Der Schmerz

, Volume 19, Issue 3, pp 225–241 | Cite as

Therapie und Prophylaxe von Cluster-Kopfschmerzen und anderen trigemino-autonomen Kopfschmerzen

Überarbeitete Empfehlungen der Deutschen Migräne- und Kopfschmerzgesellschaft
  • A. May
  • S. Evers
  • A. Straube
  • V. Pfaffenrath
  • H. C. Diener
Weiterbildung · Zertifizierte Fortbildung

Zusammenfassung

Nach der neuen IHS-Klassifikation werden der episodische und chronische Cluster-Kopfschmerz, die episodisch und chronische paroxysmale Hemikranie und das SUNCT-Syndrom („short-lasting unilateral neuralgiform headache with conjunctival injection and tearing“) unter dem Begriff trigemino-autonome Kopfschmerzen (TAK) zusammengefasst. Sie unterscheiden sich in Dauer, Frequenz, Rhythmik und Intensität der Schmerzattacken. Autonome Begleitsymptome wie Lakrimation, konjunktivale Injektion, Rhinorrhö, nasale Kongestion und Lidschwellung treten mehr oder weniger stark ausgeprägt auf. Ein wesentliches weiteres Unterscheidungsmerkmal liegt in dem unterschiedlichen Ansprechen auf Indometacin. Grundsätzlich unterteilt sich die Therapie, ähnlich wie die der Migräne, in eine Akuttherapie und eine medikamentöse Prophylaxe. Aufgrund der relativen Kürze der Attacken ist jegliche Medikation in Tablettenform nicht wirksam genug, das größte Augenmerk liegt auf der Prophylaxe. Die zeitintensive Betreuung der Patienten erfordert eine individuell zugeschnittene Kombination der verschiedenen Therapieoptionen. Obwohl ausreichend gute vergleichende Studien rar sind, kann in der Praxis in der großen Mehrzahl der Fälle eine positive Beeinflussung der Schmerzattacken erreicht werden. Die vorliegenden Therapieempfehlungen stützen sich auf Kriterien der „evidence based medicine“ (EBM).

Schlüsselwörter

Trigemino-autonome Kopfschmerzen Cluster-Kopfschmerz Therapie EBM-Kriterien 

Treatment and prophylaxis for cluster headaches and other trigeminal autonomic headaches

Revised recommendations of the German Migraine and Headache Society

Abstract

Following the new IHS classification, cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome) are included in the classification as trigeminal autonomic cephalgias (TAC). The similarities of these syndromes suggest a considerable shared pathophysiology. These syndromes have in common that they involve activation of trigeminovascular nociceptive pathways with reflex cranial autonomic activation. Clinically, this physiology predicts pain with some combination of lacrimation, conjunctival injection, nasal congestion, or eyelid edema. Broadly the management of TAC comprises acute and prophylactic treatment. Some types of trigeminal autonomic headaches such as paroxysmal hemicrania and hemicrania continua have, unlike cluster headaches, a very robust response to indometacin, leading to a consideration of indometacin-sensitive headaches. This review covers the clinical picture and therapeutic options. Although studies following the criteria of evidence-based medicine (EBM) are rare, most patients can be treated sufficiently.

