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Roy S, Lam MY, Panerai RB, Robinson TG, Minhas JS. Blood pressure variability at rest and during pressor challenges in patients with acute ischemic stroke. Blood Press Monit 2024; 29:232-241. [PMID: 38841869 DOI: 10.1097/mbp.0000000000000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Patients with acute ischemic stroke (AIS) have elevated blood pressure (BP) variability (BPV) and reduced baroreflex sensitivity (BRS) at rest for several days after initial stroke symptoms. We aimed to assess BPV and BRS in AIS patients during pressor challenge maneuvers in the acute and subacute phases of stroke. Pressor challenge maneuvers simulate day-to-day activities and can predict the quality of life. METHODS Continuous beat-to-beat BP and ECG in 15 AIS patients (mean age 69 ± 7.5 years) and 15 healthy controls (57 ± 16 years) were recorded at rest and during a 5-min rapid head positioning (RHP) paradigm. Patients were assessed within 24 h (acute phase) and 7 days (subacute phase) of stroke onset. Low frequency (LF) SBP power (measure of BPV), LF-α, and combined α-index (measure of BRS) were calculated from the recordings. RESULTS In the acute phase, at rest, LF-SBP power was higher ( P = 0.024) and α-index was lower ( P = 0.006) in AIS patients than in healthy controls. There was no change in LF-SBP during RHP in the patients but in healthy controls, it increased significantly ( P = 0.018). In the subacute phase, at rest, the alpha-index increased ( P = 0.037) and LF-SBP decreased ( P = 0.029) significantly in the AIS patients, however, there was still no rise in the LF-SBP power during RHP ( P = 0.240). CONCLUSION AIS patients have a high resting BPV. High resting BPV may be responsible for blunted BPV responses during pressor challenge maneuvers such as RHP, suggesting ongoing autonomic dysfunction and compromised quality of life.
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Affiliation(s)
- Sankanika Roy
- Department of Cardiovascular Sciences, University of Leicester
| | - Man Y Lam
- Department of Cardiovascular Sciences, University of Leicester
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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Lin L, Cheng Y, Huang P, Zhang J, Zheng J, Pan X. Synchronous monitoring of brain-heart electrophysiology using heart rate variability coupled with rapid quantitative electroencephalography in orthostatic hypotension patients with α-synucleinopathies: Rapid prediction of orthostatic hypotension and preliminary exploration of brain stimulation therapy. CNS Neurosci Ther 2024; 30:e14571. [PMID: 38421092 PMCID: PMC10850923 DOI: 10.1111/cns.14571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND In α-synucleinopathies, the dysfunction of the autonomic nervous system which typically manifests as orthostatic hypotension (OH) often leads to severe consequences and poses therapeutic challenges. This study aims to discover the brain-cardiac electrophysiological changes in OH patients with α-synucleinopathies using the rapid quantitative electroencephalography (qEEG) coupled with heart rate variability (HRV) technique to identify rapid, noninvasive biomarkers for early warning and diagnosis, as well as shed new light on complementary treatment approaches such as brain stimulation targets. METHODS In this study, 26 subjects of α-synucleinopathies with OH (α-OH group), 21 subjects of α-synucleinopathies without OH (α-NOH group), and 34 healthy controls (control group) were included from September 2021 to August 2023 (NCT05527067). The heart rate-blood pressure variations in supine and standing positions were monitored, and synchronization parameters of seated resting-state HRV coupled with qEEG were collected. Time-domain and frequency-domain of HRV measures as well as peak frequency and power of the brainwaves were extracted. Differences between these three groups were compared, and correlations between brain-heart parameters were analyzed. RESULTS The research results showed that the time-domain parameters such as MxDMn, pNN50, RMSSD, and SDSD of seated resting-state HRV exhibited a significant decrease only in the α-OH group compared to the healthy control group (p < 0.05), while there was no significant difference between the α-NOH group and the healthy control group. Several time-domain and frequency-domain parameters of seated resting-state HRV were found to be correlated with the blood pressure changes within the first 5 min of transitioning from supine to standing position (p < 0.05). Differences were observed in the power of beta1 waves (F4 and Fp2) and beta2 waves (Fp2 and F4) in the seated resting-state qEEG between the α-OH and α-NOH groups (p < 0.05). The peak frequency of theta waves in the Cz region also showed a difference (p < 0.05). The power of beta2 waves in the Fp2 and F4 brain regions correlated with frequency-domain parameters of HRV (p < 0.05). Additionally, abnormal electrical activity in the alpha, theta, and beta1 waves was associated with changes in heart rate and blood pressure within the first 5 min of transitioning from supine to standing position (p < 0.05). CONCLUSION Rapid resting-state HRV with certain time-domain parameters below normal levels may serve as a predictive indicator for the occurrence of orthostatic hypotension (OH) in patients with α-synucleinopathies. Additionally, the deterioration of HRV parameters correlates with synchronous abnormal qEEG patterns, which can provide insights into the brain stimulation target areas for OH in α-synucleinopathy patients.
