Epileptic Disorders

, Volume 14, Issue 4, pp 349–362 | Cite as

Photosensitivity: epidemiology, genetics, clinical manifestations, assessment, and management

  • Alberto Verrotti
  • Francesca Beccaria
  • Federica Fiori
  • Alessandra Montagnini
  • Giuseppe Capovilla
Review article with video sequences
  • 308 Downloads

Abstract

Photosensitivity is a genetically determined trait that may be asymptomatic throughout life or manifest with epileptic seizures. Photosensitivity usually begins before the age of 20 years with a peak age at onset at around 12. Both natural and artificial light may trigger seizures. Precise investigation must be carried out by intermittent photic stimulation that can elicit a clearly defined EEG response; video-EEG samples are reported to illustrate the various determinants of response and the main factors altering the effectiveness of intermittent photic stimulation. Management of photosensitive epilepsy includes non-pharmacological (e.g. avoidance of the provocative stimuli and wearing appropriate tinted glass) and pharmacological treatment. This review focuses on the emerging aspects of photosensitivity, in particular, the new guidelines for intermittent photic stimulation and briefly addresses epidemiological (in non-epileptic and epileptic subjects), genetic, diagnostic, and therapeutic issues.

Keywords

photosensitivity photoparoxysmal response epileptic genetic diagnosis treatment 

References

  1. Anyanwu EC, Ehiri JE, Jones J. Photosensitive epilepsy beyond adolescence: is freedom from photosensitivity agedependent? Int J Adolesc Med Health 2003; 15: 125–132.PubMedCrossRefGoogle Scholar
  2. Appleton R, Beirne M, Acomb B. Photosensitivity in juvenile myoclonic epilepsy. Seizure 2000; 9: 108–111.PubMedCrossRefGoogle Scholar
  3. Aso K, Watanabe K, Negoro T, et al. Photosensitivity epilepsy in children. Seizure 1994; 3: 67–71.PubMedCrossRefGoogle Scholar
  4. Binnie CD, Jeavons PM. Photosensitive epilepsies. In: Roger J, Bureau M, Dravet C, et al. Epileptic syndromes in infancy, childhood and adolescence. London: John Libbey, 1992: 299–305.Google Scholar
  5. Binnie CD, Kasteleijn-Nolst Trenité DG, De Korte R. Photosensitivity as a model for acute antiepileptic drugs studies. Electroencephalogr Clin Neurophysiol 1986; 63: 35–41.PubMedCrossRefGoogle Scholar
  6. Brinciotti M, Matricardi M, Pelliccia A, Trasatti G. Pattern sensitivity and photosensitivity in epileptic children with visually induced seizures. Epilepsia 1994; 35: 842–849.PubMedCrossRefGoogle Scholar
  7. Bruni J, Wilder BJ, Bauman AW, Willmore LJ. Clinical efficacy and long- term effects of valproic acid therapy on spikes and waves discharge. Neurology 1980; 30: 42–46.PubMedCrossRefGoogle Scholar
  8. Capovilla G, Dalla Bernardina B. Suppressive effect upon photoparoxysmal response using experimental blue sunglasses in pediatric age. Boll Lega It Epil 1994; 87–88: 439–440.Google Scholar
  9. Capovilla G, Beccaria F, Romeo A, Veggiotti P, Canger R, Paladin F. Effectiveness of a particular blue lens on photoparoxysmal response in photosensitive epileptic patients. Ital J Neurol Sci 1999; 20: 161–166.PubMedCrossRefGoogle Scholar
  10. Capovilla G, Gambardella A, Rubboli G, et al. Suppressive efficacy by a commercially available blue lens on PPR in 610 photosensitive epilepsy patients. Epilepsia 2006; 47: 529–533.PubMedCrossRefGoogle Scholar
