Skip to main content

Advertisement

SpringerLink
Log in

Neurocognitive-neurological complications of liver transplantation: a review

  • Original Paper
  • Published:
Metabolic Brain Disease Aims and scope Submit manuscript

Abstract

Neurological complications are common after liver transplantation (LT) and they are associated with a significant morbidity. Long-term effects of LT on cognitive and psychological outcomes are not clear. The objective of this study was to summarize the present knowledge on the neurological and cognitive complications of LT, resulting from a systematic review of the literature in the last 10 years. Several studies have investigated the incidence and the pathophysiology of neurological complications; in contrast, the knowledge of cognitive and psychological status after LT is poor. Currently, the effect of LT on mental performance is debated. Some studies have shown an improvement of cognitive function after OLTX and, at the same time, a persistence of different cognitive deficits. In addition, the quality of life (QoL) and the psychological status after LT seem to improve but LT recipients have significant deficiencies in most QoL domains. Consequently, future studies are necessary in order to investigate cognitive alterations and QoL in LT recipients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Adair JC, Woodley SL, O’Connell JB, Call GK, Baringer JR (1991) Aseptic meningitis following cardiac transplantation: clinical characteristics and relationship to immunosuppressive regimen. Neurology 41:249–252

    CAS  PubMed  Google Scholar 

  • Adams DH, Ponsford S, Gunson B, Boon A, Honigsberger L, Williams A, Buckels J, Elias E, McMaster P (1987) Neurological complications following liver transplantation. Lancet 1:949–951

    Article  CAS  PubMed  Google Scholar 

  • Amodio P, Marchetti P, Del Piccolo F, Campo G, Rizzo C, Iemmolo RM, Gerunda G, Caregaro L, Merkel C, Gatta A (1998) Visual attention in cirrhotic patients: a study on covert visual attention orienting. Hepatology 27:1517–1523

    Article  CAS  PubMed  Google Scholar 

  • Amodio P, Del Piccolo F, Petteno E, Mapelli D, Angeli P, Iemmolo R, Muraca M, Musto C, Gerunda G, Rizzo C, Merkel C, Gatta A (2001) Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol 35:37–45

    Article  CAS  PubMed  Google Scholar 

  • Amodio P, Biancardi A, Montagnese S, Angeli P, Iannizzi P, Cillo U, D’Amico D, Gatta A (2007) Neurological complications after orthotopic liver transplantation. Dig Liver Dis 39:740–747

    Article  CAS  PubMed  Google Scholar 

  • Ardizzone G, Arrigo A, Schellino MM, Stratta C, Valzan S, Skurzak S, Andruetto P, Panio A, Ballaris MA, Lavezzo B, Salizzoni M, Cerutti E (2006) Neurological complications of liver cirrhosis and orthotopic liver transplant. Transplant Proc 38:789–792

    Article  CAS  PubMed  Google Scholar 

  • Bartynski WS (2008) Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features. AJNR Am J Neuroradiol 29:1036–1042

    Article  CAS  PubMed  Google Scholar 

  • Bartynski WS, Grabb BC, Zeigler Z, Lin L, Andrews DF (1997) Watershed imaging features and clinical vascular injury in cyclosporin A neurotoxicity. J Comput Assist Tomogr 21:872–880

    Article  CAS  PubMed  Google Scholar 

  • Bartynski WS, Tan HP, Boardman JF, Shapiro R, Marsh JW (2008) Posterior reversible encephalopathy syndrome after solid organ transplantation. AJNR Am J Neuroradiol 29:924–930

    Article  CAS  PubMed  Google Scholar 

  • Bechstein WO (2000) Neurotoxicity of calcineurin inhibitors: impact and clinical management. Transpl Int 13:313–326

    Article  CAS  PubMed  Google Scholar 

  • Blanch J, Sureda B, Flavia M, Marcos V, de Pablo J, De Lazzari E, Rimola A, Vargas V, Navarro V, Margarit C, Visa J (2004) Psychosocial adjustment to orthotopic liver transplantation in 266 recipients. Liver Transpl 10:228–234

