Journal of Clinical and Experimental Neuropsychology
ISSN: 0168-8634 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/ncen19
Prevalence of the Fuld profile in temporal lobe epilepsy R. A. Bornstein & D. Share To cite this article: R. A. Bornstein & D. Share (1990) Prevalence of the Fuld profile in temporal lobe epilepsy, Journal of Clinical and Experimental Neuropsychology, 12:2, 265-269, DOI: 10.1080/01688639008400972 To link to this article: http://dx.doi.org/10.1080/01688639008400972
Published online: 04 Jan 2008.
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Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ncen20 Download by: [York University Libraries]
Date: 05 November 2015, At: 21:04
Journal of Clinical and Experimental Neuropsychology 1990, Vol. 12, No. 2, pp. 265-269
0168-8634/90/1202-0265 $3.00 0 Swets & Zeitlinger
Prevalence of the Fuld Profile in Temporal Lobe Epilepsy” R. A. Bornstein and D. Share Departments of Psychiatry, Neurology, dz Neurological Surgery Ohio State University
Downloaded by [York University Libraries] at 21:04 05 November 2015
ABSTRACT A pattern of performance on the WAIS-R presumably related to temporal lobe abnormalities associated with Alzheimer’s Disease was examined in patients with focal temporal lobe EEG abnormalities to determine if the profile was related to other forms of temporal lobe disease. Among 120 patients with unilateral or bilateral temporal lobe EEG abnormalities, only 4 (3%) demonstrated the profile. The presence of the profile was unrelated to laterality of EECi abnormality. These findings were discussed in regard to previous studies and the utility of the so-called Fuld profile.
In a recent study, Fuld (1984) identified a pattern of performance on the WAIS which was found in approximately 44% of patients with Alzheimer’s type dementia (DAT) and only 5% of non Alzheimer’s dementia patients. These results were replicated by Brinkman and Braun (1984) who found the so-called Fuld profile in 56% of DAT patients, and 5% of Multi-Infarct Dementia patients. Heinrichs and Celinski (1987) reported a 10% (5150) incidence in head trauma patients. Although the Fuld profile does not appear to be particularly sensitive (only approximately 50% of DAT patients demonstrate the profile), there does appear to be relatively high specificity in the clinical samples examined thus far. Furthermore, recent studies of normal elderly subjects using the WAIS-R (Satz, Van Gorp, Soper, & Mitrushina, 1987) or the WAIS (Tuokko & Crockett, 1987) reported an incidence of the Fuld profile of 12% and 1% respectively. These studies provide some preliminary support for the potential utility of the Fuld profile. However, it would seem to be of importance to demonstrate the specificity of the profile in regard to other disease conditions which might have abnormalities in comparable neuroanatomic areas. In view of the promient temporal lobe pathology in DAT (Hyman, VanHoesen, Damasio, & Barnes, 1984; Hyman, VanHoesen, Kromer, & Damasio, 1986; Whitehouse, 1986), one such population would be patients with focal temporal lobe seizure foci. The * The preparation of this manuscript was supported in part by a grant from the National Institute of Mental Health (MH 42209). Address for reprints and correspondence: R. A. Bornstein, I’h.D., Neuropsychology Laboratory, Ohio State University, 473 W. 12th Avenue, Columbus, OH 43210, USA.
Accepted for publication: February 28, 1989.
266
R. A. BORNSTEIN AND D. SHARE
present study, therefore, was performed to examine the incidence of the Fuld profile in a large sample of seizure patients with well documented temporal lobe EEG abnormalities.
Downloaded by [York University Libraries] at 21:04 05 November 2015
METHOD Subjects The sample consisted of 120subjects drawn from a larger sample of 266 patients who had been referred for neuropsychological investigation of seizure disorders. The selection of subjects for this study was based on EEG records (usually a prolonged, and videomonitored recording) which demonstrated a temporal lobe EEG epileptogenic focus. Table 1 Mean IQ and Demographic Variables for EEG Subgroups.
