Parkinson disease, brain volumes, and subthalamic nucleus stimulation
Identifieur interne : 000742 ( PascalFrancis/Curation ); précédent : 000741; suivant : 000743Parkinson disease, brain volumes, and subthalamic nucleus stimulation
Auteurs : F. Bonneville [France] ; M. L. Welter [France] ; C. Elie [France] ; S. Tezenas Du Montcel [France] ; D. Hasboun [France] ; C. Menuel [France] ; J. L. Houeto [France] ; A. M. Bonnet [France] ; V. Mesnage [France] ; B. Pidoux [France] ; S. Navarro [France] ; P. Cornu [France] ; Y. Agid [France] ; D. Dormont [France]Source :
- Neurology [ 0028-3878 ] ; 2005.
Descripteurs français
- Pascal (Inist)
English descriptors
Abstract
Background: High-frequency stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson disease (PD). The clinical and preoperative predictive factors of the best postoperative outcome have been identified. Radiologic predictive factors were investigated. Methods: Forty patients with PD underwent surgery for bilateral STN stimulation. MRI was performed in stereotactic conditions before surgery. Brain parenchyma, caudate nucleus, putamen, pallidum, and red nucleus volumes and the surface of the mesencephalon were measured and normalized as percentages of the intracranial volume. Clinical evaluation was performed 1 month before and 6 months after surgery. Results: The normalized brain parenchyma volume was lower in patients who were older and had a longer disease duration or a lower frontal score and was not predictive of the postoperative outcome. The residual scores for activities of daily living and parkinsonian motor disability were higher in patients with a smaller normalized mesencephalon. The normalized caudate nucleus volume was predictive of the pre- and postoperative levodopa-equivalent dosage. Conclusions: Brain atrophy is not an exclusion criterion for neurosurgery, indicating that patients' neurologic, psychiatric, and neuropsychological characteristics are the best predictive factors for neurosurgery. The fact that a smaller normalized mesencephalon surface was associated with a lower beneficial effect of the subthalamic nucleus stimulation on the parkinsonian motor disability suggests that the normalized mesencephalon surface is a predictive factor of the postoperative outcome.
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Bonnet</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique and INSERM U 289, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Mesnage, V" sort="Mesnage, V" uniqKey="Mesnage V" first="V." last="Mesnage">V. Mesnage</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique and INSERM U 289, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Pidoux, B" sort="Pidoux, B" uniqKey="Pidoux B" first="B." last="Pidoux">B. Pidoux</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Service d'Explorations Fonctionnelles Neurologiques, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>10 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Navarro, S" sort="Navarro, S" uniqKey="Navarro S" first="S." last="Navarro">S. Navarro</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Service de Neurochirurgie, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>11 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P." last="Cornu">P. Cornu</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Service de Neurochirurgie, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>11 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Y. Agid</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique and INSERM U 289, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Dormont, D" sort="Dormont, D" uniqKey="Dormont D" first="D." last="Dormont">D. Dormont</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Service de Neuroradiologie, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>UPR 640 CNRS LENA, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>6 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">05-0241458</idno><date when="2005">2005</date><idno type="stanalyst">PASCAL 05-0241458 INIST</idno><idno type="RBID">Pascal:05-0241458</idno><idno type="wicri:Area/PascalFrancis/Corpus">000C92</idno><idno type="wicri:Area/PascalFrancis/Curation">000742</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Parkinson disease, brain volumes, and subthalamic nucleus stimulation</title><author><name sortKey="Bonneville, F" sort="Bonneville, F" uniqKey="Bonneville F" first="F." last="Bonneville">F. Bonneville</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Service de Neuroradiologie, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>UPR 640 CNRS LENA, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>6 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Welter, M L" sort="Welter, M L" uniqKey="Welter M" first="M. L." last="Welter">M. L. Welter</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique and INSERM U 289, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Elie, C" sort="Elie, C" uniqKey="Elie C" first="C." last="Elie">C. Elie</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Service de