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Journal of Neurology
Erschienen in:

07.12.2018 | Review

Metronidazole-induced encephalopathy: a systematic review

verfasst von: Caspar Godthaab Sørensen, William Kristian Karlsson, Faisal Mohammad Amin, Mette Lindelof

Erschienen in: Journal of Neurology | Ausgabe 1/2020

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Abstract

Background and aims

Metronidazole, a commonly used antibiotic drug, can cause adverse effects in the central nervous system termed metronidazole-induced encephalopathy, leading to diagnostic challenges. The condition is rare and a detailed description of its phenotype is lacking. In this systematic review we investigated the clinical features of metronidazole-induced encephalopathy to promote recognition and elaborate the description.

Methods

We performed a systematic literature search using PubMed.gov and hand searched the reference lists of included articles and other publications of interest. We included case series and single reports describing individual patients developing symptoms from the central nervous system in relation to metronidazole treatment. Data were extracted and analyzed descriptively.

Results

We identified 779 publications of which 112 papers comprising 136 patients were included. Typical findings were dysarthria, gait instability, limb dyscoordination and altered mental status. Frequently, patients concomitantly presented with metronidazole-induced polyneuropathy. Liver disease was the most common pre-existing condition. MRI showed a characteristic pattern of reversible symmetrical hyperintense lesions on T2/FLAIR of the dentate nuclei in 90% of patients. Most patients improved significantly after discontinuation of metronidazole. Poor outcome was associated with severe comorbidity.

