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Multiple Sklerose

  • J. H. Faiss
  • H. Wiethölter
Chapter
  • 10k Downloads

Zusammenfassung

Die multiple Sklerose (MS) ist eine der häufigsten neurologischen Erkrankungen, für deren Ursache es bislang keine einheitliche Erklärung gibt. Grundpfeiler der Diagnostik ist die Klinik, ergänzt durch die Magnetresonanztomographie (MRT). Eine Liquoruntersuchung zum Nachweis der entzündlichen Genese nachgewiesener multifokaler Störungen ist bei allen unklaren Fällen und bei älteren Patienten erforderlich. Zur Bestätigung und Verlaufskontrolle sind elektrophysiologische Verfahren hilfreich.

Literatur

Zitierte Literatur

  1. Achiron A, Barak Y (2003) Cognitive impairment in probable multiple sclerosis. J Neurol Neurosurg Psychiatry 74: 443–446PubMedCrossRefGoogle Scholar
  2. Arnett PA, Rao SM, Bernardin L et al. (1994) Relationship between frontal lobe lesions and Wisconsin Card Sorting Test performance in patients with multiple sclerosis. Neurology 44: 420–425PubMedGoogle Scholar
  3. Barkhof F, Filippi M, Miller D et al. (1997) Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 120: 2059–2069PubMedCrossRefGoogle Scholar
  4. Bartt RE (2006) Multiple sclerosis, Natalizumab therapy, and progressive multifocal leukoencephalopathy. Curr Opin Neurol 19: 341–349PubMedCrossRefGoogle Scholar
  5. Bates D (1994) The diagnosis of multiple sclerosis. Proceedings of the MS forum modern management workshop. Professional Postgraduate Services Europe, Worthing, U. K.Google Scholar
  6. Beck RW, Cleary PA, Anderson MM et al. (1992) A randomized controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med 326: 581–588PubMedCrossRefGoogle Scholar
  7. Bielekova B, Howard T, Packer AN et al. (2009) Effect of anti-CD25 antibody daclizumab in the inhibition of inflammation and stabilization of disease progression in multiple sclerosis. Arch Neurol 66: 483–489PubMedCrossRefGoogle Scholar
  8. Brønnum-Hansen H, Koch-Hendriksen N, Hyllested K (1994) Survival of patients with multiple sclerosis in Denmark: A nation-wide, longterm epidemiologic survey. Neurology 44: 1901–1907PubMedGoogle Scholar
  9. Brück W, Stadelmann C (2005) The spectrum of multiple sclerosis: new lessons from pathology. Curr Opin Neurol 18(3): 221–224PubMedCrossRefGoogle Scholar
  10. Burt RK, Loh Y, Cohen B et al. (2009) Autologous non-myeloablative haemopoietic stem cell transplantation in relapsing-remitting multiple sclerosis: phase I/II study. Lancet Neurol 8: 244–253PubMedCrossRefGoogle Scholar
  11. Calabrese M, Filippi M, Rovaris M et al. (2008) Morphology and evolution of cortical lesions in multiple sclerosis. A longitudinal MRI study. Neuro Image 42: 1324–1328PubMedGoogle Scholar
  12. Calabresi PA, Giovannoni G, Confavreux C et al. (2007) The incidence and significance of anti-natalizumab antibodies: Results from AFFIRM and SENTINEL. Neurology 69: 1391–1403PubMedCrossRefGoogle Scholar
  13. Chang A, Smith MC, Yin X et al. (2008) Neurogenesis in the chronic lesion of multiple sclerosis. Brain 131: 2366–2375PubMedCrossRefGoogle Scholar
  14. Chen JT, Collins DL, Atkins HL et al. (2008) Magnetisation transfer ratio evolution with demyelination and remyelination in multiple sclerosis lesions. Ann Neurol 63: 254–262PubMedCrossRefGoogle Scholar
  15. Coles AJ, Compston DA, Selmaj KW et al. (2008) Alemtuzumab vs interfernon-β-1 a in early multiple sclerosis. N Engl J Med 359: 1786–1801PubMedCrossRefGoogle Scholar