  11. Capovilla G, Beccaria F, Gambardella A, Montagnini A, Avantaggiato P, Seri S. Photosensitive benign myoclonic epilepsy in infancy. Epilepsia 2007; 48: 96–100.PubMedCrossRefGoogle Scholar
  12. Capovilla G, Striano P, Gambardella A, et al. Eyelid fluttering, typical EEG pattern, and impaired intellectual function: a homogeneous epileptic condition among the patients presenting with eyelid myoclonia. Epilepsia 2009; 50: 1536–1541.PubMedCrossRefGoogle Scholar
  13. Clement MJ, Wallace SJ. A survey of adolescents with epilepsy. Dev Med Child Neurol 1990; 32: 849–857.PubMedCrossRefGoogle Scholar
  14. Covanis A. Photosensitivity in idiopathic generalized epilepsies. Epilepsia 2005; 9: 67–72.CrossRefGoogle Scholar
  15. Covanis A, Stodieck SRG, Wilkins AJ. Treatment of photosensitivity. Epilepsia 2004; 45: 40–45.PubMedCrossRefGoogle Scholar
  16. Davidson S, Watson CW. Hereditary light sensitive epilepsy. Neurology 1956; 6: 235–261.PubMedCrossRefGoogle Scholar
  17. De Bittencourt PR. Photosensitivity: the magnitude of the problem. Epilepsia 2004; 45: 30–34.PubMedCrossRefGoogle Scholar
  18. De Kovel CGF, Pinto D, Tauerm U, et al. Whole-genome linkage scan for epilepsy-related photosensitivity: a megaanalysis. Epilepsy Res 2010; 89: 286–294.PubMedCrossRefGoogle Scholar
  19. Doose H, Gerken H. On the genetics of EEG anomalies in childhood, IV: photo-convulsive reaction. Neuropadiatrie 1973; 4: 162–171.PubMedCrossRefGoogle Scholar
  20. Doose H, Waltz ST. Photosensitivity: genetics and clinical significance. Neuropediatrics 1993; 24: 249–255.PubMedCrossRefGoogle Scholar
  21. Doose H, Gerken H, Hien-Volpel KF, Volzke E. Genetics of photosensitive epilepsy. Neuropadiatrie 1969; 1: 56–73.PubMedCrossRefGoogle Scholar
  22. Driver MV, Mac Gillivray BB. Electroencephalography. In: Laidlaw J, Richens A. Textbook of epilepsy, 1st ed. Edinburgh; London; New York: Churchill Livingstone, 1976: 109–144.Google Scholar
  23. Etemadifar M, Raoufi M, Maghzi AH, et al. Televisionprovoked epilepsy in children: a follow-up survey from Isfahan, Iran. Arch Iranian Med 2008; 11: 649–653.Google Scholar
  24. Familusi JB, Adamolekun B, Olayinka BA, Muzengi D, Levy LF. Electroencephalographic photosensitivity among Zimbabwean youths. Ann Trop Paediatr 1998; 18: 267–274.PubMedGoogle Scholar
  25. Ferrie CD, De Marco P, Grunewald RA, et al. Video game induced seizures. J Neurol Neurosurg Psychiatry 1994; 57: 925–931.PubMedCrossRefGoogle Scholar
  26. Fiore LA, Valente K, Gronich G, Ono CR, Buchpiguel CA. Mesial temporal lobe epilepsy with focal photoparoxysmal response. Epileptic Disord 2003; 5: 39–43.PubMedGoogle Scholar
  27. Funatsuka M, Fujita M, Shirakawa S, Oguni H, Osawa M. Analysis of photo-pattern sensitivity in patients with Pokemon-related symptoms. Pediatr Neurol 2003; 28: 28–36.PubMedCrossRefGoogle Scholar
  28. Furusho J, Suzuki M, Tazaki I, et al. A comparison survey of seizures and other symptoms of Pokemon phenomenon. Pediatr Neurol 2002; 27: 350–355.PubMedCrossRefGoogle Scholar
  29. Fylan F, Edson AS, Harding GF. Clinical significance of EEG abnormalities during photic stimulation in patients with photosensitive epilepsy. Epilepsia 1999; 40: 370–372.PubMedCrossRefGoogle Scholar
  30. Gowers WR. Epilepsy and other chronic convulsive diseases. Their causes, symptoms and treatment. New York: Wood and Co, 1885.Google Scholar
  31. Graf WD, Chatrian GE, Glass ST, et al. Video game-related seizures: a report on 10 patients and a review of the literature. Pediatrics 1994; 93: 551–556.PubMedGoogle Scholar
