{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:45:43Z","timestamp":1789865143839,"version":"4.0.1"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T00:00:00Z","timestamp":1735171200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T00:00:00Z","timestamp":1735171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurol Sci"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>The effect of felbamate (FBM) on genetic generalized epilepsy (GGE) remains largely unknown. The utilization of FBM has been limited due to its potential risk of aplastic anemia and hepatic failure. This study aimed to comprehensively evaluate the efficacy and safety of FBM in the treatment of drug-resistant GGE.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We searched the databases, including PubMed, Web of Science, Embase, and Google Scholar, to identify cases of GGE treated with FBM. Data on outcomes and adverse events were extracted from these studies.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The literature search yielded 9 studies with 166 cases in which FBM was used as an adjunct therapy to treat drug-resistant GGE. The pooled responder rate to FBM was 65% (95% confidence interval CI, 51\u201380). 17% (95% CI, 3\u201331) achieved seizure freedom. 81% (95% CI, 60\u2013100) of patients with Epilepsy with myoclonic atonic seizures were responders. Adverse events were reported in 40% (95% CI, 26\u201354) of patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Patients with drug-resistant GGE achieved good responses to FBM. The high heterogeneity between studies calls for further research with large-scale, randomized controlled trials. Given the rare reports of idiosyncratic reactions of aplastic anemia and hepatic failure, intense laboratory monitoring and a slower titration schedule are recommended.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10072-024-07942-6","type":"journal-article","created":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T06:39:05Z","timestamp":1735195145000},"page":"1565-1572","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Felbamate as a therapeutic alternative to drug-resistant genetic generalized epilepsy: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3289-9960","authenticated-orcid":false,"given":"Yitao","family":"Ma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Kaminski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Crutcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,12,26]]},"reference":[{"key":"7942_CR1","doi-asserted-by":"publisher","unstructured":"Scheffer IE et al (2017) ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 58(4):512\u2013521. https:\/\/doi.org\/10.1111\/epi.13709","DOI":"10.1111\/epi.13709"},{"key":"7942_CR2","doi-asserted-by":"publisher","unstructured":"Marini C et al (2004) Genetic architecture of idiopathic generalized epilepsy: clinical genetic analysis of 55 multiplex families. Epilepsia 45(5):467\u2013\u200978. https:\/\/doi.org\/10.1111\/j.0013-9580.2004.46803.x","DOI":"10.1111\/j.0013-9580.2004.46803.x"},{"key":"7942_CR3","doi-asserted-by":"publisher","unstructured":"Loiseau J, Loiseau P, Guyot M, Duche B, Dartigues JF, Aublet B (1990) Survey of seizure disorders in the French southwest. I. Incidence of epileptic syndromes. Epilepsia 31(4):391-6. https:\/\/doi.org\/10.1111\/j.1528-1157.1990.tb05493.x","DOI":"10.1111\/j.1528-1157.1990.tb05493.x"},{"key":"7942_CR4","doi-asserted-by":"publisher","unstructured":"Hirsch E et al (2022) ILAE definition of the Idiopathic Generalized Epilepsy Syndromes: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia 63(6):1475\u20131499. https:\/\/doi.org\/10.1111\/epi.17236","DOI":"10.1111\/epi.17236"},{"issue":"Suppl 9","key":"7942_CR5","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1111\/j.1528-1167.2005.00309.x","volume":"46","author":"P Jallon","year":"2005","unstructured":"Jallon P, Latour P (2005) Epidemiology of idiopathic generalized epilepsies. Epilepsia 46(Suppl 9):10\u201314. https:\/\/doi.org\/10.1111\/j.1528-1167.2005.00309.x","journal-title":"Epilepsia"},{"key":"7942_CR6","doi-asserted-by":"publisher","unstructured":"Mohanraj R, Brodie MJ (2007) Outcomes of newly diagnosed idiopathic generalized epilepsy syndromes in a non-pediatric setting. Acta Neurol Scand 115(3):204\u2013208. https:\/\/doi.org\/10.1111\/j.1600-0404.2006.00791.x","DOI":"10.1111\/j.1600-0404.2006.00791.x"},{"key":"7942_CR7","doi-asserted-by":"publisher","unstructured":"Jiang T, Zhang X, Zhang M, Liu M, Zhu H, Sun Y (2023) Drug-resistant idiopathic generalized epilepsy: A meta-analysis of prevalence and risk factors. Epilepsy Behav 146:109364. https:\/\/doi.org\/10.1016\/j.yebeh.2023.109364","DOI":"10.1016\/j.yebeh.2023.109364"},{"key":"7942_CR8","doi-asserted-by":"publisher","unstructured":"Gomez-Ibanez A, McLachlan RS, Mirsattari SM, Diosy DC, Burneo JG (Feb 2017) Prognostic factors in patients with refractory idiopathic generalized epilepsy. Epilepsy Res 130:69\u201373. https:\/\/doi.org\/10.1016\/j.eplepsyres.2017.01.011","DOI":"10.1016\/j.eplepsyres.2017.01.011"},{"key":"7942_CR9","doi-asserted-by":"publisher","unstructured":"Cacao G, Parra J, Mannan S, Sisodiya SM, Sander JW (May 2018) Juvenile myoclonic epilepsy refractory to treatment in a tertiary referral center. Epilepsy Behav 82:81\u201386. https:\/\/doi.org\/10.1016\/j.yebeh.2018.03.002","DOI":"10.1016\/j.yebeh.2018.03.002"},{"key":"7942_CR10","doi-asserted-by":"publisher","unstructured":"Carter EG, Armour EA, Pagano LM, Reddy SB (2022) Epilepsy with myoclonic absences: a case series highlighting clinical heterogeneity and surgical management. Epileptic Disord 24(3):541\u2013547. https:\/\/doi.org\/10.1684\/epd.2022.1420","DOI":"10.1684\/epd.2022.1420"},{"key":"7942_CR11","doi-asserted-by":"publisher","unstructured":"Videira G, Raimundo R, Chorao R (2023) Epilepsy with myoclonic absences: A case series. Seizure 106:162\u2013163. https:\/\/doi.org\/10.1016\/j.seizure.2023.02.017","DOI":"10.1016\/j.seizure.2023.02.017"},{"issue":"11","key":"7942_CR12","doi-asserted-by":"publisher","first-page":"911","DOI":"10.2165\/00023210-200620110-00004","volume":"20","author":"P Genton","year":"2006","unstructured":"Genton P, Bureau M (2006) Epilepsy with myoclonic absences. CNS Drugs 20(11):911\u2013916. https:\/\/doi.org\/10.2165\/00023210-200620110-00004","journal-title":"CNS Drugs"},{"key":"7942_CR13","doi-asserted-by":"publisher","first-page":"S66","DOI":"10.1111\/j.1528-1157.1995.tb06000.x","volume":"36 Suppl 2","author":"IE Leppik","year":"1995","unstructured":"Leppik IE (1995) Felbamate. Epilepsia 36 Suppl 2:S66\u201372. https:\/\/doi.org\/10.1111\/j.1528-1157.1995.tb06000.x","journal-title":"Epilepsia"},{"key":"7942_CR14","unstructured":"Leroy CT (1991) RF, Pilot study of FBM in adult medically refractory primary generalized seizure patients. Epilepsia 32:13"},{"key":"7942_CR15","unstructured":"Sachdeo R (1992) Felbamate in juvenile myoclonic epilepsy. Epilepsia 33(3):118"},{"key":"7942_CR16","doi-asserted-by":"publisher","unstructured":"French J, Smith M, Faught E, Brown L (1999) Practice advisory: The use of felbamate in the treatment of patients with intractable epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 