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Uzochukwu EC, Harding KE, Hrastelj J, Kreft KL, Holmans P, Robertson NP, Tallantyre EC, Lawton M. Modelling Disease Progression of Multiple Sclerosis in a South Wales Cohort. Neuroepidemiology 2024; 58:218-226. [PMID: 38377969 PMCID: PMC11151968 DOI: 10.1159/000536427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/27/2023] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVES The objective of this study was to model multiple sclerosis (MS) disease progression and compare disease trajectories by sex, age of onset, and year of diagnosis. STUDY DESIGN AND SETTING Longitudinal EDSS scores (20,854 observations) were collected for 1,787 relapse-onset MS patients at MS clinics in South Wales and modelled using a multilevel model (MLM). The MLM adjusted for covariates (sex, age of onset, year of diagnosis, and disease-modifying treatments), and included interactions between baseline covariates and time variables. RESULTS The optimal model was truncated at 30 years after disease onset and excluded EDSS recorded within 3 months of relapse. As expected, older age of onset was associated with faster disease progression at 15 years (effect size (ES): 0.75; CI: 0.63, 0.86; p: <0.001) and female-sex progressed more slowly at 15 years (ES: -0.43; CI: -0.68, -0.18; p: <0.001). Patients diagnosed more recently (defined as 2007-2011 and >2011) progressed more slowly than those diagnosed historically (<2006); (ES: -0.46; CI: -0.75, -0.16; p: 0.006) and (ES: -0.95; CI: -1.20, -0.70; p: <0.001), respectively. CONCLUSION We present a novel model of MS outcomes, accounting for the non-linear trajectory of MS and effects of baseline covariates, validating well-known risk factors (sex and age of onset) associated with disease progression. Also, patients diagnosed more recently progressed more slowly than those diagnosed historically.
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Affiliation(s)
- Emeka C. Uzochukwu
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | | | - James Hrastelj
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Karim L. Kreft
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Peter Holmans
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Neil P. Robertson
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Emma C. Tallantyre
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Michael Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Najafi P, Hadizadeh M, Cheong JPG, Motl RW, Abdullah S, Mohafez H, Poursadeghfard M. Effects of tele-exercise training on physical and mental health and quality of life in multiple sclerosis: Do the effects differ by modality and clinical disease course? Mult Scler Relat Disord 2023; 80:105129. [PMID: 37977056 DOI: 10.1016/j.msard.2023.105129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/01/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Tele-exercise training has improved mental and physical health and quality of life (QOL) in people with multiple sclerosis (PwMS), but there is little known about the comparability of effects across modalities and clinical disease courses. OBJECTIVE To evaluate the effect of tele-Pilates and tele-yoga training on physical and mental factors and QOL in PwMS, with a focus on two phenotype classifications - relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS). METHODS Eighty-two persons with RRMS (n = 48) and SPMS (n = 34) were randomly assigned into tele-Pilates (n = 29), tele-yoga (n = 26), or control (n = 27). The tele-exercis training was conducted three times per week for eight weeks. RESULTS Significant time × group interactions were observed for QoL (p = 0.01), physical activity levels (p < 0.001), mental health (p = 0.05), and a decline in depression (p = 0.002) following tele-Pilates and tele-yoga. The corresponding subfactors, including pain, energy, emotional well-being, and role limitation due to emotional and physical problems, have shown significant improvements after interventions compared with control (all p < 0.05). The effects of exercise over control did not depend on MS phenotype (all p > 0.05). DISCUSSION Tele-yoga and tele-Pilates exercises improved QoL and mental and physical health in PwMS, and the benefits were similar across both MS phenotypes. These findings highlight the potential of implementing tele-yoga and tele-Pilates as non-pharmacological mind-body symptomatic treatments for individuals with both RRMS and SPMS.