Biostatistique, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Tezenas Du Montcel, S" sort="Tezenas Du Montcel, S" uniqKey="Tezenas Du Montcel S" first="S." last="Tezenas Du Montcel">S. Tezenas Du Montcel</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Service de Biostatistique, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Hasboun, D" sort="Hasboun, D" uniqKey="Hasboun D" first="D." last="Hasboun">D. Hasboun</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Service de Neuroradiologie, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Menuel, C" sort="Menuel, C" uniqKey="Menuel C" first="C." last="Menuel">C. Menuel</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>UPR 640 CNRS LENA, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>6 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Houeto, J L" sort="Houeto, J L" uniqKey="Houeto J" first="J. L." last="Houeto">J. L. Houeto</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique and INSERM U 289, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Bonnet, A M" sort="Bonnet, A M" uniqKey="Bonnet A" first="A. M." last="Bonnet">A. M. Bonnet</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique and INSERM U 289, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Mesnage, V" sort="Mesnage, V" uniqKey="Mesnage V" first="V." last="Mesnage">V. Mesnage</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique and INSERM U 289, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Pidoux, B" sort="Pidoux, B" uniqKey="Pidoux B" first="B." last="Pidoux">B. Pidoux</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Service d'Explorations Fonctionnelles Neurologiques, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>10 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Navarro, S" sort="Navarro, S" uniqKey="Navarro S" first="S." last="Navarro">S. Navarro</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Service de Neurochirurgie, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>11 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P." last="Cornu">P. Cornu</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Service de Neurochirurgie, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>11 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Y. Agid</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Centre d'Investigation Clinique and INSERM U 289, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Dormont, D" sort="Dormont, D" uniqKey="Dormont D" first="D." last="Dormont">D. Dormont</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Service de Neuroradiologie, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>UPR 640 CNRS LENA, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>6 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country></affiliation></author></analytic><series><title level="j" type="main">Neurology</title><title level="j" type="abbreviated">Neurology</title><idno type="ISSN">0028-3878</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Neurology</title><title level="j" type="abbreviated">Neurology</title><idno type="ISSN">0028-3878</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cerebral disorder</term><term>Nervous system diseases</term><term>Parkinson disease</term><term>Subthalamic nucleus</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Système nerveux pathologie</term><term>Noyau sousthalamique</term><term>Parkinson maladie</term><term>Encéphale pathologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: High-frequency stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson disease (PD). The clinical and preoperative predictive factors of the best postoperative outcome have been identified. Radiologic predictive factors were investigated. Methods: Forty patients with PD underwent surgery for bilateral STN stimulation. MRI was performed in stereotactic conditions before surgery. Brain parenchyma, caudate nucleus, putamen, pallidum, and red nucleus volumes and the surface of the mesencephalon were measured and normalized as percentages of the intracranial volume. Clinical evaluation was performed 1 month before and 6 months after surgery. Results: The normalized brain parenchyma volume was lower in patients who were older and had a longer disease duration or a lower frontal score and was not predictive of the postoperative outcome. The residual scores for activities of daily living and parkinsonian motor disability were higher in patients with a smaller normalized mesencephalon. The normalized caudate nucleus volume was predictive of the pre- and postoperative levodopa-equivalent dosage. Conclusions: Brain atrophy is not an exclusion criterion for neurosurgery, indicating that patients' neurologic, psychiatric, and neuropsychological characteristics are the best predictive factors for neurosurgery. The fact that a smaller normalized mesencephalon surface was associated with a lower beneficial effect of the subthalamic nucleus stimulation on the parkinsonian motor disability suggests that the normalized mesencephalon surface is a predictive factor of the postoperative outcome.