Keywords

Trigeminal autonomic cephalgias Cluster headache Treatment EBM criteria 

Literatur

  1. 1.
    Goadsby PJ, Lipton RB, Ferrari MD (2002) Migraine — current understanding and treatment. N Engl J Med 346(4):257–270PubMedGoogle Scholar
  2. 2.
    Headache Classification Committee of the International Headache Society (2004) The International Classification of Headache Disorders, 2nd edn. Cephalalgia 24:1–160Google Scholar
  3. 3.
    Goadsby PJ (1999) Short-lasting primary headaches: focus on trigeminal automatic cephalgias and indomethacin-sensitive headaches. Curr Opin Neurol 12(3):273–277PubMedGoogle Scholar
  4. 4.
    Göbel H, Diener H, Grotemeyer K, Pfaffenrath V (1998) Therapie des Clusterkopfschmerzes. Dtsch Ärztebl 95(44):2760–2769Google Scholar
  5. 5.
    Sjaastad O (1992) Cluster headache syndrome. W.B. Saunders, LondonGoogle Scholar
  6. 6.
    Goadsby PJ, Lipton RB (1997) A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain 120(Pt 1):193–209PubMedGoogle Scholar
  7. 7.
    Lance JW, Goadsby PJ (1998) Mechanism and management of headache, 6th edn. Butterworth-Heinemann, OxfordGoogle Scholar
  8. 8.
    May A, Goadsby PJ (1999) The trigeminovascular system in humans: pathophysiological implications for primary headache syndromes of the neural influences of the cerebral circulation. J Cereb Blood Flow Metab 19:115–127PubMedGoogle Scholar
  9. 9.
    May A, Evers S, Limmroth V, Straube A (2003) DGN-Leitlinien. http://www.uni-duesseldorf.de/WWW/AWMF/awmf-frs.htm
  10. 10.
    May A, Leone M (2003) Update on cluster headache. Curr Opin Neurol 16(3):333–340PubMedGoogle Scholar
  11. 11.
    Rasmussen BK (1999) Epidemiology of cluster headache. In: Olesen J, Goadsby P (eds) Cluster headache and related conditions. Oxford University Press, Oxford, pp 23–26Google Scholar
  12. 12.
    Ekbom K, Svensson DA, Traff H, Waldenlind E (2002) Age at onset and sex ratio in cluster headache: observations over three decades. Cephalalgia 22(2):94–100PubMedGoogle Scholar
  13. 13.
    Torelli P, Cologno D, Cademartiri C, Manzoni GC (2000) Primary and secondary chronic cluster headache: two separate entities? Cephalalgia 20(9):826–829PubMedGoogle Scholar
  14. 14.
    Manzoni GC, Terzano MG, Bono G et al. (1983) Cluster headache — clinical findings in 180 patients. Cephalalgia 3(1):21–30Google Scholar
  15. 15.
    Silberstein SD, Niknam R, Rozen TD, Young WB (2000) Cluster headache with aura. Neurology 54(1):219–221PubMedGoogle Scholar
  16. 16.
    Bahra A, May A, Goadsby P (1999) Diagnostic patterns in cluster headache. Oxford University Press, New YorkGoogle Scholar
  17. 17.
    Sjaastad O, Bakketeig LS (2003) Cluster headache prevalence. Vaga study of headache epidemiology. Cephalalgia 23(7):528–533PubMedGoogle Scholar
  18. 18.
    Bahra A, May A, Goadsby PJ (2002) Cluster headache: a prospective clinical study with diagnostic implications. Neurology 58(3):354–361PubMedGoogle Scholar
  19. 19.
    Leone M, Russell MB, Rigamonti A et al. (2001) Increased familial risk of cluster headache. Neurology 56(9):1233–1236PubMedGoogle Scholar
  20. 20.
    Goadsby PJ (2001) Trigeminal autonomic cephalgias (TACs). Acta Neurol Belg 101(1):10–19PubMedGoogle Scholar
  21. 21.
    May A, Buchel C, Turner R, Goadsby PJ (2001) Magnetic resonance angiography in facial and other pain: neurovascular mechanisms of trigeminal sensation. J Cereb Blood Flow Metab 21(10):1171–1176PubMedGoogle Scholar
  22. 22.
    Hardebo JE, Moskowitz MA (1993) Synthesis of cluster headache pathophysiology. In: Olesen J, Tfelt-Hansen P, Welch KMA (eds) The Headaches. Raven Press, New York, pp 569–576Google Scholar
  23. 23.
