CNS Drugs

, Volume 22, Issue 10, pp 841–860 | Cite as

Cost Effectiveness of Pharmacotherapies in Early Parkinson’s Disease

  • Karla M. Eggert
  • Jens P. Reese
  • Wolfgang H. Oertel
  • Richard Dodel
Review Article


Parkinson’s disease is one of the most common chronic neurodegenerative diseases. The progression of disease and the psychosocial consequences exert a major impact on patients’ health-related quality of life. Although levodopa provides the best symptomatic benefit with the fewest short-term adverse effects, long-term treatment results in motor complications that are associated with both higher costs and considerable increase in patients’ discomfort. The introduction of dopamine agonists early in the treatment of Parkinson’s disease leads to a delay of these motor complications, but the treatment is associated with higher costs.

In this review we evaluate available cost-effectiveness analyses of the dopamine agonists pramipexole, pergolide, bromocriptine, ropinirole, cabergoline and levodopa in the treatment of early Parkinson’s disease. Considerable method-ological differences in the identified studies complicate a comparison and impede clear evidence as to which dopamine agonist treatment is the most cost effective in early Parkinson’s disease. Novel head-to-head comparisons considering the actual treatment guidelines are necessary to identify the most cost-effective alternative in treating de novo Parkinson’s disease patients.


Levodopa Bromocriptine Dopamine Agonist Pramipexole Cabergoline 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this review. Karla Eggert, Wolfgang Oertel and Richard Dodel have received honoraria from pharmaceutical companies and are involved in clinical trials in Parkinson’s disease performed by different pharmaceutical companies. Karla Eggert has worked as a consultant for Orion, UCB-Schwarz Pharma, Solvay, Valeant, GlaxoSmithKline, Desitin, Orphane Europe and Teva. She has received scientific grants from the Germany Ministry of Education and Health, the Pitzer Foundation and the Rhön Foundation. Wolfgang Oertel has received consultancy fees and/or honoraria from Boehringer Ingelheim, Solvay, Orion, GlaxoSmithKline, sanofi-aventis, Bayer-Schering, UCB-Schwarz Pharma, Teva, Novartis, Eisai, Medtronic, Desitin, Servier and GE Health. Richard Dodel has received funding from the following companies in respect to economic studies: Solvay, Medtronic, Novartis, Merck and Schering. Jens Reese has no potential conflicts of interest that are directly relevant to the content of this review.


  1. 1.
    Rajput AH, Offord KP, Beard CM, et al. Epidemiology of parkinsonism: incidence, classification, and mortality. Ann Neurol 1984; 16(3): 278–82PubMedCrossRefGoogle Scholar
  2. 2.
    Markham CH, Diamond SG. Long-term follow-up of early dopa treatment in Parkinson’s disease. Ann Neurol 1986; 19(4): 365–72PubMedCrossRefGoogle Scholar
  3. 3.
    Marsden CD. Problems with long-term levodopa therapy for Parkinson’s disease. Clin Neuropharmacol 1994; 17Suppl. 2: S32–44PubMedGoogle Scholar
  4. 4.
    Horstink M, Tolosa E, Bonuccelli U, et al. Review of the therapeutic management of Parkinson’s disease. Report of a joint task force of the European Federation of Neurological Societies and the Movement Disorder Society-European Section, part I: early (uncomplicated) Parkinson’s disease. Eur J Neurol 2006; 13(11): 1170–85Google Scholar
  5. 5.
    Dodel RC, Berger K, Oertel WH. Health-related quality of life and healthcare utilisation in patients with Parkinson’s disease: impact of motor fluctuations and dyskinesias. Pharmacoeconomics 2001; 19(10): 1013–38PubMedCrossRefGoogle Scholar
  6. 6.
    Pechevis M, Clarke CE, Vieregge P, et al. Effects of dyskinesias in Parkinson’s disease on quality of life and health-related costs: a prospective European study. Eur J Neurol 2005; 12: 956–63PubMedCrossRefGoogle Scholar
  7. 7.
    de la Fuente-Fernandez R, Lu JQ, Sossi V, et al. Biochemical variations in the synaptic level of dopamine precede motor fluctuations in Parkinson’s disease: PET evidence of increased dopamine turnover. Ann Neurol 2001; 49(3): 298–303PubMedCrossRefGoogle Scholar
  8. 8.
