{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:47:10Z","timestamp":1792176430121,"version":"4.4.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T00:00:00Z","timestamp":1627084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T00:00:00Z","timestamp":1627084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Alberta Hospital Foundation Sankar Research Establishment Grant"},{"name":"Edmonton Civic Employees Charitable Assistance Fund"},{"name":"Charles H. Backman Fund"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Medically-refractory trigeminal neuralgia (TN) can be treated successfully with operative intervention, but a significant proportion of patients are non-responders despite undergoing technically successful surgery. The thalamus is a key component of the trigeminal sensory pathway involved in transmitting facial pain, but the role of the thalamus in TN, and its influence on durability of pain relief after TN surgery, are relatively understudied. We aimed to test the hypothesis that variations in thalamic structure and metabolism are related to surgical non-response in TN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a longitudinal, peri-operative neuroimaging study of the thalamus in medically-refractory TN patients undergoing microvascular decompression or percutaneous balloon compression rhizotomy. Patients underwent structural MRI and MR spectroscopy scans pre-operatively and at 1-week following surgery, and were classified as responders or non-responders based on 1-year post-operative pain outcome. Thalamus volume, shape, and metabolite concentration (choline\/creatine [Cho\/Cr] and N-acetylaspartate\/creatine [NAA\/Cr]) were evaluated at baseline and 1-week, and compared between responders, non-responders, and healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty healthy controls and 23 patients with medically-refractory TN treated surgically (17 responders, 6 non-responders) were included. Pre-operatively, TN patients as a group showed significantly larger thalamus volume contralateral to the side of facial pain. However, vertex-wise shape analysis showed significant contralateral thalamus volume reduction in non-responders compared to responders in an axially-oriented band spanning the outer thalamic circumference (peak p\u2009=\u20090.019). Further, while pre-operative thalamic metabolite concentrations did not differ between responders and non-responders, as early as 1-week after surgery, long-term non-responders showed a distinct decrease in contralateral thalamic Cho\/Cr and NAA\/Cr, irrespective of surgery type, which was not observed in responders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Atrophy of the contralateral thalamus is a consistent feature across patients with medically-refractory TN. Regional alterations in preoperative thalamic structure, and very early post-operative metabolic changes in the thalamus, both appear to influence the durability of pain relief after TN surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12883-021-02323-4","type":"journal-article","created":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T01:03:01Z","timestamp":1627088581000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["The thalamus in trigeminal neuralgia: structural and metabolic abnormalities, and influence on surgical response"],"prefix":"10.1186","volume":"21","author":[{"given":"Hayden","family":"Danyluk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Andrews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Kesarwani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Seres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Broad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. Matt","family":"Wheatley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tejas","family":"Sankar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,24]]},"reference":[{"key":"2323_CR1","doi-asserted-by":"publisher","unstructured":"Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1\u2013211. https:\/\/doi.org\/10.1177\/0333102417738202.","DOI":"10.1177\/0333102417738202"},{"key":"2323_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/14651858.CD007312","volume":"9","author":"JM