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Abstract
Gilles de la Tourette syndrome is a chronic and complex tic disorder accompanied by specific behavioral problems in the majority of patients. With its multifaceted interplay between motion and emotion, this condition is a paradigmatic example of the science and art of clinical neuropsychiatry. This review article encompasses the clinical phenomenology of motor and vocal tics and associated sensory experiences (premonitory urges), as well as the behavioral spectrum of the most common comorbidities, including obsessive-compulsive disorder, attention-deficit and hyperactivity disorder, affective symptoms, and impulsivity. Knowledge of the contributions of both tics and behavioral problems to patients' health-related quality of life across the lifespan should assist treating clinicians in formulating a targeted management plan. Although the exact pathophysiology of Gilles de la Tourette syndrome remains elusive, research into therapeutic interventions has expanded the range of available interventions across multiple domains. A thorough understanding of the neurology and psychiatry of this condition is of key importance to meet the needs of this patient population, from the formulation of an accurate diagnosis to the implementation of effective treatment strategies.
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Abstract
OBJECTIVE The aim of this study was to report worsening of Tourette syndrome (TS) in 2 patients treated with varenicline. BACKGROUND Abnormal dopaminergic signaling is likely involved in the pathophysiology of TS. Varenicline is a partial α4β2 nicotinic acetylcholine agonist that enhances dopamine release. Therefore, the use of varenicline may influence tics in patients with TS. METHOD We analyzed and described 2 case studies on patients with significant worsening of tics after treatment with varenicline. RESULTS Patient 1 had motor tics in childhood, which completely resolved by the age of 20 years. At the age of 25 years, he started varenicline and stopped smoking. Within 2 weeks, he developed motor followed by vocal tics that persisted despite stopping varenicline and restarting smoking. The tics were complex, medically refractory, and caused severe disability at work and school (Yale Global Tic Severity Scale score, 86). Patient 2 developed motor and vocal tics in adolescence that persisted into her 20s and caused significant disability in association with psychiatric comorbidities. At the age of 31 years, she started varenicline to quit smoking, which led to a marked increase in tic frequency and severity. Varenicline was discontinued after 3 weeks with improvement to baseline tic severity (Yale Global Tic Severity Scale score, 94). Ultimately, both patients successfully underwent deep brain stimulation to bilateral centromedian/parafascicular complex thalamic nuclei for medically refractory TS. CONCLUSIONS We report 2 patients with motor and/or vocal tics that had severe worsening of tics after varenicline use. This may be due to varenicline-induced increased striatal dopamine in conjunction with nicotine cessation, influencing dopamine receptor sensitivity in TS. Providers should be cautious in prescribing varenicline to patients with TS.
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Jo HJ, McCairn KW, Gibson WS, Testini P, Zhao CZ, Gorny KR, Felmlee JP, Welker KM, Blaha CD, Klassen BT, Min HK, Lee KH. Global network modulation during thalamic stimulation for Tourette syndrome. NEUROIMAGE-CLINICAL 2018; 18:502-509. [PMID: 29560306 PMCID: PMC5857897 DOI: 10.1016/j.nicl.2018.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/09/2018] [Accepted: 02/18/2018] [Indexed: 12/14/2022]
Abstract
Background and objectives Deep brain stimulation (DBS) of the thalamus is a promising therapeutic alternative for treating medically refractory Tourette syndrome (TS). However, few human studies have examined its mechanism of action. Therefore, the networks that mediate the therapeutic effects of thalamic DBS remain poorly understood. Methods Five participants diagnosed with severe medically refractory TS underwent bilateral thalamic DBS stereotactic surgery. Intraoperative fMRI characterized the blood oxygen level-dependent (BOLD) response evoked by thalamic DBS and determined whether the therapeutic effectiveness of thalamic DBS, as assessed using the Modified Rush Video Rating Scale test, would correlate with evoked BOLD responses in motor and limbic cortical and subcortical regions. Results Our results reveal that thalamic stimulation in TS participants has wide-ranging effects that impact the frontostriatal, limbic, and motor networks. Thalamic stimulation induced suppression of motor and insula networks correlated with motor tic reduction, while suppression of frontal and parietal networks correlated with vocal tic reduction. These regions mapped closely to major regions of interest (ROI) identified in a nonhuman primate model of TS. Conclusions Overall, these findings suggest that a critical factor in TS treatment should involve modulation of both frontostriatal and motor networks, rather than be treated as a focal disorder of the brain. Using the novel combination of DBS-evoked tic reduction and fMRI in human subjects, we provide new insights into the basal ganglia-cerebellar-thalamo-cortical network-level mechanisms that influence the effects of thalamic DBS. Future translational research should identify whether these network changes are cause or effect of TS symptoms.