    Article  PubMed  Google Scholar 

  • Blanco R, De Girolami U, Jenkins RL, Khettry U (1995) Neuropathology of liver transplantation. Clin Neuropathol 14:109–117

    CAS  PubMed  Google Scholar 

  • Bona MD, Rupolo G, Ponton P, Iemmolo RM, Boccagni P, Destro C, Ermani M, Naccarato R, Burra P (1998) The effect of recurrence of HCV infection of life after liver transplantation. Transpl Int 11(Suppl 1):S475–S479

    Article  PubMed  Google Scholar 

  • Braun KP, Glander P, Hambach P, Bohler T, Waiser J, Mai I, Neumayer HH, Budde K (2002) Pharmacokinetics and pharmacodynamics of mycophenolate mofetil under oral and intravenous therapy. Transplant Proc 34:1745–1747

    Article  CAS  PubMed  Google Scholar 

  • Bravata DM, Olkin I, Barnato AE, Keeffe EB, Owens DK (2001) Employment and alcohol use after liver transplantation for alcoholic and nonalcoholic liver disease: a systematic review. Liver Transpl 7:191–203

    Article  CAS  PubMed  Google Scholar 

  • Bronster DJ, Emre S, Mor E, Sheiner P, Miller CM, Schwartz ME (1994) Neurologic complications of orthotopic liver transplantation. Mt Sinai J Med 61:63–69

    CAS  PubMed  Google Scholar 

  • Bronster DJ, Yonover P, Stein J, Scelsa SN, Miller CM, Sheiner PA (1995) Demyelinating sensorimotor polyneuropathy after administration of FK506. Transplantation 59:1066–1068

    Article  CAS  PubMed  Google Scholar 

  • Bronster DJ, Emre S, Boccagni P, Sheiner PA, Schwartz ME, Miller CM (2000) Central nervous system complications in liver transplant recipients-incidence, timing, and long-term follow-up. Clin Transplant 14:1–7

    Article  CAS  PubMed  Google Scholar 

  • Bryan S, Ratcliffe J, Neuberger JM, Burroughs AK, Gunson BK, Buxton MJ (1998) Health-related quality of life following liver transplantation. Qual Life Res 7:115–120

    Article  CAS  PubMed  Google Scholar 

  • Buis CI, Wiesner RH, Krom RA, Kremers WK, Wijdicks EF (2002) Acute confusional state following liver transplantation for alcoholic liver disease. Neurology 59:601–605

    Article  PubMed  Google Scholar 

  • Coleman AE, Norman DJ (1990) OKT3 encephalopathy. Ann Neurol 28:837–838

    Article  CAS  PubMed  Google Scholar 

  • Craven JL (1991) Cyclosporine-associated organic mental disorders in liver transplant recipients. Psychosomatics 32:94–102

    CAS  PubMed  Google Scholar 

  • Dawson TM (1996) Immunosuppressants, immunophilins, and the nervous system. Ann Neurol 40:559–560

    Article  CAS  PubMed  Google Scholar 

  • De Bona M, Ponton P, Ermani M, Iemmolo RM, Feltrin A, Boccagni P, Gerunda G, Naccarato R, Rupolo G, Burra P (2000) The impact of liver disease and medical complications on quality of life and psychological distress before and after liver transplantation. J Hepatol 33:609–615

    Article  PubMed  Google Scholar 

  • Dhar R, Young GB, Marotta P (2008) Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocrit Care 8:253–258

    Article  PubMed  Google Scholar 

  • Dumont FJ (2000) FK506, an immunosuppressant targeting calcineurin function. Curr Med Chem 7:731–748

    CAS  PubMed  Google Scholar 

  • Eidelman BH (1999) Neurological Complications of immunosuppressive agents. Gastroenterol Int Congress Proc 12:128–134

    Google Scholar 

  • Ghaus N, Bohlega S, Rezeig M (2001) Neurological complications in liver transplantation. J Neurol 248:1042–1048