Conclusion

Metronidazole-induced encephalopathy should be considered in patients presenting with neurological symptoms in relation to newly initiated or prolonged metronidazole treatment. MRI changes are highly characteristic and specific. Patients with liver disease are at increased risk. Prognosis is good if recognized early.
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Literatur
1.
Klein EY et al (2018) Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci USA 115(15):E3463–E3470PubMed
2.
Morgan DJ et al (2011) Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis 11(9):692–701PubMedPubMedCentral
3.
Bhattacharyya S et al (2016) Antibiotic-associated encephalopathy. Neurology 86(10):963–971PubMed
4.
Lofmark S, Edlund C, Nord CE (2010) Metronidazole is still the drug of choice for treatment of anaerobic infections. Clin Infect Dis 50(Suppl 1):S16–S23PubMed
5.
Goolsby TA, Jakeman B, Gaynes RP (2018) Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature. Int J Antimicrob Agents 51(3):319–325PubMed
6.
Liberati A et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100PubMedPubMedCentral
7.
Agah E et al (2017) Metronidazole-induced neurotoxicity presenting with sudden bilateral hearing loss, encephalopathy, and cerebellar dysfunction. Eur J Clin Pharmacol 73(2):249–250PubMed
8.
9.
Ahmed A, Loes DJ, Bressler EL (1995) Reversible magnetic resonance imaging findings in metronidazole-induced encephalopathy. Neurology 45(3 Pt 1):588–589PubMed
10.
11.
Alvarez RS et al (1983) Central nervous system toxicity related to prolonged metronidazole therapy. Am J Obstet Gynecol 145(5):640–641PubMed
12.
Arik N, Cengiz N, Bilge A (2001) Metronidazole-induced encephalopathy in a uremic patient: a case report. Nephron 89(1):108–109PubMed
13.
Bae EH et al (2016) Metronidazole-Induced Encephalopathy: a case report. J Nippon Med Sch 83(2):44–45PubMed
14.
Bahn Y et al (2010) Metronidazole induced encephalopathy in a patient with brain abscess. J Korean Neurosurg Soc 48(3):301–304PubMedPubMedCentral
15.
Bailes J et al (1983) Encephalopathy with metronidazole in a child. Am J Dis Child 137(3):290–291PubMed
16.
Bates JE, Almast J, Augustine EF (2015) Neonatal dentate nucleus T2 hyperintensity after in utero metronidazole exposure. Neurology 85(11):1006PubMedPubMedCentral
17.
Beloosesky Y et al (2000) Convulsions induced by metronidazole treatment for Clostridium difficile-associated disease in chronic renal failure. Am J Med Sci 319(5):338–339PubMed
18.
Bonda C, Evans MS (2015) Metronidazole CNS toxicity. Acta Neurol Belg 115(4):709–710PubMed
19.
Bonkowsky JL, Sondrup C, Benedict SL (2007) Acute reversible cerebellar lesions associated with metronidazole therapy. Neurology 68(3):180PubMed
20.
Bottenberg MM et al (2011) Metronidazole-induced encephalopathy: a case report and review of the literature. J Clin Pharmacol 51(1):112–116PubMed
21.
Cacao G et al (2015) Metronidazole-induced central and peripheral nervous system toxicity. Neurol Sci 36(9):1737–1739PubMed
22.
23.
Cecil KM et al (2002) Reversible MR imaging and MR spectroscopy abnormalities in association with metronidazole therapy. J Comput Assist Tomogr 26(6):948–951PubMed
24.
Chacko J et al (2011) Clinical, neuroimaging and pathological features of 5-nitroimidazole-induced encephalo-neuropathy in two patients: Insights into possible pathogenesis. Neurol India 59(5):743–747PubMed
25.
Chakrabarti S, Pan K (2014) Metronidazole-induced encephalopathy: an uncommon scenario. N Z Med J 127(1393):120–122PubMed
26.
Chandak S et al (2016) A case report of metronidazole induced neurotoxicity in liver abscess patient and the usefulness of MRI for its diagnosis. J Clin Diagn Res 10(1):TD06–T7PubMedPubMedCentral
27.
Chatzkel JA, Vossough A (2010) Metronidazole-induced cerebellar toxicity. Pediatr Radiol 40(8):1453PubMed
28.
Chaudhari TS, Malhotra HS, Garg RK (2014) Face of the giant panda with bright eyes in metronidazole neurotoxicity. Neurol India 62(2):212–213PubMed
