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Mandge V, Correa DJ, McGinley J, Boro A, Legatt AD, Haut SR. Factors associated with patients not proceeding with proposed resective epilepsy surgery. Seizure 2021; 91:402-408. [PMID: 34303161 DOI: 10.1016/j.seizure.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/15/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study evaluated the association between eligible patients not proceeding with resective epilepsy surgery and various demographic, disease-specific, and epilepsy-evaluation variables. METHODS This retrospective case-control study included patients identified as candidates for resective epilepsy surgery at the Montefiore Medical Center between January 1, 2009 and June 30, 2017. Chi-squared, two-tailed, independent sample t-test, Mann-Whitney U test and logistic regression were utilized to identify variables associated with patients not proceeding with surgery. RESULTS Among the 159 potential surgical candidates reviewed over the 8.5-year study period, only 53 ultimately proceeded with surgery (33%). Eighty-seven (55%) out of these 159 patients were identified as appropriate for resective epilepsy surgery during the study period. Thirty-four (39%) of these 87 patients did not proceed with surgery. Variables independently correlated (either positively or negatively) with the patient not proceeding with surgery were: being employed [Odds Ratio (OR) 4.2, 95% confidence interval (CI) 1.12-15.73], temporal lobe lesion on MRI (OR 0.35, 95% CI 0.14-0.84), temporal lobe EEG ictal onsets (OR 0.21, 95% CI 0.07-0.62), and temporal lobe epileptogenic zone (OR 0.19, 95% CI 0.07-0.55). CONCLUSION The novel finding in this study is the association between employment status and whether the patient had epilepsy surgery: employed patients were 4.2 times more likely to not proceed with surgery compared to unemployed patients. In addition, patients with a temporal lobe lesion on MRI, temporal lobe EEG ictal onsets, and/or a temporal epileptogenic zone were more likely to proceed with surgery. Future work will be needed to evaluate these findings prospectively, determine if they generalize to other patient populations, explore the decision whether or not to proceed with epilepsy surgery from a patient-centered perspective, and suggest strategies to reduce barriers to this underutilized treatment.
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Affiliation(s)
- Vishal Mandge
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, United States.
| | - Daniel José Correa
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - John McGinley
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Alexis Boro
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Alan D Legatt
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| | - Sheryl R Haut
- Saul Korey Department of Neurology, Comprehensive Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
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Gulcebi MI, Bartolini E, Lee O, Lisgaras CP, Onat F, Mifsud J, Striano P, Vezzani A, Hildebrand MS, Jimenez-Jimenez D, Junck L, Lewis-Smith D, Scheffer IE, Thijs RD, Zuberi SM, Blenkinsop S, Fowler HJ, Foley A, Sisodiya SM, Berkovic S, Cavalleri G, Correa DJ, Martins Custodio H, Galovic M, Guerrini R, Henshall D, Howard O, Hughes K, Katsarou A, Koeleman BP, Krause R, Lowenstein D, Mandelenaki D, Marini C, O'Brien TJ, Pace A, De Palma L, Perucca P, Pitkänen A, Quinn F, Selmer KK, Steward CA, Swanborough N, Thijs R, Tittensor P, Trivisano M, Weckhuysen S, Zara F. Climate change and epilepsy: Insights from clinical and basic science studies. Epilepsy Behav 2021; 116:107791. [PMID: 33578223 PMCID: PMC9386889 DOI: 10.1016/j.yebeh.2021.107791] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/24/2020] [Accepted: 01/03/2021] [Indexed: 12/23/2022]
Abstract