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Affiliation(s)
- Lin Lin
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
| | - Yingzhe Cheng
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
| | - Peilin Huang
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
| | - Jiejun Zhang
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
- Center for GeriatricsHainan General HospitalHaikou CityHainan ProvinceChina
| | - Jiahao Zheng
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
| | - Xiaodong Pan
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
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Jung YJ, Kim A, Okamoto LE, Hong WH. Effects of Atomoxetine for the Treatment of Neurogenic Orthostatic Hypotension in Patients With Alpha-synucleinopathies: A Systematic Review of Randomized Controlled Trials and a Focus-Group Discussion. J Clin Neurol 2023; 19:165-173. [PMID: 36647224 PMCID: PMC9982187 DOI: 10.3988/jcn.2022.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Neurogenic orthostatic hypotension (nOH) is one of the most important nonmotor symptoms in patients with α-synucleinopathies. Atomoxetine is a selective norepinephrine transporter blocker that is a treatment option for nOH. This systematic review and expert focus-group study was designed to obtain evidence from published data and clinical experiences of Korean movement-disorder specialists about the efficacy and safety of atomoxetine for the pharmacological treatment of nOH in patients with α-synucleinopathies. METHODS The study comprised a systematic review and a focus-group discussion with clinicians. For the systematic review, multiple comprehensive databases including MEDLINE, Embase, Cochrane Library, CINAHL, PsycInfo, and KoreaMed were searched to retrieve articles that assessed the outcomes of atomoxetine therapy. A focus-group discussion was additionally performed to solicit opinions from experts with experience in managing nOH. RESULTS The literature review process yielded only four randomized controlled trials on atomoxetine matching the inclusion criteria. Atomoxetine effectively increased systolic blood pressure and improved OH-related symptoms as monotherapy or in combination with other drugs. Its effects were pronounced in cases with central autonomic failure, including multiple-system atrophy (MSA). Atomoxetine might be a safe monotherapy regarding the risk of supine hypertension. CONCLUSIONS Atomoxetine is an effective and safe option for short-term nOH management, which could be more evident in patients with central autonomic dysfunction such as MSA. However, there is a paucity of evidence in the literature, and data from the focus-group discussion were inadequate, and so further investigation is warranted.
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Affiliation(s)
- Yu Jin Jung
- Department of Neurology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Aryun Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Luis E. Okamoto
- Department of Medicine, Division of Clinical Pharmacology and the Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Woi-Hyun Hong
- College of Medicine and Medical Research Information Center (MedRIC), Chungbuk National University, Cheongju, Korea.
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Kermorgant M, Fernagut PO, Meissner WG, Arvanitis DN, N'Guyen D, Senard JM, Pavy-Le Traon A. Age and Gender Differences in Cardiovascular Autonomic Failure in the Transgenic PLP-syn Mouse, a Model of Multiple System Atrophy. Front Neurol 2022; 13:874155. [PMID: 35720100 PMCID: PMC9201283 DOI: 10.3389/fneur.2022.874155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/11/2022] [Indexed: 12/02/2022] Open
Abstract
Multiple system atrophy (MSA) is a rare and progressive neurodegenerative disorder. Autonomic failure (AF) is one main clinical feature which has a significant impact on health-related quality of life. The neuropathological hallmark of MSA is the abnormal accumulation of α-synuclein in oligodendrocytes forming glial cytoplasmic inclusions. Only little is known about gender and age differences in AF in MSA. This study was carried out in 6 and 12 months old transgenic PLP-α-syn and WT male and female mice. Heart rate variability (HRV) was assessed both in time, frequential and non-linear domains. Baroreflex sensitivity (BRS) was estimated by the sequence method. Duration of ventricular depolarization and repolarization (QT/QTc intervals) were evaluated from the ECG signals. Three-way ANOVA (genotype x gender x age) with Sidak's method post-hoc was used to analyze data. BRS was significantly changed in PLP-α-syn mice and was age-dependent. QT and QTc intervals were not significantly modified in PLP-α-syn mice. An impaired HRV was observed at 12 months of age in PLP-α-syn female but not in male mice, indicative of cardiovascular AF.
