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Frohman EM, Villemarette-Pittman NR, Rodriguez A, Glanzman R, Rugheimer S, Komogortsev O, Zamvil SS, Cruz RA, Varkey TC, Frohman AN, Frohman AR, Parsons MS, Konkle EH, Frohman TC. Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease. J Neurol Sci 2021; 426:117463. [PMID: 33971376 PMCID: PMC8055502 DOI: 10.1016/j.jns.2021.117463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
The COVID-19 pandemic has devastated individuals, families, and institutions throughout the world. Despite the breakneck speed of vaccine development, the human population remains at risk of further devastation. The decision to not become vaccinated, the protracted rollout of available vaccine, vaccine failure, mutational forms of the SARS virus, which may exhibit mounting resistance to our molecular strike at only one form of the viral family, and the rapid ability of the virus(es) to hitch a ride on our global transportation systems, means that we are will likely continue to confront an invisible, yet devastating foe. The enemy targets one of our human physiology's most important and vulnerable life-preserving body tissues, our broncho-alveolar gas exchange apparatus. Notwithstanding the fear and the fury of this microbe's potential to raise existential questions across the entire spectrum of human endeavor, the application of an early treatment intervention initiative may represent a crucial tool in our defensive strategy. This strategy is driven by evidence-based medical practice principles, those not likely to become antiquated, given the molecular diversity and mutational evolution of this very clever "world traveler".
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Affiliation(s)
- Elliot M Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
| | | | - Adriana Rodriguez
- Department of Emergency Medicine, Cook Children's Medical Center, Ft. Worth, TX, United States of America
| | - Robert Glanzman
- Clene Nanomedicine, Inc., Salt Lake City, UT 84121, United States of America.
| | - Sarah Rugheimer
- Department of Physics, University Oxford, Oxford OX1 3PU, UK.
| | - Oleg Komogortsev
- Department of Computer Sciences, Texas State University, San Marcos, TX, United States of America.
| | - Scott S Zamvil
- Department of Neurology and Program in Immunology, University of California San Francisco, San Francisco, CA, United States of America.
| | - Roberto Alejandro Cruz
- Department of Neurology, Doctor's Health at Renaissance Health Neurology Institute, United States of America; Department of Neurology, University of Texas Rio Grande Valley School of Medicine, United States of America.
| | - Thomas C Varkey
- Dell Medical School, University of Texas at Austin, United States of America.
| | | | | | - Matthew S Parsons
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, United States of America; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States of America.
| | | | - Teresa C Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
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Clough M, Foletta P, Frohman AN, Sears D, Ternes A, White OB, Fielding J. Multiple sclerosis: Executive dysfunction, task switching and the role of attention. Mult Scler J Exp Transl Clin 2018; 4:2055217318771781. [PMID: 29707228 PMCID: PMC5912274 DOI: 10.1177/2055217318771781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/27/2018] [Accepted: 03/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background It has been suggested that switching ability might not be affected in multiple sclerosis (MS) as previously thought; however, whether this is true under more ‘real-world’ conditions when asymmetry in task difficulty is present has not been ascertained. Objective The objective of this paper is to examine the impact of task difficulty asymmetry on task switching ability in MS. Method An ocular motor (OM) paradigm that interleaves the simple task of looking towards a target (prosaccade, PS) with the cognitively more difficult task of looking away from a target (antisaccade, PS) was used. Two switching conditions: (1) PS switch cost, switching to a simple task from a difficult task (PS switch), relative to performing two simple tasks concurrently (PS repeat); (2) AS switch cost, switching to a difficult task from a simple task (AS switch) relative to performing two difficult tasks concurrently (AS repeat). Forty-five relapsing–remitting MS patients and 30 control individuals were compared. Results Controls and patients produced a similar magnitude PS switch cost, suggesting that task difficulty asymmetry does not detrimentally impact MS patients when transitioning from a more difficult task to a simpler task. However, MS patients alone found switching from the simpler PS trial to the more difficult AS trial easier (shorter latency and reduced error) than performing two AS trials consecutively (AS switch benefit). Further, MS patients performed significantly more errors than controls when required to repeat the same trial consecutively. Conclusion MS patients appear to find the maintenance of task-relevant processes difficult not switching per se, with deficits exacerbated under increased attentional demands.
