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Mumoli L, Magro G, Le Piane E, Bosco D. Reversible dementia and insomnia in ABGA related encephalitis. Sleep Med 2024; 118:29-31. [PMID: 38581805 DOI: 10.1016/j.sleep.2024.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND ABGAs are historically associated with Encephalitis Lethargica (EL). Typically ABGAs are also found in children resulting in a variety of neuropsychiatric and extrapyramidal disorders, rare cases are reported in adults with atypical movement disorders. No description of basal ganglia reversible lesions related to ABGAs are reported and these antibodies are not included in the list of autoimmune encephalitis. METHODS AND RESULTS A 55 years old female presented sub-acute onset of an anxious-depressive disorder and obsessive-compulsive behavior associated with intractable insomnia affecting sleep onset and sleep maintenance. Brain-MRI showed diffuse hyperintensities on FLAIR sequences in the basal ganglia. A therapy with IV-immunoglobulin was started and the clinical condition improved dramatically and insomnia and psychiatric symptoms resolved completely. CONCLUSION Our case highlights the importance of making a fast diagnosis. When caught early ABGAs-related encephalitis is susceptible of a good outcome and response to treatment. Reversible insomnia and dementia in our case expand ABGA clinical presentation in adults and favors the hypothesis of an immune pathogenesis for Encephalitis Lethargica, especially in the hyperkinetic form as previously suggested, as in our case.
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Affiliation(s)
- Laura Mumoli
- Azienda Ospedaliero Universitaria R. Dulbecco, Pugliese Ciaccio Hospital, Neurology Department, Catanzaro, Italy.
| | - Giuseppe Magro
- Azienda Ospedaliero Universitaria R. Dulbecco, Magna Graecia University, Neurology Department, Catanzaro, Italy
| | - Emilio Le Piane
- Azienda Ospedaliero Universitaria R. Dulbecco, Pugliese Ciaccio Hospital, Neurology Department, Catanzaro, Italy
| | - Domenico Bosco
- Azienda Ospedaliero Universitaria R. Dulbecco, Pugliese Ciaccio Hospital, Neurology Department, Catanzaro, Italy
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2
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Scorr LM, Kilic-Berkmen G, Sutcliffe DJ, Dinasarapu AR, McKay JL, Bagchi P, Powell MD, Boss JM, Cereb N, Little M, Gragert L, Hanfelt J, McKeon A, Tyor W, Jinnah HA. Exploration of potential immune mechanisms in cervical dystonia. Parkinsonism Relat Disord 2024; 122:106036. [PMID: 38462403 DOI: 10.1016/j.parkreldis.2024.106036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Although there are many possible causes for cervical dystonia (CD), a specific etiology cannot be identified in most cases. Prior studies have suggested a relationship between autoimmune disease and some cases of CD, pointing to possible immunological mechanisms. OBJECTIVE The goal was to explore the potential role of multiple different immunological mechanisms in CD. METHODS First, a broad screening test compared neuronal antibodies in controls and CD. Second, unbiased blood plasma proteomics provided a broad screen for potential biologic differences between controls and CD. Third, a multiplex immunoassay compared 37 markers associated with immunological processes in controls and CD. Fourth, relative immune cell frequencies were investigated in blood samples of controls and CD. Finally, sequencing studies investigated the association of HLA DQB1 and DRB1 alleles in controls versus CD. RESULTS Screens for anti-neuronal antibodies did not reveal any obvious abnormalities. Plasma proteomics pointed towards certain abnormalities of immune mechanisms, and the multiplex assay pointed more specifically towards abnormalities in T lymphocytes. Abnormal immune cell frequencies were identified for some CD cases, and these cases clustered together as a potential subgroup. Studies of HLA alleles indicated a possible association between CD and DRB1*15:03, which is reported to mediate the penetrance of autoimmune disorders. CONCLUSIONS Altogether, the association of CD with multiple different blood-based immune measures point to abnormalities in cell-mediated immunity that may play a pathogenic role for a subgroup of individuals with CD.
