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Maidan I, Yam M, Glatt S, Nosatzki S, Goldstein L, Giladi N, Hausdorff JM, Mirelman A, Fahoum F. Abnormal gait and motor cortical processing in drug-resistant juvenile myoclonic epilepsy. Brain Behav 2023; 13:e2872. [PMID: 36602919 PMCID: PMC9927833 DOI: 10.1002/brb3.2872] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/12/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Juvenile myoclonic epilepsy (JME) is characterized by generalized seizures. Nearly 30% of JME patients are drug-resistant (DR-JME), indicating a widespread cortical dysfunction. Walking is an important function that necessitates orchestrated coordination of frontocentral cortical regions. However, gait alterations in JME have been scarcely investigated. Our aim was to assess changes in gait and motor-evoked responses in DR-JME patients. METHODS Twenty-nine subjects (11 JME drug-responder, 8 DR-JME, and 10 healthy controls) underwent a gait analyses during usual walking and dual-task walking. Later, subjects underwent 64-channel EEG recordings while performing a simple motor task. We calculated the motor-evoked current source densities (CSD) at a priori chosen cortical regions. Gait and CSD measures were compared between groups and tasks using mixed model analysis. RESULTS DR-JME patients demonstrated an altered gait pattern that included slower gait speed (p = .018), reduced cadence (p = .003), and smaller arm-swing amplitude (p = .011). The DR-JME group showed higher motor-evoked CSD in the postcentral gyri compared to responders (p = .049) and both JME groups showed higher CSD in the superior frontal gyri compared to healthy controls (p < .011). Moreover, higher CSD in the superior frontal gyri correlated with worse performance in dual-task walking (r > |-0.494|, p < .008). CONCLUSIONS These alterations in gait and motor-evoked responses in DRE-JME patients reflect a more severe dysfunction of motor-cognitive neural processing in frontocentral regions, leading to poorer gait performance. Further studies are needed to investigate the predictive value of altered gait and cortical motor processing as biomarkers for poor response to treatment in JME and other epilepsy syndromes.
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Affiliation(s)
- Inbal Maidan
- Brain Electrophysiology and Epilepsy Lab, Epilepsy Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Mor Yam
- Brain Electrophysiology and Epilepsy Lab, Epilepsy Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Glatt
- Brain Electrophysiology and Epilepsy Lab, Epilepsy Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Nosatzki
- Brain Electrophysiology and Epilepsy Lab, Epilepsy Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lilach Goldstein
- Brain Electrophysiology and Epilepsy Lab, Epilepsy Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Giladi
- Brain Electrophysiology and Epilepsy Lab, Epilepsy Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Sackler Faculty of Medicine, Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Firas Fahoum
- Brain Electrophysiology and Epilepsy Lab, Epilepsy Unit, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cerulli Irelli E, Cocchi E, Ramantani G, Riva A, Caraballo RH, Morano A, Giuliano L, Yilmaz T, Panagiotakaki E, Operto FF, Giraldez BG, Balestrini S, Silvennoinen K, Casciato S, Comajuan M, Fortunato F, Giallonardo AT, Gamirova R, Coppola A, Di Gennaro G, Labate A, Sofia V, Kluger GJ, Gambardella A, Kasteleijn-Nolst Trenite D, Baykan B, Sisodiya SM, Arzimanoglou A, Striano P, Di Bonaventura C. The spectrum of epilepsy with eyelid myoclonia: delineation of disease subtypes from a large multicenter study. Epilepsia 2022; 64:196-207. [PMID: 36307934 DOI: 10.1111/epi.17450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/12/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Epilepsy with eyelid myoclonia (EEM) has been associated with marked clinical heterogeneity. Early epilepsy onset has been recently linked to lower chances of achieving sustained remission and to a less favorable neuropsychiatric outcome. However, much work is still needed to better delineate this epilepsy syndrome. METHODS In this multicenter retrospective cohort study, we included 267 EEM patients from 9 countries. Data about electroclinical and demographic features, intellectual functioning, migraine with or without aura, family history of epilepsy and epilepsy syndromes in relatives were collected in each patient. The impact of age at epilepsy onset (AEO) on EEM clinical features was investigated, along with the distinctive clinical characteristics of patients showing sporadic myoclonia over body regions other than eyelids (body-MYO). RESULTS Kernel density estimation revealed a trimodal distribution of AEO and Fisher-Jenks optimization disclosed three EEM subgroups: early-onset (EO-EEM), intermediate-onset (IO-EEM) and late-onset subgroup (LO-EEM). EO-EEM was associated with the highest rate of intellectual disability, antiseizure medication refractoriness and psychiatric comorbidities and with the lowest rate of family history of epilepsy. LO-EEM was associated with the highest proportion of body-MYO and generalized tonic-clonic seizures (GTCS), whereas IO-EEM had the lowest observed rate of additional findings. A family history of EEM was significantly more frequent in IO-EEM and LO-EEM compared with EO-EEM. In the subset of patients with body-MYO (58/267), we observed a significantly higher rate of migraine and GTCS but no relevant differences in other electroclinical features and seizure outcome. SIGNIFICANCE Based on AEO, we identified consistent EEM subtypes characterized by distinct electroclinical and familial features. Our observations shed new light on the spectrum of clinical features of this generalized epilepsy syndrome and may help clinicians towards a more accurate classification and prognostic profiling of EEM patients.