  32. Greenberg DA, Pal DK. The state of the art in the genetic analysis of the epilepsies. Curr Neurol Neurosci Rep 2007; 7: 320–328.PubMedCrossRefGoogle Scholar
  33. Gregory RP, Oates T, Merry RTG. Electroencephalogram epileptiform abnormalities and candidates for aircrew training. Electroenceph Clin Neurophysiol 1993; 86: 75–77.PubMedCrossRefGoogle Scholar
  34. Grosso S, Pucci L, Bartalini G, et al. Photoparoxysmal responses in children with chromosomal aberrations. Epilepsy Res 2006; 72: 164–170.PubMedCrossRefGoogle Scholar
  35. Guerrini R, Genton P. Epileptic syndromes and visually induced seizures. Epilepsia 2004; 45: 14–18.PubMedCrossRefGoogle Scholar
  36. Harding GF. TV can be bad for your health. Nat Med 1998; 4: 265–267.PubMedCrossRefGoogle Scholar
  37. Harding GFA, Jeavons PM. Photosensitive epilepsy. London: MacKeith Press, 1994.Google Scholar
  38. Harding GF, Herrick CE, Jeavons PM. A controlled study of the effect of sodium valproate on photosensitivity epilepsy and its prognosis. Epilepsia 1978; 19: 555–565.PubMedCrossRefGoogle Scholar
  39. Harding GF, Edson A, Jeavons PM. Persistence of photosensitivity. Epilepsia 1997; 38: 663–669.PubMedCrossRefGoogle Scholar
  40. Hendriksen IJ, Elderson A. Theuse of EEG in aircrew selection. Aviat Space Environ Med 2001; 72: 1025–1033.PubMedGoogle Scholar
  41. Hennessy MJ, Binnie CD. Photogenic partial seizures. Epilepsia 2000; 41: 59–64.PubMedCrossRefGoogle Scholar
  42. Herrlin KM. Epilepsy, light-sensitivity and left-handedness in a family with monozygotic triplets. Pediatrics 1960; 25: 385–399.PubMedGoogle Scholar
  43. Iinuma K. TV-animation induced seizures. Acta Paediatr Jpn 1998; 40: 624–625.PubMedCrossRefGoogle Scholar
  44. Ishida S, Yamashita Y, Matsuishi T, et al. Photosensitive seizures provoked while viewing “Pocket Monsters”, a made-for-television animation program in Japan. Epilepsia 1998; 39: 1340–1344.PubMedCrossRefGoogle Scholar
  45. Jeavons PM, Bishop A, Harding GF. The prognosis of photosensitivity. Epilepsia 1986; 27: 569–575.PubMedCrossRefGoogle Scholar
  46. Kasteleijn-Nolst Trenité DGA. Photosensitivity in epilepsy: electrophysiological and clinical correlates. Acta Neurol Scand 1989; 80: 1–150.Google Scholar
  47. Kasteleijn-Nolst Trenité DGA. Photosensitivity, visually sensitive seizures and epilepsies. Epilepsy Res 2006; 70S: 269–279.Google Scholar
  48. Kasteleijn-Nolst Trenité DGA, Marescaux C, Stodieck S, Edelbroek PM, Oosting J. Photosensitive epilepsy: a model to study the effects of antiepileptic drugs. Evaluation of the piracetam analogue, levetiracetam. Epilepsy Res 1996; 25: 225–230.PubMedCrossRefGoogle Scholar
  49. Kasteleijn-Nolst Trenité DGA, Binnie CD, Harding GFA, Wilkins A. Photic stimulation: standardization of screening methods. Epilepsia 1999; 40: 75–79.PubMedCrossRefGoogle Scholar
  50. Kasteleijn-Nolst Trenité DG, Silva LCB, Manreza MLG. Prevalence of photoparoxysmal EEG responses in normal children and adolescents in Teofile Otoni, Brazil: 2001–2002. Epilepsia 2003; 44: 48.CrossRefGoogle Scholar
  51. Kasteleijn-Nolst Trenité DG, Van Der Beld G, Heynderickx I, Groen P. Visual stimuli in daily life. Epilepsia 2004; 45: 2–6.PubMedCrossRefGoogle Scholar
  52. Kasteleijn-Nolst Trenité DG, Pinto D, Hirsch E, Takahashi T. Photosensitivity, visually induced seizures and epileptic syndromes. In: Roger J, Bureau M, Dravet C, Genton P, Tassinari CA, Wolf P. Epileptic syndromes in infancy, childhood and adolescence. 4th ed. Eastleigh: John Libbey, 2005: 395–420.Google Scholar