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Affiliation(s)
- Laura M Scorr
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Gamze Kilic-Berkmen
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Diane J Sutcliffe
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ashok R Dinasarapu
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - J Lucas McKay
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Department of Biomedical Infortmatics, Emory School of Medicine, Atlanta, GA, 30322, USA
| | - Pritha Bagchi
- Integrated Proteomics Core, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Michael D Powell
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Jeremy M Boss
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | | | - Marian Little
- Division of Biomedical Informatics and Genomics, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Loren Gragert
- Division of Biomedical Informatics and Genomics, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology, Neurology and Immunology and Department of Neurology, Mayo Clinic, Rochester Mayo Clinic, Rochester, 55902, MN, USA
| | - William Tyor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Atlanta VA Medical Center, Decatur, GA, 30033, USA
| | - H A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA; Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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3
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Jiang Y, Li Y, Chen X, Zhai R, Peng Y, Tai R, Zhou C, Wang J. Biomarkers and Tourette syndrome: a systematic review and meta-analysis. Front Neurol 2024; 15:1262057. [PMID: 38385037 PMCID: PMC10879287 DOI: 10.3389/fneur.2024.1262057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
Objective This research aims to investigate whether peripheral biomarkers might differentiate individuals with Tourette syndrome (TS) from those without the condition. Methods A broad range of databases was searched through November 2022. This study employed a systematic literature review and subsequent meta-analysis of case-control studies that assessed the aberration of biomarkers of patients with TS and controls. Results A total of 81 studies were identified, out of which 60 met the eligibility criteria for inclusion in the meta-analysis. Following a meticulous screening procedure to determine the feasibility of incorporating case-control studies into the meta-analysis, 13 comparisons were statistically significant [CD3+ T cell, CD4+ T cell, CD4+ T cell to CD8+ T cell ratio, NK-cell, anti-streptolysin O antibodies, anti-DNase antibodies, glutamic acid (Glu), aspartic acid (Asp), ferritin (Fe), zinc (Zn), lead (Pb), vitamin D, and brain-derived neurotrophic factor (BDNF)]. Publication bias was found for anti-streptolysin O antibodies. Suggestive associations were evidenced for norsalsolinol (NSAL), neuron-specific enolase (NSE), and S100B. Conclusion In this study, we present empirical evidence substantiating the link between several peripheral biomarkers and the early diagnosis of TS. Larger and more standardized studies are necessary to replicate the observed results, elucidate the specificity of the biomarkers for TS, and evaluate their precision for use in clinical settings.
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Affiliation(s)
| | | | | | | | | | | | | | - Junhong Wang
- Department of Pediatrics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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4
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Robakis D. How Much Do We Know about Adult-onset Primary Tics? Prevalence, Epidemiology, and Clinical Features. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:441. [PMID: 28546883 PMCID: PMC5440657 DOI: 10.7916/d8sq95nd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/20/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tic disorders are generally considered to be of pediatric onset; however, reports of adult-onset tics exist in the literature. Tics can be categorized as either primary or secondary, with the latter being the larger group in adults. Primary or idiopathic tics that arise in adulthood make up a subset of tic disorders whose epidemiologic and clinical features have not been well delineated. METHODS Articles to be included in this review were identified by searching PubMed, SCOPUS, and Web of Science using the terms adult- and late-onset tics, which resulted in 120 unique articles. Duplicates were removed. Citing references were identified using Google Scholar; all references were reviewed for relevance. RESULTS The epidemiologic characteristics, clinical phenomenology, and optimal treatment of adult-onset tics have not been ascertained. Twenty-six patients with adult-onset, primary tics were identified from prior case reports. The frequency of psychiatric comorbidities may be lower in adults than in children, and obsessive compulsive disorder was the most common comorbidity. Adult-onset primary tics tend to wax and wane, occur predominantly in males, are often both motor and phonic in the same individual, and are characterized by a poor response to treatment. DISCUSSION We know little about adult-onset tic disorders, particularly ones without a secondary association or cause. They are not common, and from the limited data available, appear to share some but not all features with childhood tics. Further research will be important in gaining a better understanding of the epidemiology and clinical manifestations of this disorder.
