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Zhang JJ. Cortico-cortical paired associative stimulation: a novel neurostimulation solution for modulating brain connectivity and networks. Front Neurosci 2024; 17:1336134. [PMID: 38260030 PMCID: PMC10800620 DOI: 10.3389/fnins.2023.1336134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
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Pulverenti TS, Zaaya M, Grabowski E, Grabowski M, Knikou M. Brain and spinal cord paired stimulation coupled with locomotor training facilitates motor output in human spinal cord injury. Front Neurol 2022; 13:1000940. [PMID: 36313489 PMCID: PMC9612520 DOI: 10.3389/fneur.2022.1000940] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Combined interventions for neuromodulation leading to neurorecovery have gained great attention by researchers to resemble clinical rehabilitation approaches. In this randomized clinical trial, we established changes in the net output of motoneurons innervating multiple leg muscles during stepping when transcranial magnetic stimulation (TMS) of the primary motor cortex was paired with transcutaneous spinal (transspinal) stimulation over the thoracolumbar region during locomotor training. TMS was delivered before (TMS-transspinal) or after (transspinal-TMS) transspinal stimulation during the stance phase of the less impaired leg. Ten individuals with chronic incomplete or complete SCI received at least 20 sessions of training. Each session consisted of 240 paired stimuli delivered over 10-min blocks for 1 h during robotic assisted step training on a motorized treadmill. Body weight support, leg guidance force and treadmill speed were adjusted based on each subject's ability to step without knee buckling or toe dragging. Most transspinal evoked potentials (TEPs) recorded before and after each intervention from ankle and knee muscles during assisted stepping were modulated in a phase-dependent pattern. Transspinal-TMS and locomotor training affected motor neuron output of knee and ankle muscles with ankle TEPs to be modulated in a phase-dependent manner. TMS-transspinal and locomotor training increased motor neuron output for knee but not for ankle muscles. Our results support that targeted brain and spinal cord stimulation alters responsiveness of neurons over multiple spinal segments in people with chronic SCI. Noninvasive stimulation of the brain and spinal cord along with locomotor training is a novel neuromodulation method that can become a promising modality for rehabilitation in humans after SCI.
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Affiliation(s)
- Timothy S. Pulverenti
- Klab4Recovery Research Program, The City University of New York, New York, NY, United States
| | - Morad Zaaya
- Klab4Recovery Research Program, The City University of New York, New York, NY, United States
| | - Ewelina Grabowski
- PhD Program in Biology and Collaborative Neuroscience Program, Graduate Center of the City University of New York and College of Staten Island, New York, NY, United States
| | - Monika Grabowski
- PhD Program in Biology and Collaborative Neuroscience Program, Graduate Center of the City University of New York and College of Staten Island, New York, NY, United States
| | - Maria Knikou
- Klab4Recovery Research Program, The City University of New York, New York, NY, United States,PhD Program in Biology and Collaborative Neuroscience Program, Graduate Center of the City University of New York and College of Staten Island, New York, NY, United States,Department of Physical Therapy, College of Staten Island, The City University of New York, New York, NY, United States,*Correspondence: Maria Knikou
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3
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Al'joboori Y, Hannah R, Lenham F, Borgas P, Kremers CJP, Bunday KL, Rothwell J, Duffell LD. The Immediate and Short-Term Effects of Transcutaneous Spinal Cord Stimulation and Peripheral Nerve Stimulation on Corticospinal Excitability. Front Neurosci 2021; 15:749042. [PMID: 34744614 PMCID: PMC8566815 DOI: 10.3389/fnins.2021.749042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Rehabilitative interventions involving electrical stimulation show promise for neuroplastic recovery in people living with Spinal Cord Injury (SCI). However, the understanding of how stimulation interacts with descending and spinal excitability remain unclear. In this study we compared the immediate and short-term (within a few minutes) effects of pairing Transcranial Magnetic Stimulation (TMS) with transcutaneous Spinal Cord stimulation (tSCS) and Peripheral Nerve Stimulation (PNS) on Corticospinal excitability in healthy subjects. Three separate experimental conditions were assessed. In Experiment I, paired associative stimulation (PAS) was applied, involving repeated pairing of single pulses of TMS and tSCS, either arriving simultaneously at the spinal motoneurones (PAS0ms) or slightly delayed (PAS5ms). Corticospinal and spinal excitability, and motor performance, were assessed before and after the PAS interventions in 24 subjects. Experiment II compared the immediate effects of tSCS and PNS on corticospinal excitability in 20 subjects. Experiment III compared the immediate effects of tSCS with tSCS delivered at the same stimulation amplitude but modulated with a carrier frequency (in the kHz range) on corticospinal excitability in 10 subjects. Electromyography (EMG) electrodes were placed over the Tibialis Anterior (TA) soleus (SOL) and vastus medialis (VM) muscles and stimulation electrodes (cathodes) were placed on the lumbar spine (tSCS) and lateral to the popliteal fossa (PNS). TMS over the primary motor cortex (M1) was paired with tSCS or PNS to produce Motor Evoked Potentials (MEPs) in the TA and SOL muscles. Simultaneous delivery of repetitive PAS (PAS0ms) increased corticospinal excitability and H-reflex amplitude at least 5 min after the intervention, and dorsiflexion force was increased in a force-matching task. When comparing effects on descending excitability between tSCS and PNS, a subsequent facilitation in MEPs was observed following tSCS at 30-50 ms which was not present following PNS. To a lesser extent this facilitatory effect was also observed with HF- tSCS at subthreshold currents. Here we have shown that repeated pairing of TMS and tSCS can increase corticospinal excitability when timed to arrive simultaneously at the alpha-motoneurone and can influence functional motor output. These results may be useful in optimizing stimulation parameters for neuroplasticity in people living with SCI.