Climate change is with us. As professionals who place value on evidence-based practice, climate change is something we cannot ignore. The current pandemic of the novel coronavirus, SARS-CoV-2, has demonstrated how global crises can arise suddenly and have a significant impact on public health. Global warming, a chronic process punctuated by acute episodes of extreme weather events, is an insidious global health crisis needing at least as much attention. Many neurological diseases are complex chronic conditions influenced at many levels by changes in the environment. This review aimed to collate and evaluate reports from clinical and basic science about the relationship between climate change and epilepsy. The keywords climate change, seasonal variation, temperature, humidity, thermoregulation, biorhythm, gene, circadian rhythm, heat, and weather were used to search the published evidence. A number of climatic variables are associated with increased seizure frequency in people with epilepsy. Climate change-induced increase in seizure precipitants such as fevers, stress, and sleep deprivation (e.g. as a result of more frequent extreme weather events) or vector-borne infections may trigger or exacerbate seizures, lead to deterioration of seizure control, and affect neurological, cerebrovascular, or cardiovascular comorbidities and risk of sudden unexpected death in epilepsy. Risks are likely to be modified by many factors, ranging from individual genetic variation and temperature-dependent channel function, to housing quality and global supply chains. According to the results of the limited number of experimental studies with animal models of seizures or epilepsy, different seizure types appear to have distinct susceptibility to seasonal influences. Increased body temperature, whether in the context of fever or not, has a critical role in seizure threshold and seizure-related brain damage. Links between climate change and epilepsy are likely to be multifactorial, complex, and often indirect, which makes predictions difficult. We need more data on possible climate-driven altered risks for seizures, epilepsy, and epileptogenesis, to identify underlying mechanisms at systems, cellular, and molecular levels for better understanding of the impact of climate change on epilepsy. Further focussed data would help us to develop evidence for mitigation methods to do more to protect people with epilepsy from the effects of climate change.
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Affiliation(s)
- Medine I. Gulcebi
- Department of Medical Pharmacology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Via Suor Niccolina Infermiera 20, 59100 Prato, Italy.
| | - Omay Lee
- Department of Neurology and Clinical Neurophysiology, St. George's University Hospitals NHS Foundation Trust, London, UK.
| | - Christos Panagiotis Lisgaras
- New York University Langone Health, 100 First Ave., New York, NY 10016, USA; The Nathan S. Kline Institute for Psychiatric Research, Center for Dementia Research, 140 Old Orangeburg Rd., Orangeburg, NY 10962, USA.
| | - Filiz Onat
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey,Department of Medical Pharmacology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Janet Mifsud
- Department of Clinical Pharmacology and Therapeutics, University of Malta, Msida MSD2040, Malta.
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, DINOGMI-Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, IRCCS “Giannina Gaslini” Institute, Genova, Italy
| | - Annamaria Vezzani
- Laboratory of Experimental Neurology, Department of Neuroscience, IRCCS 'Mario Negri' Institute for Pharmacological Research, Milan, Italy.
| | - Michael S. Hildebrand
- Department of Medicine (Austin Health), University of Melbourne, and Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Diego Jimenez-Jimenez
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK and Chalfont Centre for Epilepsy, Bucks, UK.
| | - Larry Junck
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
| | - David Lewis-Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Ingrid E. Scheffer
- University of Melbourne, Austin Health and Royal Children’s Hospital, Florey Institute and Murdoch Children’s Research Institute, Melbourne, Australia
| | - Roland D. Thijs
- Department of Neurology, Leiden University Medical Centre (LUMC), PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Sameer M. Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children & Institute of Health & Wellbeing, University of Glasgow, Fraser of Allander Neurosciences Unit, Royal Hospital for Children, UK
| | | | - Hayley J. Fowler
- Centre for Earth Systems Engineering Research, School of Engineering, Newcastle University, UK
| | - Aideen Foley
- Department of Geography, Birkbeck College University of London, London, UK.
