Pathological gambling in patients with Parkinson's disease is associated with fronto‐striatal disconnection: A path modeling analysis
Identifieur interne : 000D34 ( Main/Corpus ); précédent : 000D33; suivant : 000D35Pathological gambling in patients with Parkinson's disease is associated with fronto‐striatal disconnection: A path modeling analysis
Auteurs : Roberto Cilia ; Sang Soo Cho ; Thilo Van Eimeren ; Giorgio Marotta ; Chiara Siri ; Ji Hyun Ko ; Giovanna Pellecchia ; Gianni Pezzoli ; Angelo Antonini ; Antonio P. StrafellaSource :
- Movement Disorders [ 0885-3185 ] ; 2011-02-01.
English descriptors
Abstract
Background:: Pathological gambling may occur in Parkinson's disease (PD) as a complication of dopaminergic therapy. Neuroimaging studies have suggested an abnormal dopamine transmission within the reward system, but the changes in the neural network characterizing PD patients with pathological gambling have never been investigated. Methods:: Thirty PD patients (15 with active gambling and 15 matched controls, on‐medication) and 15 healthy subjects underwent brain perfusion single photon emission tomography at rest. The severity of gambling was assessed using the South Oaks Gambling Scale. Covariance analysis was applied to identify brain regions whose activity was associated with gambling severity. These regions were used as volume‐of‐interest to identify functionally interconnected areas using voxel‐wise covariance analysis. A path model was defined by means of effective connectivity analysis within the Structural Equation Modeling framework. Results:: Gambling severity in PD was associated with a dysfunction of the brain network implicated in decision making, risk processing, and response inhibition, including the ventrolateral prefrontal cortex, anterior (ACC) and posterior cingulate cortex, medial prefrontal cortex, insula and striatum. PD gamblers showed a disconnection between the ACC and the striatum, while this interaction was very robust in both control groups. Discussion:: ACC‐striatal disconnection may underlie a specific impairment of shifting behaviors after negative outcomes, possibly explaining why PD gamblers use to perseverate into risktaking behaviors despite self‐destructive consequences. © 2011 Movement Disorder Society
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DOI: 10.1002/mds.23480
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Pathological gambling in patients with Parkinson's disease is associated with fronto‐striatal disconnection: A path modeling analysis</title><author><name sortKey="Cilia, Roberto" sort="Cilia, Roberto" uniqKey="Cilia R" first="Roberto" last="Cilia">Roberto Cilia</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Cho, Sang Soo" sort="Cho, Sang Soo" uniqKey="Cho S" first="Sang Soo" last="Cho">Sang Soo Cho</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Van Eimeren, Thilo" sort="Van Eimeren, Thilo" uniqKey="Van Eimeren T" first="Thilo" last="Van Eimeren">Thilo Van Eimeren</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Marotta, Giorgio" sort="Marotta, Giorgio" uniqKey="Marotta G" first="Giorgio" last="Marotta">Giorgio Marotta</name><affiliation><mods:affiliation>Nuclear Medicine Department, IRCCS‐OSpedale Maggiore, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Siri, Chiara" sort="Siri, Chiara" uniqKey="Siri C" first="Chiara" last="Siri">Chiara Siri</name><affiliation><mods:affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Ko, Ji Hyun" sort="Ko, Ji Hyun" uniqKey="Ko J" first="Ji Hyun" last="Ko">Ji Hyun Ko</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Pellecchia, Giovanna" sort="Pellecchia, Giovanna" uniqKey="Pellecchia G" first="Giovanna" last="Pellecchia">Giovanna Pellecchia</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Pezzoli, Gianni" sort="Pezzoli, Gianni" uniqKey="Pezzoli G" first="Gianni" last="Pezzoli">Gianni Pezzoli</name><affiliation><mods:affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Antonini, Angelo" sort="Antonini, Angelo" uniqKey="Antonini A" first="Angelo" last="Antonini">Angelo Antonini</name><affiliation><mods:affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>Institute of Neurology, IRCCS San Camillo Venice, University of Padua, Padua, Italy</mods:affiliation></affiliation></author><author><name sortKey="Strafella, Antonio P" sort="Strafella, Antonio P" uniqKey="Strafella A" first="Antonio P." last="Strafella">Antonio P. Strafella</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:989B859FEEE651B1B0AC5F763254C422B0CA3649</idno><date when="2011" year="2011">2011</date><idno type="doi">10.1002/mds.23480</idno><idno