N
Age Education VIQ
PIQ VIQ-PIQ
Left Temporal
Right Temporal
M
M
SD
BiTemporal
36
11.4 32 11.5 1.7 82.2 10.4 83.1 14.1 -0.9 8.5
35.4 9.9 11.7 2.5 84.9 12.6 87.6 13.7 -2.7 9.0
SD
M
SD
43
14 34.8 11.5 81.3 81.9 -0.6
13.7 2.5 13.9 14.1 10.8
Bitemporal L>R
M
SD
Bitemporal R>L
M
SD
15
12
30.9 11.1 11.5 1.3 77.8 13.9 82.7 19.4 -4.9 10.0
31.7 7.8 11.5 1.3 79.4 13.7 77.5 14.0 1.9 6.8
The characteristics of the subgroups of the sample are presented in Table 1. Among the subjects, 79 had unilateral seizure foci (43 left, 36 right) while the remainder had bitemporal foci. The mean age of the entire sample was 33.2 years (SD=10.9), and the mean educational level was 11.6 years ( S D X ) . There were 69 females, and 5 1 males. The WAIS-R profiles for these subjects were reviewed and rescored to derive the agecorrected scaled scores for use in the profile. The profile was computed for all subjects using the standard Fuld procedures. The calculation of the profile is based on the following computations: A = (Information Vocabulary)/2; B = (Similarities Digit Span)/Z; C = (Block Design Digit Symbol)/2; and D = Object Assembly. These scores are then entered into the formula A > B > C ID, A > D. A profile which completely satisfied this formula was designated as a ‘hit’. The incidence of this profile was then examined in the sample as a whole and in the various subgroups of the sample.
+
+
+
RESULTS
Among the patients with unilateral temporal lobe foci, there were four patients (5.1%) who demonstrated the Fuld profile (two patients each in the left and right temporal groups). None of the patients with bitemporal EEG abnormalities demonstrated the profile. With the inclusion of the patients
Downloaded by [York University Libraries] at 21:04 05 November 2015
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267
with bitemporal foci, the incidence of the profile in the total sample was approximately 3% (4/ 120). The patients who demonstrated the profile were not different from those who did not have the profile in regard to age or education, but were different on the discrepancy between VIQ and PIQ. The mean discrepancy for the entire sample was -1.6 (SD=9.06), but the mean for the patients with the Fuld profile was 7.5. The initial report by Fuld (1984) raised the possibility of an association between the presence of the profile and VIQ > PIQ discrepancies of 15 points or more. This was found in the normals treated with scopolamine, and to some extent with the dementia patients. In the current sample, approximately 10% of the total sample had discrepancies of 10 points or more. The four patients with the Fuld profile had discrepancies of 2,7, 10, and 11 points. Thus only 2 of the 12 patients with discrepancies of 10 points or more demonstrated the profile. This association was not significant (x*= 0.02, NS). DISCUSSION This study explored the specificity of the WAIS-R cholinergic deficit (Fuld) profile in patients with temporal lobe abnormalities not associated with DAT. This would appear to be a n important step in the documentation of the discriminative validity of the profile. That is, if the profile reflects cholinergic deficits (presumably related to a specific type of temporal lobe pathology associated with DAT), the profile should not occur with increased incidence in samples with presumably different pathological substrates (such as temporal lobe seizures which has no known association with cholinergic abnormalities). The current data provide some support for this differential sensitivity. In this study of seizure patients with focal temporal EEG abnormalities, the 5% incidence of the Fuld profile was similar to the proportion of non-DAT patients reported in previous studies (Brinkman & Braun, 1984; Fuld, 1984). These data suggest that the incidence of the Fuld profile is not related to the presence of focal temporal lobe abnormalities, and may be specific to the temporal lobe abnormality associatcd with DAT. Although these data are encouraging with regard to the Fuld profile, further evidence is required to support its utility. For example, the current sample was much younger than the dementia populations studied previously. It is possible that the incidence of the profile might occur in the context of increased age, although previous studies of elderly normals did not support this (Satz et al., 1987; Tuokko & Crockett, 1987). However, it should be noted that the sample reported by Satz et al. had a mean Full Scalc IQ of 121. In that study incidence of the profile was almost 13%, and it remains to be determined whether similar data is found in samples with average ability. It would also be of interest to examine the incidence of the Fuld profile in patient groups which may represent differential diagnostic questions (e.g., elderly depressed patients).