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Affiliation(s)
- Parisa Najafi
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Maryam Hadizadeh
- Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
| | | | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States.
| | - Suhailah Abdullah
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Hamidreza Mohafez
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
| | - Maryam Poursadeghfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Lo Buono V, Corallo F, Bonanno L, Pria D, Di Cara M, Palmeri R, D'Aleo G, Rifici C, Sessa E, Marino S, De Cola MC. Psychological symptoms in Multiple Sclerosis and the role of marital status: results from a retrospective single-center study. Mult Scler Relat Disord 2023; 79:105051. [PMID: 37820445 DOI: 10.1016/j.msard.2023.105051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/18/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Married people have, on average, better mental health than no married people. Psychological symptoms as anxiety and depression occur frequently in patients with multiple sclerosis (MS), increasing the severity of neurologic disability. The aim of this retrospective study was to investigate the relationship between functional disability and psychological symptoms differentiating by marital status. METHODS In this study 150 MS outpatients without a history of psychological disorders were selected from the hospital database. The outpatient procedure for all patients includes the administration of the Expanded Disability Status Scale and the questionnaire Symptoms Checklist-90-Revised (SCL-90-R) a multidimensional self-report inventory, consisting of 90 items covering nine clinical dimensions: somatization (SOM), obsessive-compulsive (OC), interpersonal sensitivity (IS), depression (DEP), anxiety (ANX), hostility (HOS), phobic anxiety (PHOB), paranoid ideation (PAR), psychoticism (PSY), and three global indices of distress: global severity index (GSI), positive symptoms total (PST) and positive symptom distress index (PSDI). According to marital status, subjects were subdivided in single, married (including cohabitants), and divorced (including separated). A nonparametric group comparisons analysis was performed, as well as multivariate analysis which included generalized linear regression models. RESULTS Regression results showed that functional disability was a significant predictor for all SCL- 90-R subscales. Moreover, it would seem that the single condition might be a protective factor for the development of psychological symptoms in SM patients. Notably, findings showed that younger subjects were predominantly single and had less psychological symptoms, whereas patients with greater psychological alterations were older in a stable affective couple relationship, presenting an elevation in depression, anxiety, somatization and compulsive, and obsessive scales. CONCLUSION Numerous factors contribute to the onset of psychological disorders in multiple sclerosis. Marriage does not represent a protective factor for the development of psychological symptoms in SM patients. Future investigation is needed to ascertain the prevalence and underlying causes of psychological symptoms.
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Affiliation(s)
| | | | - Lilla Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Deborah Pria
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | | | | | | | | | - Edoardo Sessa
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
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Zhang X, Song Y, Wei Z, Chen X, Zhuang X, Yi L. The prevalence and risk factors of anxiety in multiple sclerosis: A systematic review and meta-analysis. Front Neurosci 2023; 17:1120541. [PMID: 37139531 PMCID: PMC10149809 DOI: 10.3389/fnins.2023.1120541] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background Patients with multiple sclerosis (MS) suffer from repetitive neurological deterioration, while anxiety may play a significant role in the disease's progression. Objective To explore the prevalence of anxiety in MS and to investigate the risk factors related to anxiety in MS patients. Methods An analysis of four databases, PubMed, Web of Science, EMBASE, and Cochrane Library, has been conducted to determine the prevalence or risk factors for anxiety in MS published before May 2021. Results In total, 32 studies were found to be eligible. Anxiety prevalence was estimated to be 36% based on the pooled estimates [the 95% confidence interval (CI) = [0.30-0.42], I 2 = 98.4%]. Significant risk factors for developing of anxiety were as follows: age at survey [the weighted mean difference (WMD) = 0.96, 95% CI = [0.86-1.06], I 2 = 43.8%], female [the odd ratio (OR) = 1.78, 95% CI = [1.38-2.30], I 2 = 0%], living together (OR 2.83, 95% CI = [1.74-4.59], I 2 = 0%), past psychiatric history (OR 2.42, 95% CI = [1.56-3.75], I 2 = 0%), depression (OR 7.89, 95% CI = [3.71-16.81], I 2 = 0%), not taking MS medication (OR 2.33, 95% CI = [1.29-4.21], I 2 = 77.8%), relapsing-remitting MS (RRMS) (OR 1.50, 95% CI = [0.94-2.37], I 2 = 53.5%), and baseline Expanded Disability Status Scale (EDSS) (OR 0.84, 95% CI = [0.48-1.21], I 2 = 62.2%). Conclusion An estimated 36% of people with MS suffer from anxiety. And anxiety rates in MS patients are significantly associated with age, gender, living together, prior psychiatric history, depression, drug compliance, RRMS, and baseline EDSS. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=287069, identifier CRD42021287069.