    Holloway RG, Shoulson I, Fahn S, et al. Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial. Arch Neurol 2004; 61(7): 1044–53PubMedCrossRefGoogle Scholar
  9. 9.
    Oertel WH, Wolters E, Sampaio C, et al. Pergolide versus levodopa monotherapy in early Parkinson’s disease patients: the PELMOPET study. Mov Disord 2006; 21(3): 343–53PubMedCrossRefGoogle Scholar
  10. 10.
    Rascol O, Brooks DJ, Korczyn AD, et al. Development of dyskinesias in a 5-year trial of ropinirole and L-dopa. Mov Disord 2006; 21(11): 1844–50PubMedCrossRefGoogle Scholar
  11. 11.
    Schade R, Andersohn F, Suissa S, et al. Dopamine agonists and the risk of cardiac-valve regurgitation. New Engl J Med 2007; 356(1): 29–38PubMedCrossRefGoogle Scholar
  12. 12.
    Effect of deprenyl on the progression of disability in early Parkinson’s disease. The Parkinson Study Group. N Engl J Med 1989; 321(20): 1364–71CrossRefGoogle Scholar
  13. 13.
    Parkinson Study Group. A controlled trial of rasagiline in early Parkinson disease: the TEMPO study. Arch Neurol 2002; 59(12): 1937–43CrossRefGoogle Scholar
  14. 14.
    Marras C, Lang AE. Outcome measures for clinical trials in Parkinson’s disease: achievements and shortcomings. Expert Rev Neurother 2004; 4(6): 985–93PubMedCrossRefGoogle Scholar
  15. 15.
    Ramaker C, Marinus J, Stiggelbout AM, et al. Systematic evaluation of rating scales for impairment and disability in Parkinson’s disease. Mov Disord 2002; 17(5): 867–76PubMedCrossRefGoogle Scholar
  16. 16.
    Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology 1967; 17(5): 427–42PubMedCrossRefGoogle Scholar
  17. 17.
    Mitchell SL, Harper DW, Lau A, et al. Patterns of outcome measurement in Parkinson’s disease clinical trials. Neuroepi-demiology 2000; 19(2): 100–8CrossRefGoogle Scholar
  18. 18.
    Reynolds Jr NC, Montgomery GK. Factor analysis of Parkinson’s impairment: an evaluation of the final common pathway. Arch Neurol 1987; 44(10): 1013–6PubMedCrossRefGoogle Scholar
  19. 19.
    Schrag A, Selai C, Jahanshahi M, et al. The EQ-5D — a generic quality of life measure —is a useful instrument to measure quality of life in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2000; 69(1): 67–73PubMedCrossRefGoogle Scholar
  20. 20.
    Jenkinson C, Fitzpatrick R, Peto V, et al. The Parkinson’s Disease Questionnaire (PDQ-39): development and validation of a Parkinson’s disease summary index score. Age Ageing 1997; 26(5): 353–7PubMedCrossRefGoogle Scholar
  21. 21.
    Welsh M, McDermott MP, Holloway RG, et al. Development and testing of the Parkinson’s disease quality of life scale. Mov Disord 2003; 18(6): 637–45PubMedCrossRefGoogle Scholar
  22. 22.
    Goetz CG, Poewe W, Rascol O, et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord 2004; 19(9): 1020–8PubMedCrossRefGoogle Scholar
  23. 23.
    Fahn RE, Committee UD. Unified Parkinson’s Disease Rating Scale. In: Fahn S, Calne D, Goldstein M, editors. Recent developments in Parkinson’s disease. Florham Park (NJ): Macmillan Healthcare Information, 1987: 153–63Google Scholar
  24. 24.