    Article  CAS  PubMed  Google Scholar 

  • Goss JA, Seu P, Shackleton CR, Busuttil RW (1997) Lower extremity paralysis after use of the supraceliac aorta for hepatic arterial reconstruction of the transplanted liver. Transplantation 63:163–164

    Article  CAS  PubMed  Google Scholar 

  • Groeneweg M, Quero JC, De B, Hartmann IJ, Essink-bot ML, Hop WC, Schalm SW (1998) Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 28:45–49

    Article  CAS  PubMed  Google Scholar 

  • Guarino M (1999) Immunosuppressive therapy. Gastroenterol Int Congress Proc 12:140–145

    Google Scholar 

  • Guarino M, Stracciari A, Pazzaglia P, Sterzi R, Santilli I, Donato F, D’Alessandro R (1996) Neurological complications of liver transplantation. J Neurol 243:137–142

    Article  CAS  PubMed  Google Scholar 

  • Guarino M, Benito-Leon J, Decruyenaere J, Schmutzhard E, Weissenborn K, Stracciari A (2006) EFNS guidelines on management of neurological problems in liver transplantation. Eur J Neurol 13:2–9

    Article  CAS  PubMed  Google Scholar 

  • Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR (1996) A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334:494–500

    Article  CAS  PubMed  Google Scholar 

  • Kaplan PE, Clinchot DM, Arnett JA (1996) Cognitive deficits after hepatic transplantation: relevance to the rehabilitation potential. Brain Inj 10:599–607

    Article  CAS  PubMed  Google Scholar 

  • Karam VH, Gasquet I, Delvart V, Hiesse C, Dorent R, Danet C, Samuel D, Charpentier B, Gandjbakhch I, Bismuth H, Castaing D (2003) Quality of life in adult survivors beyond 10 years after liver, kidney, and heart transplantation. Transplantation 76:1699–1704

    Article  PubMed  Google Scholar 

  • Kim BS, Lee SG, Hwang S, Park KM, Kim KH, Ahn CS, Moon DB, Ha TY, Song GW, Kim DS, Moon KM, Jung DH (2007) Neurologic complications in adult living donor liver transplant recipients. Clin Transplant 21:544–547

    Article  PubMed  Google Scholar 

  • Kochi S, Takanaga H, Matsuo H, Naito M, Tsuruo T, Sawada Y (1999) Effect of cyclosporin A or tacrolimus on the function of blood-brain barrier cells. Eur J Pharmacol 372:287–295

    Article  CAS  PubMed  Google Scholar 

  • Krieger D, Krieger S, Jansen O, Gass P, Theilmann L, Lichtnecker H (1995) Manganese and chronic hepatic encephalopathy. Lancet 346:270–274

    Article  CAS  PubMed  Google Scholar 

  • Larsen FS, Olsen KS, Ejlersen E, Hansen BA, Paulson OB, Knudsen GM (1995) Cerebral blood flow autoregulation and transcranial Doppler sonography in patients with cirrhosis. Hepatology 22:730–736

    CAS  PubMed  Google Scholar 

  • Lewis MB, Howdle PD (2003) Neurologic complications of liver transplantation in adults. Neurology 61:1174–1178

    CAS  PubMed  Google Scholar 

  • Maraganore DM, Folger WN, Swanson JW, Ahlskog JE (1992) Movement disorders as sequelae of central pontine myelinolysis: report of three cases. Mov Disord 7:142–148

    Article  CAS  PubMed  Google Scholar 

  • Martin RJ (2004) Central pontine and extrapontine myelinolysis: the osmotic demyelination syndromes. J Neurol Neurosurg Psychiatry 75(Suppl 3):iii22–iii28

    Article  PubMed  Google Scholar 

  • Mattarozzi K, Stracciari A, Vignatelli L, D’Alessandro R, Morelli MC, Guarino M (2004) Minimal hepatic encephalopathy: longitudinal effects of liver transplantation. Arch Neurol 61:242–247

    Article  PubMed  Google Scholar 

  • Mazariegos GV, Molmenti EP, Kramer DJ (1999) Early complications after orthotopic liver transplantation. Surg Clin North Am 79:109–129