type="url">https://api.istex.fr/document/989B859FEEE651B1B0AC5F763254C422B0CA3649/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000D34</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Pathological gambling in patients with Parkinson's disease is associated with fronto‐striatal disconnection: A path modeling analysis</title><author><name sortKey="Cilia, Roberto" sort="Cilia, Roberto" uniqKey="Cilia R" first="Roberto" last="Cilia">Roberto Cilia</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Cho, Sang Soo" sort="Cho, Sang Soo" uniqKey="Cho S" first="Sang Soo" last="Cho">Sang Soo Cho</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Van Eimeren, Thilo" sort="Van Eimeren, Thilo" uniqKey="Van Eimeren T" first="Thilo" last="Van Eimeren">Thilo Van Eimeren</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Marotta, Giorgio" sort="Marotta, Giorgio" uniqKey="Marotta G" first="Giorgio" last="Marotta">Giorgio Marotta</name><affiliation><mods:affiliation>Nuclear Medicine Department, IRCCS‐OSpedale Maggiore, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Siri, Chiara" sort="Siri, Chiara" uniqKey="Siri C" first="Chiara" last="Siri">Chiara Siri</name><affiliation><mods:affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Ko, Ji Hyun" sort="Ko, Ji Hyun" uniqKey="Ko J" first="Ji Hyun" last="Ko">Ji Hyun Ko</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Pellecchia, Giovanna" sort="Pellecchia, Giovanna" uniqKey="Pellecchia G" first="Giovanna" last="Pellecchia">Giovanna Pellecchia</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Pezzoli, Gianni" sort="Pezzoli, Gianni" uniqKey="Pezzoli G" first="Gianni" last="Pezzoli">Gianni Pezzoli</name><affiliation><mods:affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation></author><author><name sortKey="Antonini, Angelo" sort="Antonini, Angelo" uniqKey="Antonini A" first="Angelo" last="Antonini">Angelo Antonini</name><affiliation><mods:affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>Institute of Neurology, IRCCS San Camillo Venice, University of Padua, Padua, Italy</mods:affiliation></affiliation></author><author><name sortKey="Strafella, Antonio P" sort="Strafella, Antonio P" uniqKey="Strafella A" first="Antonio P." last="Strafella">Antonio P. Strafella</name><affiliation><mods:affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation><affiliation><mods:affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2011-02-01">2011-02-01</date><biblScope unit="volume">26</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="225">225</biblScope><biblScope unit="page" to="233">233</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">989B859FEEE651B1B0AC5F763254C422B0CA3649</idno><idno type="DOI">10.1002/mds.23480</idno><idno type="ArticleID">MDS23480</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Parkinson's disease</term><term>SPECT</term><term>SPM</term><term>effective connectivity</term><term>pathological gambling</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background:: Pathological gambling may occur in Parkinson's disease (PD) as a complication of dopaminergic therapy. Neuroimaging studies have suggested an abnormal dopamine transmission within the reward system, but the changes in the neural network characterizing PD patients with pathological gambling have never been investigated. Methods:: Thirty PD patients (15 with active gambling and 15 matched controls, on‐medication) and 15 healthy subjects underwent brain perfusion single photon emission tomography at rest. The severity of gambling was assessed using the South Oaks Gambling Scale. Covariance analysis was applied to identify brain regions whose activity was associated with gambling severity. These regions were used as volume‐of‐interest to identify functionally interconnected areas using voxel‐wise covariance analysis. A path model was defined by means of effective connectivity analysis within the Structural Equation Modeling framework. Results:: Gambling severity in PD was associated with a dysfunction of the brain network implicated in decision making, risk processing, and response inhibition, including the ventrolateral prefrontal cortex, anterior (ACC) and posterior cingulate cortex, medial prefrontal cortex, insula and striatum. PD gamblers showed a disconnection between the ACC and the striatum, while this interaction was very robust in both control groups. Discussion:: ACC‐striatal disconnection may underlie a specific impairment of shifting behaviors after negative outcomes, possibly explaining why PD gamblers use to perseverate into risktaking behaviors despite self‐destructive consequences. © 2011 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Roberto Cilia