29.
Cheong HC et al (2011) Metronidazole-induced encephalopathy in a patient with liver cirrhosis. Korean J Hepatol 17(2):157–160PubMedPubMedCentral
30.
Clements A (2017) Case report of metronidazole-induced encephalopathy. WMJ 116(5):221–223PubMed
31.
De Bleecker JL, Leroy BP, Meire VI (2005) Reversible visual deficit and Corpus callosum lesions due to metronidazole toxicity. Eur Neurol 53(2):93–95PubMed
32.
Deenadayalu VP et al (2005) Abnormal enhancing lesion of dentate nuclei causing neurologic symptoms induced by metronidazole toxicity. Clin Gastroenterol Hepatol 3(3):xxixPubMed
33.
Demel SL, Jovin TG, Jadhav AP (2015) Metronidazole toxicity presenting with acute onset of aphasia and right sided weakness. J Clin Neurosci 22(7):1199–1200PubMed
34.
Desai JA et al (2011) Metronidazole-induced encephalopathy: case report and review of MRI findings. Can J Neurol Sci 38(3):512–513PubMed
35.
Dhar A et al (2016) Mystery case: metronidazole-induced encephalopathy. Neurology 87(9):e89–e90PubMed
36.
Erdener SE et al (2013) Brain MRI evolution of metronidazole intoxication. Neurology 80(19):1816–1817PubMed
37.
Eren F et al (2017) A case with reversible neurotoxicity induced by metronidazole. Ideggyogy Szem 70(11–12):429–432
38.
Etxeberria A et al (2012) Metronidazole-cerebellopathy associated with peripheral neuropathy, downbeat nystagmus, and bilateral ocular abduction deficit. Rev Neurol (Paris) 168(2):193–195
39.
Farmakiotis D, Zeluff B (2016) Images in clinical medicine. Metronidazole-associated encephalopathy. N Engl J Med 374(15):1465PubMed
40.
Foreid H et al. (2009) Reversible iatrogenic subacute cerebellar syndrome, myoclonus and MRI findings following metronidazole administration. BMJ Case Rep
41.
Frytak S, Moertel CH, Childs DS (1978) Neurologic toxicity associated with high-dose metronidazole therapy. Ann Intern Med 88(3):361–362PubMed
42.
Furukawa S et al (2015) Metronidazole-induced encephalopathy with contrast enhancing lesions on MRI. J Neurol Sci 352(1–2):129–131PubMed
43.
Galvez M, Brahm J, Miranda M (2009) Movement disorders as a manifestation of metronidazole-induced encephalopathy in a patient with chronic liver disease. Mov Disord 24(12):1864–1866PubMed
44.
45.
Graves TD et al (2009) Reversible metronidazole-induced cerebellar toxicity in a multiple transplant recipient. J Neurol Sci 285(1–2):238–240PubMed
46.
Groothoff MV et al (2010) Irreversible encephalopathy after treatment with high-dose intravenous metronidazole. Clin Ther 32(1):60–64PubMed
47.
Gupta AK et al (2003) Metrondazole-induced neurotoxicity. J Assoc Physicians India 51:617–618PubMed
48.
Halloran TJ (1982) Convulsions associated with high cumulative doses of metronidazole. Drug Intell Clin Pharm 16(5):409PubMed
49.
Hammami N et al (2007) Reversible metronidazole-induced encephalopathy. J Neuroradiol 34(2):133–136PubMed
50.
Hanji Y et al (2017) Metronidazole-induced encephalopathy associated with treatment for liver abscesses. J Gen Fam Med 18(5):265–267PubMedPubMedCentral
51.
Hari A, Srikanth BA, Lakshmi GS (2013) Metronidazole induced cerebellar ataxia. Indian J Pharmacol 45(3):295–297PubMedPubMedCentral
52.
Haridas A et al (2015) Metronidazole-Induced Encephalopathy in Chronic Diarrhoea. J Assoc Physicians India 63(6):77–79PubMed
53.
Heaney CJ, Campeau NG, Lindell EP (2003) MR imaging and diffusion-weighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity. AJNR Am J Neuroradiol 24(8):1615–1617PubMed
54.
Higashi M et al (2013) Metronidazole-induced encephalopathy. Intern Med 52(7):843–844PubMed
55.
Hobbs K et al (2015) Metronidazole-induced encephalopathy: not always a reversible situation. Neurocrit Care 22(3):429–436PubMed
56.
Horlen CK, Seifert CF, Malouf CS (2000) Toxic metronidazole-induced MRI changes. Ann Pharmacother 34(11):1273–1275PubMed
57.
Huang YT, Chen LA, Cheng SJ (2012) Metronidazole-induced encephalopathy: case report and review literature. Acta Neurol Taiwan 21(2):74–78PubMed