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Affiliation(s)
- Yazi Al'joboori
- Department of Medical Physics & Biomedical Engineering, University College London, London, United Kingdom
| | - Ricci Hannah
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Francesca Lenham
- Department of Medical Physics & Biomedical Engineering, University College London, London, United Kingdom
| | - Pia Borgas
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Charlotte J P Kremers
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Karen L Bunday
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom.,Psychology, School of Social Sciences, University of Westminster, London, United Kingdom
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Lynsey D Duffell
- Department of Medical Physics & Biomedical Engineering, University College London, London, United Kingdom
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4
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Huang Y, Chen JC, Tsai CH, Lu MK. Convergent Associative Motor Cortical Plasticity Induced by Conditional Somatosensory and Motor Reaction Afferents. Front Hum Neurosci 2020; 14:576171. [PMID: 33192405 PMCID: PMC7609873 DOI: 10.3389/fnhum.2020.576171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/13/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: Associative motor cortical plasticity can be non-invasively induced by paired median nerve electric stimulation and transcranial magnetic stimulation (TMS) of the primary motor cortex (M1). This study investigates whether a simultaneous motor reaction of the other hand advances the associative plasticity in M1. Methods: Twenty-four right-handed subjects received conventional paired associative stimulation (PAS) and PAS with simultaneous motor reaction (PASmr) with at least a 1-week interval. The PASmr protocol additionally included left abductor pollicis brevis muscle movement responding to a digital sound. The motor reaction time was individually measured. The M1 excitability was examined by the motor evoked potential (MEP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) before and after the PAS protocols. Results: The conventional PAS protocol significantly facilitated MEP and suppressed SICI. A negative correlation between the reaction time and the MEP change, and a positive correlation between the reaction time and the ICF change were found in the PASmr protocol. By subgrouping analysis, we further found significant facilitation of MEP and a reduction of ICF in the subjects with fast reaction times but not in those with slow reaction times. Conclusion: Synchronized motor reaction ipsilateral to the stimulated M1 induces associative M1 motor plasticity through the spike-timing dependent principle. MEP and ICF change could represent this kind of plasticity. The current findings provide a novel insight into designing rehabilitation programs concerning motor function.
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Affiliation(s)
- Yi Huang
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Jui-Cheng Chen
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Kuei Lu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan.,Ph.D. Program for Translational Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Stampanoni Bassi M, Buttari F, Nicoletti CG, Mori F, Gilio L, Simonelli I, De Paolis N, Marfia GA, Furlan R, Finardi A, Centonze D, Iezzi E. Interleukin-1β Alters Hebbian Synaptic Plasticity in Multiple Sclerosis. Int J Mol Sci 2020; 21:E6982. [PMID: 32977401 DOI: 10.3390/ijms21196982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022] Open
Abstract
In multiple sclerosis (MS), inflammation alters synaptic transmission and plasticity, negatively influencing the disease course. In the present study, we aimed to explore the influence of the proinflammatory cytokine IL-1β on peculiar features of associative Hebbian synaptic plasticity, such as input specificity, using the paired associative stimulation (PAS). In 33 relapsing remitting-MS patients and 15 healthy controls, PAS was performed on the abductor pollicis brevis (APB) muscle. The effects over the motor hot spot of the APB and abductor digiti minimi (ADM) muscles were tested immediately after PAS and 15 and 30 min later. Intracortical excitability was tested with paired-pulse transcranial magnetic stimulation (TMS). The cerebrospinal fluid (CSF) levels of IL-1β were calculated. In MS patients, PAS failed to induce long-term potentiation (LTP)-like effects in the APB muscle and elicited a paradoxical motor-evoked potential (MEP) increase in the ADM. IL-1β levels were negatively correlated with the LTP-like response in the APB muscle. Moreover, IL-1β levels were associated with synaptic hyperexcitability tested with paired-pulse TMS. Synaptic hyperexcitability caused by IL-1β may critically contribute to alter Hebbian plasticity in MS, inducing a loss of topographic specificity.