MD</name><affiliations><json:string>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</json:string><json:string>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</json:string><json:string>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item><json:item><name>Sang Soo Cho PhD</name><affiliations><json:string>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</json:string><json:string>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Thilo van Eimeren MD, PhD</name><affiliations><json:string>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</json:string><json:string>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Giorgio Marotta MD</name><affiliations><json:string>Nuclear Medicine Department, IRCCS‐OSpedale Maggiore, Milan, Italy</json:string></affiliations></json:item><json:item><name>Chiara Siri PsyD</name><affiliations><json:string>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item><json:item><name>Ji Hyun Ko PhD</name><affiliations><json:string>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</json:string><json:string>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Giovanna Pellecchia PhD</name><affiliations><json:string>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</json:string><json:string>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Gianni Pezzoli MD</name><affiliations><json:string>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</json:string></affiliations></json:item><json:item><name>Angelo Antonini MD</name><affiliations><json:string>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</json:string><json:string>Institute of Neurology, IRCCS San Camillo Venice, University of Padua, Padua, Italy</json:string></affiliations></json:item><json:item><name>Antonio P. Strafella MD, PhD, FRCPC</name><affiliations><json:string>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</json:string><json:string>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>pathological gambling</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>SPECT</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>effective connectivity</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>SPM</value></json:item></subject><articleId><json:string>MDS23480</json:string></articleId><language><json:string>eng</json:string></language><abstract>Background:: Pathological gambling may occur in Parkinson's disease (PD) as a complication of dopaminergic therapy. Neuroimaging studies have suggested an abnormal dopamine transmission within the reward system, but the changes in the neural network characterizing PD patients with pathological gambling have never been investigated. Methods:: Thirty PD patients (15 with active gambling and 15 matched controls, on‐medication) and 15 healthy subjects underwent brain perfusion single photon emission tomography at rest. The severity of gambling was assessed using the South Oaks Gambling Scale. Covariance analysis was applied to identify brain regions whose activity was associated with gambling severity. These regions were used as volume‐of‐interest to identify functionally interconnected areas using voxel‐wise covariance analysis. A path model was defined by means of effective connectivity analysis within the Structural Equation Modeling framework. Results:: Gambling severity in PD was associated with a dysfunction of the brain network implicated in decision making, risk processing, and response inhibition, including the ventrolateral prefrontal cortex, anterior (ACC) and posterior cingulate cortex, medial prefrontal cortex, insula and striatum. PD gamblers showed a disconnection between the ACC and the striatum, while this interaction was very robust in both control groups. Discussion:: ACC‐striatal disconnection may underlie a specific impairment of shifting behaviors after negative outcomes, possibly explaining why PD gamblers use to perseverate into risktaking behaviors despite self‐destructive consequences. © 2011 Movement Disorder Society</abstract><qualityIndicators><score>7.675</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 810 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1667</abstractCharCount><pdfWordCount>4999</pdfWordCount><pdfCharCount>33288</pdfCharCount><pdfPageCount>9</pdfPageCount><abstractWordCount>223</abstractWordCount></qualityIndicators><title>Pathological gambling in patients with Parkinson's disease is associated with fronto‐striatal disconnection: A path modeling analysis</title><genre><json:string>article</json:string></genre><host><volume>26</volume><publisherId><json:string>MDS</json:string></publisherId><pages><total>9</total><last>233</last><first>225</first></pages><issn><json:string>0885-3185</json:string></issn><issue>2</issue><subject><json:item><value>Research Article</value></json:item></subject><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1531-8257</json:string></eissn><title>Movement