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Affiliation(s)
- Marc Kermorgant
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
- French Reference Center for Multiple System Atrophy, Neurology Department, University Hospital of Toulouse, Toulouse, France
- *Correspondence: Marc Kermorgant
| | - Pierre-Olivier Fernagut
- Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- Laboratoire de Neurosciences Expérimentales et Cliniques INSERM U1084, University of Poitiers, Poitiers, France
| | - Wassilios G. Meissner
- Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
- CRMR AMS, Service de Neurologie - Maladies Neurodégénératives, CHU de Bordeaux, Bordeaux, France
- Department of Medicine, University of Otago, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Dina N. Arvanitis
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
| | - Du N'Guyen
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
| | - Jean-Michel Senard
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
- Department of Clinical Pharmacology, University Hospital of Toulouse, Toulouse, France
| | - Anne Pavy-Le Traon
- INSERM DR Midi-Pyrénées Limousin, Institute of Cardiovascular and Metabolic Diseases (I2MC) UMR1297, University Hospital of Toulouse, Toulouse, France
- French Reference Center for Multiple System Atrophy, Neurology Department, University Hospital of Toulouse, Toulouse, France
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Dorantes-Méndez G, Mendez MO, Méndez-Magdaleno LE, Muñoz-Mata BG, Rodríguez-Leyva I, Mejía-Rodríguez AR. Characterization and classification of Parkinson’s disease patients based on symbolic dynamics analysis of heart rate variability. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Zhu S, Li H, Xu X, Luo Y, Deng B, Guo X, Guo Y, Yang W, Wei X, Wang Q. The Pathogenesis and Treatment of Cardiovascular Autonomic Dysfunction in Parkinson's Disease: What We Know and Where to Go. Aging Dis 2021; 12:1675-1692. [PMID: 34631214 PMCID: PMC8460297 DOI: 10.14336/ad.2021.0214] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/14/2021] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular autonomic dysfunctions (CAD) are prevalent in Parkinson’s disease (PD). It contributes to the development of cognitive dysfunction, falls and even mortality. Significant progress has been achieved in the last decade. However, the underlying mechanisms and effective treatments for CAD have not been established yet. This review aims to help clinicians to better understand the pathogenesis and therapeutic strategies. The literatures about CAD in patients with PD were reviewed. References for this review were identified by searches of PubMed between 1972 and March 2021, with the search term “cardiovascular autonomic dysfunctions, postural hypotension, orthostatic hypotension (OH), supine hypertension (SH), postprandial hypotension, and nondipping”. The pathogenesis, including the neurogenic and non-neurogenic mechanisms, and the current pharmaceutical and non-pharmaceutical treatment for CAD, were analyzed. CAD mainly includes four aspects, which are OH, SH, postprandial hypotension and nondipping, among them, OH is the main component. Both non-neurogenic and neurogenic mechanisms are involved in CAD. Failure of the baroreflex circulate, which includes the lesions at the afferent, efferent or central components, is an important pathogenesis of CAD. Both non-pharmacological and pharmacological treatment alleviate CAD-related symptoms by acting on the baroreflex reflex circulate. However, pharmacological strategy has the limitation of failing to enhance baroreflex sensitivity and life quality. Novel OH treatment drugs, such as pyridostigmine and atomoxetine, can effectively improve OH-related symptoms via enhancing residual sympathetic tone, without adverse reactions of supine hypertension. Baroreflex impairment is a crucial pathological mechanism associated with CAD in PD. Currently, non-pharmacological strategy was the preferred option for its advantage of enhancing baroreflex sensitivity. Pharmacological treatment is a second-line option. Therefore, to find drugs that can enhance baroreflex sensitivity, especially via acting on its central components, is urgently needed in the scientific research and clinical practice.