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Affiliation(s)
- M Clough
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - P Foletta
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - A N Frohman
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, USA
| | - D Sears
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, USA
| | - A Ternes
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - O B White
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Australia
| | - J Fielding
- Department of Neurosciences, Central Clinical School, Monash University, Alfred Hospital, Australia.,School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
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Sobhanian MJ, Agarwal R, Meltzer E, Kildebeck E, Frohman BS, Frohman AN, Galetta SL, Saidha S, White O, Villoslada P, Paul F, Petzold A, Rennaker RL, Martinez-Lapiscina EH, Balcer LJ, Kardon R, Frohman EM, Frohman TC. Identification and treatment of the visual processing asymmetry in MS patients with optic neuritis: The Pulfrich phenomenon. J Neurol Sci 2018; 387:60-69. [PMID: 29571874 DOI: 10.1016/j.jns.2018.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/27/2017] [Accepted: 01/24/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Pulfrich phenomenon (PF) is the illusory perception that an object moving linearly along a 2-D plane appears to instead follow an elliptical 3-D trajectory, a consequence of inter-eye asymmetry in the timing of visual object identification in the visual cortex; with optic neuritis as a common etiology. OBJECTIVE We have designed an objective method to identify the presence and magnitude of the PF, in conjunction with a cooresponding strategy by which to abolish the effect; with monocular application of neutral density filters to the less affected fellow eye, in patients with MS and a history of optic neuropathy (e.g. related to acute optic neuritis or subclinical optic neuropathy). METHODS Twenty-three MS patients with a history of acute unilateral or bilateral optic neuritis, and ten healthy control subjects (HC) were recruited to participate in a pilot study to assess our strategy. Subjects were asked to indicate whether a linearly moving pendulum ball followed a linear 2-D path versus an illusory 3-D elliptical object-motion trajectory, by reporting the ball's approximation to one of nine horizontally-oriented colored wires that were positioned parallel to one another and horizontal to the linear pendulum path. Perceived motion of the bob that moved along wires behind or in front (along the 'Z' plane) of the middle reference wire indicated an illusory elliptical trajectory of ball motion consistent with the PF. RESULTS When the neutral density filter titration was applied to the fellow eye the severity of the PF decreased, eventually being fully abolished in all but one patient. The magnitude of neutral density filtering required correlated to the severity of the patient's initial PF magnitude (p < 0.001). CONCLUSIONS We ascertained the magnitude of the visual illusion associated with the PF, and the corresponding magnitude of neutral density filtering necessary to abolish it.
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Affiliation(s)
- Millad J Sobhanian
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA
| | - Rohit Agarwal
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA
| | - Ethan Meltzer
- Partner's Neurology Residency Training Program, Massachusettes General & Brigham & Women's Hospitals, Harvard Medical School, Cambridge, MA, USA
| | - Eric Kildebeck
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA; The Center for Engineering Innovation, University of Texas at Dallas, Richardson, TX, USA
| | - Benjamin S Frohman
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA
| | - Ashley N Frohman
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA
| | - Steven L Galetta
- The Department of Neurology, Population Health, New York University School of Medicine, New York, NY, USA; The Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Shiv Saidha
- The Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Owen White
- Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Department of Medicine, University of Melbourne, Parkville, Australia
| | - Pablo Villoslada
- Institut d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Barcelona, Spain; University of California at San Francisco, USA
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Clinical and Experimental, Multiple Sclerosis Research Center, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Petzold
- Moorfields Eye Hospital, City Road, London, UK; The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, Queen Square, London, UK; Neuro-ophthalmology Expertise Centre VUmc, Amsterdam, Netherlands
| | - Robert L Rennaker
- School of Biomedical Engineering, University of Texas at Dallas, Richardson, TX, USA; Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | | | - Laura J Balcer
- The Department of Neurology, Population Health, New York University School of Medicine, New York, NY, USA; The Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Randy Kardon
- Department of Ophthalmology, University of Iowa, USA; Center for Prevention and Treatment of Visual Loss, Iowa City, IA, USA
| | - Elliot M Frohman
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA; School of Biomedical Engineering, University of Texas at Dallas, Richardson, TX, USA; Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Teresa C Frohman
- Department of Neurology, Dell Medical School, University of Texas at Austin, TX, USA; School of Biomedical Engineering, University of Texas at Dallas, Richardson, TX, USA; Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA.
