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Pravallika R, Suthar R, Patil A, Malviya M, Saxena S, Saini L, Bansal A. Efficacy of Teleconsultation-Based Rehabilitation in Children with Landry-Guillain-Barré Syndrome: An Open Label Randomized Controlled Trial (Tele Rehab-LGBS Trial). Indian J Pediatr 2024; 91:455-462. [PMID: 37889455 DOI: 10.1007/s12098-023-04882-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES To evaluate the feasibility and efficacy of teleconsultation-based rehabilitation in children with Landry-Guillain-Barré syndrome (LGBS), measured with Medical Research Council (MRC) sum score and Hughes score. METHODS A pragmatic, prospective, parallel open label randomized controlled trial was conducted among a total of 50 children with LGBS. The children were randomized using computer generated block randomization into 2 groups (25 in each group): Standard of care (Group A) and teleconsultation-based rehabilitation (Group B). Primary and secondary outcomes were measured with MRC sum score and Hughes score at 12- and 24-wk follow-up. RESULTS The mean age was 6.4 ± 3.3 y; 29 (58%) were boys. Baseline MRC sum score (median, IQR), and Hughes score (median, IQR) in group A was 24 (7-31) and 5 (4-5) respectively; and in group B was 18 (9-24) and 4 (4-5) respectively. At discharge, median (IQR) MRC sum score in group A and B was 34 (28-41), and 30 (25-43) (p value = 0.31) respectively. Tele-rehabilitation was provided to group B for 24 wk with 96% compliance. At 12 wk, median MRC sum score in group A and group B were similar [48 (IQR 44-54) vs. 52 (IQR 46-60), p value = 0.08]. At 12 wk and 24 wk, median Hughes score in group A and B were similar. At 24 wk, 15 out of 23 subjects of group A and 18 out of 25 subjects of group B were ambulatory (p value = 0.61). CONCLUSIONS Teleconsultation-based rehabilitation was feasible with a high compliance rate. The functional outcomes measured with MRC sum score and Hughes score were similar in both the groups at 12 and 24 wk follow-up. Teleconsultation-based rehabilitation has similar efficacy as physical rehabilitation.
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Affiliation(s)
| | - Renu Suthar
- Department of Pediatrics, PGIMER, Chandigarh, India.
| | - Amol Patil
- Department of Pharmacology, PGIMER, Chandigarh, India
| | | | - Somya Saxena
- Department of Physical Medicine and Rehabilitation, PGIMER, Chandigarh, India
| | - Lokesh Saini
- Department of Pediatrics, PGIMER, Chandigarh, India
- Department of Pediatrics, AIIMS, Jodhpur, India
| | - Arun Bansal
- Department of Pediatrics, PGIMER, Chandigarh, India
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V S, Pattanaik A, Marate S, Mani RS, Pai AR, Mukhopadhyay C. Guillain-barré syndrome (GBS) with antecedent chikungunya infection: a case report and literature review. Neurol Res Pract 2024; 6:21. [PMID: 38600592 PMCID: PMC11008014 DOI: 10.1186/s42466-024-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
Guillain-Barré Syndrome (GBS) is an autoimmune neuropathy. Antecedent infections have been seen to be significant triggering factors for developing GBS. Among them, arboviral infections are rapidly gaining importance as significant triggers, especially in the areas where they are endemic. Chikungunya, an arboviral infection that usually causes a self-limiting acute febrile illness can lead to GBS as one its severe complications. Herein, we describe a case of a 21-year-old female who presented with weakness in all four limbs and paresthesia. Nerve conduction study and cerebrospinal fluid (CSF) analysis showed axonal, demyelinating motor and sensory neuropathy with albuminocytological dissociation indicating Acute Motor and Sensory Axonal Neuropathy (AMSAN) variant of GBS. Serum IgM antibodies against ganglioside GM1 were detected. Anti-Chikungunya IgM antibodies were found in both serum and CSF samples. The patient was initiated with Intravenous Immunoglobulin (IVIG) therapy. In view of hypoxia, she was intubated and was on mechanical ventilation. After 2 weeks of being comatose, the patient gradually improved and was discharged with no sequelae.A literature review on antecedent infections in GBS is presented alongside the case report to better understand the association of GBS with antecedent infections, especially the endemic arboviral infections like Chikungunya, Dengue and Zika. This will help in reinforcing the significance of having robust surveillance and public health control measures for infectious diseases.