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Affiliation(s)
- Shuzhen Zhu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hualing Li
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoyan Xu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuqi Luo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Bin Deng
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xingfang Guo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yang Guo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Wucheng Yang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaobo Wei
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Green AL, Paterson DJ. Using Deep Brain Stimulation to Unravel the Mysteries of Cardiorespiratory Control. Compr Physiol 2020; 10:1085-1104. [PMID: 32941690 DOI: 10.1002/cphy.c190039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article charts the history of deep brain stimulation (DBS) as applied to alleviate a number of neurological disorders, while in parallel mapping the electrophysiological circuits involved in generating and integrating neural signals driving the cardiorespiratory system during exercise. With the advent of improved neuroimaging techniques, neurosurgeons can place small electrodes into deep brain structures with a high degree accuracy to treat a number of neurological disorders, such as movement impairment associated with Parkinson's disease and neuropathic pain. As well as stimulating discrete nuclei and monitoring autonomic outflow, local field potentials can also assess how the neurocircuitry responds to exercise. This technique has provided an opportunity to validate in humans putative circuits previously identified in animal models. The central autonomic network consists of multiple sites from the spinal cord to the cortex involved in autonomic control. Important areas exist at multiple evolutionary levels, which include the anterior cingulate cortex (telencephalon), hypothalamus (diencephalon), periaqueductal grey (midbrain), parabrachial nucleus and nucleus of the tractus solitaries (brainstem), and the intermediolateral column of the spinal cord. These areas receive afferent input from all over the body and provide a site for integration, resulting in a coordinated efferent autonomic (sympathetic and parasympathetic) response. In particular, emerging evidence from DBS studies have identified the basal ganglia as a major sub-cortical cognitive integrator of both higher center and peripheral afferent feedback. These circuits in the basal ganglia appear to be central in coupling movement to the cardiorespiratory motor program. © 2020 American Physiological Society. Compr Physiol 10:1085-1104, 2020.
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Affiliation(s)
- Alexander L Green
- Division of Medical Sciences, Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David J Paterson
- Department of Physiology Anatomy and Genetics, University of Oxford, Oxford, UK
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Leys F, Fanciulli A, Ndayisaba JP, Granata R, Struhal W, Wenning GK. Cardiovascular autonomic function testing in multiple system atrophy and Parkinson's disease: an expert-based blinded evaluation. Clin Auton Res 2020; 30:255-263. [PMID: 32415621 PMCID: PMC7250951 DOI: 10.1007/s10286-020-00691-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/25/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Multiple system atrophy (MSA) and Parkinson's disease (PD) are sporadic neurodegenerative diseases characterized by an accumulation of misfolded α-synuclein. Cardiovascular autonomic failure develops in both MSA and PD, although studies indicate different sites of autonomic nervous system lesion. However, it is unclear whether this could potentially aid the differential diagnosis of these diseases. Here we determined whether cardiovascular autonomic function testing (CAFT) can discriminate between the parkinsonian variant of MSA (MSA-P) and PD based on either an expert-based blinded evaluation or a systematic comparison of cardiovascular autonomic function indices. METHODS We included 22 patients aged 55-80 with neurogenic orthostatic hypotension (nOH) who had been diagnosed with either clinically probable MSA-P (n = 11) according to current consensus criteria or clinically definite PD (n = 11) according to the Queen Square criteria. Three physicians with expertise in CAFT were blinded to the neurological diagnosis and were asked to identify the correct neurological diagnosis by applying a self-created evaluation scheme to the CAFT recordings. Afterwards, a systematic comparison of clinical-demographic characteristics and CAFT parameters was carried out. RESULTS Neither the raters (overall diagnostic accuracy: 58.46%) nor the evaluation scheme created post hoc (72.73%) showed reliable discriminatory capacity. The inter-rater reliability was slight (κ = 0.01). We observed no statistically significant differences in cardiovascular autonomic indices between PD and MSA-P patients. CONCLUSION CAFT is the gold standard for assessing the presence and severity of cardiovascular autonomic failure, but the results of our pilot study suggest that CAFT might be of limited value in the differential diagnosis between MSA-P and PD once nOH is present.