Disorders</title><doi><json:string>10.1002/(ISSN)1531-8257</json:string></doi></host><publicationDate>2011</publicationDate><copyrightDate>2011</copyrightDate><doi><json:string>10.1002/mds.23480</json:string></doi><id>989B859FEEE651B1B0AC5F763254C422B0CA3649</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/989B859FEEE651B1B0AC5F763254C422B0CA3649/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/989B859FEEE651B1B0AC5F763254C422B0CA3649/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/989B859FEEE651B1B0AC5F763254C422B0CA3649/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Pathological gambling in patients with Parkinson's disease is associated with fronto‐striatal disconnection: A path modeling analysis</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><availability><p>WILEY</p></availability><date>2011</date></publicationStmt><notesStmt><note>Author Roles and Disclosures</note><note type="content">*Relevant conflicts of interest/financial disclosures: Nothing to report. Full financial disclosures and author roles can be found in the online version of this article.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Pathological gambling in patients with Parkinson's disease is associated with fronto‐striatal disconnection: A path modeling analysis</title><author><persName><forename type="first">Roberto</forename><surname>Cilia</surname></persName><roleName type="degree">MD</roleName><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author><author><persName><forename type="first">Sang Soo</forename><surname>Cho</surname></persName><roleName type="degree">PhD</roleName><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Thilo</forename><surname>van Eimeren</surname></persName><roleName type="degree">MD, PhD</roleName><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Giorgio</forename><surname>Marotta</surname></persName><roleName type="degree">MD</roleName><affiliation>Nuclear Medicine Department, IRCCS‐OSpedale Maggiore, Milan, Italy</affiliation></author><author><persName><forename type="first">Chiara</forename><surname>Siri</surname></persName><roleName type="degree">PsyD</roleName><affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author><author><persName><forename type="first">Ji Hyun</forename><surname>Ko</surname></persName><roleName type="degree">PhD</roleName><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Giovanna</forename><surname>Pellecchia</surname></persName><roleName type="degree">PhD</roleName><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation></author><author><persName><forename type="first">Gianni</forename><surname>Pezzoli</surname></persName><roleName type="degree">MD</roleName><affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation></author><author><persName><forename type="first">Angelo</forename><surname>Antonini</surname></persName><roleName type="degree">MD</roleName><affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><affiliation>Institute of Neurology, IRCCS San Camillo Venice, University of Padua, Padua, Italy</affiliation></author><author><persName><forename type="first">Antonio P.</forename><surname>Strafella</surname></persName><roleName type="degree">MD, PhD, FRCPC</roleName><note type="correspondence"><p>Correspondence: Toronto Western Hospital and Institute, UHN, CAMH‐PET Imaging Centre, University of Toronto, Toronto, ON, Canada</p></note><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2011-02-01"></date><biblScope unit="volume">26</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="225">225</biblScope><biblScope unit="page" to="233">233</biblScope></imprint></monogr><idno type="istex">989B859FEEE651B1B0AC5F763254C422B0CA3649</idno><idno type="DOI">10.1002/mds.23480</idno><idno type="ArticleID">MDS23480</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background:: Pathological gambling may occur in Parkinson's disease (PD) as a complication of dopaminergic therapy. Neuroimaging studies have suggested an abnormal dopamine transmission within the reward system, but the changes in the neural network characterizing PD patients with pathological gambling have never been investigated. Methods:: Thirty PD patients (15 with active gambling and 15 matched controls, on‐medication) and 15 healthy subjects underwent brain perfusion single photon emission tomography at rest. The severity of gambling was assessed using the South Oaks Gambling Scale. Covariance analysis was applied to identify brain regions whose activity was associated with gambling severity. These regions were used as volume‐of‐interest to identify functionally interconnected areas using voxel‐wise covariance analysis. A path