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Affiliation(s)
- Hang Joon Jo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kevin W McCairn
- Systems Neuroscience Section, Primate Research Institute, Kyoto University, Inuyama, Aichi 484-8506, Japan
| | - William S Gibson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Paola Testini
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Cong Zhi Zhao
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Joel P Felmlee
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Kirk M Welker
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Charles D Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Bryan T Klassen
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.
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Pandey S, Srivanitchapoom P, Kirubakaran R, Berman BD, Cochrane Movement Disorders Group. Botulinum toxin for motor and phonic tics in Tourette's syndrome. Cochrane Database Syst Rev 2018; 1:CD012285. [PMID: 29304272 PMCID: PMC6491277 DOI: 10.1002/14651858.cd012285.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Gilles de la Tourette syndrome, or Tourette's syndrome, is defined as the presence of both motor and vocal (phonic) tics for more than 12 months, that manifest before the age of 18 years, in the absence of secondary causes. Treatment of motor and phonic tics is difficult and challenging. OBJECTIVES To determine the safety and effectiveness of botulinum toxin in treating motor and phonic tics in people with Tourette's syndrome, and to analyse the effect of botulinum toxin on premonitory urge and sensory tics. SEARCH METHODS We searched the Cochrane Movement Disorders Group Trials Register, CENTRAL, MEDLINE, and two trials registers to 25 October 2017. We reviewed reference lists of relevant articles for additional trials. SELECTION CRITERIA We considered all randomised, controlled, double-blind studies comparing botulinum toxin to placebo or other medications for the treatment of motor and phonic tics in Tourette's syndrome for this review. We sought both parallel group and cross-over studies of children or adults, at any dose, and for any duration. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods to select studies, assess risk of bias, extract and analyse data. All authors independently abstracted data onto standardized forms; disagreements were resolved by mutual discussion. MAIN RESULTS Only one randomised placebo-controlled, double-blind cross-over study met our selection criteria. In this study, 20 participants with motor tics were enrolled over a three-year recruitment period; 18 (14 of whom had a diagnosis of Tourette's syndrome) completed the study; in total, 21 focal motor tics were treated. Although we considered most bias domains to be at low risk of bias, the study recruited a small number of participants with relatively mild tics and provided limited data for our key outcomes. The effects of botulinum toxin injections on tic frequency, measured by videotape or rated subjectively, and on premonitory urge, are uncertain (very low-quality evidence). The quality of evidence for adverse events following botulinum toxin was very low. Nine people had muscle weakness following the injection, which could have led to unblinding of treatment group assignment. No data were available to evaluate whether botulinum injections led to immunoresistance to botulinum. AUTHORS' CONCLUSIONS We are uncertain about botulinum toxin effects in the treatment of focal motor and phonic tics in select cases, as we assessed the quality of the evidence as very low. Additional randomised controlled studies are needed to demonstrate the benefits and harms of botulinum toxin therapy for the treatment of motor and phonic tics in patients with Tourette's syndrome.