    Schwab RS, England AC. Projection technique for evaluating surgery in Parkinson’s disease. In: Gillingham FJ, Donaldson ML, editors. Third symposium on Parkinson’s disease. Edinburgh: E&S Livingstone, 1969: 152–7Google Scholar
  25. 25.
    Goetz CG, LeWitt PA, Weidenman M. Standardized training tools for the UPDRS activities of daily living scale: newly available teaching program. Mov Disord 2003; 18(12): 1455–8PubMedCrossRefGoogle Scholar
  26. 26.
    Goetz CG, Fahn S, Martinez-Martin P, et al. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): process, format, and clinimetric testing plan. Mov Disord 2007; 22(1): 41–7PubMedCrossRefGoogle Scholar
  27. 27.
    Deuschl G, Schade-Brittinger C, Krack P, et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. New Engl J Med 2006; 355(9): 896–908PubMedCrossRefGoogle Scholar
  28. 28.
    Behari M, Srivastava AK, Pandey RM. Quality of life in patients with Parkinson’s disease. Parkinsonism Relat Disord 2005; 11(4): 221–6PubMedCrossRefGoogle Scholar
  29. 29.
    Schrag A, Jahanshahi M, Quinn N. How does Parkinson’s disease affect quality of life? A comparison with quality of life in the general population. Mov Disord 2000; 15(6): 1112–8PubMedCrossRefGoogle Scholar
  30. 30.
    Reuther M, Spottke EA, Klotsche J, et al. Assessing health-related quality of life in patients with Parkinson’s disease in a prospective longitudinal study. Parkinsonism Relat Disord 2007; 13(2): 108–14PubMedCrossRefGoogle Scholar
  31. 31.
    Global Parkinson’s Disease Survey Steering Committee. Factors impacting on quality of life in Parkinson’s disease: results from an international survey. Mov Disord 2002; 17(1): 60–7CrossRefGoogle Scholar
  32. 32.
    Den Oudsten BL, Van Heck GL, De Vries J. Quality of life and related concepts in Parkinson’s disease: a systematic review. Mov Disord 2007; 22(11): 1528–37CrossRefGoogle Scholar
  33. 33.
    Torrance GW. Utility measurement in healthcare: the things I never got to. PharmacoEconomics 2006; 24(11): 1069–78PubMedCrossRefGoogle Scholar
  34. 34.
    Den Oudsten BL, Van Heck GL, De Vries J. The suitability of patient-based measures in the field of Parkinson’s disease: a systematic review. Mov Disord 2007; 22(10): 1390–401CrossRefGoogle Scholar
  35. 35.
    Dowding CH, Shenton CL, Salek SS. A review of the health-related quality of life and economic impact of Parkinson’s disease. Drugs Aging 2006; 23(9): 693–721PubMedCrossRefGoogle Scholar
  36. 36.
    Hagell P, Whalley D, McKenna SP, et al. Health status measurement in Parkinson’s disease: validity of the PDQ-39 and Nottingham Health Profile. Mov Disord 2003; 18(7): 773–83PubMedCrossRefGoogle Scholar
  37. 37.
    Martinez-Martin P, Grandas F, Linazasoro G, et al. Conversion to controlled-release levodopa/carbidopa treatment and quality of life as measured by the Nottingham Health Profile. The STAR Study Group. Neurologia 1999; 14(7): 338–43Google Scholar
  38. 38.
    Brazier JE, Harper R, Jones NM, et al. Validating the SF-36 health survey questionnaire: new outcome measure for prima-ry care. BMJ 1992; 305(6846): 160–4PubMedCrossRefGoogle Scholar
  39. 39.
    Longstreth Jr WT, Nelson L, Linde M, et al. Utility of the sickness impact profile in Parkinson’s disease. J Geriatr Psychiatry Neurol 1992; 5(3): 142–8PubMedGoogle Scholar
  40. 40.
    Siderowf A, Ravina B, Glick HA. Preference-based quality-of-life in patients with Parkinson’s disease. Neurology 2002; 59(1): 103–8PubMedCrossRefGoogle Scholar
  41. 41.
    EuroQol: a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 1990; 16(3): 199–208CrossRefGoogle Scholar
  42. 42.