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Affiliation(s)
- Fabian Leys
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alessandra Fanciulli
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jean-Pierre Ndayisaba
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Roberta Granata
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Walter Struhal
- Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Gregor K Wenning
- Division of Clinical Neurobiology, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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Garg D, Srivastava AK, Jaryal AK, Rajan R, Singh A, Pandit AK, Vibha D, Shukla G, Garg A, Pandey RM, Prasad K. Is There a Difference in Autonomic Dysfunction Between Multiple System Atrophy Subtypes? Mov Disord Clin Pract 2020; 7:405-412. [PMID: 32373657 DOI: 10.1002/mdc3.12936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/03/2020] [Accepted: 03/02/2020] [Indexed: 01/02/2023] Open
Abstract
Background Autonomic dysfunction forms the diagnostic cornerstone in MSA. Data are limited on autonomic dysfunction differences between the two subtypes, MSA-C and MSA-P. Objectives To assess autonomic dysfunction in MSA subtypes and Parkinson's disease (PD) and compare it to healthy controls. Methods We conducted a cross-sectional study. A validated questionnaire (Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction; SCOPA-AUT) was used for symptom screening. Cardiovascular autonomic testing included deep breathing (change in heart rate, E: I ratio), Valsalva ratio, diastolic blood pressure (BP) rise (hand grip, cold pressor), and postural (tilt, 30:15 ratio) tests. Disease severity was assessed by the Unified MSA Rating Scale (UMSARS), H & Y stage, and International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating scale part III. Results MSA-P (48 subjects; age, 63.6 ± 9.7 years; UMSARS, 45.0 ± 16.5), MSA-C (52 subjects; age, 58.0 ± 8.1 years; UMSARS, 44.0 ± 12.8), PD (50 subjects; age, 57.6 ± 6.7 years), and healthy controls (50 subjects; age, 58.0 ± 8.0 years) were enrolled. MSA patients had higher SCOPA-AUT scores in gastrointestinal, urinary, cardiovascular, and sexual domains than controls and in gastrointestinal, urinary, and cardiovascular domains compared to PD. The two MSA subtypes did not differ in autonomic dysfunction. Heart-rate change on tilt and deep breathing, and diastolic BP rise on cold pressor test, differed significantly between MSA and PD patients. Conclusions Autonomic dysfunction symptomatology and cardiovascular autonomic tests were similar between MSA-P and MSA-C patients. Autonomic symptoms were more prominent in MSA than PD. Emphasis on these domains may improve likelihood of accurate clinical diagnosis of MSA at earlier stages.
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Affiliation(s)
- Divyani Garg
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | | | - Ashok Kumar Jaryal
- Department of Physiology All India Institute of Medical Sciences New Delhi India
| | - Roopa Rajan
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Akanksha Singh
- Department of Physiology All India Institute of Medical Sciences New Delhi India
| | - Awadh Kishor Pandit
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Deepti Vibha
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Garima Shukla
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Ajay Garg
- Department of Neuroradiology All India Institute of Medical Sciences New Delhi India
| | | | - Kameshwar Prasad
- Department of Neurology All India Institute of Medical Sciences New Delhi India
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10
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MPTP-Induced Impairment of Cardiovascular Function. Neurotox Res 2020; 38:27-37. [PMID: 32198706 DOI: 10.1007/s12640-020-00182-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by the accumulation of Lewy bodies and loss of dopaminergic neurons in the substantia nigra pars compacta (SNpC). MPTP is widely used to generate murine PD model. In addition to classical motor disorders, PD patients usually have non-motor symptoms related to autonomic impairment, which precedes decades before the motor dysfunction. This study's objective is to examine the effects of MPTP on noradrenergic neurons in the hindbrain, thereby on the cardiovascular function in mice. Adult mice received 10 mg/kg/day of MPTP (4 consecutive days) to generate PD model. Systolic blood pressure was measured by tail cuff system in conscious mice, and baroreflex sensitivity was evaluated by heart rate alteration in response to a transient increase or decrease in blood pressure induced by intravenous infusion of phenylalanine (PE) or sodium nitroprusside (SNP) in anesthetized condition, respectively. Baseline heart rate and heart rate variability were analyzed in both sham and MPTP-treated mice. Dopamine, norepinephrine, and related metabolites in the plasma and brain tissues including SNpC, locus coeruleus (LC), rostroventrolateral medulla (RVLM), and nucleus tractus solitarii (NTS) were measured by liquid chromatography-mass spectrometry (LC-MS). Tyrosine hydroxylase-positive (TH+) neurons in above nuclei were quantified by immunoreactivities. We found that in addition to the loss of TH+ neurons in SNpC, MPTP treatment induced a dramatic reduction of TH+ cell counts in the LC, RVLM, and NTS. These are associated with significant decreases of dopamine, norepinephrine, and epinephrine in above nuclei. Meanwhile, MPTP induced a lasting effect of baroreflex desensitization, tachycardia, and decreased heart rate variability compared to the sham mice. Notably, MPTP treatment elevated sympathetic outflow and suppressed parasympathetic tonicity according to the heart rate power spectrum analysis. Our results indicate that the loss of TH+ neurons in the brainstem by MPTP treatment led to impaired autonomic cardiovascular function. These results suggest that MPTP treatment can be used to study the autonomic dysfunction in murine model.