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Affiliation(s)
- Sanjay Pandey
- G.B. Pant HospitalDepartment of NeurologyNew DelhiIndia110002
| | - Prachaya Srivanitchapoom
- Siriraj Hospital, Mahidol UniversityDepartment of Medicine, Division of Neurology2 Prannok Road, Siriraj, Bangkok‐noiBangkokThailand10700
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Center for Evidence‐Informed Health Care and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreTamil NaduIndia632002
| | - Brian D Berman
- University of Colorado, School of MedicineDepartment of NeurologyAuroraColoradoUSA80045
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Ricketts EJ, McGuire JF, Chang S, Bose D, Rasch MM, Woods DW, Specht MW, Walkup JT, Scahill L, Wilhelm S, Peterson AL, Piacentini J. Benchmarking Treatment Response in Tourette's Disorder: A Psychometric Evaluation and Signal Detection Analysis of the Parent Tic Questionnaire. Behav Ther 2018; 49:46-56. [PMID: 29405921 PMCID: PMC5988429 DOI: 10.1016/j.beth.2017.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/04/2017] [Accepted: 05/15/2017] [Indexed: 11/26/2022]
Abstract
This study assessed the psychometric properties of a parent-reported tic severity measure, the Parent Tic Questionnaire (PTQ), and used the scale to establish guidelines for delineating clinically significant tic treatment response. Participants were 126 children ages 9 to 17 who participated in a randomized controlled trial of Comprehensive Behavioral Intervention for Tics (CBIT). Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), Hopkins Motor/Vocal Tic Scale (HMVTS) and PTQ; positive treatment response was defined by a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Impressions - Improvement (CGI-I) scale. Cronbach's alpha and intraclass correlations (ICC) assessed internal consistency and test-retest reliability, with correlations evaluating validity. Receiver- and Quality-Receiver Operating Characteristic analyses assessed the efficiency of percent and raw-reduction cutoffs associated with positive treatment response. The PTQ demonstrated good internal consistency (α = 0.80 to 0.86), excellent test-retest reliability (ICC = .84 to .89), good convergent validity with the YGTSS and HM/VTS, and good discriminant validity from hyperactive, obsessive-compulsive, and externalizing (i.e., aggression and rule-breaking) symptoms. A 55% reduction and 10-point decrease in PTQ Total score were optimal for defining positive treatment response. Findings help standardize tic assessment and provide clinicians with greater clarity in determining clinically meaningful tic symptom change during treatment.
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Yu W, Shi X, Cui X, Niu Y, Zhang W, Bai X, Wang Q, Hu L, Wang S. Jian-Pi-Zhi-Dong-Decoction regulates the expression of glutamate transporters to attenuate glutamate excitotoxicity and exerts anti-tics effects in Tourette syndrome model rats. Neuropsychiatr Dis Treat 2018; 14:3381-3392. [PMID: 30587990 PMCID: PMC6301307 DOI: 10.2147/ndt.s185169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study explored whether Jian-Pi-Zhi-Dong-Decoction (JPZDD) could regulate the metabolism of glutamate (GLU) and its transporters in the striatum to exert anti-tics effects in Tourette syndrome (TS) rats. MATERIALS AND METHODS We randomly assigned 56 Sprague Dawley rats into four groups, each with 14 rats: control, model, tiapride (Tia), and JPZDD. TS groups (model, Tia, and JPZDD) received intraperitoneal injection of 3,3'-iminodipropionitrile for 7 days to establish TS model. Thereafter, rats in the four groups were treated differently once a day for 6 weeks. Behavioral evaluation was performed each week by using stereotypy recording and autonomic activity test. The level of GLU in the striatum was examined by high-performance liquid chromatography. Expression of EAAT1 and VGLUT1 were measured by quantitative real-time PCR (qRT-PCR) and laser scanning confocal microscope. RESULTS Compared with the model group, the stereotypy score and autonomic activity were decreased in Tia and JPZDD groups. Notably, the model group had increased concentration of GLU, which decreased after JPZDD and Tia treatments. In the model group, EAAT1 and glial cells were highly co-expressed and the relative fluorescence intensity (FI) of EAAT1 was significantly lower than that in the control group. Treatment with JPZDD and Tia increased the relative FI of EAAT1. The mRNA level of EAAT1 decreased in the model group compared to that in the control group, although it was significantly elevated following JPZDD or Tia treatment. In the model group, there was low co-expression of VGLUT1 and axon cells and the FI of VGLUT1 was remarkably increased relative to that in the control group and reduced following treatment with JPZDD and Tia. A similar trend was observed in the mRNA and protein expression of VGLUT1, although it was not statistically significant. CONCLUSION The mechanism by which JPZDD alleviated behavioral dysfunction of TS rats may be associated with maintaining normal GLU transport by upregulating EAAT1 and down-regulating VGLUT1 in the striatum.