model was defined by means of effective connectivity analysis within the Structural Equation Modeling framework. Results:: Gambling severity in PD was associated with a dysfunction of the brain network implicated in decision making, risk processing, and response inhibition, including the ventrolateral prefrontal cortex, anterior (ACC) and posterior cingulate cortex, medial prefrontal cortex, insula and striatum. PD gamblers showed a disconnection between the ACC and the striatum, while this interaction was very robust in both control groups. Discussion:: ACC‐striatal disconnection may underlie a specific impairment of shifting behaviors after negative outcomes, possibly explaining why PD gamblers use to perseverate into risktaking behaviors despite self‐destructive consequences. © 2011 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's disease</term></item><item><term>pathological gambling</term></item><item><term>SPECT</term></item><item><term>effective connectivity</term></item><item><term>SPM</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-02-24">Received</change><change when="2010-09-20">Registration</change><change when="2011-02-01">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/989B859FEEE651B1B0AC5F763254C422B0CA3649/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="short">Mov. Disord.</title></titleGroup></publicationMeta><publicationMeta level="part" position="20"><doi origin="wiley" registered="yes">10.1002/mds.v26.2</doi><numberingGroup><numbering type="journalVolume" number="26">26</numbering><numbering type="journalIssue">2</numbering></numberingGroup><coverDate startDate="2011-02-01">1 February 2011</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="100" status="forIssue"><doi origin="wiley" registered="yes">10.1002/mds.23480</doi><idGroup><id type="unit" value="MDS23480"></id></idGroup><countGroup><count type="pageTotal" number="9"></count></countGroup><titleGroup><title type="articleCategory">Research Article</title><title type="tocHeading1">Research Articles</title></titleGroup><copyright ownership="thirdParty">Copyright © 2011 Movement Disorder Society</copyright><eventGroup><event type="manuscriptReceived" date="2010-02-24"></event><event type="manuscriptRevised" date="2010-07-20"></event><event type="manuscriptAccepted" date="2010-09-20"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:3.0.1 mode:FullText mathml2tex" date="2012-01-23"></event><event type="publishedOnlineEarlyUnpaginated" date="2011-01-31"></event><event type="publishedOnlineFinalForm" date="2011-03-14"></event><event type="firstOnline" date="2011-01-31"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-02"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-31"></event></eventGroup><numberingGroup><numbering type="pageFirst">225</numbering><numbering type="pageLast">233</numbering></numberingGroup><correspondenceTo>Toronto Western Hospital and Institute, UHN, CAMH‐PET Imaging Centre, University of Toronto, Toronto, ON, Canada</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:MDS.MDS23480.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="4"></count><count type="tableTotal" number="2"></count><count type="referenceTotal" number="67"></count><count type="wordTotal" number="6191"></count></countGroup><titleGroup><title type="main" xml:lang="en">Pathological gambling in patients with Parkinson's disease is associated with fronto‐striatal disconnection: A path modeling analysis<link href="#fn1"></link></title><title type="short" xml:lang="en">Neural Correlates of Pathological Gambling in PD</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1 #af2 #af3"><personName><givenNames>Roberto</givenNames><familyName>Cilia</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1 #af2"><personName><givenNames>Sang Soo</givenNames><familyName>Cho</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1 #af2"><personName><givenNames>Thilo</givenNames><familyName>van Eimeren</familyName><degrees>MD, PhD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Giorgio</givenNames><familyName>Marotta</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Chiara</givenNames><familyName>Siri</familyName><degrees>PsyD</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af1 #af2"><personName><givenNames>Ji Hyun</givenNames><familyName>Ko</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au7" creatorRole="author" affiliationRef="#af1 #af2"><personName><givenNames>Giovanna</givenNames><familyName>Pellecchia</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au8" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Gianni</givenNames><familyName>Pezzoli</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au9" creatorRole="author" affiliationRef="#af3 #af5"><personName><givenNames>Angelo</givenNames><familyName>Antonini</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au10" creatorRole="author" affiliationRef="#af1 #af2" corresponding="yes"><personName><givenNames>Antonio P.