Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial
Identifieur interne : 001043 ( Main/Exploration ); précédent : 001042; suivant : 001044Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial
Auteurs : Nir Lipsman [Canada] ; D. Blake Woodside [Canada] ; Peter Giacobbe [Canada] ; Clement Hamani [Canada] ; Jacqueline C. Carter [Canada] ; Sarah Jane Norwood [Canada] ; Kalam Sutandar [Canada] ; Randy Staab [Canada] ; Gavin Elias [Canada] ; Christopher H. Lyman [États-Unis] ; Gwenn S. Smith [États-Unis] ; Andres M. Lozano [Canada]Source :
- Lancet : (British edition) [ 0140-6736 ] ; 2013.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Médecine.
English descriptors
- KwdEn :
Abstract
Background Anorexia nervosa is characterised by a chronic course that is refractory to treatment in many patients and has one of the highest mortality rates of any psychiatric disorder. Deep brain stimulation (DBS) has been applied to circuit-based neuropsychiatric diseases, such as Parkinson's disease and major depression, with promising results. We aimed to assess the safety of DBS to modulate the activity of limbic circuits and to examine how this might affect the clinical features of anorexia nervosa. Methods We did a phase 1, prospective trial of subcallosal cingulate DBS in six patients with chronic, severe, and treatment-refractory anorexia nervosa. Eligible patients were aged 20-60 years, had been diagnosed with restricting or binge-purging anorexia nervosa, and showed evidence of chronicity or treatment resistance. Patients underwent medical optimisation preoperatively and had baseline body-mass index (BMI), psychometric, and neuroimaging investigations, followed by implantation of electrodes and pulse generators for continuous delivery of electrical stimulation. Patients were followed up for 9 months after DBS activation, and the primary outcome of adverse events associated with surgery or stimulation was monitored at every follow-up visit. Repeat psychometric assessments, BMI measurements, and neuroimaging investigations were also done at various intervals. This trial is registered with ClinicalTrials.gov, number NCT01476540. Findings DBS was associated with several adverse events, only one of which (seizure during programming, roughly 2 weeks after surgery) was serious. Other related adverse events were panic attack during surgery, nausea, air embolus, and pain. After 9 months, three of the six patients had achieved and maintained a BMI greater than their historical baselines. DBS was associated with improvements in mood, anxiety, affective regulation, and anorexia nervosa-related obsessions and compulsions in four patients and with improvements in quality of life in three patients after 6 months of stimulation. These clinical benefits were accompanied by changes in cerebral glucose metabolism (seen in a comparison of composite PET scans at baseline and 6 months) that were consistent with a reversal of the abnormalities seen in the anterior cingulate, insula, and parietal lobe in the disorder. Interpretation Subcallosal cingulate DBS seems to be generally safe in this sample of patients with chronic and treatment-refractory anorexia nervosa.
Affiliations:
Links toward previous steps (curation, corpus...)
- to stream PascalFrancis, to step Corpus: 000106
- to stream PascalFrancis, to step Corpus: 000144
- to stream PascalFrancis, to step Curation: 000B26
- to stream PascalFrancis, to step Checkpoint: 000049
- to stream Main, to step Merge: 001056
- to stream Main, to step Curation: 001043
Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial</title><author><name sortKey="Lipsman, Nir" sort="Lipsman, Nir" uniqKey="Lipsman N" first="Nir" last="Lipsman">Nir Lipsman</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Blake Woodside, D" sort="Blake Woodside, D" uniqKey="Blake Woodside D" first="D." last="Blake Woodside">D. Blake Woodside</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychiatry, University ofToronto, Toronto General Hospital</s1><s2>ON</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Giacobbe, Peter" sort="Giacobbe, Peter" uniqKey="Giacobbe P" first="Peter" last="Giacobbe">Peter Giacobbe</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychiatry, University ofToronto, Toronto General Hospital</s1><s2>ON</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Carter, Jacqueline C" sort="Carter, Jacqueline C" uniqKey="Carter J" first="Jacqueline C." last="Carter">Jacqueline C. Carter</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychiatry, University ofToronto, Toronto General Hospital</s1><s2>ON</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Norwood, Sarah Jane" sort="Norwood, Sarah Jane" uniqKey="Norwood S" first="Sarah Jane" last="Norwood">Sarah Jane Norwood</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Psychology, York University</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, ON</wicri:noRegion></affiliation></author><author><name sortKey="Sutandar, Kalam" sort="Sutandar, Kalam" uniqKey="Sutandar K" first="Kalam" last="Sutandar">Kalam Sutandar</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychiatry, University