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Affiliation(s)
- Wenjing Yu
- Department of Pediatrics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaowei Shi
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xia Cui
- Department of Pediatrics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Niu
- Department of Pediatrics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wen Zhang
- Department of Pediatrics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xue Bai
- Department of Pediatrics, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qian Wang
- Department of Pediatrics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lijun Hu
- Department of Pediatrics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Sumei Wang
- Department of Pediatrics, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China,
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Sundararajan K. Tics, Tourette’s Syndrome, and Current Therapies Review—Current Pediatric Report. CURRENT PEDIATRICS REPORTS 2017. [DOI: 10.1007/s40124-017-0129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee MH. A Single Case of Tourette's Syndrome Treated with Traditional Chinese Medicine. J Acupunct Meridian Stud 2017; 10:55-61. [PMID: 28254105 DOI: 10.1016/j.jams.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 12/13/2016] [Indexed: 01/31/2023] Open
Abstract
The objective of this case study was to investigate the effectiveness of Chinese medicine in treating Tourette's syndrome. Tourette's syndrome is a childhood- onset disorder that is characterized by sudden, involuntary movements or tics. The participant in this study was a 33-year-old male who had been diagnosed with Tourette's syndrome at the age of 9 years. His major complaints included facial tics, shoulder shrugging, and clearing the throat. Using a combination of acupuncture, herbs, Gua-Sha, and lifestyle changes once a week for 35 treatments, all the symptoms were reduced by 70%, as reported by the patient. In this case, the results indicated that Chinese medicine was able to minimize the symptoms of Tourette's syndrome. Further investigation is needed to support this argument. Tourette's syndrome, which was first described in 1885 by a French physician named Gilles de la Tourette, is characterized by facial tics, involuntary body movements from the head to the extremities, or vocal tics, and it usually has its onset in childhood. It is a neuropsychiatric disorder. The treatment for Tourette's syndrome is based on pharmacological treatment, behavior treatment, and deep brain stimulation. Unfortunately, none of these could completely control the symptoms; furthermore, antipsychiatric drugs might cause additional side effects, such as Parkinson symptoms, tardive dyskinesia, and metabolic disturbances. Finding acupuncture and oriental medicine literature on treatment of Tourette's syndrome was difficult, especially that written in English. Some research papers that have been translated into English indicated that Chinese herbs and acupuncture could reduce the tics significantly. For example, a study by Dr Pao-Hua Lin reported the significant effects of using acupuncture and oriental medicine in treating 1000 Tourette's syndrome cases. This case was treated to further investigate the principles of Dr Lin's study.
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Affiliation(s)
- Min-Hwa Lee
- DAOM, Oregon College of Oriental Medicine, Portland, OR, United States.
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Hashemiyoon R, Kuhn J, Visser-Vandewalle V. Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction. Brain Topogr 2017; 30:3-29. [PMID: 27783238 PMCID: PMC5219042 DOI: 10.1007/s10548-016-0525-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/20/2016] [Indexed: 12/21/2022]
Abstract
Gilles de la Tourette syndrome is a complex, idiopathic neuropsychiatric disorder whose pathophysiological mechanisms have yet to be elucidated. It is phenotypically heterogeneous and manifests more often than not with both motor and behavioral impairment, although tics are its clinical hallmark. Tics themselves present with a complex profile as they characteristically wax and wane and are often preceded by premonitory somatosensory sensations to which it is said a tic is the response. Highly comorbid with obsessive-compulsive disorder and attention deficit-hyperactivity disorder, it is purported to be an epigenetic, neurodevelopmental spectrum disorder with a complex genetic profile. It has a childhood onset, occurs disproportionately in males, and shows spontaneous symptomatic attenuation by adulthood in the majority of those afflicted. Although not fully understood, its neurobiological basis is linked to dysfunction in the cortico-basal ganglia-thalamo-cortical network. Treatment modalities for Tourette syndrome include behavioral, pharmacological and surgical interventions, but there is presently no cure for the disorder. For those severely affected, deep brain stimulation (DBS) has recently become a viable therapeutic option. A key factor to attaining optimal results from this surgery is target selection, a topic still under debate due to the complex clinical profile presented by GTS patients. Depending on its phenotypic expression and the most problematic aspect of the disorder for the individual, one of three brain regions is most commonly chosen for stimulation: the thalamus, globus pallidus, or nucleus accumbens. Neurophysiological analyses of intra- and post-operative human electrophysiological recordings from clinical DBS studies suggest a link between tic behavior and activity in both the thalamus and globus pallidus. In particular, chronic recordings from the thalamus have shown a correlation between symptomatology and (1) spectral activity in gamma band power and (2) theta/gamma cross frequency coherence. These results suggest gamma oscillations and theta/gamma cross correlation dynamics may serve as biomarkers for dysfunction. While acute and chronic recordings from human subjects undergoing DBS have provided better insight into tic genesis and the neuropathophysiological mechanisms underlying Tourette syndrome, these studies are still sparse and the field would greatly benefit from further investigations. This review reports data and discoveries of scientific and clinical relevance from a wide variety of methods and provides up-to-date information about our current understanding of the pathomechanisms underlying Tourette syndrome. It gives a comprehensive overview of the current state of knowledge and addresses open questions in the field.