Downloaded by [York University Libraries] at 21:04 05 November 2015
268
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Although the evidence to date suggests that the Fuld profile is relatively specific for DAT, the inconsistencies between some studies, and the overall lack of diagnostic sensitivity remains problematic. The Fuld profile was initially developed on the WAIS, and it is possible that the use of the WAIS-R in the present study may account for the low incidence of the profile in the current sample. However, in the two studies of normal elderly subjects, higher rates of the profile were found in the study which used the WAIS-R (Satz et al., 1987). In addition, Filley, Kobayashi, and Heaton, (1987) reported higher (but not significantly) rates of the profile in the DAT group given the WAIS-R. Thus, there is no evidence that the low incidence of the profile in this study is related to use of the WAIS-R. The lack of sensitivity of the Fuld profile may be related to specific differences in diagnostic criteria, diagnostic certainty, duration or stage of illness, referral patterns, or nature of symptoms in particular patients. It may be that the lack of sensitivity of the profile represents evidence of diagnostic heterogeneity in DAT. For example, Martin et al. (1986) presented evidence of subtypes of DAT patients who differed on pattern of behavioral deficit as well as neurophysiological patterns. It is entirely possible that the Fuld profile may only be sensitive to certain of the patterns of deficit observed in DAT. In summary, the present study provides some support for the diagnostic specificity of the Fuld profile in that the profile is found in very few patients with focal temporal lobe EEG abnormalities. The incidence was no greater than previously reported in non-DAT samples. Regardless of the specificity of the profile, the large number of DAT patients with negative profiles raises some question in relation to the clinical contribution of the Fuld profile. While these and previous data are supportive, considerable further investigation is needed to document the specificity and diagnostic contribution of this profile.
REFERENCES Brinkman, S. D . , & Braun, P. (1984). Classification of dementia patients by a WAIS profile related to central cholinergic deficiencies. Journal of Clinical Neuropsychology, 6,393400. Filley, C . M., Kobayashi, J., & Heaton, R. K. (1987). Wechsler Intelligence Scale profiles, the cholinergic system, and Alzheimer’s Disease. Journal of Clinical and Experimental Neuropsychology, 9, 180- 186. Fuld, P. A. (1984). Test profile of cholinergic dysfunction and of Alzheimer type dementia. Journal of Clinical Neuropsychology, 6, 380-392. Heinrichs, R. W., & Celinski, M. J. (1987). Frequency of occurrence of a WAIS dementia profile in male head trauma patients. Journal of Clinical and Experimental Neuropsychology, 9, 187-190. Hyman, B. T., VanHoesen, G. W., Damasio, A. R., & Barnes, C. L. (1984). Alzheimer’s Disease: Cell specific pathology isolates the hippocampal formation. Science, 225, 1168-1170.
Downloaded by [York University Libraries] at 21:04 05 November 2015
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Hyman, B. T., VanHoesen, G. W., Kromer, L. J., & Damasio, A. R. (1986). Perforant pathway changes and the memory impairment of Alzheimer’s Disease. Annals of Neurology, 20, 472-48 1. Martin, A,, Brouwers, P., Lalonde, F., Cox, C., Teleska, P., Fedio, P., Foster, N. L., & Chasc, T. N. (1986). Towards a behavioral typology of Alzheimer’s patients. Journal of Clinical and Experimental Neuropsychology, 8, 594-610. Satz, P., Van Gorp, W. G., Soper, H. V., & Mitrushina, M. (1987). A WAIS-R marker for dementia of the Alzheimer type? An empirical and statistical induction test. Journal of Clinical and Experimental Neuropsychology, 9, 767-774. Tuokko, H. & Crockett, D. (1987). Central cholinergic deficiency WAIS profiles in a nondemented aged sample. Journal of’Clinical and Experimental Neuropsychology, 9, 225-227. Whitehouse, P. J. (1986). Clinical and neurochemical consequences of neuronal loss in the nucleus basalis of Meynert in Parkinson’s disease and Alzheimer’s disease. In M. D. Yahr & K. J. Bergman (Eds.), Advances in Neurology, 45. 393-397.