ofToronto, Toronto General Hospital</s1><s2>ON</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Staab, Randy" sort="Staab, Randy" uniqKey="Staab R" first="Randy" last="Staab">Randy Staab</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Division of Psychiatry, Credit Valley Hospital</s1><s2>Mississauga, ON</s2><s3>CAN</s3><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Mississauga, ON</wicri:noRegion></affiliation></author><author><name sortKey="Elias, Gavin" sort="Elias, Gavin" uniqKey="Elias G" first="Gavin" last="Elias">Gavin Elias</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Lyman, Christopher H" sort="Lyman, Christopher H" uniqKey="Lyman C" first="Christopher H." last="Lyman">Christopher H. Lyman</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Baltimore, MD</wicri:noRegion></affiliation></author><author><name sortKey="Smith, Gwenn S" sort="Smith, Gwenn S" uniqKey="Smith G" first="Gwenn S." last="Smith">Gwenn S. Smith</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Baltimore, MD</wicri:noRegion></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">13-0155352</idno><date when="2013">2013</date><idno type="stanalyst">PASCAL 13-0155352 INIST</idno><idno type="RBID">Pascal:13-0155352</idno><idno type="wicri:Area/PascalFrancis/Corpus">000106</idno><idno type="stanalyst">FRANCIS 13-0155352 INIST</idno><idno type="wicri:Area/PascalFrancis/Corpus">000144</idno><idno type="wicri:Area/PascalFrancis/Curation">000B26</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000049</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000049</idno><idno type="wicri:doubleKey">0140-6736:2013:Lipsman N:subcallosal:cingulate:deep</idno><idno type="wicri:Area/Main/Merge">001056</idno><idno type="wicri:Area/Main/Curation">001043</idno><idno type="wicri:Area/Main/Exploration">001043</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial</title><author><name sortKey="Lipsman, Nir" sort="Lipsman, Nir" uniqKey="Lipsman N" first="Nir" last="Lipsman">Nir Lipsman</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Blake Woodside, D" sort="Blake Woodside, D" uniqKey="Blake Woodside D" first="D." last="Blake Woodside">D. Blake Woodside</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychiatry, University ofToronto, Toronto General Hospital</s1><s2>ON</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Giacobbe, Peter" sort="Giacobbe, Peter" uniqKey="Giacobbe P" first="Peter" last="Giacobbe">Peter Giacobbe</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychiatry, University ofToronto, Toronto General Hospital</s1><s2>ON</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Carter, Jacqueline C" sort="Carter, Jacqueline C" uniqKey="Carter J" first="Jacqueline C." last="Carter">Jacqueline C. Carter</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychiatry, University ofToronto, Toronto General Hospital</s1><s2>ON</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Norwood, Sarah Jane" sort="Norwood, Sarah Jane" uniqKey="Norwood S" first="Sarah Jane" last="Norwood">Sarah Jane Norwood</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Psychology, York University</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, ON</wicri:noRegion></affiliation></author><author><name sortKey="Sutandar, Kalam" sort="Sutandar, Kalam" uniqKey="Sutandar K" first="Kalam" last="Sutandar">Kalam Sutandar</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Psychiatry, University ofToronto, Toronto General Hospital</s1><s2>ON</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>ON</wicri:noRegion></affiliation></author><author><name sortKey="Staab, Randy" sort="Staab, Randy" uniqKey="Staab R" first="Randy" last="Staab">Randy Staab</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Division of Psychiatry, Credit Valley Hospital</s1><s2>Mississauga, ON</s2><s3>CAN</s3><sZ>8 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Mississauga, ON</wicri:noRegion></affiliation></author><author><name sortKey="Elias, Gavin" sort="Elias, Gavin" uniqKey="Elias G" first="Gavin" last="Elias">Gavin Elias</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Lyman, Christopher H" sort="Lyman, Christopher H" uniqKey="Lyman C" first="Christopher H." last="Lyman">Christopher H. Lyman</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Baltimore, MD</wicri:noRegion></affiliation></author><author><name sortKey="Smith, Gwenn S" sort="Smith, Gwenn S" uniqKey="Smith G" first="Gwenn S." last="Smith">Gwenn S. Smith</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine</s1><s2>Baltimore, MD</s2><s3>USA</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Baltimore, MD</wicri:noRegion></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto</s1><s2>Toronto, ON</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author></analytic><series><title level="j" type="main">Lancet : (British edition)</title><title level="j" type="abbreviated">Lancet : (Br. ed.)</title><idno type="ISSN">0140-6736</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Lancet : (British edition)</title><title level="j" type="abbreviated">Lancet : (Br. ed.)