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Affiliation(s)
- Daphne Robakis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA
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5
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Marta M, Santos E, Coutinho E, Silva AM, Correia J, Vasconcelos C, Giovannoni G. The role of infections in Behçet disease and neuro-Behçet syndrome. Autoimmun Rev 2015; 14:609-15. [DOI: 10.1016/j.autrev.2015.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 02/25/2015] [Indexed: 11/26/2022]
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6
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Irani SR, Gelfand JM, Al-Diwani A, Vincent A. Cell-surface central nervous system autoantibodies: clinical relevance and emerging paradigms. Ann Neurol 2014; 76:168-84. [PMID: 24930434 PMCID: PMC4141019 DOI: 10.1002/ana.24200] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 01/17/2023]
Abstract
The recent discovery of several potentially pathogenic autoantibodies has helped identify patients with clinically distinctive central nervous system diseases that appear to benefit from immunotherapy. The associated autoantibodies are directed against the extracellular domains of cell-surface-expressed neuronal or glial proteins such as LGI1, N-methyl-D-aspartate receptor, and aquaporin-4. The original descriptions of the associated clinical syndromes were phenotypically well circumscribed. However, as availability of antibody testing has increased, the range of associated patient phenotypes and demographics has expanded. This in turn has led to the recognition of more immunotherapy-responsive syndromes in patients presenting with cognitive and behavioral problems, seizures, movement disorders, psychiatric features, and demyelinating disease. Although antibody detection remains diagnostically important, clinical recognition of these distinctive syndromes should ensure early and appropriate immunotherapy administration. We review the emerging paradigm of cell-surface-directed antibody-mediated neurological diseases, describe how the associated disease spectrums have broadened since the original descriptions, discuss some of the methodological issues regarding techniques for antibody detection and emphasize considerations surrounding immunotherapy administration. As these disorders continue to reach mainstream neurology and even psychiatry, more cell-surface-directed antibodies will be discovered, and their possible relevance to other more common disease presentations should become more clearly defined.
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Affiliation(s)
- Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
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7
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Balint B, Bhatia K. Reopening the case for anti-basal ganglia antibodies (ABGAs): Identification of dopamine-2 receptor antibodies associated with movement disorders. Mov Disord 2013; 28:733. [DOI: 10.1002/mds.25454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 02/25/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Bettina Balint
- Department of Neurology; Medical University Heidelberg; Heidelberg Germany
| | - Kailash Bhatia
- Institute of Neurology; University College London (UCL); London UK
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8
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Movimenti anomali secondari (distonie, mioclonie, tremori, discinesie). Neurologia 2012. [DOI: 10.1016/s1634-7072(12)62644-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Nicholson TRJ, Ferdinando S, Krishnaiah RB, Anhoury S, Lennox BR, Mataix-Cols D, Cleare A, Veale DM, Drummond LM, Fineberg NA, Church AJ, Giovannoni G, Heyman I. Prevalence of anti-basal ganglia antibodies in adult obsessive-compulsive disorder: cross-sectional study. Br J Psychiatry 2012; 200:381-6. [PMID: 22282431 DOI: 10.1192/bjp.bp.111.092007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Symptoms of obsessive-compulsive disorder (OCD) have been described in neuropsychiatric syndromes associated with streptococcal infections. It is proposed that antibodies raised against streptococcal proteins cross-react with neuronal proteins (antigens) in the brain, particularly in the basal ganglia, which is a brain region implicated in OCD pathogenesis. AIMS To test the hypothesis that post-streptococcal autoimmunity, directed against neuronal antigens, may contribute to the pathogenesis of OCD in adults. METHOD Ninety-six participants with OCD were tested for the presence of anti-streptolysin-O titres (ASOT) and the presence of anti-basal ganglia antibodies (ABGA) in a cross-sectional study. The ABGA were tested for with western blots using three recombinant antigens; aldolase C, enolase and pyruvate kinase. The findings were compared with those in a control group of individuals with depression (n = 33) and schizophrenia (n = 17). RESULTS Positivity for ABGA was observed in 19/96 (19.8%) participants with OCD compared with 2/50 (4%) of controls (Fisher's exact test P = 0.012). The majority of positive OCD sera (13/19) had antibodies against the enolase antigen. No clinical variables were associated with ABGA positivity. Positivity for ASOT was not associated with ABGA positivity nor found at an increased incidence in participants with OCD compared with controls. CONCLUSIONS These findings support the hypothesis that central nervous system autoimmunity may have an aetiological role in some adults with OCD. Further study is required to examine whether the antibodies concerned are pathogenic and whether exposure to streptococcal infection in vulnerable individuals is a risk factor for the development of OCD.
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Affiliation(s)
- Timothy R J Nicholson
- National Institute of Health Research Specialist Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and The Institute of Psychiatry, King's College London, London.
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10
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Abstract
We report here on a case of severe pervasive refusal syndrome. This is of interest for three reasons. Firstly, most reported cases are adolescent girls; our case is regarding an adolescent boy. Secondly, he was successfully treated at home and thirdly, the serology showed an apparent infective pre-cursor to the illness with evidence of possible autoimmune serology. A 14-year old boy deteriorated from a picture where diagnosed CFS/ME developed into Pervasive Refusal Syndrome. This included the inability to move or speak, with closed eyes, multiple tics, facial grimacing, heightened sensitivity to noise (hyperacusis) and touch (hyperaesthesia), and inability or unwillingness to eat anything except small amounts of sloppy food. Successful rehabilitation is reported. Finally the issue of nomenclature is discussed, raising the question whether Pervasive Refusal Syndrome would be better renamed in a way that does not imply that the condition is always volitional and oppositional, as this can distract focus away from an alliance between family and clinicians.