  16. Comi G, Pulizzi A, Rovaris M et al. (2008) Effect of laquinimod on MRI-monitored disease activity in patients with relapsing-remitting multiple sclerosis: A multicentre, randomized, double-blind, placebo-controlled phase IIb study. Lancet 371: 2085–2092PubMedCrossRefGoogle Scholar
  17. Comi G, Martinelli V, Rodegher M et al. (2009) Effect of Glatirameracetat on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomized, double-blind, placebo-controlled trial. Lancet 374: 1503–1511PubMedCrossRefGoogle Scholar
  18. De Seze J, Arndt C, Jeanjean L (2008) Relapsing inflammatory optic neuritis: Is it neuromyelitis optica. Neurology 70: 2075–2076PubMedCrossRefGoogle Scholar
  19. De Stefano N, Matthews PM, Filippi M et al. (2003) Evidence of early cortical atrophy in MS: Relevance to white matter changes and disability. Neurology 60: 1157–1162PubMedGoogle Scholar
  20. Ebers GC (2008) Environmental factors and multiple sclerosis. Lancet Neurol 7: 268–277PubMedCrossRefGoogle Scholar
  21. Faiss JH (2006) MS – Nursing. In: Schmidt RM, Hoffmann F (Hrsg) Multiple Sklerose 4. Aufl. Urban & Fischer, München, S 389–394CrossRefGoogle Scholar
  22. Fazekas F, Offenbacher H, Fuchs S et al. (1988) Criteria for an increased specificity of MRI interpretation in elderly subjects with suspected multiple sclerosis. Neurology 38: 1822–1825PubMedGoogle Scholar
  23. Fernando KTM, Tozer DJ, Miszkiel KA et al. (2005) Magnitization transfer histograms in clinically isolated syndromes suggestive of multiple sclerosis. Brain 128: 2911–2925PubMedCrossRefGoogle Scholar
  24. Frohman EM, Racke MK, Raine CS (2006) Multiple Sclerosis – the plaque and its pathogenesis. N Engl J Med 354: 942–955PubMedCrossRefGoogle Scholar
  25. Frischer JM, Bramow S, Dal-Bianco A et al. (2009) The relation between inflammation and neurodegeneration in multiple sclerosis brains. Brain 132: 1175–1189PubMedCrossRefGoogle Scholar
  26. Gauthier SA, Berger AM, Liptak Z et al. (2009) Rate of brain atrophy in benign versus early multiple sclerosis. Arch Neurol 66: 234–237PubMedCrossRefGoogle Scholar
  27. Gladstone DE, Kenneth W, Zamkoff W et al. (2006) High-dose cyclophosphamide for moderate to severe refractory multiple sclerosis. Arch Neurol 63: 1388–1393PubMedCrossRefGoogle Scholar
  28. Goodin DS (2008) Disease-modifying therapy in multiple sclerosis. Update and clinical implications. Neurology (Suppl) 71: S8–S13PubMedCrossRefGoogle Scholar
  29. Hardt C (2006) Genetik und Umweltfaktoren. In: Schmidt RM, Hoffmann F (Hrsg) Multiple Sklerose. Urban & Fischer, München, S 19–31CrossRefGoogle Scholar
  30. Hartung HP, Gonsette R, König N et al. (2002) Mitoxantrone in progressive multiple sclerosis: a placebo-controlled, double-blind, randomised, mulitcentre trial. Lancet 360: 2018–2025PubMedCrossRefGoogle Scholar
  31. Hartung HP, Warnke C, Hohlfeld R, Kieseier BC (2009) Progressive multifokale Leukencepahlopathie. Nervenarzt 80: 1143–1153PubMedCrossRefGoogle Scholar
  32. Hauser SL, Oksenberg JR (2006) The neurobiology of multiple sclerosis: Genes, inflammation, and neurogeneration. Neuron 52: 61–76PubMedCrossRefGoogle Scholar
  33. Hauser SL, Weiner HL (2006) Natalizumab: immune effects and implications for therapy. Ann Neurol 59: 731–732PubMedCrossRefGoogle Scholar
  34. Hauser SL, Waubant E, Arnold DL et al. (2008) B-cell depletion with rituximab in relapsing-remitting multiple sclerosis. N Engl J Med 358: 676–688PubMedCrossRefGoogle Scholar