</title><idno type="ISSN">0140-6736</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anorexia nervosa</term><term>Brain</term><term>Encephalon</term><term>Medicine</term><term>Phase I trial</term><term>Refractory</term><term>Stimulation</term><term>Treatment</term><term>Treatment resistance</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Anorexie mentale</term><term>Encéphale</term><term>Cerveau</term><term>Stimulation</term><term>Traitement</term><term>Résistance traitement</term><term>Réfractaire</term><term>Essai clinique phase I</term><term>Médecine</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Médecine</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background Anorexia nervosa is characterised by a chronic course that is refractory to treatment in many patients and has one of the highest mortality rates of any psychiatric disorder. Deep brain stimulation (DBS) has been applied to circuit-based neuropsychiatric diseases, such as Parkinson's disease and major depression, with promising results. We aimed to assess the safety of DBS to modulate the activity of limbic circuits and to examine how this might affect the clinical features of anorexia nervosa. Methods We did a phase 1, prospective trial of subcallosal cingulate DBS in six patients with chronic, severe, and treatment-refractory anorexia nervosa. Eligible patients were aged 20-60 years, had been diagnosed with restricting or binge-purging anorexia nervosa, and showed evidence of chronicity or treatment resistance. Patients underwent medical optimisation preoperatively and had baseline body-mass index (BMI), psychometric, and neuroimaging investigations, followed by implantation of electrodes and pulse generators for continuous delivery of electrical stimulation. Patients were followed up for 9 months after DBS activation, and the primary outcome of adverse events associated with surgery or stimulation was monitored at every follow-up visit. Repeat psychometric assessments, BMI measurements, and neuroimaging investigations were also done at various intervals. This trial is registered with ClinicalTrials.gov, number NCT01476540. Findings DBS was associated with several adverse events, only one of which (seizure during programming, roughly 2 weeks after surgery) was serious. Other related adverse events were panic attack during surgery, nausea, air embolus, and pain. After 9 months, three of the six patients had achieved and maintained a BMI greater than their historical baselines. DBS was associated with improvements in mood, anxiety, affective regulation, and anorexia nervosa-related obsessions and compulsions in four patients and with improvements in quality of life in three patients after 6 months of stimulation. These clinical benefits were accompanied by changes in cerebral glucose metabolism (seen in a comparison of composite PET scans at baseline and 6 months) that were consistent with a reversal of the abnormalities seen in the anterior cingulate, insula, and parietal lobe in the disorder. Interpretation Subcallosal cingulate DBS seems to be generally safe in this sample of patients with chronic and treatment-refractory anorexia nervosa.</div></front></TEI><affiliations><list><country><li>Canada</li><li>États-Unis</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Lipsman, Nir" sort="Lipsman, Nir" uniqKey="Lipsman N" first="Nir" last="Lipsman">Nir Lipsman</name></region><name sortKey="Blake Woodside, D" sort="Blake Woodside, D" uniqKey="Blake Woodside D" first="D." last="Blake Woodside">D. Blake Woodside</name><name sortKey="Carter, Jacqueline C" sort="Carter, Jacqueline C" uniqKey="Carter J" first="Jacqueline C." last="Carter">Jacqueline C. Carter</name><name sortKey="Elias, Gavin" sort="Elias, Gavin" uniqKey="Elias G" first="Gavin" last="Elias">Gavin Elias</name><name sortKey="Giacobbe, Peter" sort="Giacobbe, Peter" uniqKey="Giacobbe P" first="Peter" last="Giacobbe">Peter Giacobbe</name><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><name sortKey="Norwood, Sarah Jane" sort="Norwood, Sarah Jane" uniqKey="Norwood S" first="Sarah Jane" last="Norwood">Sarah Jane Norwood</name><name sortKey="Staab, Randy" sort="Staab, Randy" uniqKey="Staab R" first="Randy" last="Staab">Randy Staab</name><name sortKey="Sutandar, Kalam" sort="Sutandar, Kalam" uniqKey="Sutandar K" first="Kalam" last="Sutandar">Kalam Sutandar</name></country><country name="États-Unis"><noRegion><name sortKey="Lyman, Christopher H" sort="Lyman, Christopher H" uniqKey="Lyman C" first="Christopher H." last="Lyman">Christopher H. Lyman</name></noRegion><name sortKey="Smith, Gwenn S" sort="Smith, Gwenn S" uniqKey="Smith G" first="Gwenn S." last="Smith">Gwenn S. Smith</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Canada/explor/ParkinsonCanadaV1/Data/Main/Exploration
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 001043 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd -nk 001043 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Canada
|area= ParkinsonCanadaV1
|flux= Main
|étape= Exploration
|type= RBID
|clé= Pascal:13-0155352
|texte= Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial
}}
| This area was generated with Dilib version V0.6.29. |  |