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Quantitative autonomic function test in differentiation of multiple system atrophy from idiopathic Parkinson disease. Chin Med J (Engl) 2019; 132:1919-1924. [PMID: 31373907 PMCID: PMC6708682 DOI: 10.1097/cm9.0000000000000359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text Background: Differential diagnosis of idiopathic Parkinson disease (IPD) and multiple system atrophy-Parkinson type (MSA-P) is challenging since they share clinical features with parkinsonism and autonomic dysfunction. To distinguish MSA-P from IPD when the symptoms are relatively mild, we investigated the usefulness of the quantitative fractionalized autonomic indexes and evaluated the correlations of autonomic test indexes and functional status. Methods: Thirty-six patients with parkinsonism (22 with IPD and 14 with MSA-P) in Soonchunhyang University Bucheon Hospital from February 2014 to June 2015 were prospectively enrolled in the study. We compared fractionalized autonomic indexes and composite autonomic scoring scale between patients with IPD and MSA-P with Hoehn and Yahr (H&Y) score ≤3. Parasympathetic indexes included expiratory/inspiratory ratio during deep breathing, Valsalva ratio (VR), and regression slope of systolic blood pressure (BP) in early phase II (vagal baroreflex sensitivity) during Valsalva maneuver. Sympathetic adrenergic indexes were pressure recovery time (PRT) and adrenergic baroreflex sensitivity (BRSa) (BP decrement associated with phase 3 divided by the PRT), sympathetic index 1, sympathetic index 3, early phase II mean BP drop, and pulse pressure reduction rate. Additionally, we compared the unified multiple system atrophy rating scale (UMSARS) and H&Y scores and the autonomic indexes in all patients. Results: PRT was significantly different between the IPD and MSA-P groups (P = 0.004) despite the similar BP drop during tilt. Cut-off value of PRT was 5.5 s (sensitivity, 71.4%; specificity, 72.7%). VR (r = −0.455, P = 0.009) and BRSa (r = −0.356, P = 0.036) demonstrated a significant correlation with UMSARS and H&Y scores. Conclusions: Among the cardiovascular autonomic indexes, PRT can be a useful parameter in differentiating the early stage of MSA-P from that of IPD. Moreover, VR, and BRSa may be the optimal indexes in determining functional symptom severity.
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Mendoza-Velásquez JJ, Flores-Vázquez JF, Barrón-Velázquez E, Sosa-Ortiz AL, Illigens BMW, Siepmann T. Autonomic Dysfunction in α-Synucleinopathies. Front Neurol 2019; 10:363. [PMID: 31031694 PMCID: PMC6474181 DOI: 10.3389/fneur.2019.00363] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022] Open
Abstract
The α-synucleinopathies are a group of neurodegenerative diseases characterized by abnormal accumulation of insoluble α-synuclein in neurons and glial cells, comprising Parkinson's disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). Although varying in prevalence, symptom patterns, and severity among disorders, all α-synucleinopathies have in common autonomic nervous system dysfunctions, which reduce quality of life. Frequent symptoms among α-synucleinopathies include constipation, urinary and sexual dysfunction, and cardiovascular autonomic symptoms such as orthostatic hypotension, supine hypertension, and reduced heart rate variability. Symptoms due to autonomic dysfunction can appear before motor symptom onset, particularly in MSA and PD, hence, detection and quantitative analysis of these symptoms can enable early diagnosis and initiation of treatment, as well as identification of at-risk populations. While patients with PD, DLB, and MSA show both central and peripheral nervous system involvement of α-synuclein pathology, pure autonomic failure (PAF) is a condition characterized by generalized dysregulation of the autonomic nervous system with neuronal cytoplasmic α-synuclein inclusions in the peripheral autonomic small nerve fibers. Patients with PAF often present with orthostatic hypotension, reduced heart rate variability, anhydrosis, erectile dysfunction, and constipation, without motor or cognitive impairment. These patients also have an increased risk of developing an α-synucleinopathy with central involvement, such as PD, DLB, or MSA in later life, possibly indicating a pathophysiological disease continuum. Pathophysiological aspects, as well as developments in diagnosing and treating dysautonomic symptoms in patients with α-synucleinopathies are discussed in this review.