  35. Hawker K, O’Connor P, Freedman MS et al. (2009) Rituximab in patients with primary progressive multiple sclerosis: Results of a randomized double-blind placebo-controlled multicenter trial. Ann Neurol 66: 460–471PubMedCrossRefGoogle Scholar
  36. Heckl RW (1994) Multiple Sklerose: Klinik, Differenzialdiagnose, Behandlung. Thieme, StuttgartGoogle Scholar
  37. Henderson APD, Trip SA, Schlottmann PG et al. (2008) An investigation of the retinal nerve fibre layer in progressive multiple sclerosis using optical coherence tomography. Brain 131: 277–287PubMedGoogle Scholar
  38. Henze T (2005) Mitoxantron und Immunglobuline. Nervenheilkunde 24: 287–293Google Scholar
  39. Hohlfeld R (1995) Multiple Sklerose. Akt Neurol 22: 125–130CrossRefGoogle Scholar
  40. Jilek S, Schluep M, Meylan P et al. (2008) Strong EBV-specific CD8+ T-cell response in patients with early multiple sclerosis. Brain 131: 1712–1721PubMedCrossRefGoogle Scholar
  41. Kappos L, Bates D, Hartung HP et al. (2007) Natalizumab treatment for multiple sclerosis: Recommendations for patient selection and monitoring. Lancet Neurol 6: 431–441PubMedCrossRefGoogle Scholar
  42. Kesselring J (1997) Multiple Sklerose, 3. Aufl. Kohlhammer, Stuttgart (2. Aufl. 1993)Google Scholar
  43. Krupp LB, Alvarez LA, LaRocca NG et al. (1988) Fatigue in multiple sclerosis. Arch Neurol 45: 435–437PubMedGoogle Scholar
  44. Kuhlmann T, Miron V, Cuo Q et al. (2008) Differentiation block of oligodendroglial progenitor cells as a cause for remyelination failure in chronic multiple sclerosis. Brain 131: 1749–1758PubMedCrossRefGoogle Scholar
  45. Kumar R (2008) Approved and investigational uses of Modafinil: an evidencebased review. Drugs 68: 1803–1839PubMedCrossRefGoogle Scholar
  46. Kunkel A, Deppe R, Faiss J et al. (2009) Psychoedukatives Training für Patienten mit Multipler Sklerose: Inhalte und Evaluation. Poster 669; 82. Kongress der DGN. Aktuelle Neurologie 36 (Suppl 2): S 172Google Scholar
  47. Kurtzke JF (1983) Epidemiology of multiple sclerosis. In: Hallpike JF, Adams CWM, Tourtellotte WW (eds) Multiple sclerosis. Chapman & Hall, London, pp 47–95Google Scholar
  48. Littleton ET, Hbart JC, Palace J (2010) Modafinil for multiple sclerosis fatigue: Does it work? Clin Neurol Neurosurg 112 (1): 29–31PubMedCrossRefGoogle Scholar
  49. McDonald W, Compston A, Edan G et al. (2001) Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol 50: 121–127PubMedCrossRefGoogle Scholar
  50. Mikol DD, Barkhof F, Chang P et al. (2008) Comparison of subcutaneous interferon-β-1a with glatirameracetate in patients with relapsing remitting multiple sclerosis (The Rebif vs GlatiramerAcetate in Relapsing MS Disease [REGARD] study) a multicenter, randomized, parallel, open-label trial. Lancet Neurol 7: 903–914PubMedCrossRefGoogle Scholar
  51. Miller DH, Leary SM (2007) Primary progressive multiple sclerosis. Lancet Neurol 6: 903–912PubMedCrossRefGoogle Scholar
  52. Miller DH, Soon D, Fernando KT et al. (2007) MRI outcomes in a placebocontrolled trial of natalizumab in relapsing MS. Neurology 68: 1390–1401PubMedCrossRefGoogle Scholar
  53. Mills RJ, Yap L, Young CA (2007) Treatment for ataxia in multiple sclerosis. Cochrane Database of Systematic Reviews, Issue 1 Art No: CD005029Google Scholar
  54. MSTKG (2006) Immunmodulatorische Stufentherapie der multiplen Sklerose. Nervenarzt 77: 1506–1518CrossRefGoogle Scholar