58.
Hwang GH et al (2012) Metronidazole induced encephalopathy with peripheral polyneuropathy in patient with spinal cord injury. Korean J Spine 9(1):44–48PubMedPubMedCentral
59.
Iqbal A et al (2013) Clinical and imaging perspective and unanswered questions in a case of metronidazole induced encephalopathy. Ann Indian Acad Neurol 16(4):569–571PubMedPubMedCentral
60.
Ito H et al (2004) Reversible cerebellar lesions induced by metronidazole therapy for helicobacter pylori. J Neuroimaging 14(4):369–371PubMed
61.
Iwadate D et al (2017) Thiamine deficiency in metronidazole-induced encephalopathy: a metabolic correlation? J Neurol Sci 379:324–326PubMed
62.
Jang HJ et al (2012) Atypical metronidazole-induced encephalopathy in anaerobic brain abscess. J Korean Neurosurg Soc 52(3):273–276PubMedPubMedCentral
63.
Kafadar I et al (2013) A rare adverse effect of metronidazole: nervous system symptoms. Pediatr Emerg Care 29(6):751–752PubMed
64.
Kalia V, Vibhuti, Saggar K (2010) Case report: MRI of the brain in metronidazole toxicity. Indian J Radiol Imaging 20(3):195–197PubMedPubMedCentral
65.
Khodakaram K, Barmano N (2011) Uncommon reaction to a common prescription. Lancet 378(9787):288PubMed
66.
Kim DW et al (2004) Metronidazole-induced encephalopathy. J Neurol Sci 224(1–2):107–111PubMed
67.
Kim E et al (2007) MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings. AJNR Am J Neuroradiol 28(9):1652–1658PubMed
68.
Kim H et al (2011) Metronidazole-induced encephalopathy in a patient with infectious colitis: a case report. J Med Case Rep 5:63PubMedPubMedCentral
69.
Kim J et al (2017) Metronidazole-induced encephalopathy in a patient with Crohn’s disease. Intest Res 15(1):124–129PubMedPubMedCentral
70.
Kim SM et al (2011) Serially changing metronidazole-induced encephalopathy. Can J Neurol Sci 38(6):921–924PubMed
71.
Knorr JP et al (2012) Metronidazole-induced encephalopathy in a patient with end-stage liver disease. Case Reports Hepatol 2012:209258PubMedPubMedCentral
72.
Kumari P et al (2016) Metronidazole induced neurotoxicity in a case of liver abscess. Int J Hepatobiliary Pancreat Dis 6:96–99
73.
Kuriyama A (2017) Chestnut sign: metronidazole-induced encephalopathy. J Emerg Med 52(1):101–102PubMed
74.
Kuriyama A et al (2011) Metronidazole-induced central nervous system toxicity: a systematic review. Clin Neuropharmacol 34(6):241–247PubMed
75.
Kusumi RK et al (1980) Central nervous system toxicity associated with metronidazole therapy. Ann Intern Med 93(1):59–60PubMed
76.
Lawford R, Sorrell TC (1994) Amebic abscess of the spleen complicated by metronidazole-induced neurotoxicity: case report. Clin Infect Dis 19(2):346–348PubMed
77.
Lee HC, Kim YE, Ma HI (2017) Metronidazole-induced craniocervical myoclonus with reversible bilateral dentate nucleus lesions. J Mov Disord 10(1):67–68PubMedPubMedCentral
78.
Lee JH et al (2008) Metronidazole-induced toxic encephalopathy in a hemodialysis patient: a case report. Korean J Nephrol 27(6):743–746
79.
Lee SS et al (2009) Reversible inferior colliculus lesion in metronidazole-induced encephalopathy: magnetic resonance findings on diffusion-weighted and fluid attenuated inversion recovery imaging. J Comput Assist Tomogr 33(2):305–308PubMed
80.
81.
McCabe J, Neale J, Varghese A (2017) A case of metronidazole-induced neurotoxicity. Postgrad Med J 93(1105):712PubMed
82.
Mehndiratta MM, Pandey S, Nayak R (2013) Metronidazole encephalopathy. J Assoc Physicians India 61(7):485PubMed
83.
Mittal GK et al (2017) Dentate hyperintensities—the imaging signature of metronidazole induced encephalopathy. J Neurosci Rural Pract 8(2):272–273PubMedPubMedCentral
84.
Mizuta K et al (2018) Metronidazole-induced encephalopathy in a patient with pyogenic spondylitis: a case report. BMC Musculoskelet Disord 19(1):336PubMedPubMedCentral
85.
Moosa AN, Perkins D (2010) Neurological picture. MRI of metronidazole induced cerebellar ataxia. J Neurol Neurosurg Psychiatry 81(7):754–755PubMed