Zakrzewska","year":"2011","unstructured":"Zakrzewska JM, Akram H. Neurosurgical interventions for the treatment of classical trigeminal neuralgia. Cochrane Database Syst Rev. 2011;9:1\u201346. https:\/\/doi.org\/10.1002\/14651858.CD007312.","journal-title":"Cochrane Database Syst Rev"},{"key":"2323_CR3","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3171\/jns.1988.69.1.0035","volume":"69","author":"KIMJ Burchiel","year":"1988","unstructured":"Burchiel KIMJ, Clarke H, Haglund M, Loeser J. Long-term efficacy of microvascular decompression in trigeminal neuralgia. J Neurosurg. 1988;69:35\u20138.","journal-title":"J Neurosurg"},{"issue":"June","key":"2323_CR4","doi-asserted-by":"publisher","first-page":"1484","DOI":"10.1016\/j.cpa.2002.12.001","volume":"120","author":"PRL Leal","year":"2014","unstructured":"Leal PRL, Barbeir C, Hermier M, Souza MA, Cristino-Filho G, Sindou M. Atrophic changes in the trigeminal nerves of patients with trigeminal neuralgia due to neurovascular compression and their association with the severity of compression and clinical outcomes. J Neurosurg. 2014;120(June):1484\u201395. https:\/\/doi.org\/10.1016\/j.cpa.2002.12.001.","journal-title":"J Neurosurg"},{"issue":"10","key":"2323_CR5","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.1016\/j.pain.2011.06.029","volume":"152","author":"PRL Leal","year":"2011","unstructured":"Leal PRL, Amedee Roch J, Hermier M, Souza MAN, Cristino-Filho G, Sindou M. Structural abnormalities of the trigeminal root revealed by diffusion tensor imaging in patients with trigeminal neuralgia caused by neurovascular compression: A prospective, double-blind, controlled study. Pain. 2011;152(10):2357\u201364. https:\/\/doi.org\/10.1016\/j.pain.2011.06.029.","journal-title":"Pain"},{"issue":"12","key":"2323_CR6","doi-asserted-by":"publisher","first-page":"2365","DOI":"10.1007\/s00701-011-1168-1","volume":"153","author":"B Guclu","year":"2011","unstructured":"Guclu B, Sindou M, Meyronet D, Streichenberger N, Simon E, Mertens P. Cranial nerve vascular compression syndromes of the trigeminal, facial and vago-glossopharyngeal nerves: Comparative anatomical study of the central myelin portion and transitional zone; Correlations with incidences of corresponding hyperactive dysfunctio. Acta Neurochir (Wien). 2011;153(12):2365\u201375. https:\/\/doi.org\/10.1007\/s00701-011-1168-1.","journal-title":"Acta Neurochir (Wien)"},{"issue":"3","key":"2323_CR7","doi-asserted-by":"publisher","first-page":"532","DOI":"10.3171\/jns.2002.96.3.0532","volume":"96","author":"M Devor","year":"2002","unstructured":"Devor M, Govrin-Lippmann R, Rappaport ZH. Mechanism of trigeminal neuralgia: an ultrastructural analysis of trigeminal root specimens obtained during microvascular decompression surgery. J Neurosurg. 2002;96(3):532\u201343. https:\/\/doi.org\/10.3171\/jns.2002.96.3.0532.","journal-title":"J Neurosurg"},{"issue":"5","key":"2323_CR8","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1016\/j.ejrad.2012.11.027","volume":"82","author":"Y Liu","year":"2013","unstructured":"Liu Y, Li J, Butzkueven H, et al. Microstructural abnormalities in the trigeminal nerves of patients with trigeminal neuralgia revealed by multiple diffusion metrics. Eur J Radiol. 2013;82(5):783\u20136. https:\/\/doi.org\/10.1016\/j.ejrad.2012.11.027.","journal-title":"Eur J Radiol"},{"issue":"1","key":"2323_CR9","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.pain.2013.08.029","volume":"155","author":"DD Desouza","year":"2014","unstructured":"Desouza DD, Hodaie M, Davis KD. Abnormal trigeminal nerve microstructure and brain white matter in idiopathic trigeminal neuralgia. Pain. 2014;155(1):37\u201344. https:\/\/doi.org\/10.1016\/j.pain.2013.08.029.","journal-title":"Pain"},{"issue":"7","key":"2323_CR10","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1007\/s00701-019-03913-5","volume":"161","author":"PRL Leal","year":"2019","unstructured":"Leal PRL, Roch J, Hermier M, Berthezene Y, Sindou M. Diffusion tensor imaging abnormalities of the trigeminal nerve root in patients with classical trigeminal neuralgia: a pre- and postoperative comparative study 4 years after microvascular decompression. Acta Neurochir (Wien). 