ISSN: 0168-8634 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/ncen19
Prevalence of the Fuld profile in temporal lobe epilepsy R. A. Bornstein & D. Share To cite this article: R. A. Bornstein & D. Share (1990) Prevalence of the Fuld profile in temporal lobe epilepsy, Journal of Clinical and Experimental Neuropsychology, 12:2, 265-269, DOI: 10.1080/01688639008400972 To link to this article: http://dx.doi.org/10.1080/01688639008400972
Published online: 04 Jan 2008.
Submit your article to this journal
Article views: 3
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ncen20 Download by: [York University Libraries]
Date: 05 November 2015, At: 21:04
Journal of Clinical and Experimental Neuropsychology 1990, Vol. 12, No. 2, pp. 265-269
0168-8634/90/1202-0265 $3.00 0 Swets & Zeitlinger
Prevalence of the Fuld Profile in Temporal Lobe Epilepsy” R. A. Bornstein and D. Share Departments of Psychiatry, Neurology, dz Neurological Surgery Ohio State University
Downloaded by [York University Libraries] at 21:04 05 November 2015
ABSTRACT A pattern of performance on the WAIS-R presumably related to temporal lobe abnormalities associated with Alzheimer’s Disease was examined in patients with focal temporal lobe EEG abnormalities to determine if the profile was related to other forms of temporal lobe disease. Among 120 patients with unilateral or bilateral temporal lobe EEG abnormalities, only 4 (3%) demonstrated the profile. The presence of the profile was unrelated to laterality of EECi abnormality. These findings were discussed in regard to previous studies and the utility of the so-called Fuld profile.
In a recent study, Fuld (1984) identified a pattern of performance on the WAIS which was found in approximately 44% of patients with Alzheimer’s type dementia (DAT) and only 5% of non Alzheimer’s dementia patients. These results were replicated by Brinkman and Braun (1984) who found the so-called Fuld profile in 56% of DAT patients, and 5% of Multi-Infarct Dementia patients. Heinrichs and Celinski (1987) reported a 10% (5150) incidence in head trauma patients. Although the Fuld profile does not appear to be particularly sensitive (only approximately 50% of DAT patients demonstrate the profile), there does appear to be relatively high specificity in the clinical samples examined thus far. Furthermore, recent studies of normal elderly subjects using the WAIS-R (Satz, Van Gorp, Soper, & Mitrushina, 1987) or the WAIS (Tuokko & Crockett, 1987) reported an incidence of the Fuld profile of 12% and 1% respectively. These studies provide some preliminary support for the potential utility of the Fuld profile. However, it would seem to be of importance to demonstrate the specificity of the profile in regard to other disease conditions which might have abnormalities in comparable neuroanatomic areas. In view of the promient temporal lobe pathology in DAT (Hyman, VanHoesen, Damasio, & Barnes, 1984; Hyman, VanHoesen, Kromer, & Damasio, 1986; Whitehouse, 1986), one such population would be patients with focal temporal lobe seizure foci. The * The preparation of this manuscript was supported in part by a grant from the National Institute of Mental Health (MH 42209). Address for reprints and correspondence: R. A. Bornstein, I’h.D., Neuropsychology Laboratory, Ohio State University, 473 W. 12th Avenue, Columbus, OH 43210, USA.
Accepted for publication: February 28, 1989.
266
R. A. BORNSTEIN AND D. SHARE
present study, therefore, was performed to examine the incidence of the Fuld profile in a large sample of seizure patients with well documented temporal lobe EEG abnormalities.
Downloaded by [York University Libraries] at 21:04 05 November 2015
METHOD Subjects The sample consisted of 120subjects drawn from a larger sample of 266 patients who had been referred for neuropsychological investigation of seizure disorders. The selection of subjects for this study was based on EEG records (usually a prolonged, and videomonitored recording) which demonstrated a temporal lobe EEG epileptogenic focus. Table 1 Mean IQ and Demographic Variables for EEG Subgroups.