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Affiliation(s)
- Rowshanak Hashemiyoon
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Cologne, Germany
- Johanniter Hospital, EVKLN, Oberhausen, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
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Cavanna AE, Black KJ, Hallett M, Voon V. Neurobiology of the Premonitory Urge in Tourette's Syndrome: Pathophysiology and Treatment Implications. J Neuropsychiatry Clin Neurosci 2017; 29:95-104. [PMID: 28121259 PMCID: PMC5409107 DOI: 10.1176/appi.neuropsych.16070141] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Motor and vocal tics are relatively common motor manifestations identified as the core features of Tourette's syndrome (TS). Although traditional descriptions have focused on objective phenomenological observations, such as anatomical location, number and frequency of tics, patients' first-person accounts have consistently reported characteristic subjective correlates. These sensory phenomena are often described as a feeling of mounting inner tension or urge to move ("premonitory urge"), which is transiently relieved by tic expression. This article reviews the existing literature on the clinical and neurobiological aspects of the premonitory urge in patients with TS, with focus on its pathophysiology and possible treatment implications.
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Affiliation(s)
- Andrea E. Cavanna
- Department of Neuropsychiatry Research Group, BSMHFT and University of Birmingham, Birmingham, UK,School of Life and Health Sciences, Aston University, Birmingham, UK,University College London and Institute of Neurology, London, UK,Corresponding author: Andrea E. Cavanna, MD PhD FRCP, Department of Neuropsychiatry, The Barberry National Centre for Mental Health, 25 Vincent Drive, Birmingham B152FG, United Kingdom, , Tel: +44 121 3012280
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Anatomy & Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neurosciences Institute, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Botulinum toxin for motor and phonic tics in Tourette's syndrome. Hippokratia 2016. [DOI: 10.1002/14651858.cd012285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wang LJ, Chou WJ, Chou MC, Gau SSF. The Effectiveness of Aripiprazole for Tics, Social Adjustment, and Parental Stress in Children and Adolescents with Tourette's Disorder. J Child Adolesc Psychopharmacol 2016; 26:442-8. [PMID: 27028456 DOI: 10.1089/cap.2015.0104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Tourette's syndrome (TS) frequently results in a negative impact on multiple functional domains. This prospective open-label study investigated the potential effectiveness of aripiprazole for tics, social adjustment, and parental stress in children and adolescents with TS. METHODS Study participants consisted of 26 patients (mean age 10.4 ± 3.0 years; 22 boys and 4 girls) who were prescribed aripiprazole, with each dose ranging from 2.5 to 15 mg/day. At baseline and 2, 4, and 8 weeks from baseline, tic symptoms, social adjustment, and parenting stress were assessed using the Yale Global Tic Severity Scale (YGTSS), the Social Adjustment Inventory for Children and Adolescents (SAICA), and the Parenting Stress Index (PSI). Aripiprazole could be optionally titrated from 2.5 to 30 mg/day at each visit. RESULTS Of the 26 patients at the initial visit, 22 (84.6%) completed the study. The mean dose of aripiprazole at the endpoint was 8.0 ± 4.0 mg/day. During the 8-week aripiprazole treatment period, motor tics, phonic tics, and impairment on the YGTSS all showed significant improvement. Home behaviors on the SAICA and child domain on the PSI also showed significant improvement. Patients' phonic tics, but not motor tics, showed a positive correlation with their school function and peer relationships. The child domain on the PSI was positively correlated with motor tics, phonic tics, and impairment, as measured by the YGTSS. CONCLUSIONS An 8-week aripiprazole treatment program for children and adolescents with TS was beneficial to their tic symptoms, behaviors at home, and caregivers' stress with regard to fulfilling parenting roles. A long-term placebo-controlled trial with larger samples is warranted to confirm the effectiveness of aripiprazole for social adjustment and parental stress.