    Chazot G, Claustrat B, Brun J et al. (1984) A chronobiological study of melatonin, cortisol, growth hormone and prolactin secretion in cluster headache. Cephalalgia 4:213–220PubMedGoogle Scholar
  24. 24.
    Leone M, Lucini V, D’Amico D et al. (1995) Twenty-four-hour melatonin and cortisol plasma levels in relation to timing of cluster headache. Cephalalgia 15(3):224–229PubMedGoogle Scholar
  25. 25.
    Leone M, Attanasio A, Croci D et al. (1999) Neuroendocrinology of cluster headache. Ital J Neurol Sci 20(7):S18–S20PubMedGoogle Scholar
  26. 26.
    May A, Bahra A, Büchel C et al. (1998) Hypothalamic activation in cluster headache attacks. Lancet 352:275–278PubMedGoogle Scholar
  27. 27.
    May A, Bahra A, Büchel C et al. (2000) PET and MRA findings in cluster headache and MRA in experimental pain. Neurology 55:1328–1335PubMedGoogle Scholar
  28. 28.
    May A, Ashburner J, Buchel C et al. (1999) Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nat Med 5(7):836–838PubMedGoogle Scholar
  29. 29.
    May A (2003) Das trigeminovaskuläre System des Menschen: Zerebraler Blutfluss, funktionelle Bildgebung und primäre Kopfschmerzen. Nervenarzt 74(12):1067–1077PubMedGoogle Scholar
  30. 30.
    May A, Büchel C, Bahra A et al. (1999) Intra-cranial vessels in trigeminal transmitted pain: a PET study. Neuroimage 9:453–460PubMedGoogle Scholar
  31. 31.
    Olesen J, Tfelt-Hansen P, Welch K (1999) The headaches. 2nd edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  32. 32.
    Sjaastad O (1988) Cluster headache: the possible significance of midline structures. Cephalalgia 8(4):229–236PubMedGoogle Scholar
  33. 33.
    Monzillo PH, Sanvito WL, Da Costa AR (2000) Cluster-tic syndrome: report of five new cases. Arq Neuropsiquiatr 58(2B):518–521PubMedGoogle Scholar
  34. 34.
    Mulleners WM, Verhagen WI (1996) Cluster-tic syndrome. Neurology 47(1):302Google Scholar
  35. 35.
    Pascual J, Berciano J (1993) Relief of cluster-tic syndrome by the combination of lithium and carbamazepine. Cephalalgia 13(3):205–206PubMedGoogle Scholar
  36. 36.
    May A (2003) Headaches with (ipsilateral) autonomic symptoms. J Neurol 250(11):1273–1278PubMedGoogle Scholar
  37. 37.
    Matharu MS, Boes CJ, Goadsby PJ (2003) Management of trigeminal autonomic cephalgias and hemicrania continua. Drugs 63(16):1637–1677PubMedGoogle Scholar
  38. 38.
    Nilsson Remahl AI, Laudon Meyer E, Cordonnier C, Goadsby PJ (2003) Placebo response in cluster headache trials: a review. Cephalalgia 23(7):504–510PubMedGoogle Scholar
  39. 39.
    Fogan L (1985) Treatment of cluster headache. A double-blind comparison of oxygen v air inhalation. Arch Neurol 42(4):362–363PubMedGoogle Scholar
  40. 40.
    Ekbom K (1995) Treatment of cluster headache: clinical trials, design and results. Cephalalgia 15:33–36PubMedGoogle Scholar
  41. 41.
    Gallagher RM, Mueller L, Ciervo CA (1996) Analgesic use in cluster headache. Headache 36(2):105–107PubMedGoogle Scholar
  42. 42.
    Nilsson Remahl AI, Ansjon R, Lind F, Waldenlind E (2002) Hyperbaric oxygen treatment of active cluster headache: a double-blind placebo-controlled cross-over study. Cephalalgia 22(9):730–739PubMedGoogle Scholar
  43. 43.
    Robbins L (1995) Intranasal lidocaine for cluster headache [see comments]. Headache 35(2):83–84PubMedGoogle Scholar
  44. 44.
    Mills TM, Scoggin JA (1997) Intranasal lidocaine for migraine and cluster headaches. Ann Pharmacother 31(7–8):914–915Google Scholar
  45. 45.
    Markley HG (2003) Topical agents in the treatment of cluster headache. Curr Pain Headache Rep 7(2):139–143PubMedGoogle Scholar
  46. 46.