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Lopez-Alonso V, Liew SL, Fernández Del Olmo M, Cheeran B, Sandrini M, Abe M, Cohen LG. A Preliminary Comparison of Motor Learning Across Different Non-invasive Brain Stimulation Paradigms Shows No Consistent Modulations. Front Neurosci 2018; 12:253. [PMID: 29740271 PMCID: PMC5924807 DOI: 10.3389/fnins.2018.00253] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/03/2018] [Indexed: 12/13/2022] Open
Abstract
Non-invasive brain stimulation (NIBS) has been widely explored as a way to safely modulate brain activity and alter human performance for nearly three decades. Research using NIBS has grown exponentially within the last decade with promising results across a variety of clinical and healthy populations. However, recent work has shown high inter-individual variability and a lack of reproducibility of previous results. Here, we conducted a small preliminary study to explore the effects of three of the most commonly used excitatory NIBS paradigms over the primary motor cortex (M1) on motor learning (Sequential Visuomotor Isometric Pinch Force Tracking Task) and secondarily relate changes in motor learning to changes in cortical excitability (MEP amplitude and SICI). We compared anodal transcranial direct current stimulation (tDCS), paired associative stimulation (PAS25), and intermittent theta burst stimulation (iTBS), along with a sham tDCS control condition. Stimulation was applied prior to motor learning. Participants (n = 28) were randomized into one of the four groups and were trained on a skilled motor task. Motor learning was measured immediately after training (online), 1 day after training (consolidation), and 1 week after training (retention). We did not find consistent differential effects on motor learning or cortical excitability across groups. Within the boundaries of our small sample sizes, we then assessed effect sizes across the NIBS groups that could help power future studies. These results, which require replication with larger samples, are consistent with previous reports of small and variable effect sizes of these interventions on motor learning.
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Affiliation(s)
- Virginia Lopez-Alonso
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States.,Department of Physical Activity and Sport Sciences, "Center of Higher Education Alberta Giménez (CESAG)" Comillas Pontifical University, Palma, Spain.,Department of Physical Education, Faculty of Sciences of Sport and Physical Education, University of A Coruña, A Coruña, Spain
| | - Sook-Lei Liew
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States.,Departments of Occupational Therapy, Biokinesiology, and Neurology, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Miguel Fernández Del Olmo
- Department of Physical Education, Faculty of Sciences of Sport and Physical Education, University of A Coruña, A Coruña, Spain
| | - Binith Cheeran
- Molecular and Clinical Sciences Institute, St. George's, University of London, London, United Kingdom.,The London Clinic, London, United Kingdom
| | - Marco Sandrini
- Department of Psychology, University of Roehampton, London, United Kingdom
| | - Mitsunari Abe
- Faculty of Medicine, Center for Neurological Disorders, Fukushima Medical University, Fukushima, Japan
| | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States
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Lagas AK, Black JM, Byblow WD, Fleming MK, Goodman LK, Kydd RR, Russell BR, Stinear CM, Thompson B. Fluoxetine Does Not Enhance Visual Perceptual Learning and Triazolam Specifically Impairs Learning Transfer. Front Hum Neurosci 2016; 10:532. [PMID: 27807412 PMCID: PMC5069436 DOI: 10.3389/fnhum.2016.00532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/06/2016] [Indexed: 01/17/2023] Open
Abstract
The selective serotonin reuptake inhibitor fluoxetine significantly enhances adult visual cortex plasticity within the rat. This effect is related to decreased gamma-aminobutyric acid (GABA) mediated inhibition and identifies fluoxetine as a potential agent for enhancing plasticity in the adult human brain. We tested the hypothesis that fluoxetine would enhance visual perceptual learning of a motion direction discrimination (MDD) task in humans. We also investigated (1) the effect of fluoxetine on visual and motor cortex excitability and (2) the impact of increased GABA mediated inhibition following a single dose of triazolam on post-training MDD task performance. Within a double blind, placebo controlled design, 20 healthy adult participants completed a 19-day course of fluoxetine (n = 10, 20 mg per day) or placebo (n = 10). Participants were trained on the MDD task over the final 5 days of fluoxetine administration. Accuracy for the trained MDD stimulus and an untrained MDD stimulus configuration was assessed before and after training, after triazolam and 1 week after triazolam. Motor and visual cortex excitability were measured using transcranial magnetic stimulation. Fluoxetine did not enhance the magnitude or rate of perceptual learning and full transfer of learning to the untrained stimulus was observed for both groups. After training was complete, trazolam had no effect on trained task performance but significantly impaired untrained task performance. No consistent effects of fluoxetine on cortical excitability were observed. The results do not support the hypothesis that fluoxetine can enhance learning in humans. However, the specific effect of triazolam on MDD task performance for the untrained stimulus suggests that learning and learning transfer rely on dissociable neural mechanisms.
