Are Upper-Body Axial Symptoms a Feature of Early Parkinson’s Disease?
Identifieur interne : 001B15 ( Ncbi/Checkpoint ); précédent : 001B14; suivant : 001B16Are Upper-Body Axial Symptoms a Feature of Early Parkinson’s Disease?
Auteurs : Caroline Moreau [France] ; David Devos [France] ; Guillaume Baille [France] ; Arnaud Delval [France] ; Céline Tard [France] ; Thierry Perez [France] ; Nicolas Danel-Buhl [France] ; David Seguy [France] ; Julien Labreuche [France] ; Alain Duhamel [France] ; Marie Delliaux [France] ; Kathy Dujardin [France] ; Luc Defebvre [France]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
Axial disorders are considered to appear late in the course of Parkinson’s disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients.
To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD.
We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes.
The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men).
Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders.
Url:
DOI: 10.1371/journal.pone.0162904
PubMed: 27654040
PubMed Central: 5031440
Affiliations:
- France
- Hauts-de-France, Nord-Pas-de-Calais
- Lille
- Université Lille 2, Université Lille Nord de France
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PMC:5031440Le document en format XML
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<author><name sortKey="Danel Buhl, Nicolas" sort="Danel Buhl, Nicolas" uniqKey="Danel Buhl N" first="Nicolas" last="Danel-Buhl">Nicolas Danel-Buhl</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Are Upper-Body Axial Symptoms a Feature of Early Parkinson’s Disease?</title>
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</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Devos, David" sort="Devos, David" uniqKey="Devos D" first="David" last="Devos">David Devos</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Department of Neurology and Movement Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Neurology and Movement Disorders, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Department of Medical Pharmacology, Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Medical Pharmacology, Disorders, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Baille, Guillaume" sort="Baille, Guillaume" uniqKey="Baille G" first="Guillaume" last="Baille">Guillaume Baille</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Department of Neurology and Movement Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Neurology and Movement Disorders, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Delval, Arnaud" sort="Delval, Arnaud" uniqKey="Delval A" first="Arnaud" last="Delval">Arnaud Delval</name>
<affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Department of Clinical Neurophysiology, Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Clinical Neurophysiology, Disorders, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Tard, Celine" sort="Tard, Celine" uniqKey="Tard C" first="Céline" last="Tard">Céline Tard</name>
<affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Department of Clinical Neurophysiology, Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Clinical Neurophysiology, Disorders, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Perez, Thierry" sort="Perez, Thierry" uniqKey="Perez T" first="Thierry" last="Perez">Thierry Perez</name>
<affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>Department of Pulmonology, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Pulmonology, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Danel Buhl, Nicolas" sort="Danel Buhl, Nicolas" uniqKey="Danel Buhl N" first="Nicolas" last="Danel-Buhl">Nicolas Danel-Buhl</name>
<affiliation wicri:level="3"><nlm:aff id="aff005"><addr-line>Department of Nutrition, Lille CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Nutrition, Lille CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Seguy, David" sort="Seguy, David" uniqKey="Seguy D" first="David" last="Seguy">David Seguy</name>
<affiliation wicri:level="3"><nlm:aff id="aff005"><addr-line>Department of Nutrition, Lille CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Nutrition, Lille CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Labreuche, Julien" sort="Labreuche, Julien" uniqKey="Labreuche J" first="Julien" last="Labreuche">Julien Labreuche</name>
<affiliation wicri:level="3"><nlm:aff id="aff006"><addr-line>Department of Biostatistics, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Biostatistics, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Duhamel, Alain" sort="Duhamel, Alain" uniqKey="Duhamel A" first="Alain" last="Duhamel">Alain Duhamel</name>
<affiliation wicri:level="3"><nlm:aff id="aff006"><addr-line>Department of Biostatistics, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Biostatistics, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Delliaux, Marie" sort="Delliaux, Marie" uniqKey="Delliaux M" first="Marie" last="Delliaux">Marie Delliaux</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Department of Neurology and Movement Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Neurology and Movement Disorders, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Dujardin, Kathy" sort="Dujardin, Kathy" uniqKey="Dujardin K" first="Kathy" last="Dujardin">Kathy Dujardin</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Department of Neurology and Movement Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Neurology and Movement Disorders, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Defebvre, Luc" sort="Defebvre, Luc" uniqKey="Defebvre L" first="Luc" last="Defebvre">Luc Defebvre</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Department of Neurology and Movement Disorders, CHU, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Neurology and Movement Disorders, CHU, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
