Loading…
EEG Features in Autism Spectrum Disorder: A Retrospective Analysis in a Cohort of Preschool Children
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that can be associated with intellectual disability (ID) and epilepsy (E). The etiology and the pathogenesis of this disorder is in most cases still to be clarified. Several studies have underlined that the EEG recordings in chi...
Saved in:
Published in: | Brain sciences 2023-02, Vol.13 (2), p.345 |
---|---|
Main Authors: | , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
cited_by | cdi_FETCH-LOGICAL-c557t-1e49f94cc9c606dfbe43b221d164a344c49e683941b9112a64f21e2d59edffe53 |
---|---|
cites | cdi_FETCH-LOGICAL-c557t-1e49f94cc9c606dfbe43b221d164a344c49e683941b9112a64f21e2d59edffe53 |
container_end_page | |
container_issue | 2 |
container_start_page | 345 |
container_title | Brain sciences |
container_volume | 13 |
creator | Santarone, Marta Elena Zambrano, Stefania Zanotta, Nicoletta Mani, Elisa Minghetti, Sara Pozzi, Marco Villa, Laura Molteni, Massimo Zucca, Claudio |
description | Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that can be associated with intellectual disability (ID) and epilepsy (E). The etiology and the pathogenesis of this disorder is in most cases still to be clarified. Several studies have underlined that the EEG recordings in children with these clinical pictures are abnormal, however the precise frequency of these abnormalities and their relationship with the pathogenic mechanisms and in particular with epileptic seizures are still unknown. We retrospectively reviewed 292 routine polysomnographic EEG tracings of preschool children (age < 6 years) who had received a first multidisciplinary diagnosis of ASD according to DSM-5 clinical criteria. Children (mean age: 34.6 months) were diagnosed at IRCCS E. Medea (Bosisio Parini, Italy). We evaluated: the background activity during wakefulness and sleep, the presence and the characteristics (focal or diffuse) of the slow-waves abnormalities and the interictal epileptiform discharges. In 78.0% of cases the EEG recordings were found to be abnormal, particularly during sleep. Paroxysmal slowing and epileptiform abnormalities were found in the 28.4% of the subjects, confirming the high percentage of abnormal polysomnographic EEG recordings in children with ASD. These alterations seem to be more correlated with the characteristics of the underlying pathology than with intellectual disability and epilepsy. In particular, we underline the possible significance of the prevalence of EEG abnormalities during sleep. Moreover, we analyzed the possibility that EEG data reduces the ASD clinical heterogeneity and suggests the exams to be carried out to clarify the etiology of the disorder. |
doi_str_mv | 10.3390/brainsci13020345 |
format | article |
fullrecord | <record><control><sourceid>gale_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_760b0b2b1cd949b0afe892e42519520c</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A751914049</galeid><doaj_id>oai_doaj_org_article_760b0b2b1cd949b0afe892e42519520c</doaj_id><sourcerecordid>A751914049</sourcerecordid><originalsourceid>FETCH-LOGICAL-c557t-1e49f94cc9c606dfbe43b221d164a344c49e683941b9112a64f21e2d59edffe53</originalsourceid><addsrcrecordid>eNptUk1r3DAQNaWlCWnuPRVBL71sok_b6qFgNps0EGjpx1nI0mhXi21tJTuQf185mybZUOkgMfPe05vRFMV7gs8Yk_i8jdoPyXjCMMWMi1fFMcVVuWCcitfP7kfFaUpbnFeNMRP4bXHEypqRupbHhV2trtAl6HGKkJAfUDONPvXo5w7MGKceXfgUooX4GTXoB4wxpDnjbwE1g-7ukr9nabQMmxBHFBz6npXMJoQOLTe-sxGGd8Ubp7sEpw_nSfH7cvVr-XVx8-3qetncLIwQ1bggwKWT3BhpSlxa1wJnLaXEkpJrxrnhErJxyUkrCaG65I4SoFZIsM6BYCfF9V7XBr1Vu-h7He9U0F7dB0JcKx1HbzpQVYlb3NKWGCu5bLF2UEsKuV1ECopN1vqy19pNbQ_WwDBG3R2IHmYGv1HrcKukFJyXLAt8ehCI4c8EaVS9Twa6Tg8QpqRolb-jonU5-_74AroNU8ztnVFV9iOqmj6h1joX4AcX8rtmFlVNlW0TjrnMqLP_oPK20HsTBnA-xw8IeE8w-W9TBPdYI8FqHjT1ctAy5cPz3jwS_o0V-wvr084F</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2779525782</pqid></control><display><type>article</type><title>EEG Features in Autism Spectrum Disorder: A Retrospective Analysis in a Cohort of Preschool Children</title><source>NCBI_PubMed Central(免费)</source><source>Publicly Available Content Database</source><creator>Santarone, Marta Elena ; Zambrano, Stefania ; Zanotta, Nicoletta ; Mani, Elisa ; Minghetti, Sara ; Pozzi, Marco ; Villa, Laura ; Molteni, Massimo ; Zucca, Claudio</creator><creatorcontrib>Santarone, Marta Elena ; Zambrano, Stefania ; Zanotta, Nicoletta ; Mani, Elisa ; Minghetti, Sara ; Pozzi, Marco ; Villa, Laura ; Molteni, Massimo ; Zucca, Claudio</creatorcontrib><description>Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that can be associated with intellectual disability (ID) and epilepsy (E). The etiology and the pathogenesis of this disorder is in most cases still to be clarified. Several studies have underlined that the EEG recordings in children with these clinical pictures are abnormal, however the precise frequency of these abnormalities and their relationship with the pathogenic mechanisms and in particular with epileptic seizures are still unknown. We retrospectively reviewed 292 routine polysomnographic EEG tracings of preschool children (age < 6 years) who had received a first multidisciplinary diagnosis of ASD according to DSM-5 clinical criteria. Children (mean age: 34.6 months) were diagnosed at IRCCS E. Medea (Bosisio Parini, Italy). We evaluated: the background activity during wakefulness and sleep, the presence and the characteristics (focal or diffuse) of the slow-waves abnormalities and the interictal epileptiform discharges. In 78.0% of cases the EEG recordings were found to be abnormal, particularly during sleep. Paroxysmal slowing and epileptiform abnormalities were found in the 28.4% of the subjects, confirming the high percentage of abnormal polysomnographic EEG recordings in children with ASD. These alterations seem to be more correlated with the characteristics of the underlying pathology than with intellectual disability and epilepsy. In particular, we underline the possible significance of the prevalence of EEG abnormalities during sleep. Moreover, we analyzed the possibility that EEG data reduces the ASD clinical heterogeneity and suggests the exams to be carried out to clarify the etiology of the disorder.</description><identifier>ISSN: 2076-3425</identifier><identifier>EISSN: 2076-3425</identifier><identifier>DOI: 10.3390/brainsci13020345</identifier><identifier>PMID: 36831889</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Age ; Analysis ; Autism ; Brain research ; Children ; Children & youth ; Clinical medicine ; Cognition & reasoning ; Cognitive ability ; Development and progression ; EEG ; Electroencephalography ; Epilepsy ; epileptiform abnormalities ; Etiology ; Firing pattern ; Intellectual disabilities ; Neurodevelopmental disorders ; Neurophysiology ; paroxysmal abnormalities ; Preschool children ; Seizures ; Sleep ; Sleep and wakefulness</subject><ispartof>Brain sciences, 2023-02, Vol.13 (2), p.345</ispartof><rights>COPYRIGHT 2023 MDPI AG</rights><rights>2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 by the authors. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c557t-1e49f94cc9c606dfbe43b221d164a344c49e683941b9112a64f21e2d59edffe53</citedby><cites>FETCH-LOGICAL-c557t-1e49f94cc9c606dfbe43b221d164a344c49e683941b9112a64f21e2d59edffe53</cites><orcidid>0000-0002-3800-5697 ; 0000-0001-7621-2542</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2779525782/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2779525782?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,25731,27901,27902,36989,36990,44566,53766,53768,74869</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36831889$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Santarone, Marta Elena</creatorcontrib><creatorcontrib>Zambrano, Stefania</creatorcontrib><creatorcontrib>Zanotta, Nicoletta</creatorcontrib><creatorcontrib>Mani, Elisa</creatorcontrib><creatorcontrib>Minghetti, Sara</creatorcontrib><creatorcontrib>Pozzi, Marco</creatorcontrib><creatorcontrib>Villa, Laura</creatorcontrib><creatorcontrib>Molteni, Massimo</creatorcontrib><creatorcontrib>Zucca, Claudio</creatorcontrib><title>EEG Features in Autism Spectrum Disorder: A Retrospective Analysis in a Cohort of Preschool Children</title><title>Brain sciences</title><addtitle>Brain Sci</addtitle><description>Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that can be associated with intellectual disability (ID) and epilepsy (E). The etiology and the pathogenesis of this disorder is in most cases still to be clarified. Several studies have underlined that the EEG recordings in children with these clinical pictures are abnormal, however the precise frequency of these abnormalities and their relationship with the pathogenic mechanisms and in particular with epileptic seizures are still unknown. We retrospectively reviewed 292 routine polysomnographic EEG tracings of preschool children (age < 6 years) who had received a first multidisciplinary diagnosis of ASD according to DSM-5 clinical criteria. Children (mean age: 34.6 months) were diagnosed at