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Affiliation(s)
- Barry Wright
- Child, Adolescent & Family Unit, York, England, UK.
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11
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Viallet F, Vercueil L, Gayraud D, Bonnefoi B, Renie L. Mouvements anormaux secondaires (dystonies, myoclonies, tremblements, dyskinésies). ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s0246-0378(12)57571-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Gotkine M, Kennedy PGE, Steiner I. Post infectious CNS disorders: towards a unified approach. J Neurol 2010; 257:1963-9. [PMID: 20857134 DOI: 10.1007/s00415-010-5743-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 09/01/2010] [Indexed: 11/29/2022]
Abstract
The spectrum of post infectious (PI) central nervous system (CNS) conditions includes a range of grey and white-matter disorders which can occur after viral or bacterial infections or in response to vaccinations. The clinical, radiological and immunological phenomenology raises a number of issues regarding the nature of immune-mediated CNS abnormalities, their etiology, pathogenesis and therapy. Here we focus on crucial issues pertaining to pathogenesis and aim to identify where current knowledge is insufficient in order to suggest future avenues of clinical and experimental research that may help to devise optimal therapy for these conditions.
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Affiliation(s)
- Marc Gotkine
- Department of Neurology, Hadassah University Hospital, Hebrew University Hadassah Medical School, Jerusalem, Israel
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13
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Schrag A, Gilbert R, Giovannoni G, Robertson MM, Metcalfe C, Ben-Shlomo Y. Streptococcal infection, Tourette syndrome, and OCD: is there a connection? Neurology 2009; 73:1256-63. [PMID: 19794128 DOI: 10.1212/wnl.0b013e3181bd10fd] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A causal relationship of common streptococcal infections and childhood neuropsychiatric disorders has been postulated. OBJECTIVE To test the hypothesis of an increased rate of streptococcal infections preceding the onset of neuropsychiatric disorders. METHODS Case-control study of a large primary care database comparing the rate of possible streptococcal infections in patients aged 2-25 years with obsessive-compulsive disorder (OCD), Tourette syndrome (TS), and tics with that in controls matched for age, gender, and practice (20 per case). We also examined the influence of sociodemographic factors. RESULTS There was no overall increased risk of prior possible streptococcal infection in patients with a diagnosis of OCD, TS, or tics. Subgroup analysis showed that patients with OCD had a slightly higher risk than controls of having had possible streptococcal infections without prescription of antibiotics in the 2 years prior to the onset of OCD (odds ratio 2.59, 95% confidence interval 1.18, 5.69; p = 0.02). Cases with TS or tics were not more likely to come from more affluent or urban areas, but more cases lived in areas with a greater proportion of white population (p value for trend = 0.05). CONCLUSIONS The present study does not support a strong relationship between streptococcal infections and neuropsychiatric syndromes such as obsessive-compulsive disorder and Tourette syndrome. However, it is possible that a weak association (or a stronger association in a small susceptible subpopulation) was not detected due to nondifferential misclassification of exposure and limited statistical power. The data are consistent with previous reports of greater rates of diagnosis of Tourette syndrome or tics in white populations.
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Affiliation(s)
- A Schrag
- Department of Clinical Neurosciences, Royal Free Campus, Institute of Neurology, University College London, London, UK.
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14
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Abstract
BACKGROUND Sema4D/CD100 is a type of class 4 semaphorin, exhibiting crucial roles in growth cone guidance in developing neurons. Sema4D is widely expressed throughout the central nervous system in embryonic mouse brain, and is selectively localized to oligodendrocytes and myelin in the postnatal brain. However, direct evidence of the actual involvement of Sema4D in the neuronal network development crucial for neurobehavioral performance is still lacking. The present study therefore examined whether Sema4D deficiency leads to abnormal behavioral development. METHODS Both wild-type and Sema4D-deficient mice were subjected to behavioral analyses including open-field, adhesive tape removal, rotarod tests and a water maze task. RESULTS Open-field tests revealed increased locomotor activity in Sema4D-deficient mice with less percentage of time spent in the center of the field. In both the adhesive tape removal and rotarod tests, which examine motor coordination and balance, Sema4D-deficient mice showed significantly superior performance, suggesting facilitated motor behavior. Both Sema4D-deficient and wild-type mice successfully learnt the water maze task, locating a hidden escape platform, and also showed precise memory for the platform position in probe tests. However, the swimming speed of Sema4D-deficient mice was significantly faster than that of wild-type mice, providing further evidence of their accelerated motor behavior. CONCLUSION Our mouse behavioral analyses revealed enhanced motor activity in Sema4D-deficient mice, suggesting the crucial involvement of Sema4D in the neurodevelopmental processes of the central structures mediating motor behavior in mice.