    Greiner W, Weijnen T, Nieuwenhuizen M, et al. A single European currency for EQ-5D health states: results from a six-country study. Eur J Health Econ 2003; 4: 222–31PubMedCrossRefGoogle Scholar
  43. 43.
    Brazier JE, Walters SJ, Nicholl JP, et al. Using the SF-36 and EuroQol on an elderly population. Qual Life Res 1996; 5(2): 195–204PubMedCrossRefGoogle Scholar
  44. 44.
    Beck A, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561–7PubMedCrossRefGoogle Scholar
  45. 45.
    Gerard K. Cost-utility in practice: a policy maker’s guide to the state of the art. Health Policy 1992; 21(3): 249–79PubMedCrossRefGoogle Scholar
  46. 46.
    Noyes K, Dick AW, Holloway RG. The implications of using US-specific EQ-5D preference weights for cost-effectiveness evaluation. Med Decis Making 2007; 27(3): 327–34PubMedCrossRefGoogle Scholar
  47. 47.
    Noyes K, Dick AW, Holloway RG. Pramipexole v. levodopa as initial treatment for Parkinson’s disease: a randomized clinical-economic trial. Med Decis Making 2004; 24(5): 472–85Google Scholar
  48. 48.
    Peto V, Jenkinson C, Fitzpatrick R. PDQ-39: a review of the development, validation and application of a Parkinson’s disease quality of life questionnaire and its associated measures. J Neurol 1998; 245Suppl. 1: S10–4PubMedCrossRefGoogle Scholar
  49. 49.
    Peto V, Jenkinson C, Fitzpatrick R, et al. The development and validation of a short measure of functioning and well being for individuals with Parkinson’s disease. Qual Life Res 1995; 4(3): 241–8PubMedCrossRefGoogle Scholar
  50. 50.
    de Boer AG, Wijker W, Speelman JD, et al. Quality of life in patients with Parkinson’s disease: development of a questionnaire. J Neurol Neurosurg Psychiatry 1996; 61(1): 70–4PubMedCrossRefGoogle Scholar
  51. 51.
    Schulzer M, Mak E, Calne SM. The psychometric properties of the Parkinson’s Impact Scale (PIMS) as a measure of quality of life in Parkinson’s disease. Parkinsonism Relat Disord 2003; 9(5): 291–4PubMedCrossRefGoogle Scholar
  52. 52.
    Tan LC, Luo N, Nazri M, et al. Validity and reliability of the PDQ-39 and the PDQ-8 in English-speaking Parkinson’s disease patients in Singapore. Parkinsonism Relat Disord 2004; 10(8): 493–9PubMedCrossRefGoogle Scholar
  53. 53.
    Hely M, Chey T, Wilson A, et al. Reliability of the Columbia Scale for assessing signs of Parkinson’s disease. Mov Disord 1993; 8: 466–72PubMedCrossRefGoogle Scholar
  54. 54.
    Rubenstein LM, DeLeo A, Chrischilles EA. Economic and health-related quality of life considerations of new therapies in Parkinson’s disease. Pharmacoeconomics 2001; 19(7): 729–52PubMedCrossRefGoogle Scholar
  55. 55.
    Lindgren P. Economic evidence in Parkinson’s disease: a review. Eur J Health Econ 2004; 5Suppl. 1: S63–6PubMedCrossRefGoogle Scholar
  56. 56.
    Lindgren P, von Campenhausen S, Spottke E, et al. Cost of Parkinson’s disease in Europe. Eur J Neurol 2005; 12Suppl. 1: 68–73CrossRefGoogle Scholar
  57. 57.
    Brouwer W, Rutten F, Koopmanschap M. Costing in economic evaluations. In: Drummond M, McGuire A, editors. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press, 2001: 68–93Google Scholar
  58. 58.
    Dodel RC, Singer M, Kohne-Volland R, et al. The economic impact of Parkinson’s disease: an estimation based on a 3-month prospective analysis. Pharmacoeconomics 1998; 14(3): 299–312PubMedCrossRefGoogle Scholar
  59. 59.