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Affiliation(s)
- Xiaoyun Zhang
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Ying Song
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Zhiqiang Wei
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiao Chen
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaojia Zhuang
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Yi
- Neurology Department, Peking University Shenzhen Hospital, Shenzhen, China
- *Correspondence: Li Yi,
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Özer D, Emine Ata E, DİkeÇ G, Demİr S. The relationship between stress, anxiety, and depression levels and pseudobulbar affect in patients with Multiple Sclerosis. Contemp Nurse 2022; 58:317-329. [PMID: 35880717 DOI: 10.1080/10376178.2022.2107037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pseudobulbar affect (PBA) has recently been added to the list of mental disorders commonly observed in patients with Multiple Sclerosis (MS). The emotional changes experienced by MS patients may be associated with other mental problems and adversely affect disease prognosis. However, there are limited studies in the international and national literature on this subject. AIM This study aimed to evaluate the relationship between PBA and stress, anxiety, and depression levels in patients with MS. DESIGN This is a descriptive, relational, and cross-sectional study. METHODS A total of 442 MS patients followed in the neurology outpatient clinic of a hospital and registered with the MS Society in Turkey participated in this study. Data were collected using a personal information form, the Turkish version of the Center for Neurologic Study-Lability Scale (CNS-LS), and the Depression Anxiety Stress Scale (DASS). RESULTS In this study, 63.3% of the patients had PBA, 21% had extremely severe depression, 41.6% had extremely severe anxiety, and 24.9% had severe stress. Correlation analysis revealed weak positive correlations between CNS-LS total score and DASS subscale and total scores. Depression, anxiety, and stress levels accounted for 22.5% of the variation in CNS-LS total score. CONCLUSION The results of this study indicate that a majority of MS patients in Turkey experience PBA, depression, anxiety, and stress, and that PBA is positively associated with depression, anxiety, and stress. IMPACT STATEMENT This study, indicates that should be increased consultation-liaison psychiatry services in Turkey, and MS patients should benefit from comprehensive psychiatric services.
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Affiliation(s)
- Duygu Özer
- MsN, PhD Candidate, University of Health Sciences, Sultan II. Abdulhamid Han Training and Research Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Elvan Emine Ata
- Assis. Prof., University of Health Sciences, Hamidiye Faculty of Nursing, Department of Psychiatric Nursing, Istanbul, Turkey. E-mail:
| | - Gül DİkeÇ
- Assoc. Prof., Fenerbahce University, Faculty of Health Sciences, Department of Nursing, Istanbul, Turkey. E-mail:
| | - Serkan Demİr
- Assoc. Prof., MD, Department of Neurology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey. E-mail:
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Kavakbasi E, Rodner F, Nimalavachchlan L, Schwarte K, Schettler C, Bonnekoh LM, Opel N, Peine AC, Baune BT, Hohoff C. Immunological changes following electroconvulsive therapy in multiple sclerosis. J Psychiatr Res 2022; 150:180-183. [PMID: 35390698 DOI: 10.1016/j.jpsychires.2022.03.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 02/13/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Electroconvulsive therapy (ECT) is a well-established treatment option in case of treatment-resistant depression (TRD). Only a few cases of ECT in depressed patients with multiple sclerosis (MS) were reported so far suggesting efficacy for the treatment of severe depression in MS, while data on possible neurological deterioration remained unclear. METHODS In this case study we report on a case of a middle-aged man with MS. He was on dimethyl fumarate for relapse prevention since 2019 and without signs of active disease in a recent cerebral MRI. He suffered from treatment-resistant severe bipolar depression and thus received a total of 14 ECT sessions. We changed from right-unilateral to bilateral stimulation technique after the 7th session. We rated depression severity and measured biomarkers of neurodegeneration and inflammation before and after the ECT series to determine the impact of ECT on tolerance, response and