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15
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Diamond B, Kowal C, Huerta PT, Aranow C, Mackay M, DeGiorgio LA, Lee J, Triantafyllopoulou A, Cohen-Solal J, Volpe BT. Immunity and acquired alterations in cognition and emotion: lessons from SLE. Adv Immunol 2009; 89:289-320. [PMID: 16682277 DOI: 10.1016/s0065-2776(05)89007-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Classic immunologic teaching describes the brain as an immunologically privileged site. Studies of neuroimmunology have focused for many years almost exclusively on multiple sclerosis, a disease in which inflammatory cells actually infiltrate brain tissue, and the rodent model of this disease, experimental allergic encephalitis. Over the past decade, however, increasingly, brain-reactive antibodies have been demonstrated in the serum of patients with numerous neurological diseases. The contribution these antibodies make to neuronal dysfunction has, in general, not been determined. Here, we describe recent studies showing that serum antibodies to the N-methyl-D-aspartate receptor occur frequently in patients with systemic lupus erythematosus and can cause alterations in cognition and behavior following a breach in the blood-brain barrier.
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Affiliation(s)
- Betty Diamond
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
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Morris CM, Pardo-Villamizar C, Gause CD, Singer HS. Serum autoantibodies measured by immunofluorescence confirm a failure to differentiate PANDAS and Tourette syndrome from controls. J Neurol Sci 2008; 276:45-8. [PMID: 18823914 DOI: 10.1016/j.jns.2008.08.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 07/21/2008] [Accepted: 08/21/2008] [Indexed: 10/21/2022]
Abstract
PANDAS and some cases of Tourette syndrome (TS) have been proposed to be post-streptococcal movement disorders in which antibodies produced against group A beta-hemolytic streptococcus cross react against brain epitopes. Attempts to identify disease specific anti-striatal antibodies in the serum of affected patients have focused on the use of Western immunoblotting and ELISA methodologies. In this study, immunohistochemical techniques were used to identify serum anti-striatal antibody reactivity. In positive samples, double staining with anti-GFAP (glial) and anti-MAP2 (neuronal) was used to establish localization of the immunofluorescence. No significant differences in immunofluorescence or localization were identified in patients with PANDAS (n=30) and TS (n=30) as compared to controls (n=30). IF reactivity did not correlate with tic severity or elevated titers of antistreptococcal antibodies. Further comparisons showed no correlation between autoreactivity determined by immunofluorescence and the presence of previously measured immunoblot reactivity against human caudate or putative antigens (pyruvate kinase M1 and aldolase C). These results confirm an inability to distinguish patient populations by antibody measurements and raise further concerns about the presence of an autoimmune mechanism in PANDAS and TS.
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Affiliation(s)
- Christina M Morris
- Department of Neurology, Pathology 235, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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17
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Seijo-Martínez M, Mosquera-Martínez JA, Romero-Yuste S, Cruz-Martinez J. Ischemic stroke and epilepsy in a patient with Tourette's syndrome: association with the antiphospholipid syndrome and good response to levetiracetam. Open Neurol J 2008; 2:32-4. [PMID: 19018305 PMCID: PMC2577927 DOI: 10.2174/1874205x00802010032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 01/14/2008] [Accepted: 05/14/2008] [Indexed: 11/22/2022] Open
Abstract
The role played by different humoral factors, including antiphospholipid antibodies, in the pathogenesis of Tourette syndrome (TS) is still presently unclear. We present a patient with chronic and severe TS who, at the age of 16 years, presented an ischemic stroke in the left posterior cerebral artery and/or postero-inferior temporal branch of the left medial cerebral artery. A complete study was negative with the exception of a positive lupus anticoagulant. The stroke was related with the primary antiphospholipid syndrome (APS). The stroke manifested visual abnormalities and thereafter by secondary generalized complex partial seizures. The epileptic syndrome was initially difficult to control but responded dramatically to levetiracetam. With this therapy, the manifestations of TS, especially the tics, improved. We conclude that some TS cases may present APS. In addition, levetiracetam may be useful in the management of TS. Further investigations should pursue both these facts.