| | - Epilepsy Climate Change ConsortiumBalestriniSimonaaaBerkovicSamuelabCavalleriGianpieroacCorreaDaniel JoséadMartins CustodioHelenaaeGalovicMarianafGuerriniRenzoagHenshallDavidahHowardOlgaaiHughesKelvinajKatsarouAnnaakKoelemanBobby P.C.alKrauseRolandamLowensteinDanielanMandelenakiDespoinaaoMariniCarlaapO’BrienTerence J.aqPaceAdrianarDe PalmaLucaasPeruccaPieroatPitkänenAslaauQuinnFinolaavSelmerKaja KristineawStewardCharles A.axSwanboroughNicolaayThijsRolandazTittensorPhilbaTrivisanoMarinabbWeckhuysenSarahbcZaraFedericobdDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UKEpilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, AustraliaDepartment of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin 2, Ireland; The FutureNeuro Research Centre, Dublin 2, IrelandSaul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, 1410 Pelham Parkway South, K-312, Bronx, NY 10461, USADepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Bucks, UKUniversity Hospital Zurich, SwitzerlandDepartment of Child Neurology and Psychiatry, University of Pisa and IRCCS Fondazione Stella Maris, 56018 Calambrone, Pisa, ItalyFutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin D02 YN77, IrelandUCB Pharma Ltd, Slough, UKDravet Syndrome UK, UKLaboratory of Developmental Epilepsy, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USAUniversity Medical Center, Utrecht, The NetherlandsLuxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, LuxembourgDepartment of Neurology, University of California, San Francisco, CA, USADepartment of Pediatric Neurology, Queen Fabiola Children’s University Hospital, Brussels, Brussels Capital Region, BelgiumNeuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, ItalyMelbourne Brain Centre, Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, VIC, Australia; Departments of Neuroscience and Neurology, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, VIC, AustraliaGozo General Hospital, MaltaNeurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, ItalyDepartment of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, AustraliaA.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FIN-70211 Kuopio, FinlandILAE-IBE Congress Secretariat, Dublin, IrelandNational Centre for Rare Epilepsy-related Disorders, Oslo University Hospital, Oslo, Norway; Department of Medical Genetics, Oslo University Hospital, University of Oslo, Oslo, NorwayCongenica Ltd, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1DR, UK; Wellcome Sanger InstituteWellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UKEpilepsy Society, Bucks, UKStichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UKRoyal Wolverhampton NHS Trust, Wolverhampton, UKRare and Complex Epilepsy Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, ItalyNeurogenetics Group, Center for Molecular Neurology, VIB, University of Antwerp, Antwerp 2610, BelgiumUnit of Medical Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK and Chalfont Centre for Epilepsy, Bucks, UK,Corresponding author at: Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
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Rosengard JL, Donato J, Ferastraoaru V, Zhao D, Molinero I, Boro A, Gursky J, Correa DJ, Galanopoulou AS, Hung C, Legatt AD, Patel P, Rubens E, Moshé SL, Haut S. Seizure control, stress, and access to care during the COVID-19 pandemic in New York City: The patient perspective. Epilepsia 2020; 62:41-50. [PMID: 33258109 PMCID: PMC7753328 DOI: 10.1111/epi.16779] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/20/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
Objective Our epilepsy population recently experienced the acute effects of the COVID‐19 pandemic in New York City. Herein, we aimed to determine patient‐perceived seizure control during the surge, specific variables associated with worsened seizures, the prevalence of specific barriers to care, and patient‐perceived efficacy of epilepsy care delivered via telephone and live video visits during the pandemic. Methods We performed a cross‐sectional questionnaire study of adult epilepsy patients who had a scheduled appointment at a single urban Comprehensive Epilepsy Center (Montefiore Medical Center) between March 1, 2020 and May 31, 2020 during the peak of the COVID‐19 pandemic in the Bronx. Subjects able to answer the questionnaire themselves in English or Spanish were eligible to complete a one‐time survey via telephone or secure online platform (REDCap). Results Of 1212 subjects screened, 675 were eligible, and 177 adequately completed the questionnaire. During the COVID‐19 pandemic, 75.1% of patients reported no change in seizure control, whereas 17.5% reported that their seizure control had worsened, and 7.3% reported improvement. Subjects who reported worsened seizure control had more frequent seizures at baseline, were more likely to identify stress and headaches/migraines as their typical seizure precipitants, and were significantly more likely to report increased stress related to the pandemic. Subjects with confirmed or suspected COVID‐19 did not report worsened seizure control. Nearly 17% of subjects reported poorer epilepsy care, and 9.6% had difficulty obtaining their antiseizure medications; these subjects were significantly more likely to report worse seizure control. Significance Of the nearly 20% of subjects who reported worsened seizure control during the COVID‐19 pandemic, stress and barriers to care appear to have posed the greatest challenge. This unprecedented pandemic exacerbated existing and created new barriers to epilepsy care, which must be addressed.