</givenNames><familyName>Strafella</familyName><degrees>MD, PhD, FRCPC</degrees></personName><contactDetails><email>antonio.strafella@uhnres.utoronto.ca</email><email>antonio.strafella@camhpet.ca</email></contactDetails></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="CA" type="organization"><unparsedAffiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="CA" type="organization"><unparsedAffiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="IT" type="organization"><unparsedAffiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="IT" type="organization"><unparsedAffiliation>Nuclear Medicine Department, IRCCS‐OSpedale Maggiore, Milan, Italy</unparsedAffiliation></affiliation><affiliation xml:id="af5" countryCode="IT" type="organization"><unparsedAffiliation>Institute of Neurology, IRCCS San Camillo Venice, University of Padua, Padua, Italy</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">Parkinson's disease</keyword><keyword xml:id="kwd2">pathological gambling</keyword><keyword xml:id="kwd3">SPECT</keyword><keyword xml:id="kwd4">effective connectivity</keyword><keyword xml:id="kwd5">SPM</keyword></keywordGroup><supportingInformation><supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:08853185:media:mds23480:MDS_23480_sm_authorroles"></mediaResource><caption>Author Roles and Disclosures</caption></supportingInfoItem></supportingInformation><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><section xml:id="abs1-1"><title type="main">Background:</title><p>Pathological gambling may occur in Parkinson's disease (PD) as a complication of dopaminergic therapy. Neuroimaging studies have suggested an abnormal dopamine transmission within the reward system, but the changes in the neural network characterizing PD patients with pathological gambling have never been investigated.</p></section><section xml:id="abs1-2"><title type="main">Methods:</title><p>Thirty PD patients (15 with active gambling and 15 matched controls, on‐medication) and 15 healthy subjects underwent brain perfusion single photon emission tomography at rest. The severity of gambling was assessed using the South Oaks Gambling Scale. Covariance analysis was applied to identify brain regions whose activity was associated with gambling severity. These regions were used as volume‐of‐interest to identify functionally interconnected areas using voxel‐wise covariance analysis. A path model was defined by means of effective connectivity analysis within the Structural Equation Modeling framework.</p></section><section xml:id="abs1-3"><title type="main">Results:</title><p>Gambling severity in PD was associated with a dysfunction of the brain network implicated in decision making, risk processing, and response inhibition, including the ventrolateral prefrontal cortex, anterior (ACC) and posterior cingulate cortex, medial prefrontal cortex, insula and striatum. PD gamblers showed a disconnection between the ACC and the striatum, while this interaction was very robust in both control groups.</p></section><section xml:id="abs1-4"><title type="main">Discussion:</title><p>ACC‐striatal disconnection may underlie a specific impairment of shifting behaviors after negative outcomes, possibly explaining why PD gamblers use to perseverate into risktaking behaviors despite self‐destructive consequences. © 2011 Movement Disorder Society</p></section></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p><b>Relevant conflicts of interest/financial disclosures:</b> Nothing to report. Full financial disclosures and author roles can be found in the online version of this article.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Pathological gambling in patients with Parkinson's disease is associated with fronto‐striatal disconnection: A path modeling analysis</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Neural Correlates of Pathological Gambling in PD</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Pathological gambling in patients with Parkinson's disease is associated with fronto‐striatal disconnection: A path modeling analysis</title></titleInfo><name type="personal"><namePart type="given">Roberto</namePart><namePart type="family">Cilia</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sang Soo</namePart><namePart type="family">Cho</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thilo</namePart><namePart type="family">van Eimeren</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Giorgio</namePart><namePart