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Affiliation(s)
- José Javier Mendoza-Velásquez
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Psychiatry and Mental Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Juan Francisco Flores-Vázquez
- Dementia Laboratory, National Institute of Neurology and Neurosurgery, Ciudad de Mexico, Mexico
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Evalinda Barrón-Velázquez
- Department of Psychiatry and Mental Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ana Luisa Sosa-Ortiz
- Dementia Laboratory, National Institute of Neurology and Neurosurgery, Ciudad de Mexico, Mexico
| | - Ben-Min Woo Illigens
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Timo Siepmann
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Qiu F, Wang K, Li T, Song D, Wang Z, Zhang H, Liu J, Ren M, Qi X. Differential Diagnosis Of Multiple-System Atrophy With Parkinson's Disease By External Anal- And Urethral-Sphincter Electromyography. Neuropsychiatr Dis Treat 2019; 15:3061-3067. [PMID: 31806975 PMCID: PMC6842278 DOI: 10.2147/ndt.s218073] [Citation(s) in RCA: 2] [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] [Received: 06/02/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The differential diagnosis of Parkinson's disease (PD) with multiple-system atrophy (MSA) is difficult because of their similarity in symptoms and signs. The objective of this study was to investigate the value of external anal-sphincter electromyography (EAS-EMG) and urethral-sphincter electromyography (US-EMG) in differentiating MSA from PD. METHODS A total of 201 patients, - 101 MSA and 100 PD - were recruited in this study. Average duration and amplitude of motor unit potentials (MUPs), percentage of polyphasic MUPs, amplitude during strong contractions, and recruitment patterns during maximal voluntary contractions were recorded and analyzed to assess diagnostic efficiency of EAS-EMG and US-EMG for MSA. RESULTS Significant differences in average MUP duration and recruitment patterns during maximal voluntary contractions were found between patients with MSA and patients with PD using both EAS-EMG (P<0.001, P<0.001) and US-EMG (P<0.001, P<0.001). The percentage of polyphasic MUPs and amplitude during strong contractions showed significant differences in MSA and PD using only EAS-EMG (P<0.001, P=0.005). Cutoff points for average MUP duration in EAS-EMG and US-EMG for differential diagnosis of MSA with PD were 10.9 and 11.1 milliseconds, respectively. With average MUP duration of EAS-EMG and US-EMG being applied jointly, sensitivity and specificity in distinguishing MSA from PD were 83.2% and 71.8%, respectively. CONCLUSION EAS-EMG and US-EMG were sensitive and specific methods for the diagnosis and differential diagnosis of MSA, and the combination of both would improve the diagnostic rate of MSA compared to only one method being used.
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Affiliation(s)
- Feng Qiu
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Kunyu Wang
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Tingting Li
- Department of Gastroenterology, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Dandan Song
- Department of Medicine, Beijing Northern Hospital of China North Industries Group Corporation, Beijing 100089, People's Republic of China
| | - Zhiwei Wang
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Hailing Zhang
- Department of Neurology, Changhai Hospital, Shanghai 200433, People's Republic of China
| | - Jianguo Liu
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Ming Ren
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, People's Republic of China
| | - Xiaokun Qi
- Department of Neurology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
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Miyasato RS, Silva-Batista C, Peçanha T, Low DA, de Mello MT, Piemonte ME, Ugrinowitsch C, Forjaz CL, Kanegusuku H. Cardiovascular Responses During Resistance Exercise in Patients With Parkinson Disease. PM R 2018; 10:1145-1152. [DOI: 10.1016/j.pmrj.2018.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/17/2018] [Accepted: 04/27/2018] [Indexed: 11/30/2022]
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Adoor M, Jaideep SS, Sujan MU, Kramer BW, Raju TR, Sathyaprabha TN. Influence of age and gender on blood pressure variability and baroreflex sensitivity in a healthy population in the Indian sub-continent. J Basic Clin Physiol Pharmacol 2018; 29:329-337. [PMID: 30007058 DOI: 10.1515/jbcpp-2017-0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/03/2018] [Indexed: 11/15/2022]
Abstract
Background The current exploratory study was aimed at estimating measures of blood pressure variability (BPV) and baroreflex sensitivity (BRS) in a healthy population in the Indian sub-continent. Methods One hundred and forty-two healthy subjects were recruited for the study. Blood pressure (BP) was recorded continuously for 15 min using the Finometer (Finapres Medical Systems, The Netherlands). For offline analysis, Nevrokard cardiovascular parameter analysis (CVPA) software (version 2.1.0) was used for BPV analysis. BRS was determined by spectral and sequence methods. One-way ANOVA and Bonferroni's test were used to compare parameters. Pearson's correlation coefficient was employed to look for possible associations between age and other continuous variables. Results Out of 196 screened volunteers, 54 were excluded and 142 subjects were grouped based on ages as 10-19 years (group 1), 20-29 years (group 2), 30-39 years (group 3), 40-49 years (group 4), and 50-59 years (group 5). Within groups, body mass index (BMI, p=0.000) and BP (systolic and diastolic) were significantly different. Post hoc analysis showed mean blood pressure (MBP) and diastolic blood pressure (DBP) differing significantly between groups 1 and 4 (p<0.05 for both) along with other cardiovascular parameters. Age correlated positively with BMI and all parameters of BP. Significant gender differences were observed for stroke volume, cardiac output, up BRS, total BRS, peripheral resistance (PR), and aortic impedance. Conclusions Our study has provided reference values for BPV and BRS in an Indian population. It also indicates age-related neurocardiac imbalance and possible utility of these tests for screening at the start of neurocardiac damage in a healthy population.