IRCCS E. Medea (Bosisio Parini, Italy). We evaluated: the background activity during wakefulness and sleep, the presence and the characteristics (focal or diffuse) of the slow-waves abnormalities and the interictal epileptiform discharges. In 78.0% of cases the EEG recordings were found to be abnormal, particularly during sleep. Paroxysmal slowing and epileptiform abnormalities were found in the 28.4% of the subjects, confirming the high percentage of abnormal polysomnographic EEG recordings in children with ASD. These alterations seem to be more correlated with the characteristics of the underlying pathology than with intellectual disability and epilepsy. In particular, we underline the possible significance of the prevalence of EEG abnormalities during sleep. Moreover, we analyzed the possibility that EEG data reduces the ASD clinical heterogeneity and suggests the exams to be carried out to clarify the etiology of the disorder.</description><subject>Age</subject><subject>Analysis</subject><subject>Autism</subject><subject>Brain research</subject><subject>Children</subject><subject>Children & youth</subject><subject>Clinical medicine</subject><subject>Cognition & reasoning</subject><subject>Cognitive ability</subject><subject>Development and progression</subject><subject>EEG</subject><subject>Electroencephalography</subject><subject>Epilepsy</subject><subject>epileptiform abnormalities</subject><subject>Etiology</subject><subject>Firing pattern</subject><subject>Intellectual disabilities</subject><subject>Neurodevelopmental disorders</subject><subject>Neurophysiology</subject><subject>paroxysmal abnormalities</subject><subject>Preschool children</subject><subject>Seizures</subject><subject>Sleep</subject><subject>Sleep and wakefulness</subject><issn>2076-3425</issn><issn>2076-3425</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptUk1r3DAQNaWlCWnuPRVBL71sok_b6qFgNps0EGjpx1nI0mhXi21tJTuQf185mybZUOkgMfPe05vRFMV7gs8Yk_i8jdoPyXjCMMWMi1fFMcVVuWCcitfP7kfFaUpbnFeNMRP4bXHEypqRupbHhV2trtAl6HGKkJAfUDONPvXo5w7MGKceXfgUooX4GTXoB4wxpDnjbwE1g-7ukr9nabQMmxBHFBz6npXMJoQOLTe-sxGGd8Ubp7sEpw_nSfH7cvVr-XVx8-3qetncLIwQ1bggwKWT3BhpSlxa1wJnLaXEkpJrxrnhErJxyUkrCaG65I4SoFZIsM6BYCfF9V7XBr1Vu-h7He9U0F7dB0JcKx1HbzpQVYlb3NKWGCu5bLF2UEsKuV1ECopN1vqy19pNbQ_WwDBG3R2IHmYGv1HrcKukFJyXLAt8ehCI4c8EaVS9Twa6Tg8QpqRolb-jonU5-_74AroNU8ztnVFV9iOqmj6h1joX4AcX8rtmFlVNlW0TjrnMqLP_oPK20HsTBnA-xw8IeE8w-W9TBPdYI8FqHjT1ctAy5cPz3jwS_o0V-wvr084F</recordid><startdate>20230201</startdate><enddate>20230201</enddate><creator>Santarone, Marta Elena</creator><creator>Zambrano, Stefania</creator><creator>Zanotta, Nicoletta</creator><creator>Mani, Elisa</creator><creator>Minghetti, Sara</creator><creator>Pozzi, Marco</creator><creator>Villa, Laura</creator><creator>Molteni, Massimo</creator><creator>Zucca, Claudio</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7XB</scope><scope>8FE</scope><scope>8FH</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>LK8</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-3800-5697</orcidid><orcidid>https://orcid.org/0000-0001-7621-2542</orcidid></search><sort><creationdate>20230201</creationdate><title>EEG Features in Autism Spectrum Disorder: A Retrospective Analysis in a Cohort of Preschool Children</title><author>Santarone, Marta Elena ; Zambrano, Stefania ; Zanotta, Nicoletta ; Mani, Elisa ; Minghetti, Sara ; Pozzi, Marco ; Villa, Laura ; Molteni, Massimo ; Zucca, Claudio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c557t-1e49f94cc9c606dfbe43b221d164a344c49e683941b9112a64f21e2d59edffe53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Age</topic><topic>Analysis</topic><topic>Autism</topic><topic>Brain research</topic><topic>Children</topic><topic>Children & youth</topic><topic>Clinical medicine</topic><topic>Cognition & reasoning</topic><topic>Cognitive ability</topic><topic>Development and progression</topic><topic>EEG</topic><topic>Electroencephalography</topic><topic>Epilepsy</topic><topic>epileptiform abnormalities</topic><topic>Etiology</topic><topic>Firing pattern</topic><topic>Intellectual disabilities</topic><topic>Neurodevelopmental disorders</topic><topic>Neurophysiology</topic><topic>paroxysmal abnormalities</topic><topic>Preschool children</topic><topic>Seizures</topic><topic>Sleep</topic><topic>Sleep and wakefulness</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Santarone, Marta