1
|
Lin S, Rodriguez CO, Wolf SL. Vagus Nerve Stimulation Paired With Upper Extremity Rehabilitation for Chronic Ischemic Stroke: Contribution of Dosage Parameters. Neurorehabil Neural Repair 2024:15459683241258769. [PMID: 38836606 DOI: 10.1177/15459683241258769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Vagus nerve stimulation (VNS) combined with rehabilitation is a Food and Drug Administration approved intervention for moderate to severe upper extremity deficits in chronic ischemic stroke patients. Previous studies demonstrated that VNS improves upper extremity motor impairments, using the Fugl Meyer Assessment of Upper Extremity (FMA-UE); however, delineating where these improvements occur, and the role of VNS dosage parameters were not reported. OBJECTIVE This study explored the relationship between dosing (time over which task repetitions were executed and number of VNS stimulations) and changes within proximal and distal components of the FMA-UE. METHODS Participants underwent VNS implantation, with 1 group receiving VNS paired with rehabilitation (Active VNS) and the other group receiving rehabilitation with sham stimulation (Controls). Both groups received 6 weeks of in-clinic therapy followed by a 90-day at-home, self-rehabilitation program. Participants who completed at least 12 of 18 in-clinic sessions were included in the analyses (n = l06). Pearson correlations and analysis of covariance were used to investigate the relationship between dosing and FMA-UE outcome change along with the effect of covariates including baseline severity, time since stroke, age, and paretic side. RESULTS Compared to Controls, active VNS favorably influenced distal function with sustained improvement after the home program. Significant improvements were observed in only distal components (FMdist) at both post day-1 (1.80 points, 95% Cl [0.85, 2.73], P < .001) and post-day 90 (1.62 points, 95% CI [0.45, 2.80], P < .007). CONCLUSIONS VNS paired with rehabilitation resulted in significant improvements in wrist and hand impairment compared to Controls, despite similar in-clinic dosing across both groups.NCT03131960.
Collapse
Affiliation(s)
- Shiyu Lin
- Department of Rehabilitation Medicine, Division of Physical Therapy, Center for Movement Science and Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Chelsea O Rodriguez
- Department of Rehabilitation Medicine, Division of Physical Therapy, Center for Movement Science and Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Division of Physical Therapy, Center for Movement Science and Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, USA
- Senior Research Scientist, Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care Center, Decatur, GA, USA
| |
Collapse
|
2
|
Tang X, Zhang N, Shen Z, Guo X, Xing J, Tian S, Xing Y. Transcranial direct current stimulation for upper extremity motor dysfunction in poststroke patients: A systematic review and meta-analysis. Clin Rehabil 2024; 38:749-769. [PMID: 38425282 DOI: 10.1177/02692155241235336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of transcranial direct current stimulation in poststroke patients with upper extremity motor dysfunction using a systematic review and meta-analysis. DATA SOURCES We searched the Web of Science, Cochrane Library, EMBASE, and PubMed for randomized controlled trials investigating the effects of both active and sham stimulation up until January 27, 2024. REVIEW METHODS Efficacy, including the upper extremity Fugl-Meyer Assessment, Action Research Arm Test, Barthel Index, and safety, were assessed. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool and the Physiotherapy Evidence Database Scale. Meta-analysis was performed using the RevMan 5.4 software. RESULTS Forty-four studies with 1555 participants were included. Transcranial direct current stimulation proved effective in improving upper extremity motor function (standardized mean difference = 0.22, 95% confidence interval: 0.12-0.32, P < 0.001) and Barthel Index (mean difference = 4.65, 95% confidence interval: 2.82-6.49, P < 0.001). Subgroup analysis revealed the highest transcranial direct current stimulation efficacy in patients with subacute stroke. Both anodal and cathodal stimulation were effective against upper extremity motor dysfunction. C3/C4 was the most effective stimulus target. Optimal stimulation parameters included stimulus current densities <0.057 mA/cm2 for 20-30 min and <30 sessions. Adverse effects and dropouts during follow-up showed that transcranial direct current stimulation is safe and feasible. CONCLUSIONS Our findings suggest that both anodal and cathodal stimulation were significantly effective in subacute stroke patients, particularly when preceding other treatments and when C3/C4 is targeted.