    The Sumatriptan Cluster Headache Study Group (1991) Treatment of acute cluster headache with sumatriptan. N Engl J Med 325(5):322–326PubMedGoogle Scholar
  47. 47.
    Ekbom K, Monstad I, Prusinski A et al. (1993) Subcutaneous sumatriptan in the acute treatment of cluster headache: a dose comparison study. The Sumatriptan Cluster Headache Study Group. Acta Neurol Scand 88(1):63–69PubMedGoogle Scholar
  48. 48.
    Stovner LJ, Sjaastad O (1995) Treatment of cluster headache and its variants. Curr Opin Neurol 8(3):243–247PubMedGoogle Scholar
  49. 49.
    Wilkinson M, Pfaffenrath V, Schoenen J et al. (1995) Migraine and cluster headache — their management with sumatriptan: a critical review of the current clinical experience. Cephalalgia 15(5):337–357PubMedGoogle Scholar
  50. 50.
    Ekbom K, Krabbe A, Micelli G et al. (1995) Cluster headache attacks treated for up to three months with subcutaneous sumatriptan (6 mg). Sumatriptan Cluster Headache Long-term Study Group. Cephalalgia 15(3):230–236PubMedGoogle Scholar
  51. 51.
    Van Vliet JA, Bahra A, Martin V et al. (2003) Intranasal sumatriptan in cluster headache: Randomized placebo-controlled double-blind study. Neurology 60(4):630–633PubMedGoogle Scholar
  52. 52.
    Bahra A, Gawel MJ, Hardebo JE et al. (2000) Oral zolmitriptan is effective in the acute treatment of cluster headache. Neurology 54(9):1832–1839PubMedGoogle Scholar
  53. 53.
    Bernstein W (2000) Oral zolmitriptan is effetive in the acute treatment of cluster headache. Neurology 55(8):1239Google Scholar
  54. 54.
    Ekbom K, Krabbe AE, Paalzow G et al. (1983) Optimal routes of administration of ergotamine tartrate in cluster headache patients. A pharmacokinetic study. Cephalalgia 3(1):15–20Google Scholar
  55. 55.
    Gabai IJ, Spierings EL (1989) Prophylactic treatment of cluster headache with verapamil. Headache 29(3):167–168PubMedGoogle Scholar
  56. 56.
    Dodick DW, Capobianco DJ (2001) Treatment and management of cluster headache. Curr Pain Headache Rep 5(1):83–91PubMedGoogle Scholar
  57. 57.
    Ekbom K, Hardebo JE (2002) Cluster headache: aetiology, diagnosis and management. Drugs 62(1):61–69PubMedGoogle Scholar
  58. 58.
    Ekbom K (1981) Lithium for cluster headache: review of the literature and preliminary results of long-term treatment. Headache 21(4):132–139PubMedGoogle Scholar
  59. 59.
    Steiner TJ, Hering R, Couturier EGM et al. (1997) Double-blind placebo-controlled trial of lithium in episodic cluster headache. Cephalalgia 17:673–675PubMedGoogle Scholar
  60. 60.
    Ekbom K (1969) Prophylactic treatment of cluster headache with a new serotonin antagonist, BC 105. Acta Neurol Scand 45(5):601–610PubMedGoogle Scholar
  61. 61.
    Gallagher RM, Mueller LL, Freitag FG (2002) Divalproex sodium in the treatment of migraine and cluster headaches. J Am Osteopath Assoc 102(2):92–94PubMedGoogle Scholar
  62. 62.
    Hering R, Kuritzky A (1989) Sodium valproate in the treatment of cluster headache: an open clinical trial. Cephalalgia 9(3):195–198PubMedGoogle Scholar
  63. 63.
    El Amrani M, Massiou H, Bousser MG (2002) A negative trial of sodium valproate in cluster headache: methodological issues. Cephalalgia 22(3):205–208PubMedGoogle Scholar
  64. 64.
    Campbell JK (1993) Diagnosis and treatment of cluster headache. J Pain Symptom Manage 8(3):155–164PubMedGoogle Scholar
  65. 65.
    Brandt T, Paulus W, Pöllmann W (1991) Cluster headache and chronic paroxysmal hemicrania: current therapy. Nervenarzt 62(6):329–339PubMedGoogle Scholar
  66. 66.
    Liano H, Lopez-Zuazo I (1995) Prophylactic treatment of episodic forms of cluster headache. Rev Neurol 23 [Suppl 4]:S525–529Google Scholar
  67. 67.