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Affiliation(s)
- Liang-Jen Wang
- 1 Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - Wen-Jiun Chou
- 1 Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - Miao-Chun Chou
- 1 Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - Susan Shur-Fen Gau
- 2 Department of Psychiatry, National Taiwan University Hospital and College of Medicine , Taipei, Taiwan
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Koy A, Lin JP, Sanger TD, Marks WA, Mink JW, Timmermann L. Advances in management of movement disorders in children. Lancet Neurol 2016; 15:719-735. [PMID: 27302239 DOI: 10.1016/s1474-4422(16)00132-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/20/2016] [Accepted: 03/10/2016] [Indexed: 02/06/2023]
Abstract
Movement disorders in children are causally and clinically heterogeneous and present in a challenging developmental context. Treatment options are broad ranging, from pharmacotherapy to invasive neuromodulation and experimental gene and stem cell therapies. The clinical effects of these therapies are variable and often poorly sustained, and only a few of the management strategies used in paediatric populations have been tested in randomised controlled studies with age-appropriate cohorts. Identification of the most appropriate treatment is uniquely challenging in children because of the incomplete knowledge about the pathophysiology of movement disorders and their influence on normal motor development; thus, effective therapeutic options for these children remain an unmet need. It is vital to transfer the expanding knowledge of the movement disorders into the development of novel symptomatic or, ideally, disease-modifying treatments, and to assess these therapeutic strategies in appropriately designed and well done trials.
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Affiliation(s)
- Anne Koy
- Department of Neurology, University of Cologne, Cologne, Germany; Department of Paediatrics, University of Cologne, Cologne, Germany.
| | - Jean-Pierre Lin
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Lars Timmermann
- Department of Neurology, University of Cologne, Cologne, Germany
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Grant JE, Fineberg N, van Ameringen M, Cath D, Visser H, Carmi L, Pallanti S, Hollander E, van Balkom AJLM. New treatment models for compulsive disorders. Eur Neuropsychopharmacol 2016; 26:877-84. [PMID: 26621260 DOI: 10.1016/j.euroneuro.2015.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 08/12/2015] [Accepted: 11/08/2015] [Indexed: 01/21/2023]
Abstract
Obsessive compulsive disorder (OCD) as well as related disorders such as body dysmorphic disorder, tic disorder, and trichotillomania are all common and often debilitating. Although treatments are available, more effective approaches to these problems are needed. Thus this review article presents what is currently known about OCD and related disorders and suggests that understanding OCD more broadly as a compulsive disorder may allow for more effective treatment options. Toward that goal, the review presents new models of psychopharmacology and psychotherapy, as well as new brain stimulation strategies. Treatment advances, grounded in the neuroscience, have promise in advancing treatment response for OCD as well as other disorders of compulsivity.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 3077, Chicago, IL 60637, USA.
| | - Naomi Fineberg
- Highly Specialized OCD and BDD Services, Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, UK
| | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University and MacAnxiety Research Centre, Hamilton, Ontario, Canada
| | - Danielle Cath
- Utrecht University and Altrecht Academic Anxiety Disorders Center, Utrecht, The Netherlands
| | - Henny Visser
- Innova Research Centre, Mental Health Care Institute GGZ Centraal, Ermelo, The Netherlands
| | - Lior Carmi
- Department of Psychology, Tel Aviv University, Tel Aviv, Israel; Department of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Stefano Pallanti
- Department of Psychiatry and Behavioral Sciences UC Davis Health System, Albert Einstein College of Medicine and Montefiore Medical Center, Sacramento, CA, USA
| | - Eric Hollander
- Department of Psychiatry, Albert Einstein Medical School, Montefiore Medical Center, New York City, NY, USA
| | - Anton J L M van Balkom
- Department of Psychiatry and EMGO(+) Institute, VU-University Medical Centre and GGZ ingest, Amsterdam, The Netherlands
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Abstract
Objective To demonstrate the usefulness of neurophysiological evaluation to distinguish simple motor tics and functional myoclonus. Methods Careful clinical assessments, multichannel surface EMG, and EEG-EMG jerk-locked back-averaging were performed. Results Urge to move and ability to voluntarily suppress the movement were reported. EMG bursts showed variable duration and triphasic pattern of the antagonist muscles mimicking voluntary movements. Only the late component of the Bereitschaftspotential (BP2) was present prior to the involuntary movement onset. Conclusion Combination of the isolated late BP, premonitory urge, and suppressibility leads to the diagnosis of simple motor tics rather than functional myoclonus. Significance The physiological approach in addition to careful clinical assessment is helpful to support the diagnosis of tic.