Collapse
Affiliation(s)
- Xian Tang
- Department of Rehabilitation Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Nan Zhang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, China
- Hebei Key Laboratory of Brain Science and Psychiatric-Psychologic Disease, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhiyuan Shen
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China
| | - Xin Guo
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China
| | - Jun Xing
- Department of Rehabilitation Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China
| | - Shujuan Tian
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China
| | - Yuan Xing
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, China
- Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China
| |
Collapse
|
3
|
Palimeris S, Ansari Y, Remaud A, Tremblay F, Corriveau H, Boudrias MH, Milot MH. Effect of a tailored upper extremity strength training intervention combined with direct current stimulation in chronic stroke survivors: A Randomized Controlled Trial. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:978257. [PMID: 36189037 PMCID: PMC9397935 DOI: 10.3389/fresc.2022.978257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
Strengthening exercises are recommended for managing persisting upper limb (UL) weakness following a stroke. Yet, strengthening exercises often lead to variable gains because of their generic nature. For this randomized controlled trial (RCT), we aimed to determine whether tailoring strengthening exercises using a biomarker of corticospinal integrity, as reflected in the amplitude of motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS), could optimize training effects in the affected UL. A secondary aim was to determine whether applying anodal transcranial direct current stimulation (tDCS) could enhance exercise-induced training effects. For this multisite RCT, 90 adults at the chronic stage after stroke (>6 months) were recruited. Before training, participants underwent TMS to detect the presence of MEPs in the affected hand. The MEP amplitude was used to stratify participants into three training groups: (1) low-intensity, MEP <50 μV, (2) moderate-intensity, 50 μV < MEP < 120 μV, and (3) high-intensity, MEP>120 μV. Each group trained at a specific intensity based on the one-repetition maximum (1 RM): low-intensity, 35–50% 1RM; moderate-intensity, 50–65% 1RM; high-intensity, 70–85% 1RM. The strength training targeted the affected UL and was delivered 3X/week for four consecutive weeks. In each training group, participants were randomly assigned to receive either real or sham anodal tDCS (2 mA, 20 min) over the primary motor area of the affected hemisphere. Pre-/post-intervention, participants underwent a clinical evaluation of their UL to evaluate motor impairments (Fugl-Meyer Assessment), manual dexterity (Box and Blocks test) and grip strength. Post-intervention, all groups exhibited similar gains in terms of reduced impairments, improved dexterity, and grip strength, which was confirmed by multivariate and univariate analyses. However, no effect of interaction was found for tDCS or training group, indicating that tDCS had no significant impact on outcomes post-intervention. Collectively, these results indicate that adjusting training intensity based on the size of MEPs in the affected extremity provides a useful approach to optimize responses to strengthening exercises in chronic stroke survivors. Also, the lack of add-on effects of tDCS applied to the lesioned hemisphere on exercise-induced improvements in the affected UL raises questions about the relevance of combining such interventions in stroke.
Collapse
Affiliation(s)
- Stephania Palimeris
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
- BRAIN Lab, Jewish Rehabilitation Hospital, Laval, QC, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR) and CISSS-Laval, Montréal, QC, Canada
| | | | | | - François Tremblay
- Bruyère Research Institute, Ottawa, ON, Canada
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Hélène Corriveau
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, École de réadaptation, Sherbrooke, QC, Canada
- Centre de recherche sur le vieillissement, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Marie Hélène Boudrias
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
- BRAIN Lab, Jewish Rehabilitation Hospital, Laval, QC, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR) and CISSS-Laval, Montréal, QC, Canada
| | - Marie Hélène Milot
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, École de réadaptation, Sherbrooke, QC, Canada
- Centre de recherche sur le vieillissement, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
- *Correspondence: Marie Hélène Milot
| |
Collapse
|
4
|
Taud B, Lindenberg R, Darkow R, Wevers J, Höfflin D, Grittner U, Meinzer M, Flöel A. Limited Add-On Effects of Unilateral and Bilateral Transcranial Direct Current Stimulation on Visuo-Motor Grip Force Tracking Task Training Outcome in Chronic Stroke. A Randomized Controlled Trial. Front Neurol 2021; 12:736075. [PMID: 34858310 PMCID: PMC8631774 DOI: 10.3389/fneur.2021.736075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This randomized controlled trial investigated if uni- and bihemispheric transcranial direct current stimulation (tDCS) of the motor cortex can enhance the effects of visuo-motor grip force tracking task training and transfer to clinical assessments of upper extremity motor function. Methods: In a randomized, double-blind, sham-controlled trial, 40 chronic stroke patients underwent 5 days of visuo-motor grip force tracking task training of the paretic hand with either unilateral or bilateral (N = 15/group) or placebo tDCS (N = 10). Immediate and long-term (3 months) effects on training outcome and motor recovery (Upper Extremity Fugl-Meyer, UE-FM, Wolf Motor Function Test, and WMFT) were investigated. Results: Trained task performance significantly improved independently of tDCS in a curvilinear fashion. In the anodal stimulation group UE-FM scores were higher than in the sham group at day 5 (adjusted mean difference: 2.6, 95%CI: 0.6–4.5, p = 0.010) and at 3 months follow up (adjusted mean difference: 2.8, 95%CI: 0.8–4.7, p = 0.006). Neither training alone, nor the combination of training and tDCS improved WMFT performance. Conclusions: Visuo-motor grip force tracking task training can facilitate recovery of upper extremity function. Only minimal add-on effects of anodal but not dual tDCS were observed. Clinical Trial Registration:https://clinicaltrials.gov/ct2/results?recrs=&cond=&term=NCT01969097&cntry=&state=&city=&dist=, identifier: NCT01969097, retrospectively registered on 25/10/2013.