    Muller R, Weller P, Chemaissani A (1991) Pleural fibrosis as a side effect of years-long methysergide therapy. Dtsch Med Wochenschr 116(38):1433–1436PubMedGoogle Scholar
  68. 68.
    McGeeney BE (2003) Topiramate in the treatment of cluster headache. Curr Pain Headache Rep 7(2):135–138PubMedGoogle Scholar
  69. 69.
    Förderreuther S, Mayer M, Straube A (2002) Treatment of cluster headache with topiramate: effects and side-effects in five patients. Cephalalgia 22(3):186–189PubMedGoogle Scholar
  70. 70.
    Rozen TD (2001) Antiepileptic drugs in the management of cluster headache and trigeminal neuralgia. Headache 41 [Suppl 1]:25–33Google Scholar
  71. 71.
    Ekbom K, Lindgren L, Nilsson BY et al. (1987) Retro-Gasserian glycerol injection in the treatment of chronic cluster headache. Cephalalgia 7(1):21–27PubMedGoogle Scholar
  72. 72.
    Taha JM, Tew JM Jr (1995) Long-term results of radiofrequency rhizotomy in the treatment of cluster headache. Headache 35(4):193–196PubMedGoogle Scholar
  73. 73.
    Lovely TJ, Kotsiakis X, Jannetta PJ (1998) The surgical management of chronic cluster headache. Headache 38(8):590–594PubMedGoogle Scholar
  74. 74.
    Ford RG, Ford KT, Swaid S et al. (1998) Gamma knife treatment of refractory cluster headache. Headache 38(1):3–9PubMedGoogle Scholar
  75. 75.
    Onofrio BM, Campbell JK (1986) Surgical treatment of chronic cluster headache. Mayo Clin Proc 61(7):537–544PubMedGoogle Scholar
  76. 76.
    Sanders M, Zuurmond WW (1997) Efficacy of sphenopalatine ganglion blockade in 66 patients suffering from cluster headache: a 12- to 70-month follow-up evaluation. J Neurosurg 87(6):876–880PubMedGoogle Scholar
  77. 77.
    Matharu MS, Goadsby PJ (2002) Persistence of attacks of cluster headache after trigeminal nerve root section. Brain 125(Pt 5):976–984PubMedGoogle Scholar
  78. 78.
    Black D, Dodick DW (2002) Two cases of medically and surgically intractable SUNCT: a reason for caution and an argument for a central mechanism. Cephalalgia 3:201–204Google Scholar
  79. 79.
    Jarrar RG, Black DF, Dodick DW, Davis DH (2003) Outcome of trigeminal nerve section in the treatment of chronic cluster headache. Neurology 60(8):1360–1362PubMedGoogle Scholar
  80. 80.
    Anthony M (1985) Arrest of attacks of cluster headache by local steroid injection of the occipital nerve. In: Rose C (ed) Migraine. Karger, Basel, p 169–173Google Scholar
  81. 81.
    Matharu MS, Bartsch T, Ward N et al. (2004) Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain 127(Pt 1):220–230PubMedGoogle Scholar
  82. 82.
    Leone M, Franzini A, Broggi G et al. (2004) Long-term follow-up of bilateral hypothalamic stimulation for intractable cluster headache. Brain 127(Pt 10):2259–2264PubMedGoogle Scholar
  83. 83.
    Franzini A, Ferroli P, Leone M, Broggi G (2003) Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery 52(5):1095–1101PubMedGoogle Scholar
  84. 84.
    Headache Classification Committee of the International Headache Society (1988) Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 8(7):1–96Google Scholar
  85. 85.
    Sjaastad O, Apfelbaum R, Caskey W et al. (1980) Chronic paroxysmal hemicrania (CPH). The clinical manifestations. A review. Ups J Med Sci Suppl 31:27–33PubMedGoogle Scholar
  86. 86.
    Antonaci F, Sjaastad O (1989) Chronic paroxysmal hemicrania (CPH): a review of the clinical manifestations. Headache 29(10):648–656PubMedGoogle Scholar
  87. 87.
    Sjaastad O, Stovner LJ, Stolt Nielsen A et al. (1995) CPH and hemicrania continua: requirements of high indomethacin dosages — an ominous sign? Headache 35(6):363–367PubMedGoogle Scholar
  88. 88.