neurobiology. RESULTS The ECT series was tolerated well without neurological deterioration and any new neurological symptoms. The seizure quality was sufficient on average. We saw partial response corresponding to an improvement of about 35% in BDI-II and MADRS. The concentration of inflammation and neurodegeneration biomarkers was low both pre-treatment and post-treatment with increases from pre- to post ECT mainly in the CCL-2 pathway. CONCLUSION In our patient with TRD and MS ECT was safe and feasible. We did not see any neurobiological signs of disease activation of MS or neurodegeneration during the course of ECT, which may even be beneficial as it led to increase in the neuroprotective CCL-2 pathway in the presented patient.
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Affiliation(s)
- Erhan Kavakbasi
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany.
| | - Franziska Rodner
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Lavanja Nimalavachchlan
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Kathrin Schwarte
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Christiane Schettler
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Linda M Bonnekoh
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Nils Opel
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Anne-Christin Peine
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany; Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Christa Hohoff
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
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Gasperi C, Hapfelmeier A, Daltrozzo T, Schneider A, Donnachie E, Hemmer B. Systematic Assessment of Medical Diagnoses Preceding the First Diagnosis of Multiple Sclerosis. Neurology 2021; 96:e2977-e2988. [PMID: 33903190 DOI: 10.1212/wnl.0000000000012074] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/15/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore the occurrence of diseases and symptoms in the 5 years before diagnosis in patients with multiple sclerosis (MS) in a case-control study. METHODS Using ambulatory claims data, we systematically assessed differences in the occurrence of diseases and symptoms in the 5 years before first diagnosis in patients with MS (n = 10,262) compared to patients with 2 other autoimmune diseases, Crohn disease (n = 15,502) and psoriasis (n = 98,432), and individuals without these diseases (n = 73,430). RESULTS Forty-three ICD-10 codes were recorded more frequently for patients with MS before diagnosis compared to controls without autoimmune disease. Many of these findings were confirmed in a comparison to the other control groups. A high proportion of these ICD-10 codes represent symptoms suggestive of demyelinating events or other neurologic diagnoses. In a sensitivity analysis excluding patients with such recordings before first diagnosis, no association remained significant. Seven ICD-10 codes were associated with lower odds ratios of MS, 4 of which represent upper respiratory tract infections. Here, the relations with MS were even more pronounced in the sensitivity analysis. CONCLUSIONS Our analyses suggest that patients with MS are frequently not diagnosed at their first demyelinating event but often years later. Symptoms and physician encounters before MS diagnosis seem to be related to already ongoing disease rather than a prodrome. The observed association of upper respiratory tract infections with lower odds ratios of MS diagnosis suggests a link between protection from infection and MS that, however, needs to be validated and further investigated.
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Affiliation(s)
- Christiane Gasperi
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Alexander Hapfelmeier
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Tanja Daltrozzo
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Antonius Schneider
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Ewan Donnachie
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany
| | - Bernhard Hemmer
- From the Department of Neurology (C.G., B.H.), Klinikum rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (A.H.), Department of Psychosomatic Medicine and Psychotherapy (T.D.), Klinikum rechts der Isar, and Institute of General Practice and Health Services Research (A.H., A.S.), TUM School of Medicine, Technical University of Munich; Bavarian Association of Statutory Health Insurance Physicians (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany.
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