86.
Moriya M et al (2013) Reversible lesions of cerebellar dentate nuclei associated with metronidazole therapy. Neurol Clin Neurosci 1(6):227–228
87.
Mulcahy H, Chaddha SK (2008) MRI of metronidazole-induced encephalopathy. Radiol Case Rep 3(4):239PubMed
88.
Naqi R, Azeemuddin M, Beg MA (2012) Magnetic resonance imaging of metronidazole induced encephalopathy. J Pak Med Assoc 62(8):843–844PubMed
89.
Ng PS, Saini M (2014) Reversible metronidazole-induced subacute cerebellar syndrome. QJM 107(12):1051–1052PubMed
90.
Onuma Y et al (2017) Irreversible metronidazole encephalopathy in an elderly woman with primary biliary cholangitis. J Gen Fam Med 18(6):436–438PubMedPubMedCentral
91.
Papathanasiou A et al (2013) Metronidazole-induced reversible encephalopathy in a patient with facioscapulohumeral muscular dystrophy. Clin Neuroradiol 23(3):217–219PubMed
92.
Park KI, Chung JM, Kim JY (2011) Metronidazole neurotoxicity: sequential neuroaxis involvement. Neurol India 59(1):104–107PubMed
93.
Patel K et al (2008) Cerebellar ataxia following prolonged use of metronidazole: case report and literature review. Int J Infect Dis 12(6):e111–e114PubMed
94.
Rizvi I et al (2018) Metronidazole-associated encephalopathy: a reversible condition. Intern Emerg Med 13(8):1323–1325PubMed
95.
Roy U et al (2016) Clinical and neuroradiological spectrum of metronidazole induced encephalopathy: our experience and the review of literature. J Clin Diagn Res 10(6):OE01–O9PubMedPubMedCentral
96.
Sandip S, Afshan I, Khandelwal RK (2015) MR features of metronidazole-induced encephalopathy. BMJ Case Rep
97.
Sarna JR, Brownell AK, Furtado S (2009) Cases: reversible cerebellar syndrome caused by metronidazole. CMAJ 181(9):611–613PubMedPubMedCentral
98.
Senthilkumaran S et al (2015) Metronidazole encephalopathy: uncommon reaction to a common drug. Int J Crit Illn Inj Sci 5(2):123–124PubMedPubMedCentral
99.
Seok JI et al (2003) Metronidazole-induced encephalopathy and inferior olivary hypertrophy: lesion analysis with diffusion-weighted imaging and apparent diffusion coefficient maps. Arch Neurol 60(12):1796–1800PubMed
100.
Sevy A et al (2011) Central and peripheral neurotoxicity of metronidazole after treatment for brain abscess. Acta Neurochir (Wien) 153(12):2491–2492
101.
102.
Singh R et al (2017) Sequential MR imaging (with diffusion-weighted imaging) changes in metronidazole-induced encephalopathy. Indian J Radiol Imaging 27(2):129–132PubMedPubMedCentral
103.
Sonthalia N et al (2016) Metronidazole-induced encephalopathy in alcoholic liver disease: a diagnostic and therapeutic challenge. J Emerg Med 51(4):e79–e83PubMed
104.
Sørensen CG et al. (2018) Convulsive seizures as presenting symptom of metronidazole-induced encephalopathy: a case report. Case Rep Neurol 10(1):34–37PubMedPubMedCentral
105.
Sudan YS et al (2016) Headphone sign: Metronidazole-induced encephalopathy. Neurol India 64(6):1374–1376PubMed
106.
Takada K et al (2018) Metronidazole Induced encephalopathy mimicking an acute ischemic stroke event. Neurol Med Chir (Tokyo) 58(9):400–403
107.
Tan CH et al (2011) Painful neuropathy due to skin denervation after metronidazole-induced neurotoxicity. J Neurol Neurosurg Psychiatry 82(4):462–465PubMed
108.
109.
Thakkar N et al (2016) Metronidazole Induced Encephalopathy. J Assoc Physicians India 64(11):72–74PubMed
110.
Vitturi BK et al (2018) Metronidazole-induced encephalopathy. Rev Neurol (Paris) 174(5):342–343
111.
112.
Ward F, Crowley P, Cotter PE (2015) Acute cerebellar syndrome associated with metronidazole. Pract Neurol 15(4):298–299PubMed
113.
Wienbren M et al (1985) Convulsions and encephalopathy in a patient with leukemia after treatment with metronidazole. J Clin Pathol 38(9):1076PubMedPubMedCentral
114.
Woodruff BK, Wijdicks EF, Marshall WF (2002) Reversible metronidazole-induced lesions of the cerebellar dentate nuclei. N Engl J Med 346(1):68–69PubMed
