Neuroferritinopathy (NF) is a rare autosomal dominant disease caused by
mutations in the ferritin light chain 1 (FTL1) gene
leading to abnormal excessive iron accumulation in the brain, predominantly in the
basal ganglia. Methods A literature search was performed on Pubmed, for English-language articles,
utilizing the terms iron metabolism, neurodegeneration with brain iron
accumulation, and NF. The relevant articles were reviewed with a focus on the
pathophysiology, clinical presentation, differential diagnoses, and management of
NF. Results There have been nine reported mutations worldwide in the FTL1
gene in 90 patients, the most common mutation being 460InsA. Chorea and dystonia
are the most common presenting symptoms in NF. There are specific features, which
appear to depend upon the genetic mutation. We discuss the occurrence of specific
mutations in various regions along with their associated presenting phenomenology.
We have compared and contrasted the commonly occurring syndromes in the
differential diagnosis of NF to guide the clinician. Discussion NF must be considered in patients presenting clinically as a progressive movement
disorder with variable phenotype and imaging evidence of iron deposition within
the brain, decreased serum ferritin, and negative genetic testing for other more
common movement disorders such as Huntington’s disease. In the absence of a
disease-specific treatment, symptomatic drug therapy for specific movement
disorders may be used, although with variable success.
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Affiliation(s)
- Niraj Kumar
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Philippe Rizek
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
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Keogh MJ, Aribisala BS, He J, Tulip E, Butteriss D, Morris C, Gorman G, Horvath R, Chinnery PF, Blamire AM. Voxel-based analysis in neuroferritinopathy expands the phenotype and determines radiological correlates of disease severity. J Neurol 2015; 262:2232-40. [PMID: 26142024 DOI: 10.1007/s00415-015-7832-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 10/23/2022]
Abstract
Neuroferritinopathy is an autosomal dominant adult-onset movement disorder which occurs due to mutations in the ferritin light chain gene (FTL). Extensive iron deposition and cavitation are observed post-mortem in the basal ganglia, but whether more widespread pathological changes occur, and whether they correlate with disease severity is unknown. 3D-T1w and quantitative T2 whole brain MRI scans were performed in 10 clinically symptomatic patients with the 460InsA FTL mutation and 10 age-matched controls. Voxel-based morphometry (VBM) and voxel-based relaxometry (VBR) were subsequently performed. Clinical assessment using the Unified Dystonia Rating Scale (UDRS) and Unified Huntington's Disease Rating Scale (UHDRS) was undertaken in all patients. VBM detected significant tissue changes within the substantia nigra, midbrain and dentate together with significant cerebellar atrophy in patients (FWE, p < 0.05). Iron deposition in the caudate head and cavitation in the lateral globus pallidus correlated with UDRS score (p < 0.001). There were no differences between groups with VBR. Our data show that progressive iron accumulation in the caudate nucleus, and cavitation of the globus pallidus correlate with disease severity in neuroferritinopathy. We also confirm sub-clinical cerebellar atrophy as a feature of the disease. We suggest that VBM is an effective technique to detect regions of iron deposition and cavitation, with potential wider utility to determine radiological markers of disease severity for all NBIA disorders.
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Affiliation(s)
- M J Keogh
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, England, UK.
| | - B S Aribisala
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, England, UK
| | - J He
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, England, UK
| | - E Tulip
- School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, England, UK
| | - D Butteriss
- Department of Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, England, UK
| | - C Morris
- Medical Toxicology Centre, Wolfson Building, Claremont Place, Newcastle University, Newcastle upon Tyne, NE2 4AA, England, UK
| | - G Gorman
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, NE2 4HH, England, UK
| | - R Horvath
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, England, UK
| | - P F Chinnery
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, England, UK.,Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, NE2 4HH, England, UK
| | - Andrew M Blamire
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, England, UK.
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Levi S, Rovida E. Neuroferritinopathy: From ferritin structure modification to pathogenetic mechanism. Neurobiol Dis 2015; 81:134-43. [PMID: 25772441 DOI: 10.1016/j.nbd.2015.02.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/20/2015] [Accepted: 02/05/2015] [Indexed: 12/23/2022] Open
Abstract
Neuroferritinopathy is a rare, late-onset, dominantly inherited movement disorder caused by mutations in L-ferritin gene. It is characterized by iron and ferritin aggregate accumulation in brain, normal or low serum ferritin levels and high variable clinical feature. To date, nine causative mutations have been identified and eight of them are frameshift mutations determined by nucleotide(s) insertion in the exon 4 of L-ferritin gene altering the structural conformation of the C-terminus of the L-ferritin subunit. Acting in a dominant negative manner, mutations are responsible for an impairment of the iron storage efficiency of ferritin molecule. Here, we review the main characteristics of neuroferritinopathy and present a computational analysis of some representative recently defined mutations with the purpose to gain new information about the pathogenetic mechanism of the disorder. This is particularly important as neuroferritinopathy can be considered an interesting model to study the relationship between iron, oxidative stress and neurodegeneration.