52(8):1540-5. https:\/\/doi.org\/10.1212\/wnl.52.8.1540","DOI":"10.1212\/wnl.52.8.1540"},{"key":"7942_CR17","doi-asserted-by":"publisher","unstructured":"Shah YD, Singh K, Friedman D, Devinsky O, Kothare SV (2016) Evaluating the safety and efficacy of felbamate in the context of a black box warning: A single center experience. Epilepsy Behav 56:50\u2013\u20093. https:\/\/doi.org\/10.1016\/j.yebeh.2016.01.006","DOI":"10.1016\/j.yebeh.2016.01.006"},{"key":"7942_CR18","doi-asserted-by":"publisher","unstructured":"Cilio MR, Kartashov AI, Vigevano F (Nov 2001) The long-term use of felbamate in children with severe refractory epilepsy. Epilepsy Res 47:1\u20132. https:\/\/doi.org\/10.1016\/s0920-1211(01)00290-x","DOI":"10.1016\/s0920-1211(01)00290-x"},{"key":"7942_CR19","doi-asserted-by":"publisher","unstructured":"Reed L et al (Mar 2024) Efficacy of felbamate in a cohort of patients with epilepsy with myoclonic atonic seizures (EMAtS). Epilepsy Res 201:107314. https:\/\/doi.org\/10.1016\/j.eplepsyres.2024.107314","DOI":"10.1016\/j.eplepsyres.2024.107314"},{"key":"7942_CR20","doi-asserted-by":"publisher","first-page":"979725","DOI":"10.3389\/fneur.2022.979725","volume":"13","author":"S Rabinowicz","year":"2022","unstructured":"Rabinowicz S et al (2022) Felbamate for pediatric epilepsy-should we keep on using it as the last resort? Front Neurol 13:979725. https:\/\/doi.org\/10.3389\/fneur.2022.979725","journal-title":"Front Neurol"},{"key":"7942_CR21","doi-asserted-by":"publisher","unstructured":"Page MJ et al (2021) PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 372:n160. https:\/\/doi.org\/10.1136\/bmj.n160","DOI":"10.1136\/bmj.n160"},{"key":"7942_CR22","doi-asserted-by":"publisher","unstructured":"Deeks JJ et al (2003) Evaluating non-randomised intervention studies. Health Technol Assess 7(27):iii-x, 1-173. https:\/\/doi.org\/10.3310\/hta7270","DOI":"10.3310\/hta7270"},{"key":"7942_CR23","doi-asserted-by":"publisher","unstructured":"Guyatt G et al (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64(4):383\u2013\u200994. https:\/\/doi.org\/10.1016\/j.jclinepi.2010.04.026","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"7942_CR24","doi-asserted-by":"publisher","unstructured":"Zupanc ML et al (2010) Efficacy of felbamate in the treatment of intractable pediatric epilepsy. Pediatr Neurol 42(6):396\u2013403. https:\/\/doi.org\/10.1016\/j.pediatrneurol.2010.02.013","DOI":"10.1016\/j.pediatrneurol.2010.02.013"},{"key":"7942_CR25","doi-asserted-by":"publisher","unstructured":"Heyman E, Levin N, Lahat E, Epstein O, Gandelman-Marton R (2014) Efficacy and safety of felbamate in children with refractory epilepsy. Eur J Paediatr Neurol 18(6):658\u2013\u200962. https:\/\/doi.org\/10.1016\/j.ejpn.2014.05.005","DOI":"10.1016\/j.ejpn.2014.05.005"},{"key":"7942_CR26","doi-asserted-by":"publisher","unstructured":"Grosso S et al (Sep 2008) Efficacy and safety of felbamate in children under 4 years of age: a retrospective chart review. Eur J Neurol 15(9):940\u2013946. https:\/\/doi.org\/10.1111\/j.1468-1331.2008.02215.x","DOI":"10.1111\/j.1468-1331.2008.02215.x"},{"key":"7942_CR27","doi-asserted-by":"publisher","unstructured":"Avanzini G, Canger R, Dalla Bernardina B, Vigevano F (1996) Felbamate in therapy-resistant epilepsy: an Italian experience. Felbamate Italian Study Group. Epilepsy Res 25(3):249\u2013\u200955. https:\/\/doi.org\/10.1016\/s0920-1211(96)00070-8","DOI":"10.1016\/s0920-1211(96)00070-8"},{"issue":"3","key":"7942_CR28","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0896-6974(94)90028-0","volume":"7","author":"O Devinsky","year":"1994","unstructured":"Devinsky O, Kothari M, Savino L, Luciano D (1994) Felbamate for refractory absence seizures. J