    LePen C, Wait S, Moutard-Martin F, et al. Cost of illness and disease severity in a cohort of French patients with Parkinson’s disease. Pharmacoeconomics 1999; 16(1): 59–69PubMedCrossRefGoogle Scholar
  60. 60.
    Hagell P, Nordling S, Reimer J, et al. Resource use and costs in a Swedish cohort of patients with Parkinson’s disease. Mov Disord 2002; 17(6): 1213–20PubMedCrossRefGoogle Scholar
  61. 61.
    Findley L, Aujla M, Bain PG, et al. Direct economic impact of Parkinson’s disease: a research survey in the United Kingdom. Mov Disord 2003; 18(10): 1139–45PubMedCrossRefGoogle Scholar
  62. 62.
    Keränen T, Kaakkola S, Sotaniemi K, et al. Economic burden and quality of life impairment increase with severity of PD. Parkinsonism Relat Disord 2003; 9(3): 163–8PubMedCrossRefGoogle Scholar
  63. 63.
    Spottke AE, Reuter M, Machat O, et al. Cost of illness and its predictors for Parkinson’s disease in Germany. Pharmacoeconomics 2005; 23(8): 817–36PubMedCrossRefGoogle Scholar
  64. 64.
    Huse DM, Schulman K, Orsini L, et al. Burden of illness in Parkinson’s disease. Mov Disord 2005; 20(11): 1449–54PubMedCrossRefGoogle Scholar
  65. 65.
    Dengler I, Leukel N, Meuser T, et al. Prospective study of the direct and indirect costs of idiopathic Parkinson’s disease. Der Nervenarzt 2006; 77(10): 1204–9PubMedCrossRefGoogle Scholar
  66. 66.
    Gold MR, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996Google Scholar
  67. 67.
    Kurlan R, Clark S, Shoulson I, et al. Economic impact of protective therapy for early Parkinson’s disease [abstract]. Ann Neurology 1988; 24(1): 153Google Scholar
  68. 68.
    Sculpher M. The role and estimation of productivity costs in economic evaluation. In: Drummond M, McGuire A, editors. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press, 2001: 94–112Google Scholar
  69. 69.
    Tranmer JE, Guerriere DN, Ungar WJ, et al. Valuing patient and caregiver time: a review of the literature. Pharmacoeconomics 2005; 23(5): 449–59PubMedCrossRefGoogle Scholar
  70. 70.
    Schöffski O, von derSchulenburg J-M. Deutsche Empfehlungen zur gesundheitsökonomischen Evaluation. Revidierte Fassung des Hannoveraner Konsens. In: Schöffski O, von der Schulenburg J-M, editors. Gesundheitsökonomische Evaluationen. Berlin: Springer, 2007: 479–84Google Scholar
  71. 71.
    Siderowf AD, Holloway RG, Stern MB. Cost-effectiveness analysis in Parkinson’s disease: determining the value of interventions. Mov Disord 2000; 15(3): 439–45PubMedCrossRefGoogle Scholar
  72. 72.
    Coyle D, Barbeau M, Guttman M, et al. The economic evaluation of pharmacotherapies for Parkinson’s disease. Parkinsonism Relat Disord 2003; 9(5): 301–7PubMedCrossRefGoogle Scholar
  73. 73.
    Drummond M, Sculpher M. Common methodological flaws in economic evaluations. Med Care 2005; 43(7 Suppl.): 5–14PubMedGoogle Scholar
  74. 74.
    Ramsey S, Willke R, Briggs A, et al. Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA Task Force report. Value Health 2005; 8(5): 521–33PubMedCrossRefGoogle Scholar
  75. 75.
    Glick HA, Polsky DP, Schulman KA. Trial-based economic evaluations: an overview of design and analysis. In: Drummond M, McGuire A, editors. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press, 2001: 113–40Google Scholar
  76. 76.
    Claxton K, Sculpher M, Drummond M. A rational framework for decision making by the National Institute for Clinical Excellence (NICE). Lancet 2002; 360(9334): 711–5PubMedCrossRefGoogle Scholar
  77. 77.