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Meltzer E, Sguigna PV, Subei A, Beh S, Kildebeck E, Conger D, Conger A, Lucero M, Frohman BS, Frohman AN, Saidha S, Galetta S, Calabresi PA, Rennaker R, Frohman TC, Kardon RH, Balcer LJ, Frohman EM. Retinal Architecture and Melanopsin-Mediated Pupillary Response Characteristics: A Putative Pathophysiologic Signature for the Retino-Hypothalamic Tract in Multiple Sclerosis. JAMA Neurol 2017; 74:574-582. [PMID: 28135360 PMCID: PMC5822208 DOI: 10.1001/jamaneurol.2016.5131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/21/2016] [Indexed: 12/19/2022]
Abstract
Importance A neurophysiologic signature of the melanopsin-mediated persistent constriction phase of the pupillary light reflex may represent a surrogate biomarker for the integrity of the retinohypothalamic tract, with potential utility for investigating alterations in homeostatic mechanisms associated with brain disorders and implications for identifying new treatments. Objective To characterize abnormalities of retinal architecture in patients with multiple sclerosis (MS) and corresponding alterations in the melanopsin-mediated sustained pupillary constriction response. Design, Setting, and Participants The case-control study was an experimental assessment of various stimulus-induced pupillary response characteristics and was conducted at a university clinical center for MS from September 6, 2012, to February 2015. Twenty-four patients with MS (48 eyes) and 15 individuals serving as controls (30 eyes) participated. The melanopsin-mediated, sustained pupillary constriction phase response following cessation of a blue light stimulus was compared with the photoreceptor-mediated pupillary constriction phase response following cessation of a red light stimulus. Optical coherence tomography was used to characterize the association between pupillary response characteristics and alterations in retinal architecture, specifically, the thickness of the retinal ganglion cell layer and inner plexiform layer (GCL + IPL). Main Outcomes and Measures Association of pupillary response characteristics with alterations in retinal architecture. Results Of 24 patients with MS included in the analysis, 17 were women (71%); mean (SD) age was 47 (11) years. Compared with eyes from individuals with MS who had normal optical coherence tomography-derived measures of retinal GCL + IPL thickness, eyes of patients who had GCL + IPL thickness reductions to less than the first percentile exhibited a correspondingly significant attenuation of the melanopsin-mediated sustained pupillary response (mean [SD] pupillary diameter ratios at a point in time, 0.18 [0.1] vs 0.33 [0.09]; P < .001, generalized estimating equation models accounting for age and within-patient intereye correlations). Conclusions and Relevance In this case-control study, attenuation of the melanopsin-mediated sustained pupillary constriction response was significantly associated with thinning of the GCL + IPL sector of the retina in the eyes of patients with MS, particularly those with a history of acute optic neuritis. Melanopsin-containing ganglion cells in the retina represent, at least in part, the composition of the retinohypothalamic tract. As such, our findings may signify the ability to elucidate a putative surrogate neurophysiologic signature that correlates with a constellation of homeostatic mechanisms in both health and illness.