    Article  CAS  PubMed  Google Scholar 

  • McAlister VC, Peltekian KM, Malatjalian DA, Colohan S, MacDonald S, Bitter-Suermann H, MacDonald AS (2001) Orthotopic liver transplantation using low-dose tacrolimus and sirolimus. Liver Transpl 7:701–708

    Article  CAS  PubMed  Google Scholar 

  • McDiarmid SV, Busuttil RW, Ascher NL, Burdick J, D’Alessandro AM, Esquivel C, Kalayoglu M, Klein AS, Marsh JW, Miller CM (1995) FK506 (tacrolimus) compared with cyclosporine for primary immunosuppression after pediatric liver transplantation. Results from the U.S. Multicenter Trial. Transplantation 59:530–536

    CAS  PubMed  Google Scholar 

  • Mechtcheriakov S, Graziadei IW, Mattedi M, Bodner T, Kugener A, Hinterhuber HH, Marksteiner J, Vogel W (2004) Incomplete improvement of visuo-motor deficits in patients with minimal hepatic encephalopathy after liver transplantation. Liver Transpl 10:77–83

    Article  PubMed  Google Scholar 

  • Menegaux F, Keeffe EB, Andrews BT, Egawa H, Monge H, Concepcion W, So SK, Esquivel CO (1994) Neurological complications of liver transplantation in adult versus pediatric patients. Transplantation 58:447–450

    Article  CAS  PubMed  Google Scholar 

  • Minguez B, Rovira A, Alonso J, Cordoba J (2007) Decrease in the volume of white matter lesions with improvement of hepatic encephalopathy. AJNR Am J Neuroradiol 28:1499–1500

    Article  CAS  PubMed  Google Scholar 

  • Moore KA, McL JR, Burrows GD (2000) Quality of life and cognitive function of liver transplant patients: a prospective study. Liver Transpl 6:633–642

    Article  CAS  PubMed  Google Scholar 

  • Moreno E, Gomez SR, Gonzalez I, Loinaz C, Garcia I, Perez A, Palomo C, Alvarado A, Maffettone V, Perez-Cerda F (1993) Neurologic complications in liver transplantation. Acta Neurol Scand 87:25–31

    Article  CAS  PubMed  Google Scholar 

  • Mueller AR, Platz KP, Bechstein WO, Schattenfroh N, Stoltenburg-Didinger G, Blumhardt G, Christe W, Neuhaus P (1994a) Neurotoxicity after orthotopic liver transplantation. A comparison between cyclosporine and FK506. Transplantation 58:155–170

    CAS  PubMed  Google Scholar 

  • Mueller AR, Platz KP, Christe W, Bechstein WO, Blumhardt G, Neuhaus P (1994b) Severe neurotoxicity afetr liver transplantation: associatiom between FK 506 therapy and hepatitis C virus disease. Transplant Proc 26:3131–3132

    CAS  PubMed  Google Scholar 

  • Naegele T, Grodd W, Viebahn R, Seeger U, Klose U, Seitz D, Kaiser S, Mader I, Mayer J, Lauchart W, Gregor M, Voigt K (2000) MR imaging and (1)H spectroscopy of brain metabolites in hepatic encephalopathy: time-course of renormalization after liver transplantation. Radiology 216:683–691

    CAS  PubMed  Google Scholar 

  • Nakamura M, Fuchinoue S, Sato S, Hoshino T, Sawada T, Sageshima J, Kitajima K, Tojinbara T, Fujita S, Nakajima I, Agishi T, Tanaka K (1998) Clinical and radiological features of two cases of tacrolimus-related posterior leukoencephalopathy in living related liver transplantation. Transplant Proc 30:1477–1478

    Article  CAS  PubMed  Google Scholar 

  • O’Carroll RE, Couston M, Cossar J, Masterton G, Hayes PC (2003) Psychological outcome and quality of life following liver transplantation: a prospective, national, single-center study. Liver Transpl 9:712–720

    Article  PubMed  Google Scholar 

  • Patchell RA (1994) Neurological complications of organ transplantation. Ann Neurol 36:688–703