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Affiliation(s)
| | - Enrico Cocchi
- Department of Precision Medicine and Genomics, Department of Medicine, Columbia University, New York
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Antonella Riva
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Roberto H Caraballo
- Department of Neurology, Hospital de Pediatría "Prof. Dr. Juan P Garrahan", Buenos Aires, Argentina
| | - Alessandra Morano
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Tülay Yilmaz
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Eleni Panagiotakaki
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | - Francesca F Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Beatriz Gonzalez Giraldez
- Epilepsy Unit, Neurology Service, Hospital Universitario and IIS Fundación Jiménez Díaz and CIBERER, Madrid, Spain
| | - Simona Balestrini
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK; Neuroscience Department, Meyer Children's Hospital-University of Florence, Member of the ERN EpiCARE, Florence, Italy
| | - Katri Silvennoinen
- Department of Clinical and Experimental Epilepsy, Partner of the ERN EpiCARE, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK
| | | | - Marion Comajuan
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | | | - Anna T Giallonardo
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
| | | | - Antonietta Coppola
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Italy
| | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Gerhard J Kluger
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Clinic Vogtareuth, Vogtareuth, Germany; PMU, Salzburg, Salzburg, Austria
| | | | - Dorothee Kasteleijn-Nolst Trenite
- Department of Neurosurgery and Epilepsy, University Medical Center, Member of the ERN EpiCARE, Utrecht University, Utrecht, The Netherlands; Nesmos Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Betul Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, Partner of the ERN EpiCARE, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UK
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Member of the ERN EpiCARE, Genoa, Italy; Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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Hatano K, Fujimoto A, Sato K, Yamamoto T, Enoki H. Omitting Hyperventilation in Electroencephalogram during the COVID-19 Pandemic May Reduce Interictal Epileptiform Discharges in Patients with Juvenile Myoclonic Epilepsy. Brain Sci 2022; 12:769. [PMID: 35741654 DOI: 10.3390/brainsci12060769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To prevent the spread of coronavirus disease 2019 (COVID-19), hyperventilation (HV) activation has been avoided in electroencephalograms (EEGs) since April 2020. The influence of omitting HV in EEG on epilepsy diagnosis remains uncertain for patients with epilepsies other than child absence epilepsy. We hypothesized that EEGs with HV would show more interictal epileptiform discharges (IEDs) than EEGs without HV in patients with juvenile myoclonic epilepsy (JME). METHODS We reviewed the EEGs of seizure-free patients with JME who underwent EEG, both with and without HV, from January 2019 to October 2021, in our institution, and compared IEDs between EEG with and without HV. RESULTS This study analyzed 23 JME patients. The IED-positive rate was significantly higher in EEG with HV (65.2%) than in EEG without HV (34.8%, p = 0.016). The mean ± standard deviation number of IEDs per minute was significantly larger during HV (1.61 ± 2.25 × 10-1) than during non-activation of both first EEG (0.57 ± 0.93 × 10-1, p = 0.039) and second EEG (0.39 ± 0.76 × 10-1, p = 0.009). CONCLUSIONS In JME patients, performing HV during EEG may increase IEDs and appears to facilitate the accurate diagnosis of epilepsy.