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0028-3878</s0></fA01><fA02 i1="01"><s0>NEURAI</s0></fA02><fA03 i2="1"><s0>Neurology</s0></fA03><fA05><s2>64</s2></fA05><fA06><s2>9</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Parkinson disease, brain volumes, and subthalamic nucleus stimulation</s1></fA08><fA11 i1="01" i2="1"><s1>BONNEVILLE (F.)</s1></fA11><fA11 i1="02" i2="1"><s1>WELTER (M. L.)</s1></fA11><fA11 i1="03" i2="1"><s1>ELIE (C.)</s1></fA11><fA11 i1="04" i2="1"><s1>TEZENAS DU MONTCEL (S.)</s1></fA11><fA11 i1="05" i2="1"><s1>HASBOUN (D.)</s1></fA11><fA11 i1="06" i2="1"><s1>MENUEL (C.)</s1></fA11><fA11 i1="07" i2="1"><s1>HOUETO (J. L.)</s1></fA11><fA11 i1="08" i2="1"><s1>BONNET (A. M.)</s1></fA11><fA11 i1="09" i2="1"><s1>MESNAGE (V.)</s1></fA11><fA11 i1="10" i2="1"><s1>PIDOUX (B.)</s1></fA11><fA11 i1="11" i2="1"><s1>NAVARRO (S.)</s1></fA11><fA11 i1="12" i2="1"><s1>CORNU (P.)</s1></fA11><fA11 i1="13" i2="1"><s1>AGID (Y.)</s1></fA11><fA11 i1="14" i2="1"><s1>DORMONT (D.)</s1></fA11><fA14 i1="01"><s1>Service de Neuroradiologie, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ><sZ>14 aut.</sZ></fA14><fA14 i1="02"><s1>UPR 640 CNRS LENA, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>1 aut.</sZ><sZ>6 aut.</sZ><sZ>14 aut.</sZ></fA14><fA14 i1="03"><s1>Centre d'Investigation Clinique and INSERM U 289, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>13 aut.</sZ></fA14><fA14 i1="04"><s1>Service de Biostatistique, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>3 aut.</sZ><sZ>4 aut.</sZ></fA14><fA14 i1="05"><s1>Service d'Explorations Fonctionnelles Neurologiques, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>10 aut.</sZ></fA14><fA14 i1="06"><s1>Service de Neurochirurgie, Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris</s1><s3>FRA</s3><sZ>11 aut.</sZ><sZ>12 aut.</sZ></fA14><fA20><s1>1598-1604</s1></fA20><fA21><s1>2005</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>6345</s2><s5>354000129836570190</s5></fA43><fA44><s0>0000</s0><s1>© 2005 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>44 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>05-0241458</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Neurology</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>Background: High-frequency stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson disease (PD). The clinical and preoperative predictive factors of the best postoperative outcome have been identified. Radiologic predictive factors were investigated. Methods: Forty patients with PD underwent surgery for bilateral STN stimulation. MRI was performed in stereotactic conditions before surgery. Brain parenchyma, caudate nucleus, putamen, pallidum, and red nucleus volumes and the surface of the mesencephalon were measured and normalized as percentages of the intracranial volume. Clinical evaluation was performed 1 month before and 6 months after surgery. Results: The normalized brain parenchyma volume was lower in patients who were older and had a longer disease duration or a lower frontal score and was not predictive of the postoperative outcome. The residual scores for activities of daily living and parkinsonian motor disability were higher in patients with a smaller normalized mesencephalon. The normalized caudate nucleus volume was predictive of the pre- and postoperative levodopa-equivalent dosage. Conclusions: Brain atrophy is not an exclusion criterion for neurosurgery, indicating that patients' neurologic, psychiatric, and neuropsychological characteristics are the best predictive factors for neurosurgery. The fact that a smaller normalized mesencephalon surface was associated with a lower beneficial effect of the subthalamic nucleus stimulation on the parkinsonian motor disability suggests that the normalized mesencephalon surface is a predictive factor of the postoperative outcome.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17</s0></fC02><fC02 i1="02" i2="X"><s0>002B17G</s0></fC02><fC02 i1="03" i2="X"><s0>002B17A03</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Système nerveux pathologie</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Noyau sousthalamique</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Subthalamic nucleus</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Núcleo subtalámico</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Parkinson maladie</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Parkinson disease</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Encéphale pathologie</s0><s5>07</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>07</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>07</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Extrapyramidal syndrome</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Système nerveux central</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Central nervous system</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Sistema nervioso central</s0><s5>40</s5></fC07><fN21><s1>164</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist></record>Pour manipuler ce document sous Unix (Dilib)
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