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Affiliation(s)
- Alice K Lagas
- School of Optometry and Vision Science, University of AucklandAuckland, New Zealand; Centre for Brain Research, University of AucklandAuckland, New Zealand
| | - Joanna M Black
- School of Optometry and Vision Science, University of AucklandAuckland, New Zealand; Centre for Brain Research, University of AucklandAuckland, New Zealand
| | - Winston D Byblow
- Centre for Brain Research, University of AucklandAuckland, New Zealand; Department of Exercise Sciences, University of AucklandAuckland, New Zealand
| | - Melanie K Fleming
- Department of Exercise Sciences, University of AucklandAuckland, New Zealand; Centre of Human and Aerospace Physiological Sciences, King's College LondonLondon, UK
| | - Lucy K Goodman
- School of Optometry and Vision Science, University of AucklandAuckland, New Zealand; Centre for Brain Research, University of AucklandAuckland, New Zealand
| | - Robert R Kydd
- Centre for Brain Research, University of AucklandAuckland, New Zealand; Department of Psychological Medicine, University of AucklandAuckland, New Zealand
| | - Bruce R Russell
- School of Pharmacy, University of AucklandAuckland, New Zealand; National School of Pharmacy, University of OtagoDunedin, New Zealand
| | - Cathy M Stinear
- Centre for Brain Research, University of AucklandAuckland, New Zealand; Department of Medicine, University of AucklandAuckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of AucklandAuckland, New Zealand; Centre for Brain Research, University of AucklandAuckland, New Zealand; School of Optometry and Vision Science, University of Waterloo, WaterlooON, Canada
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Klöppel S, Lauer E, Peter J, Minkova L, Nissen C, Normann C, Reis J, Mainberger F, Bach M, Lahr J. LTP-like plasticity in the visual system and in the motor system appear related in young and healthy subjects. Front Hum Neurosci 2015; 9:506. [PMID: 26441603 PMCID: PMC4585301 DOI: 10.3389/fnhum.2015.00506] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/31/2015] [Indexed: 01/12/2023] Open
Abstract
LTP-like plasticity measured by visual evoked potentials (VEP) can be induced in the intact human brain by presenting checkerboard reversals. Also associated with LTP-like plasticity, around two third of participants respond to transcranial magnetic stimulation (TMS) with a paired-associate stimulation (PAS) protocol with a potentiation of their motor evoked potentials. LTP-like processes are also required for verbal and motor learning tasks. We compared effect sizes, responder rates and intercorrelations as well as the potential influence of attention between these four assessments in a group of 37 young and healthy volunteers. We observed a potentiation effect of the N75 and P100 VEP component which positively correlated with plasticity induced by PAS. Subjects with a better subjective alertness were more likely to show PAS and VEP potentiation. No correlation was found between the other assessments. Effect sizes and responder rates of VEP potentiation were higher compared to PAS. Our results indicate a high variability of LTP-like effects and no evidence for a system-specific nature. As a consequence, studies wishing to assess individual levels of LTP-like plasticity should employ a combination of multiple assessments.
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Affiliation(s)
- Stefan Klöppel
- Center of Geriatrics and Gerontology Freiburg, University Medical Center Freiburg Freiburg, Germany ; Department of Neurology, Freiburg Brain Imaging, University Medical Center Freiburg Freiburg, Germany ; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany ; Department of Neurology, University Medical Center Freiburg Freiburg, Germany
| | - Eliza Lauer
- Department of Neurology, Freiburg Brain Imaging, University Medical Center Freiburg Freiburg, Germany
| | - Jessica Peter
- Department of Neurology, Freiburg Brain Imaging, University Medical Center Freiburg Freiburg, Germany ; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany ; Department of Neurology, University Medical Center Freiburg Freiburg, Germany
| | - Lora Minkova
- Department of Neurology, Freiburg Brain Imaging, University Medical Center Freiburg Freiburg, Germany ; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany ; Laboratory for Biological and Personality Psychology, Department of Psychology, University of Freiburg Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany
| | - Janine Reis
- Department of Neurology, University Medical Center Freiburg Freiburg, Germany
| | - Florian Mainberger
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany ; Department of Pediatrics, Kinderzentrum München gGmbH, Technical University Munich Munich, Germany
| | - Michael Bach
- Eye Center, University Medical Center Freiburg Freiburg, Germany
| | - Jacob Lahr
- Department of Neurology, Freiburg Brain Imaging, University Medical Center Freiburg Freiburg, Germany ; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg Freiburg, Germany ; Department of Neurology, University Medical Center Freiburg Freiburg, Germany
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