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Affiliation(s)
- Sreelakshmi V
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Amrita Pattanaik
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Srilatha Marate
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
| | - Reeta S Mani
- Department of Neurovirology, National Institute of Mental Health and Neurosciences (NIMHANS), Karnataka, Bengaluru, India
| | - Aparna R Pai
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Chiranjay Mukhopadhyay
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India
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Shibeshi MS, Mengesha AA, Gari KT. Pediatric Guillain-Barré Syndrome in a Resource Limited Setting: Clinical Features, Diagnostic and Management Challenges, and Hospital Outcome. Pediatric Health Med Ther 2023; 14:107-115. [PMID: 36993874 PMCID: PMC10040339 DOI: 10.2147/phmt.s401461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
Background Guillain-Barré syndrome (GBS) is an acute immune-mediated peripheral neuropathy with a highly variable clinical course and outcome. There remain diagnostic and treatment challenges in resource limited settings. This study aimed to describe the clinical presentation, diagnostic and management challenges, and hospital outcome of children with GBS in southern Ethiopia. Methods A retrospective chart review of children aged ≤14 years who were admitted with a diagnosis of GBS to Hawassa University Comprehensive Specialized Hospital from 2017 to 2021 was done. Medical records of 102 children who fulfilled the Brighton Criteria for GBS were reviewed, and data on demographic, clinical characteristics, investigation findings, treatment, and outcome were collected. Logistic regression analysis was done to determine factors associated with mortality. Results The mean age of the study subjects was 7.25±3.91 years and 63.7% were male. Antecedent event was present in 48% of the cases, and the most common triggering factor was upper respiratory tract infection (63.8%). The mean Hughes disability score was 4.23±0.54, 4.48±0.71, and 4.03±0.86 at admission, nadir and discharge from hospital, respectively. Cranial nerve involvement was present in 27.5% of patients and bulbar palsy was the most common finding. Dysautonomia was observed in 57.8% of the participants. Sixty-three patients (61.8%) needed ICU care but only 43 of them (68.3%) were admitted to ICU. Similarly, 31 patients (30.4%) required respiratory support but only 24 of them (77.4%) were on mechanical ventilator. No patient had nerve conduction study. Only 5.9% of patients received IVIG. Thirteen patients (12.7%) died of GBS and the presence of respiratory failure was the only determinant of mortality [AOR = 11.40 (95% CI: 1.818, 71.52), p = 0.009]. Conclusion There is a gap in the diagnosis and management of children with GBS; and mortality from the disease is higher than reports from other settings.
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Affiliation(s)
- Mulugeta Sitot Shibeshi
- Department of Pediatrics and Child Health, Hawassa University, Hawassa, Ethiopia
- Correspondence: Mulugeta Sitot Shibeshi, Email
| | - Adane Alto Mengesha
- Department of Pediatrics and Child Health, Arba Minch University, Arba Minch, Ethiopia
| | - Kefyalew Taye Gari
- Department of Pediatrics and Child Health, Hawassa University, Hawassa, Ethiopia
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Sugumar K, Chidambaram AC, Gunasekaran D. Assessment of neurological sequelae and new-onset symptoms in the long-term follow-up of paediatric Guillain-Barre syndrome: A longitudinal study from India. J Paediatr Child Health 2022; 58:2211-2217. [PMID: 36054714 DOI: 10.1111/jpc.16185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Guillain-Barre syndrome (GBS) is the commonest cause of acute flaccid paralysis in children. There is a paucity of studies that assess the long-term outcome of paediatric GBS. AIM To assess the frequency of neurological sequelae and the new-onset symptoms in the long-term follow-up of paediatric GBS and to identify the risk factors associated with them. METHODS This longitudinal study involved 78 children with GBS treated between January 2015 and 2021. The parents of those children were contacted to visit the hospital for a detailed neurological examination and to look for new-onset symptoms after the initial treatment for GBS. RESULTS Of the 78 children, acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, and acute motor-sensory axonal neuropathy variants were observed in 30 (38.5%), 27 (34.6%) and 11 (14.1%) children, respectively. The median (interquartile range (IQR)) duration of follow-up was 3 (2, 4.5) years. The median (IQR) time to independent ambulation was 30 (13.5, 105) days. The neurological sequelae were found in 22 (28.2%) children. GBS disability score at admission (odds ratio (OR) = 4.6; 95% confidence interval (CI): 1.1-19.8; P = 0.04) and axonal variant of GBS (OR = 4.1; 95% CI: 1.5-20.8; P = 0.04) were found to be independent predictors of neurologic sequelae. A total of 28 children experienced new-onset symptoms after GBS, with frequent falls while running and fatigue being the predominant symptoms. Those children with demyelinating variant achieved independent ambulation earlier than the axonal group on survival analysis (log-rank P value = 0.04). CONCLUSION The presence of neurological sequelae and new-onset symptoms were found in 28.2 and 35% of the GBS children, respectively. High GBS disability score at admission and axonal variant of GBS were independent predictors of neurological sequelae. Knowledge about these would help in devising a plan for rehabilitation.
