Clinical neuroimaging and electrophysiological assessment of three DYT6 dystonia families
Identifieur interne : 000C69 ( Istex/Curation ); précédent : 000C68; suivant : 000C70Clinical neuroimaging and electrophysiological assessment of three DYT6 dystonia families
Auteurs : Simone Zittel [Allemagne] ; Christian K. E. Moll [Allemagne] ; Norbert Brüggemann [Allemagne] ; Vera Tadic [Allemagne] ; Wolfgang Hamel [Allemagne] ; Meike Kasten [Allemagne] ; Katja Lohmann [Allemagne] ; Thora Lohnau [Allemagne] ; Susen Winkler [Allemagne] ; Christian Gerloff [Allemagne] ; Rainer Schönweiler [Allemagne] ; Johann Hagenah [Allemagne] ; Christine Klein [Allemagne] ; Alexander Münchau [Allemagne] ; Susanne A. Schneider [Allemagne]Source :
- Movement Disorders [ 0885-3185 ] ; 2010-10-30.
English descriptors
Abstract
The purpose of the study was to delineate clinical and electrophysiological characteristics as well as laryngoscopical and transcranial ultrasound (TCS) findings in THAP1 mutation carriers (MutC). According to recent genetic studies, DYT6 (THAP1) gene mutations are an important cause of primary early‐onset dystonia. In contrast to DYT1 mutations, THAP1 mutations are associated with primary early‐onset segmental or generalised dystonia frequently involving the craniocervical region and the larynx. Blood samples from twelve individuals of three German families with DYT6 positive index cases were obtained to test for THAP1 mutations. Eight THAP1 MutC were identified. Of these, six (three symptomatic and three asymptomatic) THAP1 MutC could be clinically evaluated. Laryngoscopy was performed to evaluate laryngeal dysfunction in patients. Brainstem echogenicity was investigated in all MutC using TCS. Two of the patients had undergone bilateral pallidal DBS. In all three symptomatic MutC, early‐onset laryngeal dystonia was a prominent feature. Laryngeal assessment demonstrated adductor‐type dystonia in all of them. On clinical examination, the three asymptomatic MutC also showed subtle signs of focal or segmental dystonia. TCS revealed increased substantia nigra (SN) hyperechogenicity in all MutC. Intraoperative microelectrode recordings under general anesthesia in two of the patients showed no difference between THAP1 and previously operated DYT1 MutC. The presence of spasmodic dysphonia in patients with young‐onset segmental or generalised dystonia is a hallmark of DYT6 dystonia. SN hyperechogenicity on TCS may represent an endophenotype in these patients. Pallidal DBS in two patients was unsatisfactory. © 2010 Movement Disorder Society
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DOI: 10.1002/mds.23279
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Moll</name><affiliation wicri:level="1"><mods:affiliation>Institute of Neurophysiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Neurophysiology, University Medical Center Hamburg Eppendorf, Hamburg</wicri:regionArea></affiliation></author><author><name sortKey="Bruggemann, Norbert" sort="Bruggemann, Norbert" uniqKey="Bruggemann N" first="Norbert" last="Brüggemann">Norbert Brüggemann</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Tadic, Vera" sort="Tadic, Vera" uniqKey="Tadic V" first="Vera" 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last="Kasten">Meike Kasten</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Lohmann, Katja" sort="Lohmann, Katja" uniqKey="Lohmann K" first="Katja" last="Lohmann">Katja Lohmann</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Lohnau, Thora" sort="Lohnau, Thora" uniqKey="Lohnau T" first="Thora" last="Lohnau">Thora Lohnau</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Winkler, Susen" sort="Winkler, Susen" uniqKey="Winkler S" first="Susen" last="Winkler">Susen Winkler</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Gerloff, Christian" sort="Gerloff, Christian" uniqKey="Gerloff C" first="Christian" last="Gerloff">Christian Gerloff</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg</wicri:regionArea></affiliation></author><author><name sortKey="Schonweiler, Rainer" sort="Schonweiler, Rainer" uniqKey="Schonweiler R" first="Rainer" last="Schönweiler">Rainer Schönweiler</name><affiliation wicri:level="1"><mods:affiliation>Department of Phoniatrics and Pediatric Audiology, (Speech, Language, Voice, Swallowing, and Hearing Disorders), University Clinic of Schleswig‐Holstein, Campus Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Phoniatrics and Pediatric Audiology, (Speech, Language, Voice, Swallowing, and Hearing Disorders), University Clinic of Schleswig‐Holstein, Campus Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Hagenah, Johann" sort="Hagenah, Johann" uniqKey="Hagenah