    Weinstein MC, O’Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation. Report of the ISPOR Task Force on Good Research Practices: modeling studies. Value Health 2003; 6(1): 9–17Google Scholar
  78. 78.
    Siebert U, Bornschein B, Walbert T, et al. Systematic assessment of decision models in Parkinson’s disease. Value Health 2004; 7(5): 610–26PubMedCrossRefGoogle Scholar
  79. 79.
    Weinstein MC. Recent developments in decision-analytic modelling for economic evaluation. Pharmacoeconomics 2006; 24(11): 1043–53PubMedCrossRefGoogle Scholar
  80. 80.
    Briggs A. Handling uncertainty in economic evaluation and presenting the results. In: Drummond M, McGuire A, editors. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press, 2001: 172–214Google Scholar
  81. 81.
    Briggs A, Sculpher M, Buxton M. Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ 1994; 3(2): 95–104PubMedCrossRefGoogle Scholar
  82. 82.
    O’Hagan A, McCabe C, Akehurst R, et al. Incorporation of uncertainty in health economic modelling studies. Pharmacoeconomics 2005; 23(6): 529–36PubMedCrossRefGoogle Scholar
  83. 83.
    O’Brien BJ, Briggs AH. Analysis of uncertainty in health care cost-effectiveness studies: an introduction to statistical issues and methods. Stat Methods Med Res 2002; 11(6): 455–68PubMedCrossRefGoogle Scholar
  84. 84.
    Hoerger TJ, Bala MV, Rowland C, et al. Cost effectiveness of pramipexole in Parkinson’s disease in the US. Pharmacoeconomics 1998; 14(5): 541–57PubMedCrossRefGoogle Scholar
  85. 85.
    Noyes K, Dick AW, Holloway RG. Pramipexole and levodopa in early Parkinson’s disease: dynamic changes in cost effectiveness. Pharmacoeconomics 2005; 23(12): 1257–70PubMedCrossRefGoogle Scholar
  86. 86.
    Lindgren P, Jonsson B, Duchane J. The cost-effectiveness of early cabergoline treatment compared to levodopa in Sweden. Eur J Health Econ 2003; 4(1): 37–42PubMedCrossRefGoogle Scholar
  87. 87.
    Smala AM, Spottke EA, Machat O, et al. Cabergoline versus levodopa monotherapy: a decision analysis. Mov Disord 2003; 18(8): 898–905PubMedCrossRefGoogle Scholar
  88. 88.
    Davey P, Rajan N, Lees M, et al. Cost-effectiveness of pergolide compared to bromocriptine in the treatment of Parkinson’s disease: a decision-analytic model. Value Health 2001; 4(4): 308–15PubMedGoogle Scholar
  89. 89.
    Shimbo T, Hira K, Takemura M, et al. Cost-effectiveness analysis of dopamine agonists in the treatment of Parkinson’s disease in Japan. Pharmacoeconomics 2001; 19(8): 875–86PubMedCrossRefGoogle Scholar
  90. 90.
    Iskedjian M, Einarson TR. Cost analysis of ropinirole versus levodopa in the treatment of Parkinson’s disease. Pharmacoeconomics 2003; 21(2): 115–27PubMedCrossRefGoogle Scholar
  91. 91.
    Rinne UK, Bracco F, Chouza C, et al. Early treatment of Parkinson’s disease with cabergoline delays the onset of motor complications: results of a double-blind levodopa controlled trial. The PKDS009 Study Group. Drugs 1998; 55Suppl. 1: 23–30Google Scholar
  92. 92.
    Rascol O, Brooks DJ, Korczyn AD, et al. A five-year study of the incidence of dyskinesia in patients with early Parkinson’s disease who were treated with ropinirole or levodopa. 056 Study Group. New Engl J Med 2000; 342: 1484–91CrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Karla M. Eggert
    • 1
  • Jens P. Reese
    • 1
  • Wolfgang H. Oertel
    • 1
  • Richard Dodel
    • 1
  1. 1.Department of NeurologyPhilipps-University MarburgMarburgGermany

Personalised recommendations