  53. Kasteleijn-Nolst Trenité DG, Rubboli G, Hirsh E, et al. Methodology of photic stimulation revisited. Updated European algorithm for visual stimulation in the EEG laboratory. Epilepsia 2012; 53: 16–24.PubMedCrossRefGoogle Scholar
  54. Kerson TS, Kerson LA. Implacable images: why epileptiform events continue tobefeatured infilmandtelevision. Epileptic Disord 2006; 8: 103–113.PubMedGoogle Scholar
  55. Kooi KA, Thomas MH, Morteson FN. Photoconvulsive and photomyoclonic responses in adults. Neurology 1960; 10: 1051–1058.PubMedCrossRefGoogle Scholar
  56. Livingston S. Comments on the study of light-induced epilepsy in children. Am J Dis Child 1952; 83: 409.Google Scholar
  57. Lu Y, Waltz S, Stenzel K, Muhle H, Stephani U. Photosensitivity in epileptic syndromes of childhood and adolescence. Epileptic Disord 2008; 10: 136–143. doi: 10.1684/epd.2008.0183.PubMedGoogle Scholar
  58. Nagarajan L, Kulkarni A, Palumbo-Clark L, et al. Photoparoxysmal responses in children: their characteristics and clinical correlates. Pediatr Neurol 2003; 29: 222–226.PubMedCrossRefGoogle Scholar
  59. Naquet R. Photic epilepsy problems raised in man and animals. Ital J Neurol Sci 1987; 8: 437–447.PubMedCrossRefGoogle Scholar
  60. Neubauer BA, Waltz S, Grothe M, et al. Photosensitivity: genetics and clinical significance. Adv Neurol 2005; 95: 217–226.PubMedGoogle Scholar
  61. Newmark ME, Kiffin Penry J. Photosensitivity and epilepsy: a review. New York: Raven Press, 1979.Google Scholar
  62. Panayiotopoulos CP. Photosensitive seizures and epileptic syndromes. In: Panayotopoulos CP. The Epilepsies: seizures, syndromes and management. Chipping Norton (Oxfordshire, UK): Bladon Medical Publishing, 2005: 452–469.Google Scholar
  63. Papatheophilou R, Turland DN. The electroencephalogram of normal adolescent males: visual assessment and relationship with other variables. Dev Med Child Neurol 1976; 18: 603–619.PubMedCrossRefGoogle Scholar
  64. Parra J, Stiliyan N, Kalitzin H, Fernando H, Da Silva L. Photosensitivity and visually induced seizures. Curr Opin Neurol 2005; 18: 155–159.PubMedCrossRefGoogle Scholar
  65. Patry G, Naquet R. Action of dipropylacetic acid upon photosensitive Papio papio. Can J Physiol Pharmacol 1971; 49: 568–572.PubMedCrossRefGoogle Scholar
  66. Petrukhin AS, Mukhin KIU, Kolpachki LM, Glyzova KI, Volchenkova MM. Television epilepsy. ZhNevrol Psikhiatr Im S S Korsakova 1997; 97: 13–16.Google Scholar
  67. Pinto D, Westland B, De Haan GJ, et al. Genome wide-linkage scan of epilepsy-related photoparoxysmal electroencephalographic response: evidence for linkage on chromosomes 7q32 and 16p13. Hum Mol Genet 2005; 14: 171–178.PubMedCrossRefGoogle Scholar
  68. Quirk JA, Fish DR, Smith SJ, Sander JW, Shorvon SD, Allen PJ. Incidence of photosensitive epilepsy: a prospective national study. Electroenceph Clin Neurophysiol 1995; 95: 260–267.PubMedCrossRefGoogle Scholar
  69. Radhakrishnan K, St Louis EK, Johnson JA, McClelland RL, Westmoreland BF, Klass DW. Pattern -sensitive epilepsy: electroclinical characteristics, natural history, and delineation of epileptic syndrome. Epilepsia 2005; 46: 48–58.PubMedCrossRefGoogle Scholar
  70. Richens A, Yuen AW. Overview of the clinical efficacy of lamotrigine. Epilepsia 1991; 32: 13–16.CrossRefGoogle Scholar