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Affiliation(s)
- Ethan Meltzer
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Peter V. Sguigna
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Adnan Subei
- Department of Neurology, Michigan State University, East Lansing
| | - Shin Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Eric Kildebeck
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
- Center for Engineering Innovation, University of Texas at Dallas
| | - Darrel Conger
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Amy Conger
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Marlen Lucero
- Student, Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Benjamin S. Frohman
- Student, Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Ashley N. Frohman
- Student, Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Steven Galetta
- Department of Neurology, Population Health, New York University School of Medicine, New York
| | | | | | - Teresa C. Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
| | - Randy H. Kardon
- Department of Ophthalmology, University of Iowa, Iowa City
- Iowa City Veterans Affairs Center for Prevention and Treatment of Visual Loss, Iowa City
| | - Laura J. Balcer
- Department of Neurology, Population Health, New York University School of Medicine, New York
- Department of Ophthalmology, New York University School of Medicine, New York
| | - Elliot M. Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas
- Department of Bioengineering, University of Texas at Dallas
- Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas
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Fielding J, Clough M, Beh S, Millist L, Sears D, Frohman AN, Lizak N, Lim J, Kolbe S, Rennaker RL, Frohman TC, White OB, Frohman EM. Ocular motor signatures of cognitive dysfunction in multiple sclerosis. Nat Rev Neurol 2015; 11:637-45. [PMID: 26369516 DOI: 10.1038/nrneurol.2015.174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The anatomical and functional overlap between ocular motor command circuitry and the higher-order networks that form the scaffolding for cognition makes for a compelling hypothesis that measures of ocular motility could provide a means to sensitively interrogate cognitive dysfunction in people with multiple sclerosis (MS). Such an approach may ultimately provide objective and reproducible measures of cognitive dysfunction that offer an innovative capability to refine diagnosis, improve prognostication, and more accurately codify disease burden. A further dividend may be the validation and application of biomarkers that can be used in studies aimed at identifying and monitoring preventative, protective and even restorative properties of novel neurotherapeutics in MS. This Review discusses the utility of ocular motor measures in patients with MS to characterize disruption to wide-ranging networks that support cognitive function.
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Affiliation(s)
- Joanne Fielding
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia.,Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Parkville, VIC 3050, Australia
| | - Meaghan Clough
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Shin Beh
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Lynette Millist
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Parkville, VIC 3050, Australia
| | - Derek Sears
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Ashley N Frohman
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Nathaniel Lizak
- Monash School of Medicine, Monash University, Wellington Road, Clayton, VIC 3800, Australia
| | - Jayne Lim
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Parkville, VIC 3050, Australia
| | - Scott Kolbe
- Department of Anatomy and Neuroscience, Medical Building, University of Melbourne, Parkville, VIC 3010, Australia
| | - Robert L Rennaker
- Department of Bioengineering and Computer Science, University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, USA
| | - Teresa C Frohman
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Owen B White
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Parkville, VIC 3050, Australia
| | - Elliot M Frohman
- Departments of Neurology and Neurotherapeutics, University of Texas Southwestern School of Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.,Department of Bioengineering and Computer Science, University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, USA
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Frohman AN, Okuda DT, Beh S, Treadaway K, Mooi C, Davis SL, Shah A, Frohman TC, Frohman EM. Aquatic training in MS: neurotherapeutic impact upon quality of life. Ann Clin Transl Neurol 2015; 2:864-72. [PMID: 26339680 PMCID: PMC4554447 DOI: 10.1002/acn3.220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/12/2015] [Indexed: 11/26/2022] Open
Abstract
Three fundamental principals associated with aquatic therapy differentiate it with respect to exercise on land, and in air. These are buoyancy (reduction in weight of the body within the buoyant medium of water), viscosity (a “drag force” is generated when moving within water, when compared with the same movement in air), and the thermodynamic aspect of water exercise, during which the heat capacity of water is about 1000 times greater than that of an equivalent amount of air; equating to a heat transfer from the body into water at a rate 25 times faster than that of air. Aquatic conditioning, can improve neurologic functioning, with dividends favorably impacting activities of daily living, health maintenance, safety, and ultimately quality of life. Here, we review the application of aquatic exercise training in MS patients.
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Affiliation(s)
- Ashley N Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Shin Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas ; Multiple Sclerosis, Neuroimmunology, Neuro-Ophthalmology, Neuro-Otology Fellow, Collaborative MS Fellowship Training Program, UT Southwestern, Johns Hopkins Hospital Baltimore, Maryland and New York University NYU Langone Medical Center, New York
| | - Katherine Treadaway
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Caroline Mooi
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Scott L Davis
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas ; Department of Applied Physiology and Wellness, Southern Methodist University Dallas, Texas
| | - Anjali Shah
- Department of Physical Medicine Rehabilitation, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
| | - Teresa C Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas ; Department of Behavioral and Brain Sciences, University of Texas at Dallas Dallas, Texas ; Department of BioEngineering, University of Texas at Dallas Dallas, Texas
| | - Elliot M Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas Dallas, Texas ; Department of Behavioral and Brain Sciences, University of Texas at Dallas Dallas, Texas ; Department of BioEngineering, University of Texas at Dallas Dallas, Texas ; Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas Dallas, Texas
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