N
Age Education VIQ
PIQ VIQ-PIQ
Left Temporal
Right Temporal
M
M
SD
BiTemporal
36
11.4 32 11.5 1.7 82.2 10.4 83.1 14.1 -0.9 8.5
35.4 9.9 11.7 2.5 84.9 12.6 87.6 13.7 -2.7 9.0
SD
M
SD
43
14 34.8 11.5 81.3 81.9 -0.6
13.7 2.5 13.9 14.1 10.8
Bitemporal L>R
M
SD
Bitemporal R>L
M
SD
15
12
30.9 11.1 11.5 1.3 77.8 13.9 82.7 19.4 -4.9 10.0
31.7 7.8 11.5 1.3 79.4 13.7 77.5 14.0 1.9 6.8
The characteristics of the subgroups of the sample are presented in Table 1. Among the subjects, 79 had unilateral seizure foci (43 left, 36 right) while the remainder had bitemporal foci. The mean age of the entire sample was 33.2 years (SD=10.9), and the mean educational level was 11.6 years ( S D X ) . There were 69 females, and 5 1 males. The WAIS-R profiles for these subjects were reviewed and rescored to derive the agecorrected scaled scores for use in the profile. The profile was computed for all subjects using the standard Fuld procedures. The calculation of the profile is based on the following computations: A = (Information Vocabulary)/2; B = (Similarities Digit Span)/Z; C = (Block Design Digit Symbol)/2; and D = Object Assembly. These scores are then entered into the formula A > B > C ID, A > D. A profile which completely satisfied this formula was designated as a ‘hit’. The incidence of this profile was then examined in the sample as a whole and in the various subgroups of the sample.
+
+
+
RESULTS
Among the patients with unilateral temporal lobe foci, there were four patients (5.1%) who demonstrated the Fuld profile (two patients each in the left and right temporal groups). None of the patients with bitemporal EEG abnormalities demonstrated the profile. With the inclusion of the patients
Downloaded by [York University Libraries] at 21:04 05 November 2015
F'C1.D PROFILE IN [EMPORAL I D R E EPII.T:PSY
267
with bitemporal foci, the incidence of the profile in the total sample was approximately 3% (4/ 120). The patients who demonstrated the profile were not different from those who did not have the profile in regard to age or education, but were different on the discrepancy between VIQ and PIQ. The mean discrepancy for the entire sample was -1.6 (SD=9.06), but the mean for the patients with the Fuld profile was 7.5. The initial report by Fuld (1984) raised the possibility of an association between the presence of the profile and VIQ > PIQ discrepancies of 15 points or more. This was found in the normals treated with scopolamine, and to some extent with the dementia patients. In the current sample, approximately 10% of the total sample had discrepancies of 10 points or more. The four patients with the Fuld profile had discrepancies of 2,7, 10, and 11 points. Thus only 2 of the 12 patients with discrepancies of 10 points or more demonstrated the profile. This association was not significant (x*= 0.02, NS). DISCUSSION This study explored the specificity of the WAIS-R cholinergic deficit (Fuld) profile in patients with temporal lobe abnormalities not associated with DAT. This would appear to be a n important step in the documentation of the discriminative validity of the profile. That is, if the profile reflects cholinergic deficits (presumably related to a specific type of temporal lobe pathology associated with DAT), the profile should not occur with increased incidence in samples with presumably different pathological substrates (such as temporal lobe seizures which has no known association with cholinergic abnormalities). The current data provide some support for this differential sensitivity. In this study of seizure patients with focal temporal EEG abnormalities, the 5% incidence of the Fuld profile was similar to the proportion of non-DAT patients reported in previous studies (Brinkman & Braun, 1984; Fuld, 1984). These data suggest that the incidence of the Fuld profile is not related to the presence of focal temporal lobe abnormalities, and may be specific to the temporal lobe abnormality associatcd with DAT. Although these data are encouraging with regard to the Fuld profile, further evidence is required to support its utility. For example, the current sample was much younger than the dementia populations studied previously. It is possible that the incidence of the profile might occur in the context of increased age, although previous studies of elderly normals did not support this (Satz et al., 1987; Tuokko & Crockett, 1987). However, it should be noted that the sample reported by Satz et al. had a mean Full Scalc IQ of 121. In that study incidence of the profile was almost 13%, and it remains to be determined whether similar data is found in samples with average ability. It would also be of interest to examine the incidence of the Fuld profile in patient groups which may represent differential diagnostic questions (e.g., elderly depressed patients).