Collapse
Affiliation(s)
- Benedikt Taud
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany
| | - Robert Lindenberg
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany.,Department of History, Philosophy and Ethics of Medicine, Heinrich Heine University, Düsseldorf, Germany
| | - Robert Darkow
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany
| | - Jasmin Wevers
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany
| | - Dorothee Höfflin
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany
| | - Ulrike Grittner
- Berlin Institute of Health at Charité, Charité University Medicine, Berlin, Germany.,Institute of Biometry and Clinical Epidemiology, Charité University Medicine, Berlin, Germany
| | - Marcus Meinzer
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany.,Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Neurocure Cluster of Excellence, Charité University Medicine, Berlin, Germany.,Department of Neurology, University Medicine Greifswald, Greifswald, Germany.,German Centre for Neurodegenerative Diseases, Site Greifswald/Rostock, Greifswald, Germany.,Center for Stroke Research, Charité University Medicine, Berlin, Germany
| |
Collapse
|
5
|
Besson P, Muthalib M, De Vassoigne C, Rothwell J, Perrey S. Effects of Multiple Sessions of Cathodal Priming and Anodal HD-tDCS on Visuo Motor Task Plateau Learning and Retention. Brain Sci 2020; 10:E875. [PMID: 33228236 PMCID: PMC7699517 DOI: 10.3390/brainsci10110875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/24/2020] [Accepted: 11/18/2020] [Indexed: 01/18/2023] Open
Abstract
A single session of priming cathodal transcranial direct current stimulation (tDCS) prior to anodal tDCS (c-a-tDCS) allows cumulative effects on motor learning and retention. However, the impact of multiple sessions of c-a-tDCS priming on learning and retention remains unclear. Here, we tested whether multiple sessions of c-a-tDCS (over 3 consecutive days) applied over the left sensorimotor cortex can further enhance motor learning and retention of an already learned visuo-motor task as compared to anodal tDCS (a-tDCS) or sham. In a between group and randomized double-blind sham-controlled study design, 25 participants separated in 3 independent groups underwent 2 days of baseline training without tDCS followed by 3-days of training with both online and offline tDCS, and two retention tests (1 and 14 days later). Each training block consisted of five trials of a 60 s circular-tracing task intersected by 60 s rest, and performance was assessed in terms of speed-accuracy trade-off represented notably by an index of performance (IP). The main findings of this exploratory study were that multiple sessions of c-a-tDCS significantly further enhanced IP above baseline training levels over the 3 training days that were maintained over the 2 retention days, but these learning and retention performance changes were not significantly different from the sham group. Subtle differences in the changes in speed-accuracy trade-off (components of IP) between c-a-tDCS (maintenance of accuracy over increasing speed) and a-tDCS (increasing speed over maintenance of accuracy) provide preliminary insights to a mechanistic modulation of motor performance with priming and polarity of tDCS.
Collapse
Affiliation(s)
- Pierre Besson
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, 34090 Montpellier, France; (P.B.); (M.M.); (C.D.V.)
| | - Makii Muthalib
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, 34090 Montpellier, France; (P.B.); (M.M.); (C.D.V.)
- SilverLine Research, 4127 Brisbane, Australia
| | - Christophe De Vassoigne
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, 34090 Montpellier, France; (P.B.); (M.M.); (C.D.V.)
| | - Jonh Rothwell
- Institute of Neurology, University College London, London WC1N 3BG, UK;
| | - Stephane Perrey
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, 34090 Montpellier, France; (P.B.); (M.M.); (C.D.V.)