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Affiliation(s)
- Meghana Adoor
- Departments of Neurophysiology, National Institute of Mental Health and Neuroscience (NIMHANS), Bangalore, India
| | - Sriranjini S Jaideep
- Ramaiah Indic Specialty Ayurveda (RISA), Gokula Education Foundation (Medical), Bangalore, India
| | - M U Sujan
- Departments of Neurophysiology, National Institute of Mental Health and Neuroscience (NIMHANS), Bangalore, India
| | - Boris W Kramer
- Department of Pediatrics, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T R Raju
- Departments of Neurophysiology, National Institute of Mental Health and Neuroscience (NIMHANS), Bangalore, India
| | - Talakad N Sathyaprabha
- Departments of Neurophysiology, National Institute of Mental Health and Neuroscience (NIMHANS), Bangalore 560 029, Karnataka, India, Phone: +91 80 26 995 172, Fax: +91 80 26564830
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Kim YH, Phillips V Z, Paik SH, Jeon NJ, Kim BM, Kim BJ. Prefrontal hemodynamic changes measured using near-infrared spectroscopy during the Valsalva maneuver in patients with orthostatic intolerance. NEUROPHOTONICS 2018; 5:015002. [PMID: 29392157 PMCID: PMC5786506 DOI: 10.1117/1.nph.5.1.015002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/04/2018] [Indexed: 05/04/2023]
Abstract
The Valsalva maneuver (VM) with beat-to-beat blood pressure and heart rate monitoring are used to evaluate orthostatic intolerance (OI). However, they lack the ability to detect cerebral hemodynamic changes, which may be a cause of OI symptoms. Therefore, we utilized near-infrared spectroscopy during VM. Patients with OI symptoms and normal healthy subjects were recruited. Patients were subgrouped according to VM results: patients with normal VM (NVM) and abnormal VM (AbVM). Oxyhemoglobin (HbO), deoxyhemoglobin, and total hemoglobin changes were measured at four different source-detector distances (SD) (15, 30, 36, and 45 mm), and latency, amplitude, duration, and integrated total signal were calculated. Those parameters were compared between a normal healthy control (HC) group and the two OI patient subgroups. We found that HbO increment latency at 30-mm SD in the HC, NVM, and AbVM groups was as follows: [Formula: see text], [Formula: see text], and [Formula: see text], respectively ([Formula: see text]). Among the four parameters we evaluated, latency of HbO increment was the best marker for differentiating OI.
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Affiliation(s)
- Yoo Hwan Kim
- Hallym University Medical Center, Department of Neurology, Seoul, Republic of Korea
- Korea University Medical Center, Department of Neurology, Seoul, Republic of Korea
| | - Zephaniah Phillips V
- Korea University College of Health Science, Department of Bioconvergence Engineering, Seoul, Republic of Korea
| | - Seung-ho Paik
- Korea University College of Health Science, Department of Bioconvergence Engineering, Seoul, Republic of Korea
| | - Nam-Joon Jeon
- Korea University Anam Hospital, Neurophysiology Laboratory, Seoul, Republic of Korea
| | - Beop-Min Kim
- Korea University College of Health Science, Department of Bioconvergence Engineering, Seoul, Republic of Korea
- Address all correspondence to: Beop-Min Kim, E-mail: ; Byung-Jo Kim, E-mail:
| | - Byung-Jo Kim
- Korea University Medical Center, Department of Neurology, Seoul, Republic of Korea
- Korea University Anam Hospital, Brain Convergence Research Center, Seoul, Republic of Korea
- Address all correspondence to: Beop-Min Kim, E-mail: ; Byung-Jo Kim, E-mail:
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