Downloaded by [York University Libraries] at 21:04 05 November 2015
268
R. A. BORNSTEIN AND 0.SHARE
Although the evidence to date suggests that the Fuld profile is relatively specific for DAT, the inconsistencies between some studies, and the overall lack of diagnostic sensitivity remains problematic. The Fuld profile was initially developed on the WAIS, and it is possible that the use of the WAIS-R in the present study may account for the low incidence of the profile in the current sample. However, in the two studies of normal elderly subjects, higher rates of the profile were found in the study which used the WAIS-R (Satz et al., 1987). In addition, Filley, Kobayashi, and Heaton, (1987) reported higher (but not significantly) rates of the profile in the DAT group given the WAIS-R. Thus, there is no evidence that the low incidence of the profile in this study is related to use of the WAIS-R. The lack of sensitivity of the Fuld profile may be related to specific differences in diagnostic criteria, diagnostic certainty, duration or stage of illness, referral patterns, or nature of symptoms in particular patients. It may be that the lack of sensitivity of the profile represents evidence of diagnostic heterogeneity in DAT. For example, Martin et al. (1986) presented evidence of subtypes of DAT patients who differed on pattern of behavioral deficit as well as neurophysiological patterns. It is entirely possible that the Fuld profile may only be sensitive to certain of the patterns of deficit observed in DAT. In summary, the present study provides some support for the diagnostic specificity of the Fuld profile in that the profile is found in very few patients with focal temporal lobe EEG abnormalities. The incidence was no greater than previously reported in non-DAT samples. Regardless of the specificity of the profile, the large number of DAT patients with negative profiles raises some question in relation to the clinical contribution of the Fuld profile. While these and previous data are supportive, considerable further investigation is needed to document the specificity and diagnostic contribution of this profile.
REFERENCES Brinkman, S. D . , & Braun, P. (1984). Classification of dementia patients by a WAIS profile related to central cholinergic deficiencies. Journal of Clinical Neuropsychology, 6,393400. Filley, C . M., Kobayashi, J., & Heaton, R. K. (1987). Wechsler Intelligence Scale profiles, the cholinergic system, and Alzheimer’s Disease. Journal of Clinical and Experimental Neuropsychology, 9, 180- 186. Fuld, P. A. (1984). Test profile of cholinergic dysfunction and of Alzheimer type dementia. Journal of Clinical Neuropsychology, 6, 380-392. Heinrichs, R. W., & Celinski, M. J. (1987). Frequency of occurrence of a WAIS dementia profile in male head trauma patients. Journal of Clinical and Experimental Neuropsychology, 9, 187-190. Hyman, B. T., VanHoesen, G. W., Damasio, A. R., & Barnes, C. L. (1984). Alzheimer’s Disease: Cell specific pathology isolates the hippocampal formation. Science, 225, 1168-1170.
Downloaded by [York University Libraries] at 21:04 05 November 2015
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269
Hyman, B. T., VanHoesen, G. W., Kromer, L. J., & Damasio, A. R. (1986). Perforant pathway changes and the memory impairment of Alzheimer’s Disease. Annals of Neurology, 20, 472-48 1. Martin, A,, Brouwers, P., Lalonde, F., Cox, C., Teleska, P., Fedio, P., Foster, N. L., & Chasc, T. N. (1986). Towards a behavioral typology of Alzheimer’s patients. Journal of Clinical and Experimental Neuropsychology, 8, 594-610. Satz, P., Van Gorp, W. G., Soper, H. V., & Mitrushina, M. (1987). A WAIS-R marker for dementia of the Alzheimer type? An empirical and statistical induction test. Journal of Clinical and Experimental Neuropsychology, 9, 767-774. Tuokko, H. & Crockett, D. (1987). Central cholinergic deficiency WAIS profiles in a nondemented aged sample. Journal of’Clinical and Experimental Neuropsychology, 9, 225-227. Whitehouse, P. J. (1986). Clinical and neurochemical consequences of neuronal loss in the nucleus basalis of Meynert in Parkinson’s disease and Alzheimer’s disease. In M. D. Yahr & K. J. Bergman (Eds.), Advances in Neurology, 45. 393-397.