    Sjaastad O, Dale I (1976) A new (?) Clinical headache entity „chronic paroxysmal hemicrania“. Acta Neurol Scand 54(2):140–159PubMedGoogle Scholar
  89. 89.
    Evers S, Husstedt IW (1996) Alternatives in drug treatment of chronic paroxysmal hemicrania. Headache 36(7):429–432PubMedGoogle Scholar
  90. 90.
    Shabbir N, McAbee G (1994) Adolescent chronic paroxysmal hemicrania responsive to verapamil monotherapy. Headache 34(4):209–210PubMedGoogle Scholar
  91. 91.
    Warner JS, Wamil AW, McLean MJ (1994) Acetazolamide for the treatment of chronic paroxysmal hemicrania. Headache 34(10):597–599PubMedGoogle Scholar
  92. 92.
    Matharu MS, Cohen AS, Boes CJ, Goadsby PJ (2003) Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing syndrome: a review. Curr Pain Headache Rep 7(4):308–318PubMedGoogle Scholar
  93. 93.
    Schwaag S, Frese A, Husstedt IW, Evers S (2003) SUNCT syndrome: the first German case series. Cephalalgia 23(5):398–400PubMedGoogle Scholar
  94. 94.
    Porta-Etessam J, Benito-Leon J, Martinez-Salio A, Berbel A (2002) Gabapentin in the treatment of SUNCT syndrome. Headache 42(6):523–524PubMedGoogle Scholar
  95. 95.
    Hunt CH, Dodick DW, Bosch EP (2002) SUNCT responsive to gabapentin. Headache 42(6):525–526PubMedGoogle Scholar
  96. 96.
    Matharu MS, Boes CJ, Goadsby PJ (2002) SUNCT syndrome: prolonged attacks, refractoriness and response to topiramate. Neurology 58(8):1307PubMedGoogle Scholar
  97. 97.
    Chakravarty A, Mukherjee A (2003) SUNCT syndrome responsive to lamotrigine: documentation of the first Indian case. Cephalalgia 23(6):474–475PubMedGoogle Scholar
  98. 98.
    Piovesan EJ, Siow C, Kowacs PA, Werneck LC (2003) Influence of lamotrigine over the SUNCT syndrome: one patient follow-up for two years. Arq Neuropsiquiatr 61(3A):691–694PubMedGoogle Scholar
  99. 99.
    Hannerz J, Linderoth B (2002) Neurosurgical treatment of short-lasting, unilateral, neuralgiform hemicrania with conjunctival injection and tearing. Br J Neurosurg 16(1):55–58PubMedGoogle Scholar
  100. 100.
    Pareja JA, Vincent M, Antonaci F, Sjaastad O (2001) Hemicrania continua: diagnostic criteria and nosologic status. Cephalalgia 21(9):874–877PubMedGoogle Scholar
  101. 101.
    Evers S, Goadsby PJ (2003) Hypnic headache: clinical features, pathophysiology, and treatment. Neurology 60(6):905–909PubMedGoogle Scholar
  102. 102.
    Evers S, Rahmann A, Schwaag S et al. (2003) Hypnic headache — the first German cases including polysomnography. Cephalalgia 23(1):20–23PubMedGoogle Scholar
  103. 103.
    Raskin NH (1995) The cough headache syndrome: treatment. Neurology 45(9):1784PubMedGoogle Scholar
  104. 104.
    Sjaastad O, Pettersen H, Bakketeig LS (2001) The Vaga study; epidemiology of headache I: the prevalence of ultrashort paroxysms. Cephalalgia 21(3):207–215PubMedGoogle Scholar
  105. 105.
    Sjaastad O, Pettersen H, Bakketeig LS (2002) The Vaga study of headache epidemiology II. Jabs: clinical manifestations. Acta Neurol Scand 105(1):25–31PubMedGoogle Scholar
  106. 106.
    Rozen TD (2003) Melatonin as treatment for idiopathic stabbing headache. Neurology 61(6):865–866PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  • A. May
    • 1
    • 6
  • S. Evers
    • 2
  • A. Straube
    • 3
  • V. Pfaffenrath
    • 4
  • H. C. Diener
    • 5
  1. 1.Neurologische Universitätsklinik Regensburg
  2. 2.Klinik und Poliklinik für NeurologieUniversitätsklinikum Münster
  3. 3.Klinik und Poliklinik für NeurologieUniversität München
  4. 4.NeurologeMünchen
  5. 5.Neurologische Universitätsklinik Essen
  6. 6.Neurologische UniversitätsklinikHamburg

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