| |
Collapse
|
6
|
Wang H, Su Q, Yan Z, Lu F, Zhao Q, Liu Z, Zhou F. Rehabilitation Treatment of Motor Dysfunction Patients Based on Deep Learning Brain-Computer Interface Technology. Front Neurosci 2020; 14:595084. [PMID: 33192282 PMCID: PMC7642128 DOI: 10.3389/fnins.2020.595084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/08/2020] [Indexed: 01/20/2023] Open
Abstract
In recent years, brain-computer interface (BCI) is expected to solve the physiological and psychological needs of patients with motor dysfunction with great individual differences. However, the classification method based on feature extraction requires a lot of prior knowledge when extracting data features and lacks a good measurement standard, which makes the development of BCI. In particular, the development of a multi-classification brain-computer interface is facing a bottleneck. To avoid the blindness and complexity of electroencephalogram (EEG) feature extraction, the deep learning method is applied to the automatic feature extraction of EEG signals. It is necessary to design a classification model with strong robustness and high accuracy for EEG signals. Based on the research and implementation of a BCI system based on a convolutional neural network, this article aims to design a brain-computer interface system that can automatically extract features of EEG signals and classify EEG signals accurately. It can avoid the blindness and time-consuming problems caused by the machine learning method based on feature extraction of EEG data due to the lack of a large amount of prior knowledge.
Collapse
Affiliation(s)
| | - Qinglun Su
- Department of Rehabilitation Medicine, The First People’s Hospital of Lianyungang, Lianyungang, China
| | | | | | | | | | | |
Collapse
|
7
|
Wijesundera C, Vingrys AJ, Wijeratne T, Crewther SG. Acquired Visual Deficits Independent of Lesion Site in Acute Stroke. Front Neurol 2020; 11:705. [PMID: 32765410 PMCID: PMC7380328 DOI: 10.3389/fneur.2020.00705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/10/2020] [Indexed: 11/24/2022] Open
Abstract
Most clinical diagnoses of stroke are based on the persistence of symptoms relating to consciousness, language, visual-field loss, extraocular movement, neglect (visual), motor strength, and sensory loss following acute cerebral infarction. Yet despite the fact that most motor actions and cognition are driven by vision, functional vision per se is seldom tested rigorously during hospitalization. Hence we set out to determine the effects of acute stroke on functional vision, using an iPad application (Melbourne Rapid Field-Neural) that can be used to assess vision (visual acuity and visual field sensitivity) at the bedside or in the emergency ward in about 6 min per eye. Our convenience sample comprised 60 (29–88 years, 65 ± 14 years, 33 males) of 160 sequentially presenting first episode, acute (<7 days) ischemic stroke patients at Sunshine Hospital, Melbourne. One hundred patients were excluded due to existing eye disease, inadequate radiological confirmation, inability to comply with English directions or too ill to participate. Stroke cases were compared with 37 (29–85 years, 64 ± 12 years,14 males) similar-aged controls using a Mann-Whitney U-test. A significant loss in visual field sensitivity was measured in 68% of stroke cases (41/60, Mean Deviation: Stroke: −5.39 ± 6.26 dB, Control: 0.30 ± 0.60 dB, MWU = 246, p < 0.0001). Surprisingly, 44% (18/41) of these patients were unaware of their field loss. Although high contrast visual acuity was unaffected in most (55/60) patients, visual acuity-in-noise was reduced in 62% (37/60, Stroke: mean 6/12−2, log MAR 0.34 ± 0.21 vs. Control: mean 6/7·5–2, log MAR 0.14 ± 0.10; MWU = 470, p < 0.0001). Visual field defects were associated with all occipital, parietal and posterior cerebellar artery strokes while 9/15 middle cerebral artery lesions and 11 lesions in other brain regions were also associated with visual field defects. Our findings demonstrate that ~2/3 of acute first episode ischemic stroke patients experience acquired vision deficits, often unrelated to the confirmed lesion site. Our results also imply that visual dysfunction may be associated with a more generalized cerebral dysfunction while highlighting the need for bedside testing of vision for every stroke patient and demonstrating the translational clinical value of the “Melbourne Rapid Field- Neural” iPad application. Clinical Trial:http://www.ANZCTR.org.au/ACTRN12618001111268.aspx.
Collapse
Affiliation(s)
- Chamini Wijesundera
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Department of Neurology, Sunshine Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Algis J Vingrys
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Tissa Wijeratne
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Department of Neurology, Sunshine Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Sheila G Crewther
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Department of Neurology, Sunshine Hospital, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
8
|
Pavlova EL, Semenov RV, Guekht AB. Effect of tDCS on Fine Motor Control of Patients in Subacute and Chronic Post-Stroke Stages. J Mot Behav 2019; 52:383-395. [DOI: 10.1080/00222895.2019.1639608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- E. L. Pavlova
- Department of Clinical Sciences Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
| | - R. V. Semenov
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation
| | - A. B. Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, Moscow, Russian Federation
- Russian National Research Medical University, Moscow, Russian Federation
| |
Collapse
|