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18
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van de Warrenburg BPC, Church AJ, Martino D, Candler PM, Bhatia KP, Giovannoni G, Quinn NP. Antineuronal antibodies in Parkinson's disease. Mov Disord 2008; 23:958-963. [PMID: 18383532 DOI: 10.1002/mds.21929] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Antineuronal antibodies (ANAs) have been implicated in the pathophysiology of postinfectious movement disorders, such as Sydenham's chorea. However, their relevance in other movement disorders--in the absence of infectious triggers--remains much disputed. We sought to assess the frequency of ANAs in idiopathic Parkinson's disease (IPD) and to explore whether a specific phenotype is associated with the presence of ANAs. For this purpose, we recruited 76 IPD patients, 9 patients with genetic parkinsonism, and 10 with one of the parkinson-plus syndromes. They were all subjected to a comprehensive clinical review. In addition, 50 patients with non-extrapyramidal neurological disease and 30 healthy blood donors served as control populations. Blood samples were tested for the presence of ANAs with Western blotting, using recombinant proteins of the three putative antigens (aldolase C, neuron-specific enolase, and pyruvate kinase M1). We found these antibodies in 11.8% of the 76 IPD patients, which differed significantly from healthy controls (0%, P = 0.043), but nonsignificantly from patients with genetic parkinsonism (11.1%), with a parkinson-plus syndrome (10%), or from neurological disease controls (4%). With respect to relevant disease characteristics, IPD patients with or without ANAs were indistinguishable, except for atypical disease features (mainly early falls or freezing and marked Pisa syndrome), which were more frequent in the ANA-positive IPD group. We conclude that ANAs do not play a role in the majority of patients with IPD, but might be relevant in the pathogenesis of IPD with atypical features.
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Affiliation(s)
- Bart P C van de Warrenburg
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Andrew J Church
- Department of Neuroimmunology, Institute of Neurology, London, United Kingdom
| | - Davide Martino
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
- Department of Neuroimmunology, Institute of Neurology, London, United Kingdom
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Paul M Candler
- Department of Neuroimmunology, Institute of Neurology, London, United Kingdom
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
| | - Gavin Giovannoni
- Institute of Cell and Molecular Science, Queen Mary University London and the Department of Neurology, Barts and The London NHS Trust, London, United Kingdom
| | - Niall P Quinn
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom
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Kerbeshian J, Burd L, Tait A. Chain reaction or time bomb: a neuropsychiatric-developmental/neurodevelopmental formulation of tourettisms, pervasive developmental disorder, and schizophreniform symptomatology associated with PANDAS. World J Biol Psychiatry 2007; 8:201-7. [PMID: 17654411 DOI: 10.1080/15622970601182652] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We present the case of a boy who over time sequentially exhibited symptoms consistent with a pervasive developmental disorder, schizophreniform symptomatology, multiple motor and vocal tics, and myoclonus. During this period he experienced multiple episodes of group A beta-haemolytic streptococcal (strep) infection confirmed by culture and serological studies. We speculate that paediatric autoimmune neuropsychiatric disorder associated with strep (PANDAS) may have served as an element in a complex chain of causation influencing the expression of his symptoms. Our main emphasis is to utilize our case study as an example of the application in case formulation of the neuropsychiatric developmental model and of the neurodevelopmental model on symptom ontogenesis and clinical outcome.
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Affiliation(s)
- Jacob Kerbeshian
- Department of Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, USA
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20
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Martino D, Defazio G, Church AJ, Dale RC, Giovannoni G, Robertson MM, Orth M. Antineuronal antibody status and phenotype analysis in Tourette's syndrome. Mov Disord 2007; 22:1424-1429. [PMID: 17516471 DOI: 10.1002/mds.21454] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The Gilles de la Tourette syndrome (GTS) spectrum includes psychiatric comorbidities, mainly obsessive-compulsive disorder (OCD) and attention-deficit-hyperactivity disorder (ADHD). The role of environmental factors, e.g., antineuronal antibodies (ANeA), remains unclear. We compared the clinical features of ANeA-positive and ANeA-negative patients in 53 children and 75 adults with GTS. All diagnoses were made according to DSM-IV-TR criteria. A positive ANeA Western immunoblot showed bands for at least 1 of 3 reported striatal antigens (40, 45, and 60 kDa). Twelve children (23%) and 18 adults (25%) with GTS were ANeA-positive. Disease duration, tic phenomenology and severity, frequency of echo/pali/coprophenomena, self-injurious and aggressive behavior, or frequency of OCD comorbidity did not significantly differ between ANeA-positive and negative patients. Similar findings were obtained analyzing separately the three different antibody reactivities. A comorbid diagnosis of ADHD was significantly less frequent in GTS patients positive for the anti-60 kDa antibody only. Using a multivariate logistic regression model, adjusting for age, gender, and age at disease onset, a comorbid diagnosis of ADHD remained inversely associated with anti-60 kDa antibodies (odds ratio = 0.14; P = 0.002; 95% confidence interval 0.04-0.49). ANeA status does not differentiate a specific phenotype of GTS.