J" first="Johann" last="Hagenah">Johann Hagenah</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Klein, Christine" sort="Klein, Christine" uniqKey="Klein C" first="Christine" last="Klein">Christine Klein</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Christine Klein, Section for Clinical and Molecular Neurogenetics, Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, GermanyAlexander Münchau, Department of Neurology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Christine Klein, Section for Clinical and Molecular Neurogenetics, Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, GermanyAlexander Münchau, Department of Neurology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg</wicri:regionArea></affiliation></author><author><name sortKey="Munchau, Alexander" sort="Munchau, Alexander" uniqKey="Munchau A" first="Alexander" last="Münchau">Alexander Münchau</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Christine Klein, Section for Clinical and Molecular Neurogenetics, Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, GermanyAlexander Münchau, Department of Neurology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Christine Klein, Section for Clinical and Molecular Neurogenetics, Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, GermanyAlexander Münchau, Department of Neurology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg</wicri:regionArea></affiliation></author><author><name sortKey="Schneider, Susanne A" sort="Schneider, Susanne A" uniqKey="Schneider S" first="Susanne A." last="Schneider">Susanne A. Schneider</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:2433B4BAB443B92917544897C31812306FD01015</idno><date when="2010" year="2010">2010</date><idno type="doi">10.1002/mds.23279</idno><idno type="url">https://api.istex.fr/document/2433B4BAB443B92917544897C31812306FD01015/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000C69</idno><idno type="wicri:Area/Istex/Curation">000C69</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Clinical neuroimaging and electrophysiological assessment of three DYT6 dystonia families</title><author><name sortKey="Zittel, Simone" sort="Zittel, Simone" uniqKey="Zittel S" first="Simone" last="Zittel">Simone Zittel</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg</wicri:regionArea></affiliation></author><author><name sortKey="Moll, Christian K E" sort="Moll, Christian K E" uniqKey="Moll C" first="Christian K. E." last="Moll">Christian K. E. Moll</name><affiliation wicri:level="1"><mods:affiliation>Institute of Neurophysiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute of Neurophysiology, University Medical Center Hamburg Eppendorf, Hamburg</wicri:regionArea></affiliation></author><author><name sortKey="Bruggemann, Norbert" sort="Bruggemann, Norbert" uniqKey="Bruggemann N" first="Norbert" last="Brüggemann">Norbert Brüggemann</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Tadic, Vera" sort="Tadic, Vera" uniqKey="Tadic V" first="Vera" last="Tadic">Vera Tadic</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Hamel, Wolfgang" sort="Hamel, Wolfgang" uniqKey="Hamel W" first="Wolfgang" last="Hamel">Wolfgang Hamel</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg</wicri:regionArea></affiliation></author><author><name sortKey="Kasten, Meike" sort="Kasten, Meike" uniqKey="Kasten M" first="Meike" last="Kasten">Meike Kasten</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Lohmann, Katja" sort="Lohmann, Katja" uniqKey="Lohmann K" first="Katja" last="Lohmann">Katja Lohmann</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Lohnau, Thora" sort="Lohnau, Thora" uniqKey="Lohnau T" first="Thora" last="Lohnau">Thora Lohnau</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Winkler, Susen" sort="Winkler, Susen" uniqKey="Winkler S" first="Susen" last="Winkler">Susen Winkler</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Gerloff, Christian" sort="Gerloff, Christian" uniqKey="Gerloff C" first="Christian" last="Gerloff">Christian Gerloff</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg</wicri:regionArea></affiliation></author><author><name sortKey="Schonweiler, Rainer" sort="Schonweiler, Rainer" uniqKey="Schonweiler R" first="Rainer" last="Schönweiler">Rainer Schönweiler</name><affiliation wicri:level="1"><mods:affiliation>Department of Phoniatrics and Pediatric Audiology, (Speech, Language, Voice, Swallowing, and Hearing Disorders), University Clinic of Schleswig‐Holstein, Campus Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Phoniatrics and Pediatric