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Affiliation(s)
- Pattamon Panyakaew
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA, 20892; Department of Medicine, Faculty of Medicine, Chulalongkorn Center of Excellence on Parkinson Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand 10330
| | - Hyun Joo Cho
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA, 20892
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA, 20892
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66
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Gadoth N. Tourette syndrome: Update. Brain Dev 2016; 38:266. [PMID: 26507772 DOI: 10.1016/j.braindev.2015.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Natan Gadoth
- Department of Neurology, Maynei Hyeshua Medical Centre, 17, Povarsky St, Bnei Barak, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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68
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Zhang W, Wei L, Yu W, Cui X, Liu X, Wang Q, Wang S. Effect of Jian-Pi-Zhi-Dong Decoction on striatal glutamate and γ-aminobutyric acid levels detected using microdialysis in a rat model of Tourette syndrome. Neuropsychiatr Dis Treat 2016; 12:1233-42. [PMID: 27279743 PMCID: PMC4878666 DOI: 10.2147/ndt.s106330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Jian-Pi-Zhi-Dong Decoction (JPZDD) is a dedicated treatment of Tourette syndrome (TS). The balance of neurotransmitters in the cortico-striato-pallido-thalamo-cortical network is crucial to the occurrence of TS and related to its severity. This study evaluated the effect of JPZDD on glutamate (Glu) and γ-aminobutyric acid (GABA) and their receptors in a TS rat model. MATERIALS AND METHODS Rats were divided into four groups (n=12 each). TS was induced in three of the groups by injecting them with 3,3'-iminodipropionitrile for 7 consecutive days. Two model groups were treated with tiapride (Tia) or JPZDD, while the control and the remaining model group were gavaged with saline. Behavior was assessed by stereotypic score and autonomic activity. Striatal Glu and GABA contents were detected using microdialysis. Expressions of N-methyl-D-aspartate receptor 1 and GABAA receptor (GABAAR) were observed using Western blot and real-time polymerase chain reaction. RESULTS Tia and JPZDD groups had decreased stereotypy compared with model rats; however, the JPZDD group showed a larger decrease in stereotypy than the Tia group at a 4-week time point. In a spontaneous activity test, the total distance of the JPZDD and Tia groups was significantly decreased compared with the model group. The Glu levels of the model group were higher than the control group and decreased with Tia or JPZDD treatment. The GABA level was higher in the model group than the control group. Expressions of GABAAR protein in the model group were higher than in the control group. Treatment with Tia or JPZDD reduced the expression of GABAAR protein. In the case of the mRNA expression, only Tia reduced the expression of N-methyl-D-aspartate receptor 1, compared with the model group. CONCLUSION JPZDD could alleviate impairments in behavior and dysfunctional signaling by downregulating GABAAR in the striatum. We suggest that this acts to maintain the balance of Glu and GABA.