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Maccarinelli F, Pagani A, Cozzi A, Codazzi F, Di Giacomo G, Capoccia S, Rapino S, Finazzi D, Politi LS, Cirulli F, Giorgio M, Cremona O, Grohovaz F, Levi S. A novel neuroferritinopathy mouse model (FTL 498InsTC) shows progressive brain iron dysregulation, morphological signs of early neurodegeneration and motor coordination deficits. Neurobiol Dis 2014; 81:119-33. [PMID: 25447222 PMCID: PMC4642750 DOI: 10.1016/j.nbd.2014.10.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/01/2014] [Accepted: 10/29/2014] [Indexed: 02/05/2023] Open
Abstract
Neuroferritinopathy is a rare genetic disease with a dominant autosomal transmission caused by mutations of the ferritin light chain gene (FTL). It belongs to Neurodegeneration with Brain Iron Accumulation, a group of disorders where iron dysregulation is tightly associated with neurodegeneration. We studied the 498–499InsTC mutation which causes the substitution of the last 9 amino acids and an elongation of extra 16 amino acids at the C-terminus of L-ferritin peptide. An analysis with cyclic voltammetry on the purified protein showed that this structural modification severely reduces the ability of the protein to store iron. In order to analyze the impact of the mutation in vivo, we generated mouse models for the some pathogenic human FTL gene in FVB and C57BL/6J strains. Transgenic mice in the FVB background showed high accumulation of the mutated ferritin in brain where it correlated with increased iron deposition with age, as scored by magnetic resonance imaging. Notably, the accumulation of iron–ferritin bodies was accompanied by signs of oxidative damage. In the C57BL/6 background, both the expression of the mutant ferritin and the iron levels were lower than in the FVB strain. Nevertheless, also these mice showed oxidative alterations in the brain. Furthermore, post-natal hippocampal neurons obtained from these mice experienced a marked increased cell death in response to chronic iron overload and/or acute oxidative stress, in comparison to wild-type neurons. Ultrastructural analyses revealed an accumulation of lipofuscin granules associated with iron deposits, particularly enriched in the cerebellum and striatum of our transgenic mice. Finally, experimental subjects were tested throughout development and aging at 2-, 8- and 18-months for behavioral phenotype. Rotarod test revealed a progressive impaired motor coordination building up with age, FTL mutant old mice showing a shorter latency to fall from the apparatus, according to higher accumulation of iron aggregates in the striatum. Our data show that our 498–499InsTC mouse models recapitulate early pathological and clinical traits of the human neuroferritinopathy, thus providing a valuable model for the study of the disease. Finally, we propose a mechanistic model of lipofuscine formation that can account for the etiopathogenesis of human neuroferritinopathy. We developed two new neuroferritinopathy mice models (NF). NF brains are characterized by iron/ferritin accumulation and oxidative damage. NF brains show granules of lipofuscine associated with iron. A mechanism of lipofuscine formation is proposed. NF mice show impaired motor coordination increasing with age.
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Affiliation(s)
| | - Antonella Pagani
- San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Anna Cozzi
- San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy; Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milano, Italy
| | - Franca Codazzi
- San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | | | - Sara Capoccia
- Section of Behavioral Neuroscience, Department of Cell Biology, Istituto Superiore di Sanità, Rome, Italy
| | - Stefania Rapino
- Department of Experimental Oncology, European Institute of Oncology, Via Adamello 16, 20139 Milan, Italy
| | - Dario Finazzi
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | | | - Francesca Cirulli
- Section of Behavioral Neuroscience, Department of Cell Biology, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Giorgio
- Department of Experimental Oncology, European Institute of Oncology, Via Adamello 16, 20139 Milan, Italy
| | - Ottavio Cremona
- San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy; Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milano, Italy
| | - Fabio Grohovaz
- San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy; Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milano, Italy.
| | - Sonia Levi
- San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy; Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milano, Italy.