2019;161(7):1415\u201325. https:\/\/doi.org\/10.1007\/s00701-019-03913-5.","journal-title":"Acta Neurochir (Wien)"},{"issue":"January","key":"2323_CR11","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1016\/j.nicl.2017.06.017","volume":"15","author":"PSP Hung","year":"2017","unstructured":"Hung PSP, Chen DQ, Davis KD, Zhong J, Hodaie M. Predicting pain relief: Use of pre-surgical trigeminal nerve diffusion metrics in trigeminal neuralgia. NeuroImage Clin. 2017;15(January):710\u20138. https:\/\/doi.org\/10.1016\/j.nicl.2017.06.017.","journal-title":"NeuroImage Clin"},{"issue":"August","key":"2323_CR12","doi-asserted-by":"publisher","first-page":"539","DOI":"10.3171\/2018.3.JNS172936","volume":"131","author":"S Tohyama","year":"2018","unstructured":"Tohyama S, Hung PS, Zhong J, Hodaie M. Early postsurgical diffusivity metrics for prognostication of long-term pain relief after Gamma Knife radiosurgery for trigeminal neuralgia. J Neurosurg. 2018;131(August):539\u201348. https:\/\/doi.org\/10.3171\/2018.3.JNS172936.","journal-title":"J Neurosurg"},{"issue":"5\u20136","key":"2323_CR13","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1016\/j.wneu.2012.01.040","volume":"79","author":"H Zhang","year":"2013","unstructured":"Zhang H, Lei D, You C, Mao BY, Wu B, Fang Y. The long-term outcome predictors of pure microvascular decompression for primary trigeminal neuralgia. World Neurosurg. 2013;79(5\u20136):756\u201362. https:\/\/doi.org\/10.1016\/j.wneu.2012.01.040.","journal-title":"World Neurosurg"},{"issue":"2","key":"2323_CR14","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1093\/neuros\/nyz075","volume":"86","author":"K Holste","year":"2019","unstructured":"Holste K, Chan AY, Rolston JD, Englot DJ. Pain Outcomes Following Microvascular Decompression for Drug-Resistant Trigeminal Neuralgia: A Systematic Review and Meta-Analysis. Neurosurgery. 2019;86(2):182\u201390. https:\/\/doi.org\/10.1093\/neuros\/nyz075.","journal-title":"Neurosurgery"},{"issue":"2","key":"2323_CR15","doi-asserted-by":"publisher","first-page":"573","DOI":"10.3171\/2019.4.JNS19299","volume":"133","author":"MS Willsey","year":"2020","unstructured":"Willsey MS, Collins KL, Conrad EC, Chubb HA, Patil PG. Diffusion tensor imaging reveals microstructural differences between subtypes of trigeminal neuralgia. J Neurosurg. 2020;133(2):573\u20139. https:\/\/doi.org\/10.3171\/2019.4.JNS19299.","journal-title":"J Neurosurg"},{"issue":"5","key":"2323_CR16","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1097\/j.pain.0000000000001777","volume":"161","author":"S Tohyama","year":"2020","unstructured":"Tohyama S, Hung PSP, Cheng JC, et al. Trigeminal neuralgia associated with a solitary pontine lesion: clinical and neuroimaging definition of a new syndrome. Pain. 2020;161(5):916\u201325. https:\/\/doi.org\/10.1097\/j.pain.0000000000001777.","journal-title":"Pain"},{"issue":"3","key":"2323_CR17","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1093\/brain\/awv389","volume":"139","author":"N Vartiainen","year":"2016","unstructured":"Vartiainen N, Perchet C, Magnin M, et al. Thalamic pain: Anatomical and physiological indices of prediction. Brain. 2016;139(3):708\u201322. https:\/\/doi.org\/10.1093\/brain\/awv389.","journal-title":"Brain"},{"key":"2323_CR18","doi-asserted-by":"publisher","unstructured":"Rutland JW, Huang K-H, Gill CM, et al. First application of 7-T ultra\u2013high field diffusion tensor imaging to detect altered microstructure of thalamic-somatosensory anatomy in trigeminal neuralgia. J Neurosurg. Published online 2019:1\u20139. doi:https:\/\/doi.org\/10.3171\/2019.6.jns19541","DOI":"10.3171\/2019.6.jns19541"},{"issue":"16","key":"2323_CR19","doi-asserted-by":"publisher","first-page":"5956","DOI":"10.1523\/JNEUROSCI.5980-10.2011","volume":"31","author":"SM Gustin","year":"2011","unstructured":"Gustin SM, Peck CC, Wilcox SL, Nash PG, Murray GM, Henderson LA. Different pain, different brain: thalamic anatomy in neuropathic and non-neuropathic chronic pain syndromes. J Neurosci. 