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Affiliation(s)
- Kiruthiga Sugumar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Aakash C Chidambaram
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Dhandapany Gunasekaran
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Maramattom BV, Krishnan P, Paul R, Padmanabhan S, Cherukudal Vishnu Nampoothiri S, Syed AA, Mangat HS. Guillain-Barré Syndrome following ChAdOx1-S/nCoV-19 Vaccine. Ann Neurol 2021; 90:312-314. [PMID: 34114256 DOI: 10.1002/ana.26143] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/23/2021] [Accepted: 05/30/2021] [Indexed: 11/09/2022]
Abstract
As of April 22, 2021, around 1.5 million individuals in three districts of Kerala, India had been vaccinated with COVID-19 vaccines. Over 80% of these individuals (1.2 million) received the ChAdOx1-S/nCoV-19 vaccine. In this population, during this period of 4 weeks (mid-March to mid-April 2021), we observed seven cases of Guillain-Barre syndrome (GBS) that occurred within 2 weeks of the first dose of vaccination. All seven patients developed severe GBS. The frequency of GBS was 1.4- to 10-fold higher than that expected in this period for a population of this magnitude. In addition, the frequency of bilateral facial weakness, which typically occurs in <20% of GBS cases, suggests a pattern associated with the vaccination. While the benefits of vaccination substantially outweigh the risk of this relatively rare outcome (5.8 per million), clinicians should be alert to this possible adverse event, as six out of seven patients progressed to areflexic quadriplegia and required mechanical ventilatory support. ANN NEUROL 2021;90:312-314.
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Affiliation(s)
- Boby V Maramattom
- Department of Neurology, Aster Medcity, Kochi, India.,Department of Neurology, Indo-American Brain and Spine Center, Vaikom, India
| | | | - Reji Paul
- Department of Neurology, Aster Medcity, Kochi, India
| | | | | | - Akheel A Syed
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Halinder S Mangat
- Department of Neurology, Division of Neurocritical Care, University of Kansas Medical Center, Kansas City, KS, USA
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Kasemsap N, Vorasoot N, Kongbunkiat K, Tiamkao S, Chotmongkol V, Sawanyawisuth K, Panitchote A. The epidemiology of Guillain-Barré syndrome in Thailand over 13 years (2005-2017): A nationwide population-based retrospective cohort study. J Peripher Nerv Syst 2021; 26:202-208. [PMID: 33969589 DOI: 10.1111/jns.12453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/30/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
There have been no published studies examining the epidemiology of Guillain-Barré syndrome (GBS) in large populations in Thailand. This study aimed to explore the incidence, patient characteristics, seasonality, treatments, and outcomes of GBS in Thailand. The National Health Security Office (NHSO) provided data on in-patient admission between fiscal year 2005 and 2017. We selected all patients with a primary diagnosis of GBS. We retrieved data regarding the total population from the Department of Provincial Administration. A total of 4521 patients with GBS were included. The median age was 42 years (IQR 22-56), and 61.5% were male. The incidence rate increased from 0.48 to 0.93 per 100 000 population over the 13 years. The incidence was increased with age and a male-to-female ratio of 1.6:1. There was seasonal variation in the rate of admission for GBS, with significantly more patients admitted in rainy vs summer (IRR 1.94, 95%CI 1.80-2.10, P < .001) and winter vs summer (IRR 1.48, 95%CI 1.36-1.60, P < .001). Treatment with IVIg increased from 4.4% to 29.6% (P < .001), whereas plasmapheresis decreased significantly from 4% to 1.32% (P = .017). The mortality rate was 3.5%. Elderly and young adults had a significantly higher mortality rate when compared to children and teenagers (P < .001 and P = .003). The incidence of GBS in Thailand was steady over 13 years and was greater in rainy and winter season. Treatment with IVIg increased while plasmapheresis decreased. Mortality was higher in elderly patients.