115.
Yagi S, Matsumoto H, Hashida H (2018) Asymmetric magnetic resonance imaging findings in metronidazole-induced encephalopathy. Intern Med 57(13):1955–1956PubMedPubMedCentral
116.
Yagi T et al (2015) Metronidazole-induced encephalopathy and myoclonus: case report and a review of the literature. Neurol Clin Neurosci 3(3):111–113
117.
Yamamoto T et al (2012) Metronidazole-induced neurotoxicity developed in liver cirrhosis. J Clin Med Res 4(4):295–298PubMedPubMedCentral
118.
Yui JC, Bonnes SL (2017) 74-Year-old woman with dysarthria and left lower extremity weakness. Mayo Clin Proc 92(6):973–977PubMed
119.
de Souza A, Narvencar KP, Sindhoora KV (2013) The neurological effects of methyl bromide intoxication. J Neurol Sci 335(1–2):36–41PubMed
120.
Gopinath KG et al (2015) Ornidazole-induced ataxia in an Indian woman: a case report. SAGE Open Med Case Rep 3:2050313 × 15621857
121.
Taskapilioglu O et al (2010) Reversible cerebellar toxicity during treatment with ornidazole: the first case report. J Neurol Neurosurg Psychiatry 81(3):349–350PubMed
122.
Bond KM et al (2017) Dentate update: imaging features of entities that affect the dentate nucleus. AJNR Am J Neuroradiol 38(8):1467–1474PubMed
123.
Khadilkar S et al (2016) A practical approach to diseases affecting dentate nuclei. Clin Radiol 71(1):107–119PubMed
124.
Dainer MJ (1979) Untoward reaction to Flagyl (metronidazole). Am J Obstet Gynecol 133(8):939–940PubMed
125.
Davidson K, Clare AW (1989) Psychotic illness following termination of pregnancy. Br J Psychiatry 154:559–560PubMed
126.
Khandheria M, Snook E, Thomas C (2014) Psychotic episode secondary to metronidazole use. Gen Hosp Psychiatry 36(2):231 e3–e4
127.
Schreiber W, Spernal J (1997) Metronidazole-induced psychotic disorder. Am J Psychiatry 154(8):1170–1171PubMed
128.
Uhl MD, Riely CA (1996) Metronidazole in treating portosystemic encephalopathy. Ann Intern Med 124(4):455PubMed
129.
Zahiruddin O, Shanooha M, Mohd MY, Azhar (2014) Psychosis induced by cefuroxime and metronidazole. Med J Malaysia 69(1):33–34PubMed
130.
Lamp KC et al (1999) Pharmacokinetics and pharmacodynamics of the nitroimidazole antimicrobials. Clin Pharmacokinet 36(5):353–373PubMed
131.
Nau R, Sorgel F, Eiffert H (2010) Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. Clin Microbiol Rev 23(4):858–883PubMedPubMedCentral
132.
Cavanagh JB (1988) Lesion localisation: implications for the study of functional effects and mechanisms of action. Toxicology 49(1):131–136PubMed
133.
Rogulja Pv, Kovac W, Schmid H (1973) Metronidazol-encephalopathie der ratte. Acta Neuropathol 25(1):36–45
134.
Alston TA, Abeles RH (1987) Enzymatic conversion of the antibiotic metronidazole to an analog of thiamine. Arch Biochem Biophys 257(2):357–362PubMed
135.
Zuccoli G, Pipitone N (2009) Neuroimaging findings in acute Wernicke’s encephalopathy: review of the literature. AJR Am J Roentgenol 192(2):501–508PubMed
136.
Zuccoli G et al (2009) MR imaging findings in 56 patients with Wernicke encephalopathy: nonalcoholics may differ from alcoholics. AJNR Am J Neuroradiol 30(1):171–176PubMed
137.
Evans J et al (2003) Diazepam as a treatment for metronidazole toxicosis in dogs: a retrospective study of 21 cases. J Vet Intern Med 17(3):304–310PubMed
138.
139.
Rao DN, Mason RP (1987) Generation of nitro radical anions of some 5-nitrofurans, 2- and 5-nitroimidazoles by norepinephrine, dopamine, and serotonin. A possible mechanism for neurotoxicity caused by nitroheterocyclic drugs. J Biol Chem 262(24):11731–11736PubMed
Metadaten
Titel
Metronidazole-induced encephalopathy: a systematic review
verfasst von
Caspar Godthaab Sørensen
William Kristian Karlsson
Faisal Mohammad Amin
Mette Lindelof
Publikationsdatum
07.12.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Neurology / Ausgabe 1/2020
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-018-9147-6

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