<placeName><settlement type="city">Lille</settlement>
<region type="region" nuts="2">Hauts-de-France</region>
<region type="old region" nuts="2">Nord-Pas-de-Calais</region>
</placeName>
<orgName type="university" n="3">Université Lille 2</orgName>
<orgName type="institution" wicri:auto="newGroup">Université Lille Nord de France</orgName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff007"><addr-line>INSERM UMR_S 1171, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>INSERM UMR_S 1171, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
<placeName><settlement type="city">Lille</settlement>
<region type="region" nuts="2">Hauts-de-France</region>
<region type="old region" nuts="2">Nord-Pas-de-Calais</region>
</placeName>
<orgName type="university" n="3">Université Lille 2</orgName>
<orgName type="institution" wicri:auto="newGroup">Université Lille Nord de France</orgName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>University of Lille, Lille, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>University of Lille, Lille</wicri:regionArea>
<placeName><region type="region">Hauts-de-France</region>
<region type="old region">Nord-Pas-de-Calais</region>
<settlement type="city">Lille</settlement>
</placeName>
<placeName><settlement type="city">Lille</settlement>
<region type="region" nuts="2">Hauts-de-France</region>
<region type="old region" nuts="2">Nord-Pas-de-Calais</region>
</placeName>
<orgName type="university" n="3">Université Lille 2</orgName>
<orgName type="institution" wicri:auto="newGroup">Université Lille Nord de France</orgName>
</affiliation>
</author>
</analytic>
<series><title level="j">PLoS ONE</title>
<idno type="eISSN">1932-6203</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title>
<p>Axial disorders are considered to appear late in the course of Parkinson’s disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients.</p>
</sec>
<sec id="sec002"><title>Objectives</title>
<p>To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD.</p>
</sec>
<sec id="sec003"><title>Methods</title>
<p>We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes.</p>
</sec>
<sec id="sec004"><title>Results</title>
<p>The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men).</p>
</sec>
<sec id="sec005"><title>Conclusion</title>
<p>Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="De Lau, Lm" uniqKey="De Lau L">LM De Lau</name>
</author>
<author><name sortKey="Giebsbergen, Pc" uniqKey="Giebsbergen P">PC Giebsbergen</name>
</author>
<author><name sortKey="De Rijk, Mc" uniqKey="De Rijk M">MC De Rijk</name>
</author>
<author><name sortKey="Hofman, A" uniqKey="Hofman A">A Hofman</name>
</author>
<author><name sortKey="Koudstaal, Pj" uniqKey="Koudstaal P">PJ Koudstaal</name>
</author>
<author><name sortKey="Breteler, Mm" uniqKey="Breteler M">MM Breteler</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Muller, J" uniqKey="Muller J">J Müller</name>
</author>
<author><name sortKey="Wenning, Gk" uniqKey="Wenning G">GK Wenning</name>
</author>
<author><name sortKey="Verny, M" uniqKey="Verny M">M Verny</name>
</author>
<author><name sortKey="Mckee, A" uniqKey="Mckee A">A McKee</name>
</author>
<author><name sortKey="Chaudhuri, Kr" uniqKey="Chaudhuri K">KR Chaudhuri</name>
</author>
<author><name sortKey="Jellinger, K" uniqKey="Jellinger K">K Jellinger</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Evans, Jr" uniqKey="Evans J">JR Evans</name>
</author>
<author><name sortKey="Mason, Sl" uniqKey="Mason S">SL Mason</name>
</author>
<author><name sortKey="Williams Gray, Ch" uniqKey="Williams Gray C">CH Williams-Gray</name>
</author>
<author><name sortKey="Foltynie, T" uniqKey="Foltynie T">T Foltynie</name>
</author>
<author><name sortKey="Brayne, C" uniqKey="Brayne C">C Brayne</name>
</author>
<author><name sortKey="Robbins, Tw" uniqKey="Robbins T">TW Robbins</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Pinto, S" uniqKey="Pinto S">S Pinto</name>
</author>
<author><name sortKey="Ozsancak, C" uniqKey="Ozsancak C">C Ozsancak</name>
</author>
<author><name sortKey="Tripoliti, E" uniqKey="Tripoliti E">E Tripoliti</name>
</author>
<author><name sortKey="Thobois, S" uniqKey="Thobois S">S Thobois</name>
</author>
<author><name sortKey="Limousin Dowsey, P" uniqKey="Limousin Dowsey P">P Limousin-Dowsey</name>
</author>
<author><name sortKey="Auzou, P" uniqKey="Auzou P">P Auzou</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Moreau, C" uniqKey="Moreau C">C Moreau</name>
</author>
<author><name sortKey="Pennel Ployart, O" uniqKey="Pennel Ployart O">O Pennel-Ployart</name>
</author>
<author><name sortKey="Pinto, S" uniqKey="Pinto S">S Pinto</name>
</author>
<author><name sortKey="Plachez, A" uniqKey="Plachez A">A Plachez</name>
</author>
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