    Article  CAS  PubMed  Google Scholar 

  • Penn I (1999) Posttransplant malignancies. Transplant Proc 31:1260–1262

    Article  CAS  PubMed  Google Scholar 

  • Pereira SP, Howard LM, Muiesan P, Rela M, Heaton N, Williams R (2000) Quality of life after liver transplantation for alcoholic liver disease. Liver Transpl 6:762–768

    Article  CAS  PubMed  Google Scholar 

  • Philips BJ, Armstrong IR, Pollock A, Lee A (1998) Cerebral blood flow and metabolism in patients with chronic liver disease undergoing orthotopic liver transplantation. Hepatology 27:369–376

    Article  CAS  PubMed  Google Scholar 

  • Pratschke J, Neuhaus R, Tullius SG, Haller GW, Jonas S, Steinmueller T, Bechstein WO, Neuhaus P (1997) Treatment of cyclosporine-related adverse effects by conversion to tacrolimus after liver transplantation. Transplantation 64:938–940

    Article  CAS  PubMed  Google Scholar 

  • Pujol A, Graus F, Rimola A, Beltran J, Garcia-Valdecasas JC, Navasa M, Grande L, Galofre J, Visa J, Rodes J (1994) Predictive factors of in-hospital CNS complications following liver transplantation. Neurology 44:1226–1230

    CAS  PubMed  Google Scholar 

  • Reeves RR, Struve FA, Rash CJ, Burke RS (2007) P300 cognitive evoked potentials before and after liver transplantation. Metab Brain Dis 22:139–144

    Article  PubMed  Google Scholar 

  • Riether AM, Smith SL, Lewison BJ, Cotsonis GA, Epstein CM (1992) Quality-of-life changes and psychiatric and neurocognitive outcome after heart and liver transplantation. Transplantation 54:444–450

    Article  CAS  PubMed  Google Scholar 

  • Rose C, Jalan R (2004) Is minimal hepatic encephalopathy completely reversible following liver transplantation? Liver Transpl 10:84–87

    Article  PubMed  Google Scholar 

  • Rovira A, Minguez B, Aymerich FX, Jacas C, Huerga E, Cordoba J, Alonso J (2007) Decreased white matter lesion volume and improved cognitive function after liver transplantation. Hepatology 46:1485–1490

    Article  PubMed  Google Scholar 

  • Saner F, Gu Y, Minouchehr S, Ilker K, Fruhauf NR, Paul A, Radtke A, Dammann M, Katsarava Z, Koeppen S, Malago M, Broelsch CE (2006) Neurological complications after cadaveric and living donor liver transplantation. J Neurol 253:612–617

    Article  PubMed  Google Scholar 

  • Saner FH, Sotiropoulos GC, Gu Y, Paul A, Radtke A, Gensicke J, Kavuk I, Malago M, Broelsch CE (2007) Severe neurological events following liver transplantation. Arch Med Res 38:75–79

    Article  PubMed  Google Scholar 

  • Saner FH, Gensicke J, Damink SW, Pavlakovic G, Treckmann J, Dammann M, Kaiser GM, Sotiropoulos GC, Radtke A, Koeppen S, Beckebaum S, Cicinnati V, Nadalin S, Malago M, Paul A, Broelsch CE (2009) Neurologic complications in adult living donor liver transplant patients: an underestimated factor? J Neurol published online 1 sept 2009

  • Singh N, Bonham A, Fukui M (2000) Immunosuppressive-associated leukoencephalopathy in organ transplant recipients. Transplantation 69:467–472

    Article  CAS  PubMed  Google Scholar 

  • Sorrell JH, Brown JR (2006) Sexual functioning in patients with end-stage liver disease before and after transplantation. Liver Transpl 12:1473–1477

    Article  PubMed  Google Scholar 

  • Sotil EU, Gottstein J, Ayala E, Randolph C, Blei AT (2009) Impact of preoperative overt hepatic encephalopathy on neurocognitive function after liver transplantation. Liver Transpl 15:184–192