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Affiliation(s)
- Davide Martino
- Department of Neuroinflammation, Institute of Neurology, University College London, London, United Kingdom
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Giovanni Defazio
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Andrew J Church
- Department of Neuroinflammation, Institute of Neurology, University College London, London, United Kingdom
| | - Russell C Dale
- Department of Neuroinflammation, Institute of Neurology, University College London, London, United Kingdom
- Neurosciences Unit, Great Ormond Street Hospital NHS Trust and Institute of Child Health, University College London, Queen Square, London, United Kingdom
| | - Gavin Giovannoni
- Department of Neuroinflammation, Institute of Neurology, University College London, London, United Kingdom
| | - Mary M Robertson
- Department of Mental Health Sciences, University College London, Queen Square, London, United Kingdom
| | - Michael Orth
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London, United Kingdom
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Abstract
The paroxysmal nonepileptic events of childhood are a group of disorders, syndromes, and phenomena that mimic true epileptic seizures. Clinical experience and a clear description of the event in question will usually lead to a correct categorization. They span in age from neonate to young adult and are apt to be the most common diagnostic challenges clinicians face regularly. The key to diagnosis is a detailed history and careful observation. Despite the large number of discrete entities enumerated herein, common principles in clinical approach are successful and described. Each entity can pose a significant clinical challenge in identification, etiologic pathophysiology, genetics, and management. A simple division is offered here separating those episodes that are associated with an altered mental status or occurring during sleep and those without an altered mental status or occurring while awake.
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Affiliation(s)
- Francis J DiMario
- School of Medicine, The University of Connecticut, Farmington, CT 06106, USA.
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Abstract
BACKGROUND Young-onset dementia is best defined as dementia presenting at age less than 65 years. And, while cognitive impairment in the elderly is dominated by dementia of the Alzheimer type, young-onset dementia has a vast differential diagnosis. REVIEW SUMMARY This article reviews an extensive differential diagnosis for young-onset dementia by utilizing different clues in the historical records and laboratory findings to aid with diagnosis. Laboratory testing should be completed in at least 2 stages. In the first stage, referred to as the first "wave," we suggest more routine testing, particularly for treatable causes of dementia. The second "wave," which we also outline, emphasizes more esoteric testing that may require referral to a tertiary care medical facility. The manuscript is divided into 2 parts, with part 1 focusing on clues from the historical data, while part 2 focuses on laboratory abnormalities. CONCLUSION Unlike dementia presenting in the elderly, the differential diagnosis in young-onset dementia is vast. A thorough historical review of the symptoms, with special emphasis on the pattern of cognitive impairment, temporal profile of the disease, detailed family history, and extensive but coordinated laboratory and ancillary testing, may yield subtle clues to the diagnosis.
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Affiliation(s)
- Basil Ridha
- Dementia Research Center, Institute of Neurology and Neurosurgery, Queen Square, London, UK
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Abstract
In this series of case vignettes, the authors have emphasized that the diagnosis of functional symptoms should normally rest on the presence of positive evidence of the problem being functional rather than the absence of evidence of organic disease. In addition, practitioners should be prepared to make a functional diagnosis in a patient who also has evidence of disease. Misdiagnosis of functional symptoms occurs no more than for other neuro-logical and psychiatric disorders. The neurologist has an important role in being able to transmit the diagnosis in a way that will not offend the patient but will also facilitate recovery. The key elements of this explanation are making the patient feel believed and emphasizing potential reversibility. A multidisciplinary approach involving concurrent physical and psychological treatments is often recommended, although further study is required to determine the best approaches to explain and treat these conditions.
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Affiliation(s)
- Jon Stone
- School of Molecular and Clinical Medicine, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, Scotland.