Audiology, (Speech, Language, Voice, Swallowing, and Hearing Disorders), University Clinic of Schleswig‐Holstein, Campus Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Hagenah, Johann" sort="Hagenah, Johann" uniqKey="Hagenah J" first="Johann" last="Hagenah">Johann Hagenah</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation></author><author><name sortKey="Klein, Christine" sort="Klein, Christine" uniqKey="Klein C" first="Christine" last="Klein">Christine Klein</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Christine Klein, Section for Clinical and Molecular Neurogenetics, Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, GermanyAlexander Münchau, Department of Neurology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Christine Klein, Section for Clinical and Molecular Neurogenetics, Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, GermanyAlexander Münchau, Department of Neurology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg</wicri:regionArea></affiliation></author><author><name sortKey="Munchau, Alexander" sort="Munchau, Alexander" uniqKey="Munchau A" first="Alexander" last="Münchau">Alexander Münchau</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Christine Klein, Section for Clinical and Molecular Neurogenetics, Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, GermanyAlexander Münchau, Department of Neurology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Christine Klein, Section for Clinical and Molecular Neurogenetics, Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, GermanyAlexander Münchau, Department of Neurology, University Medical Center Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg</wicri:regionArea></affiliation></author><author><name sortKey="Schneider, Susanne A" sort="Schneider, Susanne A" uniqKey="Schneider S" first="Susanne A." last="Schneider">Susanne A. Schneider</name><affiliation wicri:level="1"><mods:affiliation>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Section of Clinical and Molecular Neurogenetics at the Department of Neurology, University of Luebeck, Luebeck</wicri:regionArea></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="2010-10-30">2010-10-30</date><biblScope unit="vol">25</biblScope><biblScope unit="issue">14</biblScope><biblScope unit="page" from="2405">2405</biblScope><biblScope unit="page" to="2412">2412</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">2433B4BAB443B92917544897C31812306FD01015</idno><idno type="DOI">10.1002/mds.23279</idno><idno type="ArticleID">MDS23279</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>THAP1</term><term>deep brain stimulation</term><term>laryngoscopy</term><term>transcranial ultrasound</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The purpose of the study was to delineate clinical and electrophysiological characteristics as well as laryngoscopical and transcranial ultrasound (TCS) findings in THAP1 mutation carriers (MutC). According to recent genetic studies, DYT6 (THAP1) gene mutations are an important cause of primary early‐onset dystonia. In contrast to DYT1 mutations, THAP1 mutations are associated with primary early‐onset segmental or generalised dystonia frequently involving the craniocervical region and the larynx. Blood samples from twelve individuals of three German families with DYT6 positive index cases were obtained to test for THAP1 mutations. Eight THAP1 MutC were identified. Of these, six (three symptomatic and three asymptomatic) THAP1 MutC could be clinically evaluated. Laryngoscopy was performed to evaluate laryngeal dysfunction in patients. Brainstem echogenicity was investigated in all MutC using TCS. Two of the patients had undergone bilateral pallidal DBS. In all three symptomatic MutC, early‐onset laryngeal dystonia was a prominent feature. Laryngeal assessment demonstrated adductor‐type dystonia in all of them. On clinical examination, the three asymptomatic MutC also showed subtle signs of focal or segmental dystonia. TCS revealed increased substantia nigra (SN) hyperechogenicity in all MutC. Intraoperative microelectrode recordings under general anesthesia in two of the patients showed no difference between THAP1 and previously operated DYT1 MutC. The presence of spasmodic dysphonia in patients with young‐onset segmental or generalised dystonia is a hallmark of DYT6 dystonia. SN hyperechogenicity on TCS may represent an endophenotype in these patients. Pallidal DBS in two patients was unsatisfactory. © 2010 Movement Disorder Society</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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