  55. Multiple Sklerose Konsensus Gruppe (MSTKG) (2004) Symptomatische Therapie der Multiplen Sklerose. Nervenarzt 75(Suppl 1): S2–S39Google Scholar
  56. Mumford CJ, Wood NW, Kellar-Wood H (1994) The British isles survey of multiple sclerosis in twins. Neurology 44: 11–15PubMedGoogle Scholar
  57. Neuhaus O, Kieseier BC, Hartung HP (2006) Therapeutic role of mitoxanrone in multiple sclerosis. Pharmacology & Therapeutics 109: 198–209CrossRefGoogle Scholar
  58. O’Connor P, Comi G, Montalban X et al. (2009a) Oral fingolimod (FTY 720) in multiple sclerosis: Two-year results of a phase II extension study. Neurology 72: 73–79CrossRefGoogle Scholar
  59. O’Connor P, Filippi M, Arnason B et al. (2009b) 250 µg or 500 µg interferon beta-1b versus 20 mg glatiramer acetate in relapsing-remitting multiple sclerosis: a prospective, randomized, multicentre study. Lancet Neurol 8: 889–897CrossRefGoogle Scholar
  60. Paty DW, Li DK, the UBC MS/MRI Study Group and the IFNB Multiple Sclerosis Study Group (1993) Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. II. MRI analysis results of a randomized, double-blind, placebo-controlled trial. Neurology 43: 662–667PubMedGoogle Scholar
  61. Pittock SJ, Weinshenker BG, Noseworthy JH et al. (2006) Not every patient with multiple sclerosis should be treated at time of diagnosis. Arch Neurol 63: 611–614PubMedCrossRefGoogle Scholar
  62. Polman CH, Reingold SC, Edan G et al. (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions of the »McDonald criteria«. Ann Neurol 58(6): 840–846PubMedCrossRefGoogle Scholar
  63. Polman CH, O’Connor PW, Havrdova E et al. (2006) A randomized, placebocontrolled trial of Natalizumab for relapsing multiple sclerosis. N Engl J Med 354: 899–910PubMedCrossRefGoogle Scholar
  64. Poser S, Wikström J, Bauer HJ et al. (1979) Clinical data and identification of special forms of multiple sclerosis in 1271 cases studied with a standardized documentation system. J Neurol Sci 40: 159–168PubMedCrossRefGoogle Scholar
  65. Poser CM, Paty DW, Scheinberg L et al. (1983) New diagnostic criteria for multiple sclerosis: Guidelines for research protocols. Ann Neurol 13: 227–231PubMedCrossRefGoogle Scholar
  66. Preiningerova J (2009) Oral laquinimod therapy in relapsing multiple sclerosis. Expert Opin Investig Drugs 18(7): 985–989PubMedCrossRefGoogle Scholar
  67. Pueyo V, Martin J, Fernandez J et al. (2008) Axonal loss in the retinal nerve fiber layer in patients with multiple sclerosis. Multiple Sclerosis 14: 609–614PubMedCrossRefGoogle Scholar
  68. Pulicken M, Gordon-Lipkin E, Balcer LJ et al. (2007) Optical coherence tomography and disease subtype in multiple sclerosis. Neurology 69: 2085–2092PubMedCrossRefGoogle Scholar
  69. Ramsaransing GSM, De Keyser J (2007) Predictive value of clinical characteristics for »benign« multiple sclerosis. Europ J Neurol 14: 885–889CrossRefGoogle Scholar
  70. Ransohoff RM (2007) Natalizumab for multiple sclerosis. N Engl J Med 356: 2622–2629PubMedCrossRefGoogle Scholar
  71. Rieckmann P (2006) Immunmodulatorische Stufentherapie der Multiplen Sklerose (MSTKG). Nervenarzt 77: 1506–1518PubMedCrossRefGoogle Scholar
  72. Rieckmann P, Kallmann B (2005) Neue Therapieansätze bei Multipler Sklerose. Nervenheilkunde 24: 294–300Google Scholar