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Huerta PT, Kowal C, DeGiorgio LA, Volpe BT, Diamond B. Immunity and behavior: antibodies alter emotion. Proc Natl Acad Sci U S A 2006; 103:678-83. [PMID: 16407105 PMCID: PMC1334673 DOI: 10.1073/pnas.0510055103] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Systemic lupus erythematosus is an autoimmune disease in which most patients express Abs that bind double-stranded DNA. Recent work has shown that a subset of lupus Abs can crossreact with the NR2A and NR2B subunits of the NMDA receptor. This receptor is expressed in neurons throughout the brain but is at highest density within cells of the hippocampus, amygdala, and hypothalamus. The neurons in the CNS are normally protected from brain-reactive Abs by the blood-brain barrier (BBB); however, a breach in the barrier's integrity exposes neurons to potentially pathogenic Abs. Previously, we have shown that mice that are immunized with a peptide mimetope of DNA produce lupus-like Abs that crossreact with DNA and the NMDA receptor. Moreover, after abrogation of the BBB by treatment with lipopolysaccharide, the immunized mice display hippocampal neuron damage with ensuing memory impairment. Given that rises in epinephrine can increase cerebral blood flow and can cause leaks in the BBB, we decided to investigate whether epinephrine could act as a permissive agent for Ab-mediated neurotoxicity. Here, we show that peptide-immunized mice, given epinephrine to open the BBB, lose neurons in the lateral amygdala and develop a behavioral disorder characterized by a deficient response to fear-conditioning paradigms. Thus, the agent used to open the BBB determines which brain region is made vulnerable to neurotoxic Abs, and Abs that penetrate brain tissue can cause changes not only in cognitive competence, but also in emotional behavior.
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Teixeira AL, Corrêa H, Cardoso F, Fontenelle LF. Síndromes neuropsiquiátricas pós-estreptocócicas. JORNAL BRASILEIRO DE PSIQUIATRIA 2006. [DOI: 10.1590/s0047-20852006000100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Nesta revisão narrativa, o nosso objetivo foi descrever as síndromes neuropsiquiátricas pós-estreptocócicas e discuti-las à luz das evidências científicas atuais sobre os possíveis mecanismos patogenéticos envolvidos. Nos últimos anos, uma série de distúrbios do movimento, como tiques, distonia, parkinsonismo, e transtornos psiquiátricos, como o transtorno obsessivo-compulsivo (TOC) e o transtorno de hiperatividade com déficit de atenção (THDA), vem sendo considerada parte do espectro das manifestações pós-estreptocócicas. O termo PANDAS (acrônimo do inglês: pediatric autoimmune neuropsychiatric disorder associated with streptococcus) foi inclusive cunhado para descrever um subgrupo de pacientes com TOC e tiques que exibe flutuação clínica dos sintomas associada a infecção estreptocócica. Entretanto a análise crítica das evidências clinicolaboratoriais não apóia esse espectro ampliado das manifestações pós-estreptocócicas. Apenas na coréia de Sydenham há evidências consistentes de patogênese mediada por processo auto-imune pós-estreptocócico.
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Yeh CB, Wu CH, Tsung HC, Chen CW, Shyu JF, Leckman JF. Antineural antibody in patients with Tourette's syndrome and their family members. J Biomed Sci 2005; 13:101-12. [PMID: 16215701 DOI: 10.1007/s11373-005-9033-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Accepted: 09/08/2005] [Indexed: 10/25/2022] Open
Abstract
It has been proposed that antineural antibodies were present in patients with Tourette's syndrome (TS) and other neuropsychiatric disorders. The purpose of our study was to investigate the presence of antineural antibodies in the individuals with Tourette's syndrome and the family members of TS patients. The sera of four TS patients with no current streptococcal infection, their tic-free family members including father, mother and sibling, and a age-matched control group who were tic free were assayed for antineural antibodies directed against rat tissue and neurons in primary cell culture. There were prominent antineural antibodies present in TS patients and their first-degree family members, but not in the control group. Western blotting showed proteins of about 120 kDa in their sera that were not present in the sera of controls. The preliminary results of our study suggest the importance of genetic vulnerability in the immunological pathophysiology of tic disorders. Future studies should investigate the interactions of genetics, environment, infectious agents, and immunity on symptom expression in families with tic disorders.
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Affiliation(s)
- Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
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Millichap JG. Poststreptococcal Dyskinesias. Pediatr Neurol Briefs 2004. [DOI: 10.15844/pedneurbriefs-18-7-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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