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Affiliation(s)
- Wen Zhang
- Department of Pediatrics, The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Li Wei
- Department of Pediatrics, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Wenjing Yu
- Department of Pediatrics, The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xia Cui
- Department of Pediatrics, The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xiaofang Liu
- Department of Pediatrics, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Qian Wang
- Department of Pediatrics, The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Sumei Wang
- Department of Pediatrics, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
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69
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Altered histamine neurotransmission in HPRT-deficient mice. Neurosci Lett 2015; 609:74-80. [DOI: 10.1016/j.neulet.2015.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/01/2015] [Accepted: 10/03/2015] [Indexed: 01/03/2023]
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70
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Delorme C, Salvador A, Valabrègue R, Roze E, Palminteri S, Vidailhet M, de Wit S, Robbins T, Hartmann A, Worbe Y. Enhanced habit formation in Gilles de la Tourette syndrome. Brain 2015; 139:605-15. [DOI: 10.1093/brain/awv307] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/01/2015] [Indexed: 12/31/2022] Open
Abstract
Abstract
Tics are sometimes described as voluntary movements performed in an automatic or habitual way. Here, we addressed the question of balance between goal-directed and habitual behavioural control in Gilles de la Tourette syndrome and formally tested the hypothesis of enhanced habit formation in these patients. To this aim, we administered a three-stage instrumental learning paradigm to 17 unmedicated and 17 antipsychotic-medicated patients with Gilles de la Tourette syndrome and matched controls. In the first stage of the task, participants learned stimulus-response-outcome associations. The subsequent outcome devaluation and ‘slip-of-action’ tests allowed evaluation of the participants’ capacity to flexibly adjust their behaviour to changes in action outcome value. In this task, unmedicated patients relied predominantly on habitual, outcome-insensitive behavioural control. Moreover, in these patients, the engagement in habitual responses correlated with more severe tics. Medicated patients performed at an intermediate level between unmedicated patients and controls. Using diffusion tensor imaging on a subset of patients, we also addressed whether the engagement in habitual responding was related to structural connectivity within cortico-striatal networks. We showed that engagement in habitual behaviour in patients with Gilles de la Tourette syndrome correlated with greater structural connectivity within the right motor cortico-striatal network. In unmedicated patients, stronger structural connectivity of the supplementary motor cortex with the sensorimotor putamen predicted more severe tics. Overall, our results indicate enhanced habit formation in unmedicated patients with Gilles de la Tourette syndrome. Aberrant reinforcement signals to the sensorimotor striatum may be fundamental for the formation of stimulus-response associations and may contribute to the habitual behaviour and tics of this syndrome.
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Affiliation(s)
- Cécile Delorme
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 975, CNRS UMR 7225, ICM, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l’Hôpital, Paris, France
| | - Alexandre Salvador
- Centre de Psychiatrie et Neuroscience - INSERM U894, 2 ter Rue d'Alésia – Paris, France
- Laboratoire de Neurosciences Cognitives, Ecole Normale Supérieure, 29 rue d’Ulm, Paris, France
| | - Romain Valabrègue
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 975, CNRS UMR 7225, ICM, Paris, France
- Centre de NeuroImagerie de Recherche (CENIR), Sorbonne Universités, UPMC Univ Paris 06, UMR S 975, CNRS UMR 7225, ICM, Paris, France
| | - Emmanuel Roze
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 975, CNRS UMR 7225, ICM, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l’Hôpital, Paris, France
| | - Stefano Palminteri
- Centre de Psychiatrie et Neuroscience - INSERM U894, 2 ter Rue d'Alésia – Paris, France
- Institute of Cognitive Neuroscience, Alexandra House 17 Queen Square, London, UK
| | - Marie Vidailhet
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 975, CNRS UMR 7225, ICM, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l’Hôpital, Paris, France
| | - Sanne de Wit
- Department of Psychology, University of Amsterdam, 1018 WB Amsterdam, The Netherlands
| | - Trevor Robbins
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Andreas Hartmann
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 975, CNRS UMR 7225, ICM, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l’Hôpital, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l’Hôpital, Paris, France
| | - Yulia Worbe
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 975, CNRS UMR 7225, ICM, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l’Hôpital, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, 47 boulevard de l’Hôpital, Paris, France
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71
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Jankovic J. Therapeutic Developments for Tics and Myoclonus. Mov Disord 2015; 30:1566-73. [PMID: 26315614 DOI: 10.1002/mds.26414] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 12/19/2022] Open
Abstract
Tics and myoclonus are phenomenologically similar given that both are jerk-like movements, but, in contrast to myoclonus, tics are often preceded by premonitory sensations and are typically associated with a variety of behavioral comorbidities, including attention deficit and obsessive-compulsive disorder. There are many other clinical features that help differentiate these two hyperkinetic disorders. Whereas behavioral and antidopaminergic therapies are most effective in the management of tics, clonazepam, other anticonvulsants, and serotonergic drugs are often used to control myoclonic movements. Botulinum toxin may also be helpful in focal tics and in segmental forms of myoclonus. DBS plays an increasingly important role in the treatment of these disorders, particularly when they are generalized and are disabling despite optimal medical therapy.
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Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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Espay AJ, Lang AE. Phenotype-Specific Diagnosis of Functional (Psychogenic) Movement Disorders. Curr Neurol Neurosci Rep 2015; 15:32. [DOI: 10.1007/s11910-015-0556-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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