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Rainer LJ, Kronbichler M, Kuchukhidze G, Trinka E, Langthaler PB, Kronbichler L, Said-Yuerekli S, Kirschner M, Zimmermann G, Höfler J, Schmid E, Braun M. Emotional Word Processing in Patients With Juvenile Myoclonic Epilepsy. Front Neurol 2022; 13:875950. [PMID: 35720080 PMCID: PMC9201996 DOI: 10.3389/fneur.2022.875950] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Objective According to Panksepp's hierarchical emotion model, emotion processing relies on three functionally and neuroanatomically distinct levels. These levels comprise subcortical networks (primary level), the limbic system (secondary level), and the neocortex (tertiary level) and are suggested to serve differential emotional processing. We aimed to validate and extend previous evidence of discrete and dimensional emotion processing in patient with juvenile myoclonic epilepsy (JME). Methods We recorded brain activity of patients with JME and healthy controls in response to lexical decisions to words reflecting the discrete emotion fear and the affective dimension negativity previously suggested to rely on different brain regions and to reflect different levels of processing. In all study participants, we tested verbal cognitive functions, as well as the relationship of psychiatric conditions, seizure types and duration of epilepsy and emotional word processing. Results In support of the hierarchical emotion model, we found an interaction of discrete emotion and affective dimensional processing in the right amygdala likely to reflect secondary level processing. Brain activity related to affective dimensional processing was found in the right inferior frontal gyrus and is suggested to reflect tertiary level processing. Psychiatric conditions, type of seizure nor mono- vs. polytherapy and duration of epilepsy within patients did not have any effect on the processing of emotional words. In addition, no differences in brain activity or response times between patients and controls were observed, despite neuropsychological testing revealed slightly decreased verbal intelligence, verbal fluency and reading speed in patients with JME. Significance These results were interpreted to be in line with the hierarchical emotion model and to highlight the amygdala's role in processing biologically relevant stimuli, as well as to suggest a semantic foundation of affective dimensional processing in prefrontal cortex. A lack of differences in brain activity of patients with JME and healthy controls in response to the emotional content of words could point to unaffected implicit emotion processing in patients with JME.
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Affiliation(s)
- Lucas Johannes Rainer
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Martin Kronbichler
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
| | - Giorgi Kuchukhidze
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT–University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Karl-Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Patrick Benjamin Langthaler
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Department of Mathematics, Paris-Lodron University, Naturwissenschaftliche Fakultaet, Salzburg, Austria
| | - Lisa Kronbichler
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Department of Psychiatry, Psychotherapy & Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Sarah Said-Yuerekli
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
| | - Margarita Kirschner
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Georg Zimmermann
- Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
- Research and Innovation Management, Paracelsus Medical University, Salzburg, Austria
| | - Julia Höfler
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Elisabeth Schmid
- Department of Neurology, Christian-Doppler Medical Centre, Paracelsus Medical University, Centre for Cognitive Neuroscience Salzburg, Member of the European Reference Network, Epicare, Salzburg, Austria
| | - Mario Braun
- Department of Psychology, Naturwissenschaftliche Fakultaet, Centre for Cognitive Neuroscience, Paris-Lodron University, Salzburg, Austria
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Al-Otaibi F. Safety and Efficacy of Clonazepam in the Treatment of Juvenile Myoclonic Epilepsy: A Meta-Analysis. J Pharm Bioallied Sci 2022; 14:126-131. [PMID: 36506728 PMCID: PMC9728065 DOI: 10.4103/jpbs.jpbs_298_22] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 12/15/2022] Open
Abstract
Background Juvenile myoclonic epilepsy (JME) is referred to as one of the most common epileptic syndromes. Several anti-epilepsy drugs (AEDs) have been developed and remain part of clinical intervention with varying safety and efficacy profiles. Comprehensive synthesis of the scientific evidence examining the safety and efficacy of clonazepam toward the treatment of JME was carried out in the study. Methods A detailed scientific literature search was made utilizing the most relevant scientific studies published to date on the intervention of clonazepam in the management of JME. In this study, a detailed search was made in multiple databases, including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scielo databases. Confidence intervals among the studies and continuous measures, proportion, and risk factor analysis were determined using the MedCalC tool (Version 20.110) as per PRISMA guidelines. Results A total of 6 studies out of 70 were found eligible for meta-analysis, where 186 JME patients were subjected to clonazepam intervention with controls. Clonazepam was reported effective in comparative analysis among six studies where P < 0.001. The result also shows a higher prevalence of JME in the female population compared to males (male versus female; 86/110). Efficacy and safety of clonazepam were reported significant as well. Conclusion Clonazepam is effective AEDs for the management of JME. However, more clinical evidence requires for statistical validation of clinical efficacy.
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Affiliation(s)
- Faisal Al-Otaibi
- Department of Pharmacy Practice, College of Pharmacy, Shaqra University, Al-Dawadmi, Saudi Arabia,Address for correspondence: Dr. Faisal Al-Otaibi, Department of Pharmacy Practice, College of Pharmacy, Shaqra University, Al-Dawadmi, P. O. BOX 33, Saudi Arabia. E-mail:
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