Elena</creatorcontrib><creatorcontrib>Zambrano, Stefania</creatorcontrib><creatorcontrib>Zanotta, Nicoletta</creatorcontrib><creatorcontrib>Mani, Elisa</creatorcontrib><creatorcontrib>Minghetti, Sara</creatorcontrib><creatorcontrib>Pozzi, Marco</creatorcontrib><creatorcontrib>Villa, Laura</creatorcontrib><creatorcontrib>Molteni, Massimo</creatorcontrib><creatorcontrib>Zucca, Claudio</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>Biological Sciences</collection><collection>ProQuest_Research Library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Brain sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Santarone, Marta Elena</au><au>Zambrano, Stefania</au><au>Zanotta, Nicoletta</au><au>Mani, Elisa</au><au>Minghetti, Sara</au><au>Pozzi, Marco</au><au>Villa, Laura</au><au>Molteni, Massimo</au><au>Zucca, Claudio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>EEG Features in Autism Spectrum Disorder: A Retrospective Analysis in a Cohort of Preschool Children</atitle><jtitle>Brain sciences</jtitle><addtitle>Brain Sci</addtitle><date>2023-02-01</date><risdate>2023</risdate><volume>13</volume><issue>2</issue><spage>345</spage><pages>345-</pages><issn>2076-3425</issn><eissn>2076-3425</eissn><abstract>Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that can be associated with intellectual disability (ID) and epilepsy (E). The etiology and the pathogenesis of this disorder is in most cases still to be clarified. Several studies have underlined that the EEG recordings in children with these clinical pictures are abnormal, however the precise frequency of these abnormalities and their relationship with the pathogenic mechanisms and in particular with epileptic seizures are still unknown. We retrospectively reviewed 292 routine polysomnographic EEG tracings of preschool children (age < 6 years) who had received a first multidisciplinary diagnosis of ASD according to DSM-5 clinical criteria. Children (mean age: 34.6 months) were diagnosed at IRCCS E. Medea (Bosisio Parini, Italy). We evaluated: the background activity during wakefulness and sleep, the presence and the characteristics (focal or diffuse) of the slow-waves abnormalities and the interictal epileptiform discharges. In 78.0% of cases the EEG recordings were found to be abnormal, particularly during sleep. Paroxysmal slowing and epileptiform abnormalities were found in the 28.4% of the subjects, confirming the high percentage of abnormal polysomnographic EEG recordings in children with ASD. These alterations seem to be more correlated with the characteristics of the underlying pathology than with intellectual disability and epilepsy. In particular, we underline the possible significance of the prevalence of EEG abnormalities during sleep. Moreover, we analyzed the possibility that EEG data reduces the ASD clinical heterogeneity and suggests the exams to be carried out to clarify the etiology of the disorder.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>36831889</pmid><doi>10.3390/brainsci13020345</doi><orcidid>https://orcid.org/0000-0002-3800-5697</orcidid><orcidid>https://orcid.org/0000-0001-7621-2542</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 2076-3425 |
ispartof | Brain sciences, 2023-02, Vol.13 (2), p.345 |
issn | 2076-3425 2076-3425 |
language | eng |
recordid | cdi_doaj_primary_oai_doaj_org_article_760b0b2b1cd949b0afe892e42519520c |
source | NCBI_PubMed Central(免费); Publicly Available Content Database |
subjects | Age Analysis Autism Brain research Children Children & youth Clinical medicine Cognition & reasoning Cognitive ability Development and progression EEG Electroencephalography Epilepsy epileptiform abnormalities Etiology Firing pattern Intellectual disabilities Neurodevelopmental disorders Neurophysiology paroxysmal abnormalities Preschool children Seizures Sleep Sleep and wakefulness |
title | EEG Features in Autism Spectrum Disorder: A Retrospective Analysis in a Cohort of Preschool Children |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T11%3A05%3A15IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=EEG%20Features%20in%20Autism%20Spectrum%20Disorder:%20A%20Retrospective%20Analysis%20in%20a%20Cohort%20of%20Preschool%20Children&rft.jtitle=Brain%20sciences&rft.au=Santarone,%20Marta%20Elena&rft.date=2023-02-01&rft.volume=13&rft.issue=2&rft.spage=345&rft.pages=345-&rft.issn=2076-3425&rft.eissn=2076-3425&rft_id=info:doi/10.3390/brainsci13020345&rft_dat=%3Cgale_doaj_%3EA751914049%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c557t-1e49f94cc9c606dfbe43b221d164a344c49e683941b9112a64f21e2d59edffe53%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2779525782&rft_id=info:pmid/36831889&rft_galeid=A751914049&rfr_iscdi=true |