  71. Rimmer EM, Milligan MN, Richens A. A comparison of the acute effect of single doses of vigabatrin and sodium valproate on photosensitivity in epileptic patients. Epilepsy Res 1987; 1: 339–346.PubMedCrossRefGoogle Scholar
  72. Roy AK, Pinheiro L, Rajesh SV. Prevalence of photosensitivity: an Indian experience. Neurol India 2003; 51: 241–243.PubMedGoogle Scholar
  73. Rubboli G, Parra J, Seri S, Takahashi T, Thomas P. EEG diagnostic procedures and special investigations in the assessment of photosensitivity. Epilepsia 2004; 45: 35–39.PubMedCrossRefGoogle Scholar
  74. Shiraishi H, Fujiwara T, Inoue Y, Yagi K. Photosensitivity in relation to epileptic syndromes: a survey from an epilepsy center in Japan. Epilepsia 2001; 42: 393–397.PubMedCrossRefGoogle Scholar
  75. Silva-Barrat C, Menini C, Naquet R. Brainstem involvement in paroxysmal discharges and in photosensitive seizures of the Papio papio baboon. Electroenceph Clin Neurophysiol 1986; 64: 455–468.PubMedCrossRefGoogle Scholar
  76. So EL, Ruggles KH, Ahmann PA, Olson KA. Prognosis of photoparoxysmal response in non-epileptic patients. Neurology 1993; 43: 1719–1722.PubMedCrossRefGoogle Scholar
  77. Stephani U, Tauer U, Koeleman B, et al. Genetics of photosensitivity (photoparoxysmal response): a review. Epilepsia 2004; 45: 19–23.PubMedCrossRefGoogle Scholar
  78. Striano P, Coppola A, Pezzella M, et al. An open-label trial of levetiracetam in severe myoclonic epilepsy of infancy. Neurology 2007; 69: 250–254.PubMedCrossRefGoogle Scholar
  79. Striano S, Capovilla G, Sofia V, et al. Eyelid myoclonia with absences (Jeavons syndrome): a well-defined idiopathic generalized epilepsy syndrome or a spectrum of photosensitive conditions? Epilepsia 2009; 50Suppl 5: 15–19.PubMedCrossRefGoogle Scholar
  80. Takada H, Aso K, Watanabe K, Okumura A, Negoro T, Ishikawa T. Epileptic seizures induced by animated cartoon, “Pocket Monster”. Epilepsia 1999; 40: 997–1002.PubMedCrossRefGoogle Scholar
  81. Takahashi T, Tsukahara Y. Influence of colour on the photoconvulsive response. Electroenceph Clin Neurophysiol 1976; 41: 124–136.PubMedCrossRefGoogle Scholar
  82. Takahashi T, Tsukahara Y. Usefullness of blue sunglasses in photosensitive epilepsy. Epilepsia 1992; 33: 517–521.PubMedCrossRefGoogle Scholar
  83. Takahashi T, Tsukahara Y. Pocket Monster incident and low luminance visual stimuli: special reference to deep red flicker stimulation. Acta Paediatr Jpn 1998; 40: 631–637.PubMedCrossRefGoogle Scholar
  84. Takahashi T, Tsukahara Y, Nomura M, Matsuoka H. Pokemon seizures. Neurol J Southeast Asia 1999a; 4: 1–11.Google Scholar
  85. Takahashi Y, Fujiwara T, Yagi K, Seino M. Photosensitive epilepsies and pathophysiologic mechanisms of the photoparoxysmal response. Neurology 1999b; 53: 926–932.PubMedCrossRefGoogle Scholar
  86. Takahashi Y, Sato T, Goto K, et al. Optical filters inhibiting television-induced seizures. Neurology 2001; 57: 1767–1773.PubMedCrossRefGoogle Scholar
  87. Tassinari CA, Rubboli G, Plasmati R, et al. Television-induced epilepsy with occipital seizures. A variety of idiopathic partial seizures. In: Beaumanoir A, Gastaut H, Naquet R. Reflex seizures and reflex epilepsies. Geneva: Mèdecine et Hygiène, 1988: 241–243.Google Scholar
  88. Tauer U, Lorenz S, Lenzen KH, et al. Genetic dissection of photosensitivity and its relation to idiopathic generalized epilepsy. Ann Neurol 2005; 57: 866–873.PubMedCrossRefGoogle Scholar