2011;31(16):5956\u201364. https:\/\/doi.org\/10.1523\/JNEUROSCI.5980-10.2011.","journal-title":"J Neurosci"},{"issue":"3","key":"2323_CR20","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1179\/016164107X235473","volume":"30","author":"T Gu","year":"2008","unstructured":"Gu T, Ma X-X, Xu Y-H, Xiu J-J, Li C-F. Metabolite concentration ratios in thalami of patients with migraine and trigeminal neuralgia measured with 1H-MRS. Neurol Res. 2008;30(3):229\u201333. https:\/\/doi.org\/10.1179\/016164107X235473.","journal-title":"Neurol Res"},{"issue":"8","key":"2323_CR21","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1007\/s00234-014-1376-5","volume":"56","author":"Y Wang","year":"2014","unstructured":"Wang Y, Li D, Bao F, et al. Thalamic metabolic alterations with cognitive dysfunction in idiopathic trigeminal neuralgia: A multivoxel spectroscopy study. Neuroradiology. 2014;56(8):685\u201393. https:\/\/doi.org\/10.1007\/s00234-014-1376-5.","journal-title":"Neuroradiology"},{"issue":"6","key":"2323_CR22","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1177\/0333102419877659","volume":"40","author":"H Danyluk","year":"2020","unstructured":"Danyluk H, Lee EK, Wong S, et al. Hippocampal and trigeminal nerve volume predict outcome of surgical treatment for trigeminal neuralgia. Cephalalgia. 2020;40(6):586\u201396. https:\/\/doi.org\/10.1177\/0333102419877659.","journal-title":"Cephalalgia"},{"issue":"6","key":"2323_CR23","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.3171\/JNS-07\/12\/1144","volume":"107","author":"M Sindou","year":"2007","unstructured":"Sindou M, Leston J, Decullier E, Chapuis F. Microvascular decompression for primary trigeminal neuralgia: Long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clear-cut neurovascular conflicts who underwent pure decompression. J Neurosurg. 2007;107(6):1144\u201353. https:\/\/doi.org\/10.3171\/JNS-07\/12\/1144.","journal-title":"J Neurosurg"},{"key":"2323_CR24","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1159\/000029771","volume":"47","author":"PP Han","year":"2000","unstructured":"Han PP, Shetter AG, Smith KA, et al. Gamma Knife radiosurgery for trigeminal neuralgia: Experience at the Barrow Neurological Institute. Int J Radiat Oncol Biol Phys. 2000;47:1013\u20139. https:\/\/doi.org\/10.1159\/000029771.","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"S1","key":"2323_CR25","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1016\/j.neuroimage.2004.07.051","volume":"23","author":"SM Smith","year":"2004","unstructured":"Smith SM, Jenkinson M, Woolrich MW, et al. Advances in functional and structural MR image analysis and implementation as FSL. Neuroimage. 2004;23(S1):208\u201319.","journal-title":"Neuroimage"},{"issue":"1","key":"2323_CR26","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1006\/nimg.2002.1040","volume":"17","author":"SM Smith","year":"2002","unstructured":"Smith SM, Zhang Y, Jenkinson M, et al. Accurate, robust and automated longitudinal and cross-sectional brain change analysis. Neuroimage. 2002;17(1):479\u201389.","journal-title":"Neuroimage"},{"issue":"2","key":"2323_CR27","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1016\/j.neuroimage.2011.09.015","volume":"62","author":"M Jenkinson","year":"2012","unstructured":"Jenkinson M, Beckmann CF, Behrens TEJ, Woolrich MW, Smith SM. FSL Neuroimage. 2012;62(2):782\u201390. https:\/\/doi.org\/10.1016\/j.neuroimage.2011.09.015.","journal-title":"FSL Neuroimage"},{"key":"2323_CR28","doi-asserted-by":"publisher","unstructured":"Patenaude B, Smith SM, Kennedy D, Jenkinson M. A Bayesian Model of Shape and Appearance for Subcortical Brain. Neuroimage. 2011;56(3):907\u201322. https:\/\/doi.org\/10.1016\/j.neuroimage.2011.02.046.","DOI":"10.1016\/j.neuroimage.2011.02.046"},{"issue":"4","key":"2323_CR29","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1002\/nbm.698","volume":"14","author":"SW Provencher","year":"2001","unstructured":"Provencher SW. Automatic quantitation of localized in vivo 1H spectra with LCModel. NMR Biomed. 2001;14(4):260\u20134. https:\/\/doi.org\/10.1002\/nbm.698.","journal-title":"NMR Biomed"},{"key":"2323_CR30","unstructured":"Schaltenbrand G, Wahren W, Hassler RG. Atlas for Stereotaxy of the Human Brain. 