  73. Robinson I (1991) The context and consequences of communicating the diagnosis of multiple sclerosis. In: Wiethölter H, Dichgans J, Mertin J (eds) Current concepts in multiple sclerosis. Elsevier, Amsterdam, pp 17–22Google Scholar
  74. Rocca MA, Colombo B, Falini A et al. (2005) Cortical adaption in patients with MS: A cross-sectional functional MRI study of disease phenotypes. Lancet Neurol 4: 618–626PubMedCrossRefGoogle Scholar
  75. Ropper AH (2006) Selective treatment of multiple sclerosis. N Engl J Med 354: 965–967PubMedCrossRefGoogle Scholar
  76. Rudick RA, Stuart WH, Calabresi PA et al. (2006) Natalizumab plus Interferon beta – 1 a for relapsing multiple sclerosis. N Engl J Med 354: 911–923PubMedCrossRefGoogle Scholar
  77. Sailer M, Fazekas F, Gass A et al. (2008) Zerebrale und spinale MRT-Untersuchung bei Patienten mit klinisch isoliertem Syndrom oder gesicherter Multipler Sklerose. Fortschr Röntgenstr 180: 994–1001CrossRefGoogle Scholar
  78. Sayao AL, Devonshire V, Tremlett H (2007) Longitudinal follow-up of »benign« multiple sclerosis at 20 years. Neurology 68: 496–500PubMedCrossRefGoogle Scholar
  79. Scheglmann K (1995) Multiple Sklerose: Multimodal evozierte Potenziale in der Diagnose. TW Neurol Psychiatr 9 : 562–573Google Scholar
  80. Schulz D, Kopp B, Kunkel A, Faiss JH (2006) Cognition in the early stage of multiple sclerosis. J Neurol 253: 1002–1010PubMedCrossRefGoogle Scholar
  81. Seidel D (1995) MS – Symptomatische Therapie und Rehabilitation. TW Neurol Psychiatr 9: 578–582Google Scholar
  82. Simon JH, Jacobs LD, Campion MK et al. (1999) A longitudinal study of brain atrophy in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group. Neurology 53: 139–148PubMedGoogle Scholar
  83. Sloka JS, Stefanelli M (2005) The mechanism of action of methylprednisolone in the treatment of multiple sclerosis. Multiple Sclerosis 11: 425–432PubMedCrossRefGoogle Scholar
  84. Steinbrecher A, Dichgans J, Martin R (1995) Diagnostik und Therapie der multiplen Sklerose. Nervenheilkunde 14: 180–188Google Scholar
  85. Stüve O, Marra CM, Jerome KR et al. (2006) Immune surveillance in multiple sclerosis patients treated with Natalizumab. Ann Neurol 59: 743–747PubMedCrossRefGoogle Scholar
  86. Stüve O, Marra CM, Cravens PD et al. (2007) Potential risk of progressive multifocal leukoencephalopathy with Natalizumab therapy: Possible interventions. Arch Neurol 64: 169–176PubMedCrossRefGoogle Scholar
  87. Thompson A (2004) Overview of primary progressive multiple sclerosis (PPMS): Similarities and differences from other forms of MS, diagnostic criteria, pros and cons of progressive diagnosis. Mult Scler 10: S2–S7PubMedCrossRefGoogle Scholar
  88. Tintoré M, Rovira A, Rio J et al. (2008) Do oligoclonal bands add information to MRI in first attacks of multiple sclerosis? Neurology 70: 1079–1083PubMedCrossRefGoogle Scholar
  89. Trapp BD, Peterson J, Ransohoff RM et al. (1998) Axonal transection in the lesions of multiple sclerosis. N Engl J Med 338(5): 323–325CrossRefGoogle Scholar
  90. Vetrugno R, Stecchi S, Scandellari C et al. (2007) Sleep-wake and body core temperature rhythms in multiple sclerosis with fatigue. Clinical Neurophys 118: 228–234CrossRefGoogle Scholar
  91. Villar LM, Garcia-Barragán N, Sádaba MC et al. (2008) Accuracy of CSF and MRI criteria for dissemination in space in the diagnosis of multiple sclerosis. J Neurol Sciences 266: 34–37CrossRefGoogle Scholar