    Article  PubMed  Google Scholar 

  • Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR (1963) Homotransplantation of the liver in humans. Surg Gynecol Obstet 117:659–676

    CAS  PubMed  Google Scholar 

  • Starzl TE, Iwatsuki S, Esquivel CO, Todo S, Kam I, Lynch S, Gordon RD, Shaw BW Jr (1985) Refinements in the surgical technique of liver transplantation. Semin Liver Dis 5:349–356

    Article  CAS  PubMed  Google Scholar 

  • Stracciari A, Guarino M (2001) Neuropsychiatric complications of liver transplantation. Metab Brain Dis 16:3–11

    Article  CAS  PubMed  Google Scholar 

  • Tarter RE, Switala JA, Arria A, Plail J, Van Thiel DH (1990) Subclinical hepatic encephalopathy. Comparison before and after orthotopic liver transplantation. Transplantation 50:632–637

    Article  CAS  PubMed  Google Scholar 

  • Thuluvath PJ, Edwin D, Yue NC, deVilliers C, Hochman S, Klein A (1995) Increased signals seen in globus pallidus in T1-weighted magnetic resonance imaging in cirrhotics are not suggestive of chronic hepatic encephalopathy. Hepatology 21:440–442

    CAS  PubMed  Google Scholar 

  • Tome S, Wells JT, Said A, Lucey MR (2008) Quality of life after liver transplantation. A systematic review. J Hepatol 48:567–577

    Article  PubMed  Google Scholar 

  • Wang WL, Yang ZF, Lo CM, Liu CL, Fan ST (2000) Intracerebral hemorrhage after liver transplantation. Liver Transpl 6:345–348

    CAS  PubMed  Google Scholar 

  • Ward R, Jones D, Haponik EF (1995) Paradoxical embolism. An underrecognized problem. Chest 108:549–558

    Article  CAS  PubMed  Google Scholar 

  • Weissenborn K, Bokemeyer M, Ahl B, Fischer-Wasels D, Giewekemeyer K, van den HJ, Kostler H, Berding G (2004) Functional imaging of the brain in patients with liver cirrhosis. Metab Brain Dis 19:269–280

    Article  PubMed  Google Scholar 

  • Wijdicks EF, Wiesner RH, Dahlke LJ, Krom RA (1994) FK506-induced neurotoxicity in liver transplantation. Ann Neurol 35:498–501

    Article  CAS  PubMed  Google Scholar 

  • Wijdicks EF, Wiesner RH, Krom RA (1995) Neurotoxicity in liver transplant recipients with cyclosporine immunosuppression. Neurology 45:1962–1964

    CAS  PubMed  Google Scholar 

  • Wijdicks EF, Blue PR, Steers JL, Wiesner RH (1996a) Central pontine myelinolysis with stupor alone after orthotopic liver transplantation. Liver Transpl Surg 2:14–16

    Article  CAS  PubMed  Google Scholar 

  • Wijdicks EF, Litchy WJ, Wiesner RH, Krom RA (1996b) Neuromuscular complications associated with liver transplantation. Muscle Nerve 19:696–700

    Article  CAS  PubMed  Google Scholar 

  • Yu J, Zheng SS, Liang TB, Shen Y, Wang WL, Ke QH (2004) Possible causes of central pontine myelinolysis after liver transplantation. World J Gastroenterol 10:2540–2543

    PubMed  Google Scholar 

Download references

Conflict of interest:

None.

Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Padova, Clinica Medica 5, Via Giustiniani, 35128, Padova, Italy

    Francesca Campagna, A. Biancardi, A. Gatta & P. Amodio

  2. Department of General Surgery and Organ Transplantation, University of Padua, Padua, Italy

    U. Cillo

Authors
  1. Francesca Campagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Biancardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Cillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Gatta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Amodio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesca Campagna.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Campagna, F., Biancardi, A., Cillo, U. et al. Neurocognitive-neurological complications of liver transplantation: a review. Metab Brain Dis 25, 115–124 (2010). https://doi.org/10.1007/s11011-010-9183-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11011-010-9183-0

Keywords

Search

Navigation