Epilepsy 7(3):189\u2013194","journal-title":"J Epilepsy"},{"issue":"10","key":"7942_CR29","first-page":"326","volume":"102","author":"H Kearney","year":"2009","unstructured":"Kearney H, Delanty N (2009) Felbamate in an Adult Population with Severe Refractory Epilepsy. Ir Med J 102(10):326","journal-title":"Ir Med J"},{"key":"7942_CR30","doi-asserted-by":"publisher","unstructured":"Rho JM, Donevan SD, Rogawski MA (1994) Mechanism of action of the anticonvulsant felbamate: opposing effects on N-methyl-D-aspartate and gamma-aminobutyric acidA receptors. Ann Neurol 35(2):229\u2013\u200934. https:\/\/doi.org\/10.1002\/ana.410350216","DOI":"10.1002\/ana.410350216"},{"key":"7942_CR31","doi-asserted-by":"crossref","unstructured":"Taglialatela M, Ongini E, Brown AM, Di Renzo G, Annunziato L (1996) Felbamate inhibits cloned voltage-dependent Na\u2009+\u2009channels from human and rat brain. Eur J Pharmacol 316(2\u20133):373\u2013377. [Online]. Available: https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0014299996008023?via%3Dihub","DOI":"10.1016\/S0014-2999(96)00802-3"},{"key":"7942_CR32","doi-asserted-by":"crossref","unstructured":"Stefani A, Calabresi P, Pisani A, Mercuri NB, Siniscalchi A, Bernardi G (1996) Felbamate inhibits dihydropyridine-sensitive calcium channels in central neurons. J Pharmacol Exp Ther 277(1):121\u2013127. [Online]. Available: https:\/\/jpet.aspetjournals.org\/content\/277\/1\/121.long","DOI":"10.1016\/S0022-3565(25)12797-3"},{"key":"7942_CR33","first-page":"117","volume-title":"New anticonvulsant drugs","author":"WI Perhach","year":"1986","unstructured":"Perhach WI, Newton JL, Sofia JJ, Romanyshyn RD, Arndt WM Jr. (1986) Felbamate. In: Meldrum PR BS (ed) New anticonvulsant drugs. John Libbey, London\/Paris, pp 117\u2013123"},{"key":"7942_CR34","doi-asserted-by":"publisher","unstructured":"Ticku MK, Kamatchi GL, Sofia RD (1991) Effect of anticonvulsant felbamate on GABAA receptor system. Epilepsia 32(3):389\u2013\u200991. https:\/\/doi.org\/10.1111\/j.1528-1157.1991.tb04667.x","DOI":"10.1111\/j.1528-1157.1991.tb04667.x"},{"key":"7942_CR35","doi-asserted-by":"publisher","unstructured":"Sankar R, Holmes GL (Aug 2004) Mechanisms of action for the commonly used antiepileptic drugs: relevance to antiepileptic drug-associated neurobehavioral adverse effects. J Child Neurol 19(1):S6\u201314. https:\/\/doi.org\/10.1177\/088307380401900102","DOI":"10.1177\/088307380401900102"},{"key":"7942_CR36","doi-asserted-by":"publisher","unstructured":"Ketter TA et al (1996) Felbamate monotherapy has stimulant-like effects in patients with epilepsy. Epilepsy Res 23(2):129\u2013\u200937. https:\/\/doi.org\/10.1016\/0920-1211(95)00089-5","DOI":"10.1016\/0920-1211(95)00089-5"},{"key":"7942_CR37","doi-asserted-by":"publisher","unstructured":"Liu L et al (Nov 2006) The mechanism of carbamazepine aggravation of absence seizures. J Pharmacol Exp Ther 319(2):790\u2013798. https:\/\/doi.org\/10.1124\/jpet.106.104968","DOI":"10.1124\/jpet.106.104968"},{"key":"7942_CR38","doi-asserted-by":"publisher","unstructured":"Cocito L, Primavera A (1998) Vigabatrin aggravates absences and absence status. Neurology 51(5):1519-20. https:\/\/doi.org\/10.1212\/wnl.51.5.1519","DOI":"10.1212\/wnl.51.5.1519"},{"key":"7942_CR39","doi-asserted-by":"publisher","unstructured":"Wallace SJ (1998) Myoclonus and epilepsy in childhood: a review of treatment with valproate, ethosuximide, lamotrigine and zonisamide. Epilepsy Res 29(2):147\u2013\u200954. https:\/\/doi.org\/10.1016\/s0920-1211(97)00080-6","DOI":"10.1016\/s0920-1211(97)00080-6"},{"key":"7942_CR40","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.ebcr.2016.09.006","volume":"7","author":"D