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Affiliation(s)
- Jillian L Rosengard
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Jad Donato
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Victor Ferastraoaru
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Dan Zhao
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isaac Molinero
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Isabelle Rapin Division of Child Neurology, Bronx, NY, USA
| | - Alexis Boro
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Jonathan Gursky
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Daniel José Correa
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Aristea S Galanopoulou
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Dominick P. Purpura Department of Neuroscience, Bronx, NY, USA
| | - Christine Hung
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Alan D Legatt
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Puja Patel
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Isabelle Rapin Division of Child Neurology, Bronx, NY, USA
| | - Elayna Rubens
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA.,Isabelle Rapin Division of Child Neurology, Bronx, NY, USA.,Dominick P. Purpura Department of Neuroscience, Bronx, NY, USA.,Department of Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Sheryl Haut
- Saul R. Korey Department of Neurology and Comprehensive Einstein/Montefiore Epilepsy Center, Bronx, NY, USA
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4
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Affiliation(s)
- Juan Vazquez
- Albert Einstein College of Medicine, New York City, New York
| | - Tanzina Islam
- Department of Neuroscience, Princeton University, Princeton, New Jersey
| | - Jennifer Beller
- Department of Neurology, Montefiore Medical Center, New York City, New York
| | - Kevin Fiori
- Department of Family & Social Medicine, Albert Einstein College of Medicine, New York City, New York
| | - Ricardo Correa
- Department of Medicine, Phoenix VA Medical Center, College of Medicine, University of Arizona, Tucson, Arizona
| | - Daniel José Correa
- Department of Neurology
- Montefiore Medical Center
- New York City, New York
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York City, New York
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Correa DJ, Milano L, Kwon CS, Jetté N, Dlugos D, Harte-Hargrove L, Pugh MJ, Smith JK, Moshé SL. Quantitative readability analysis of websites providing information on traumatic brain injury and epilepsy: A need for clear communication. Epilepsia 2020; 61:528-538. [PMID: 32096225 DOI: 10.1111/epi.16446] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/21/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The use of the Internet for health-related questions is increasing, but it is not clear whether individuals can understand the information available online. Most health organizations recommend that health educational materials (HEMs) be written below the sixth grade reading level. This study was designed to evaluate the readability level of available online HEMs pertaining to traumatic brain injury (TBI), epilepsy, and posttraumatic epilepsy (PTE). METHODS This cross-sectional readability assessment included HEMs from TBI and epilepsy stakeholder organizations and those obtained from four Internet searches. The search strategy was designed to replicate a nonmedical individual's keyword searches. Each HEM was assessed with an online automated readability tool using three indices (Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Simple Measure of Gobbledygook). Findings were compared as a function of organization type (journalistic news or health organization), targeted medical condition (TBI, epilepsy, or PTE), or content topic (patient health education, clinical research education, or both). RESULTS Readability analysis of 405 identified HEMs revealed scores above the sixth grade reading level recommendation. Only 6.2% of individual HEMs met the sixth grade recommendation. Journalistic news organizations' HEMs had similar readability levels to health organizations' HEMs. PTE-related HEMs required the highest readability level, >11th grade (P < .001). There were significant differences in the readability scores (P < .01 for all indices) among HEMs with information on health education, research education, or both topics. The highest required readability level (>12 grade level) was for HEMs that included both health and research education. SIGNIFICANCE The majority of TBI-, epilepsy-, and PTE-related online HEMs do not meet the sixth grade reading recommendation. Improving the readability of HEMs may advance health literacy around TBI, epilepsy, and PTE, leading to more effective participant recruitment/retention strategies for future antiepileptogenesis trials in persons with TBI and perhaps better patient-centered outcomes.
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Affiliation(s)
- Daniel José Correa
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Lindsey Milano
- University of North Carolina Wilmington, Wilmington, North Carolina
| | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis Dlugos
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Mary Jo Pugh
- VA Salt Lake City Health Care System and the University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Solomon L Moshé
- Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, and Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
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