  92. Walderveen MAA van, Barkhof F, Pouwels PJW et al. (1999) Neuronal damage in T1-hypointensive multiple sclerosis lesions demonstrated in vivo using proton magnetic resonance spectroscopy. Ann Neurol 46: 79–87PubMedCrossRefGoogle Scholar
  93. Weiner HL (2009) The challenge of multiple sclerosis: How do we cure an chronic heterogenous disease? Ann Neurol 65: 239–248PubMedCrossRefGoogle Scholar
  94. Weinshenker BC, Bass R, Rice GPA et al. (1989) The natural history of multiple sclerosis: A geographically based study. I. Clinical course and disability. Brain 112: 133–146PubMedCrossRefGoogle Scholar
  95. Wingerchuk DM, Lennon VA, Pittok SJ et al. (2006) Revised diagnostic criteria for neuromyelitis optica. Neurology 66: 1485–1489PubMedCrossRefGoogle Scholar
  96. Wolinsky JS, Narayana PA, O’Connor P et al. (2007) Glatiramer Acetat in primary progressive multiple sclerosis: Results of a multinational, multicenter, double-blind, placebo-controlled trial. Ann Neurol 61: 14–24PubMedCrossRefGoogle Scholar
  97. Wood DD, Bilbao JM, O’Connors P, Moscarello MA (1996) Acute multiple sclerosis (Marburg type) is associated with developementally immature myelin basic protein. Ann Neurol 40: 18–24PubMedCrossRefGoogle Scholar
  98. Zeis T, Graumann U, Reynolds R, Schaeren-Wiemers N (2008) Normal-appearing white matter in multiple sclerosis is in a subtle balance between inflammation and neuroprotection. Brain 131: 288–303PubMedCrossRefGoogle Scholar
  99. Zivadinov R (2007) Can imaging techniques measure neuroprotection and remyelination in multiple sclerosis? Neurology 68 (Suppl): S72–S82PubMedCrossRefGoogle Scholar

Weiterführende Literatur

  1. Betts CD, Jones SJ, Fowler CG, Fowler CJ (1994) Erectile dysfunction in multiple sclerosis; associated neurological and neurophysiological deficits, and treatment of the condition. Brain 117: 1303–1310PubMedCrossRefGoogle Scholar
  2. Compston A (2006) McAlpine’s multiple sclerosis. 4th edn. Churchill Livingstone, LondonGoogle Scholar
  3. Giovannoni G, Hartung H-P (1996) The immunopathogenesis of multiple sclerosis and Guillain-Barré syndrome. Curr Op Neurol 9: 165–177CrossRefGoogle Scholar
  4. Kesselring J (1997) Multiple Sklerose. Kohlhammer, StuttgartGoogle Scholar
  5. Leary SM, Thompson AJ (2005) Primary progressive multiple sclerosis: Current and future treatment options. CNS Drugs 19(5): 369–376PubMedCrossRefGoogle Scholar
  6. McFarland HF, Frand JA, Albert PS et al. (1992) Using gadolinium-enhanced magnetic resonance imaging lesions to monitor disease activity in multiple sclerosis. Ann Neurol 32: 758–766PubMedCrossRefGoogle Scholar
  7. Moulin DE (1989) Pain in multiple sclerosis. Neurol Clin 7: 321–331PubMedGoogle Scholar
  8. Poser S (1996) Diagnose. In: Poser S (Hrsg) Taschenbuch Multiple Sklerose. Blackwell, Berlin, S 53–87Google Scholar
  9. Seidel D (1995) Multiple Sklerose – Symptomatische Therapie und Rehabilitation. TW Neurol Psychiatr 9: 574–582Google Scholar
  10. The IFNB Multiple Sclerosis Study Group (1993) Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 43: 655–661Google Scholar
  11. Wiethölter H (2005) Schubprophylaxe mi Interferonen und Glatiramerazetat. Nervenheilkunde 24: 279–286Google Scholar

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© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • J. H. Faiss
    • 1
  • H. Wiethölter
    • 2
  1. 1.Klinik für NeurologieAsklepios Fachklinikum TeupitzTeupitz
  2. 2.Stuttgart

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