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Affiliation(s)
- Narongrit Kasemsap
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Nisa Vorasoot
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Kannikar Kongbunkiat
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Veerajit Chotmongkol
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anupol Panitchote
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Abstract
Guillain–Barré syndrome (GBS) is an inflammatory disorder and an acute immune-mediated demyelinating neuropathy that causes reduced signal transmissions, progressive muscle weakness, and paralysis. The etiology of the syndrome still remains controversial and uncertain. GBS can be initiated and triggered by respiratory tract infections such as influenza, and intestinal infections such as Campylobacter jejuni. In addition, there is considerable evidence suggesting links between influenza vaccination and GBS. As reported previously, the incidence of GBS in individuals receiving swine flu vaccine was about one to two cases per million. Despite the influenza vaccine efficacy, its association with an immune-mediated demyelinating process can be challenging as millions of people get vaccinated every year. In this review we will discuss the association between influenza infection and vaccination with GBS by focusing on the possible immunopathological mechanisms.
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Mathew T, Hareesh P, Souza DD, Avati A, Sarma GRK, Nadig R, Therambil M, Parry GJ. Bell's palsy and guillain–barré syndrome may be 2 ends of the same spectrum. Muscle Nerve 2019; 59:E48-E49. [DOI: 10.1002/mus.26477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Thomas Mathew
- Department of NeurologySt John's Medical College Hospital Bengaluru Karnataka India
| | - Prarthana Hareesh
- Department of NeurologySt John's Medical College Hospital Bengaluru Karnataka India
| | - Delon D. Souza
- Department of NeurologySt John's Medical College Hospital Bengaluru Karnataka India
| | - Amrutha Avati
- Department of NeurologySt John's Medical College Hospital Bengaluru Karnataka India
| | - G. R. K. Sarma
- Department of NeurologySt John's Medical College Hospital Bengaluru Karnataka India
| | - Raghunandan Nadig
- Department of NeurologySt John's Medical College Hospital Bengaluru Karnataka India
| | - Manjusha Therambil
- Department of NeurologySt John's Medical College Hospital Bengaluru Karnataka India
| | - Gareth J. Parry
- Department of NeurologySt John's Medical College Hospital Bengaluru Karnataka India
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Wu X, Shen D, Li T, Zhang B, Li C, Mao M, Zhao J, Liu K, Zhang HL. Distinct Clinical Characteristics of Pediatric Guillain-Barré Syndrome: A Comparative Study between Children and Adults in Northeast China. PLoS One 2016; 11:e0151611. [PMID: 26974666 PMCID: PMC4790924 DOI: 10.1371/journal.pone.0151611] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/01/2016] [Indexed: 01/19/2023] Open
Abstract
Objective Clinical characteristics of pediatric Guillain-Barré syndrome (GBS) have been extensively studied whereas scarcely been compared with those of adult GBS. Herein we compared the clinical features of GBS between pediatric and adult patients. Methods We retrospectively collected the clinical data of 750 patients with GBS (541 adults and 209 children), and compared the clinical characteristics between children and adults. Results Pain was a more frequent complaint in children (17.2% vs 9.6%, p < 0.01), who were also found with shorter interval from disease onset to nadir (6.3d vs 7.3d, p < 0.01) and higher incidence of bulbar dysfunction (22.0% vs 14.8%, p < 0.05). The disease severity in children was comparable with adults. In addition, a higher incidence of pediatric GBS was found in summer, especially in July and August (both p < 0.01). However, the incidence of antecedent infections of different seasons in adult and pediatric patients was comparable (p > 0.05). The clinical features of acute motor axonal neuropathy (AMAN) and acute inflammatory demyelinating polyneuropathy (AIDP) in children were overall comparable with adult ones (p > 0.05). Similar to adults, bulbar dysfunction (odds ratio [OR]: 4.621, 95% confidence interval [CI]: 1.240–17.218, p < 0.05) and lower nadir Medical Research Council (MRC) sum score (OR: 0.897, 95% CI: 0.855–0.941, p < 0.01) were also risk factors for mechanical ventilation in children. However, distinct from adult ones, autonomic dysfunction was significantly higher in mechanically ventilated childhood GBS (39.1% vs 8.8%, p < 0.01), which also served as a predictor for mechanical ventilation in pediatric GBS (OR: 70.415, 95% CI: 9.265–535.158, p < 0.01). As to the efficacy of intravenous immunoglobulin, insignificant difference was identified between children and adults. Conclusion The clinical features of pediatric GBS differ from those of adults. Autonomic dysfunction is an independent risk factor for mechanical ventilation in pediatric patients.
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Affiliation(s)
- Xiujuan Wu
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Donghui Shen
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Ting Li
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Bing Zhang
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Chunrong Li
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Mei Mao
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Jixue Zhao
- Department of Pediatric Surgery, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Kangding Liu
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
| | - Hong-Liang Zhang
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Changchun, China
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