type="family">Marotta</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Nuclear Medicine Department, IRCCS‐OSpedale Maggiore, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chiara</namePart><namePart type="family">Siri</namePart><namePart type="termsOfAddress">PsyD</namePart><affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Ji Hyun</namePart><namePart type="family">Ko</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Giovanna</namePart><namePart type="family">Pellecchia</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gianni</namePart><namePart type="family">Pezzoli</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Angelo</namePart><namePart type="family">Antonini</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Parkinson Institute, Department of Neurology, Istituti Clinici di Perfezionamento, Milan, Italy</affiliation><affiliation>Institute of Neurology, IRCCS San Camillo Venice, University of Padua, Padua, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Antonio P.</namePart><namePart type="family">Strafella</namePart><namePart type="termsOfAddress">MD, PhD, FRCPC</namePart><affiliation>Division of Brain, Imaging and Behaviorur‐Systems Neuroscience, Toronto Western Research Institute and Hospital, UHN, University of Toronto, Toronto, Ontario, Canada</affiliation><affiliation>PET Imaging Centre, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada</affiliation><description>Correspondence: Toronto Western Hospital and Institute, UHN, CAMH‐PET Imaging Centre, University of Toronto, Toronto, ON, Canada</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2011-02-01</dateIssued><dateCaptured encoding="w3cdtf">2010-02-24</dateCaptured><dateValid encoding="w3cdtf">2010-09-20</dateValid><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">4</extent><extent unit="tables">2</extent><extent unit="references">67</extent><extent unit="words">6191</extent></physicalDescription><abstract lang="en">Background:: Pathological gambling may occur in Parkinson's disease (PD) as a complication of dopaminergic therapy. Neuroimaging studies have suggested an abnormal dopamine transmission within the reward system, but the changes in the neural network characterizing PD patients with pathological gambling have never been investigated. Methods:: Thirty PD patients (15 with active gambling and 15 matched controls, on‐medication) and 15 healthy subjects underwent brain perfusion single photon emission tomography at rest. The severity of gambling was assessed using the South Oaks Gambling Scale. Covariance analysis was applied to identify brain regions whose activity was associated with gambling severity. These regions were used as volume‐of‐interest to identify functionally interconnected areas using voxel‐wise covariance analysis. A path model was defined by means of effective connectivity analysis within the Structural Equation Modeling framework. Results:: Gambling severity in PD was associated with a dysfunction of the brain network implicated in decision making, risk processing, and response inhibition, including the ventrolateral prefrontal cortex, anterior (ACC) and posterior cingulate cortex, medial prefrontal cortex, insula and striatum. PD gamblers showed a disconnection between the ACC and the striatum, while this interaction was very robust in both control groups. Discussion:: ACC‐striatal disconnection may underlie a specific impairment of shifting behaviors after negative outcomes, possibly explaining why PD gamblers use to perseverate into risktaking behaviors despite self‐destructive consequences. © 2011 Movement Disorder Society</abstract><note type="additional physical form">Author Roles and Disclosures</note><note type="content">*Relevant conflicts of interest/financial disclosures: Nothing to report. Full financial disclosures and author roles can be found in the online version of this article.</note><subject lang="en"><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>pathological gambling</topic><topic>SPECT</topic><topic>effective connectivity</topic><topic>SPM</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><genre type="Journal">journal</genre><subject><genre>article category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>26</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>225</start><end>233</end><total>9</total></extent></part></relatedItem><identifier type="istex">989B859FEEE651B1B0AC5F763254C422B0CA3649</identifier><identifier type="DOI">10.1002/mds.23480</identifier><identifier type="ArticleID">MDS23480</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2011 Movement Disorder Society</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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