  89. Taylor I, Hodgson B, Scheffer IE, Mulley J, Berkovic SF, Dibbens L. Is photosensitive epilepsy less common in males due to variation in X chromosome photopigment genes? Epilepsia 2007; 48: 1807–1809.PubMedCrossRefGoogle Scholar
  90. Trenité DG, French JA, Hirsch E, et al. Evaluation of carisbamate, a novel antiepileptic drug in photosensitive patients: an exploratory, placebo-controlled study. Epilepsy Res 2007; 74: 193–200.PubMedCrossRefGoogle Scholar
  91. Trojaborg W. EEG abnormalities in 5,893 jet pilot applicants registered in a 20-year period. Clin Electroenceph 1992; 23: 72–78.Google Scholar
  92. Van Esch H, Syrrou M, Lagae L. Refractory photosensitive epilepsy associated with a complex rearrangement of chromosome 2. Neuropediatrics 2002; 33: 320–323.PubMedCrossRefGoogle Scholar
  93. Verrotti A, Basciani F, Trotta D, et al. Photoparoxysmal responses in non-epileptic children in long-term follow-up. Acta Neurol Scand 2002; 105: 400–402.PubMedCrossRefGoogle Scholar
  94. Verrotti A, Trotta D, Salladini C, et al. Photosensitivity and epilepsy: a follow-up study. Dev Med Child Neurol 2004; 46: 347–351.PubMedCrossRefGoogle Scholar
  95. Verrotti A, Tocco AM, Salladini C, Latini C, Chiarelli F. Human photosensitivity: from pathophysiology to treatment. Eur J Neurol 2005; 12: 828–841.PubMedCrossRefGoogle Scholar
  96. Verrotti A, Fiori F, Coppola G, Franzoni E, Parisi P, Chiarelli F. Idiopathic generalized tonic-clonic epilepsy and photosensitivity: a long-term follow-up study. Acta Paediatr 2009; 98: 1999–2001.PubMedCrossRefGoogle Scholar
  97. Von Spiczak S, Muhle H, Helbig I, et al. Association study of TRPC4 as a candidate gene for generalized epilepsy with photosensitivity. Neuromolecular Med 2010; 12: 292–299.CrossRefGoogle Scholar
  98. Waltz S, Stephani U. Inheritance of photosensitivity. Neuropediatrics 2000; 31: 82–85.PubMedCrossRefGoogle Scholar
  99. Waltz S, Beck-Managetta G, Janz D. Are there syndromerelated spike and wave patterns in generalized epilepsy? Epilepsia 1990; 31: 819.Google Scholar
  100. Waltz S, Christen HJ, Doose H. The different patterns of the photoparoxysmal response: a genetic study. Electroenceph Clin Neurophysiol 1992; 83: 138–145.PubMedCrossRefGoogle Scholar
  101. Waltz S, Christen HJ, Doose H. The EEG in juvenilemyoclonic epilepsy. In: Schmitz B, Sander Hrsg T. The Janz syndrome: juvenilemyoclonic epilepsy. Petersfield: Wrightson Biomedical, 2000: 47–54.Google Scholar
  102. William DG, Gian-Emilio C, Stephen TG. Video game-related seizures: a report on 10 patients and a review of the literature. Pediatrics 1994; 93: 551–556.Google Scholar
  103. Wolf P, Goosses R. Relation of photosensitivity to epileptic syndromes. J Neurol Neurosurg Psychiatry 1986; 49: 1386–1391.PubMedCrossRefGoogle Scholar
  104. Zifkin BG, Kasteleijn-Nolst Trenité DGA. Reflex epilepsy and reflex seizure of the visual system: a clinical review. Epileptic Disord 2000; 2: 129–136.PubMedGoogle Scholar

Copyright information

© John Libbey Eurotext and Springer-Verlag France 2012

Authors and Affiliations

  • Alberto Verrotti
    • 1
  • Francesca Beccaria
    • 2
  • Federica Fiori
    • 1
  • Alessandra Montagnini
    • 2
  • Giuseppe Capovilla
    • 2
    • 3
  1. 1.Department of PaediatricsUniversity of ChietiChietiItaly
  2. 2.Epilepsy Centre, Department of Child NeuropsychiatryC Poma HospitalMantovaItaly
  3. 3.Giuseppe Capovilla Epilepsy Centre, Dept of Child NeuropsychiatryC Poma HospitalMantovaItaly

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