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Moutton S, Fergelot P, Trocello JM, Plante-Bordeneuve V, Houcinat N, Wenisch E, Larue V, Brugières P, Clot F, Lacombe D, Arveiler B, Goizet C. A novel FTL mutation responsible for neuroferritinopathy with asymmetric clinical features and brain anomalies. Parkinsonism Relat Disord 2014; 20:935-7. [PMID: 24907184 DOI: 10.1016/j.parkreldis.2014.04.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/24/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Sébastien Moutton
- Service de génétique médicale, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France; Laboratoire MRGM: Maladies Rares, Génétique et Métabolisme, Université de Bordeaux, Bordeaux, France.
| | - Patricia Fergelot
- Service de génétique médicale, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France; Laboratoire MRGM: Maladies Rares, Génétique et Métabolisme, Université de Bordeaux, Bordeaux, France
| | - Jean-Marc Trocello
- Centre national de référence de la maladie de Wilson, service de neurologie, APHP, Hôpital Lariboisière, Paris, France
| | | | - Nada Houcinat
- Service de génétique médicale, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France; Laboratoire MRGM: Maladies Rares, Génétique et Métabolisme, Université de Bordeaux, Bordeaux, France
| | - Emilie Wenisch
- Centre national de référence de la maladie de Wilson, service de neurologie, APHP, Hôpital Lariboisière, Paris, France
| | - Vincent Larue
- Service de génétique médicale, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Pierre Brugières
- Service de neuroradiologie, APHP, Hôpital Henri Mondor, Creteil, France
| | - Fabienne Clot
- UF de Neurogénétique Moléculaire et Cellulaire, Département de Génétique, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, France
| | - Didier Lacombe
- Service de génétique médicale, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France; Laboratoire MRGM: Maladies Rares, Génétique et Métabolisme, Université de Bordeaux, Bordeaux, France
| | - Benoit Arveiler
- Service de génétique médicale, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France; Laboratoire MRGM: Maladies Rares, Génétique et Métabolisme, Université de Bordeaux, Bordeaux, France
| | - Cyril Goizet
- Service de génétique médicale, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France; Laboratoire MRGM: Maladies Rares, Génétique et Métabolisme, Université de Bordeaux, Bordeaux, France
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van den Bogaard SJA, Kruit MC, Dumas EM, Roos RAC. Eye-of-the-tiger-sign in a 48 year healthy adult. J Neurol Sci 2013; 336:254-6. [PMID: 24268924 DOI: 10.1016/j.jns.2013.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/25/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
We report a healthy adult male, who underwent, as a control subject, part of a Huntington's disease study, extensive testing during three visits in a two year follow-up, including clinical examination and 3.0 T MRI scans. The T2-weighted MRI sequences revealed the "eye-of-the-tiger-sign". No clinical abnormalities in either motor, cognitive or behavioural domains were observed. PKAN2 and FTL gene mutation analysis were negative. This finding implies that an eye-of-the-tiger sign, which is considered a pathognomonic feature of neurodegeneration with brain iron accumulation (NBIA), can occur without any clinical symptoms.
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Affiliation(s)
| | - Mark C Kruit
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eve M Dumas
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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Abstract
INTRODUCTION Neuroferritinopathy is an autosomal dominant neurodegenerative disorder that includes a movement disorder, cognitive decline, and characteristic findings on brain magnetic resonance imaging (MRI) due to abnormal iron deposition. Here, we present a late-onset case, along with diffusion tensor imaging (DTI). CASE PRESENTATION We report the case of a 74-year-old Caucasian female with no significant past medical history who presented for evaluation of orofacial dyskinesia, suspected to be edentulous dyskinesia given her history of ill-fitting dentures. She had also developed slowly progressive dysarthria, dysphagia, visual hallucinations as well as stereotypic movements of her hands and feet. RESULTS The eye-of-the-tiger sign was demonstrated on T2 MRI. Increased fractional anisotropy and T2 hypointensity were observed in the periphery of the globus pallidus, putamen, substantia nigra, and dentate nucleus. T2 hyperintensity was present in the medial dentate nucleus and central globus pallidus. DISCUSSION The pallidal MRI findings were more typical of pantothenate kinase-associated neurodegeneration (PKAN), but given additional dentate and putamenal involvement, lack of retinopathy, and advanced age of onset, PKAN was less likely. Although the patient's ferritin levels were within low normal range, her clinical and imaging features led to a diagnosis of neuroferritinopathy. CONCLUSION Neurodegeneration with brain iron accumulation (NBIA) is a rare cause of orofacial dyskinesia. DTI MRI can confirm abnormal iron deposition. The location of abnormal iron deposits helps in differentiating NBIA subtypes. Degeneration of the dentate and globus pallidus may occur via an analogous process given their similar T2 and DTI MRI appearance.
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Affiliation(s)
- Syed Omar Shah
- Department of Neurology, New York Medical College, Valhalla, N.Y., USA
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