Birnbaum","year":"2017","unstructured":"Birnbaum D, Koubeissi M (2017) Unmasking of myoclonus by lacosamide in generalized epilepsy. Epilepsy Behav Case Rep 7:28\u201330. https:\/\/doi.org\/10.1016\/j.ebcr.2016.09.006","journal-title":"Epilepsy Behav Case Rep"},{"key":"7942_CR41","doi-asserted-by":"publisher","unstructured":"Healy DG, Ingle GT, Brown P (2009) Pregabalin- and gabapentin-associated myoclonus in a patient with chronic renal failure. Mov Disord 24(13):2028-9. https:\/\/doi.org\/10.1002\/mds.22286","DOI":"10.1002\/mds.22286"},{"issue":"6","key":"7942_CR42","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1097\/MJT.0b013e3182053ef2","volume":"19","author":"KH Chaudrey","year":"2012","unstructured":"Chaudrey KH et al (2012) Thinking beyond the obvious: hepatotoxicity secondary to idiosyncratic depakote toxicity. Am J Ther 19(6):403\u2013406","journal-title":"Am J Ther"},{"key":"7942_CR43","doi-asserted-by":"crossref","unstructured":"Bromfield E, Dworetzky B, Wyszynski D, Smith C, Baldwin E, Holmes L (2008) Valproate teratogenicity and epilepsy syndrome. Epilepsia 49(12):2122\u20132124","DOI":"10.1111\/j.1528-1167.2008.01696.x"},{"key":"7942_CR44","doi-asserted-by":"crossref","unstructured":"Pellock JM, Wilder B, Deaton R, Sommerville KW (2002) Acute pancreatitis coincident with valproate use: a critical review. Epilepsia 43(11):1421\u20131424","DOI":"10.1046\/j.1528-1157.2002.18502.x"},{"key":"7942_CR45","doi-asserted-by":"publisher","first-page":"107939","DOI":"10.1016\/j.yebeh.2021.107939","volume":"118","author":"BJ Steinhoff","year":"2021","unstructured":"Steinhoff BJ et al (2021) Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: a systematic review. Epilepsy Behav 118:107939","journal-title":"Epilepsy Behav"}],"updated-by":[{"DOI":"10.1007\/s10072-025-08229-0","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T00:00:00Z","timestamp":1746835200000}}],"container-title":["Neurological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10072-024-07942-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10072-024-07942-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10072-024-07942-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,10]],"date-time":"2025-05-10T13:02:38Z","timestamp":1746882158000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10072-024-07942-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,26]]},"references-count":45,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["7942"],"URL":"https:\/\/doi.org\/10.1007\/s10072-024-07942-6","relation":{},"ISSN":["1590-1874","1590-3478"],"issn-type":[{"value":"1590-1874","type":"print"},{"value":"1590-3478","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,26]]},"assertion":[{"value":"1 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 December 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 December 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 May 2025","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1007\/s10072-025-08229-0","URL":"https:\/\/doi.org\/10.1007\/s10072-025-08229-0","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors declare no competing interests. We confirmed that we have read the Journals\u2019 position on issues involved in ethical publications and affirm that this report is consistent with those guidelines.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The views expressed in the article are those of the authors and do not reflect the official policy of the Department of Army\/Navy\/Air Force, Department of health agency or the US government.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}]}}