2d, rev. a ed. Stuttgart: Thieme; 1977."},{"issue":"2","key":"2323_CR31","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1177\/0333102418783294","volume":"39","author":"TB Heinskou","year":"2019","unstructured":"Heinskou TB, Rochat P, Maarbjerg S, et al. Prognostic factors for outcome of microvascular decompression in trigeminal neuralgia: A prospective systematic study using independent assessors. Cephalalgia. 2019;39(2):197\u2013208. https:\/\/doi.org\/10.1177\/0333102418783294.","journal-title":"Cephalalgia"},{"key":"2323_CR32","doi-asserted-by":"publisher","unstructured":"Magown P, Ko AL, Burchiel KJ. The Spectrum of Trigeminal Neuralgia Without Neurovascular Compression. Neurosurgery. 2019;85(43):553\u20139. https:\/\/doi.org\/10.1093\/neuros\/nyz0481.","DOI":"10.1093\/neuros\/nyz0481"},{"issue":"9","key":"2323_CR33","doi-asserted-by":"publisher","first-page":"2751","DOI":"10.1093\/brain\/awt211","volume":"136","author":"JA Hashmi","year":"2013","unstructured":"Hashmi JA, Baliki MN, Huang L, et al. Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain. 2013;136(9):2751\u201368. https:\/\/doi.org\/10.1093\/brain\/awt211.","journal-title":"Brain"},{"issue":"1\u20132","key":"2323_CR34","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.pain.2006.05.004","volume":"125","author":"T Schmidt-Wilcke","year":"2006","unstructured":"Schmidt-Wilcke T, Leinisch E, G\u00e4n\u00dfbauer S, et al. Affective components and intensity of pain correlate with structural differences in gray matter in chronic back pain patients. Pain. 2006;125(1\u20132):89\u201397. https:\/\/doi.org\/10.1016\/j.pain.2006.05.004.","journal-title":"Pain"},{"issue":"2","key":"2323_CR35","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.pneurobio.2006.12.003","volume":"81","author":"JR Moffett","year":"2007","unstructured":"Moffett JR, Ross B, Arun P, Madhavarao CN, Namboodiri AMA. N-Acetylaspartate in the CNS: From neurodiagnostics to neurobiology. Prog Neurobiol. 2007;81(2):89\u2013131. https:\/\/doi.org\/10.1016\/j.pneurobio.2006.12.003.","journal-title":"Prog Neurobiol"},{"issue":"3","key":"2323_CR36","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1515\/cclm-2012-0559","volume":"51","author":"SK Tayebati","year":"2013","unstructured":"Tayebati SK, Amenta F. Choline-containing phospholipids: Relevance to brain functional pathways. Clin Chem Lab Med. 2013;51(3):513\u201321. https:\/\/doi.org\/10.1515\/cclm-2012-0559.","journal-title":"Clin Chem Lab Med"},{"key":"2323_CR37","doi-asserted-by":"publisher","unstructured":"Henssen DJHA, Kurt E, Kozicz T, van Dongen R, Bartels RHMA, van Cappellen van Walsum AM. New insights in trigeminal anatomy: a double orofacial tract for nociceptive input. Front Neuroanat. 2016;10(5):1\u201314. https:\/\/doi.org\/10.3389\/fnana.2016.00053","DOI":"10.3389\/fnana.2016.00053"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02323-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-021-02323-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02323-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T01:04:15Z","timestamp":1627088655000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-021-02323-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,24]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2323"],"URL":"https:\/\/doi.org\/10.1186\/s12883-021-02323-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-334295\/v2","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-334295\/v1","asserted-by":"object"}]},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,24]]},"assertion":[{"value":"5 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the institutional human research ethics board at the University of Alberta (Protocol #00067116). All patients from whom data was included in this manuscript provided written informed and ongoing consent. Administrative\/operational approval was provided by Alberta Health Services (Health Information Act Research Agreement #81929).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All study participants willingly consented to the use of their information for dissemination and publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"290"}}