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  1. Article ; Online: New knowledge on anti-IgLON5 disease.

    Gaig, Carles / Sabater, Lidia

    Current opinion in neurology

    2024  Volume 37, Issue 3, Page(s) 316–321

    Abstract: Purpose of review: Anti-IgLON5 disease is characterized by a distinctive sleep disorder, associated with a heterogeneous spectrum of neurological symptoms. Initial autopsies showed a novel neuronal tauopathy predominantly located in the tegmentum of the ...

    Abstract Purpose of review: Anti-IgLON5 disease is characterized by a distinctive sleep disorder, associated with a heterogeneous spectrum of neurological symptoms. Initial autopsies showed a novel neuronal tauopathy predominantly located in the tegmentum of the brainstem. Recently, new diagnostic red flags, biomarkers predictors of response to immunotherapy, and novel insights into the autoimmune pathogenesis of the disease have been reported.
    Recent findings: Patients with diagnosis of neurodegenerative dementia, progressive supranuclear palsy (PSP) or with motor-neuron disease (MND)-like syndrome have been reported to have IgLON5 antibodies, which are the hallmark of anti-IgLON5 disease. Second, low levels of neurofilament light chain in serum and cerebrospinal fluid of patients at disease onset could be a predictor of immunotherapy response. Recent neuropathological studies indicate that the neuronal tau deposits occur late in the course of the disease. Moreover, IgLON5 antibodies induce cytoskeletal changes in cultured hippocampal neurons suggesting that the tauopathy could be secondary of the IgLON5 antibody effects.
    Summary: Anti-IgLON5 disease can mimic and should be considered in atypical presentations of MND, neurodegenerative dementia and PSP. Neurofilament light chain levels seem promising biomarker for disease prognosis. Finally, the neuropathological and in vitro experimental studies strengthen the autoimmune hypothesis of the disease.
    MeSH term(s) Humans ; Cell Adhesion Molecules, Neuronal/immunology ; Cell Adhesion Molecules, Neuronal/metabolism ; Autoantibodies/immunology ; Supranuclear Palsy, Progressive/immunology ; Supranuclear Palsy, Progressive/diagnosis ; Animals ; Neurofilament Proteins/immunology ; Biomarkers/cerebrospinal fluid ; Biomarkers/metabolism
    Chemical Substances IgLON5 protein, human ; Cell Adhesion Molecules, Neuronal ; Autoantibodies ; Neurofilament Proteins ; Biomarkers
    Language English
    Publishing date 2024-04-01
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 1182686-1
    ISSN 1473-6551 ; 1350-7540
    ISSN (online) 1473-6551
    ISSN 1350-7540
    DOI 10.1097/WCO.0000000000001271
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  2. Article: Motor symptoms in nonparaneoplastic CNS disorders associated with neural antibodies.

    Gaig, Carles / Graus, Francesc

    Handbook of clinical neurology

    2023  Volume 196, Page(s) 277–294

    Abstract: Motor symptoms are common, and sometimes predominant, in almost all nonparaneoplastic CNS disorders associated with neural antibodies. These CNS disorders can be classified into five groups: (1) Autoimmune encephalitis with antibodies against synaptic ... ...

    Abstract Motor symptoms are common, and sometimes predominant, in almost all nonparaneoplastic CNS disorders associated with neural antibodies. These CNS disorders can be classified into five groups: (1) Autoimmune encephalitis with antibodies against synaptic receptors, (2) cerebellar ataxias associated with neuronal antibodies that mostly target intracellular antigens. (3) Stiff-person syndrome and progressive encephalomyelitis with rigidity and myoclonus which have antibodies against glutamic acid decarboxylase and glycine receptor, respectively. Both diseases have in common the presence of predominant muscle stiffness and rigidity. (4) Three diseases associated with glial antibodies. Two present motor symptoms mainly due to the involvement of the spinal cord: neuromyelitis optica spectrum disorders with aquaporin-4 antibodies and myelin oligodendrocyte glycoprotein antibody-associated disease. The third disorder is the meningoencephalitis associated with glial fibrillar acidic protein antibodies which frequently also presents a myelopathy. (5) Two antibody-related diseases which are characterized by prominent sleep dysfunction: anti-IgLON5 disease, a disorder that frequently presents a variety of movement disorders, and Morvan syndrome associated with contactin-associated protein-like 2 antibodies and clinical manifestations of peripheral nerve hyperexcitability. In this chapter, we describe the main clinical features of these five groups with particular emphasis on the presence, frequency, and types of motor symptoms.
    MeSH term(s) Humans ; Central Nervous System Diseases ; Spinal Cord Diseases ; Autoantibodies ; Movement Disorders
    Chemical Substances Autoantibodies
    Language English
    Publishing date 2023-07-14
    Publishing country Netherlands
    Document type Review ; Journal Article
    ISSN 0072-9752
    ISSN 0072-9752
    DOI 10.1016/B978-0-323-98817-9.00004-1
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  3. Article ; Online: REM sleep latency changes after version 2.1 of the AASM manual for scoring sleep.

    Mayà, Gerard / Gaig, Carles / Iranzo, Àlex / Santamaria, Joan

    Sleep medicine

    2022  Volume 90, Page(s) 142–144

    Abstract: Background: The classical criteria for scoring REM sleep changed in version 2.1 of the AASM manual for scoring sleep, by allowing N1 epochs with atonia precedent and contiguous to definite REM sleep to be scored as REM sleep in the absence of rapid eye ... ...

    Abstract Background: The classical criteria for scoring REM sleep changed in version 2.1 of the AASM manual for scoring sleep, by allowing N1 epochs with atonia precedent and contiguous to definite REM sleep to be scored as REM sleep in the absence of rapid eye movements when the EEG was compatible. This may shorten the REM latency in the Multiple Sleep Latency Test (MSLT) in naps with wake/N1 to REM transitions, characteristic of narcolepsy type 1. Since REM latency of <5 or <6 min is a biomarker of NT-1 we have assessed the impact of this change in scoring REM sleep in the MSLT.
    Methods: Ninety-two consecutive five-nap MSLT studies (460 naps) performed in our center between 2013 and 2019 for evaluation of hypersomnolence with ≥1 sleep onset REM (SOREM) naps were included. REM latencies were measured using both classical and new criteria.
    Results: SOREMs occurred in 255 (55.9%) naps, 134 directly from wake/N1. By using the new criteria REM latency shortened in 29.1% of these naps (mean 0.2 ± 0.5, range 0-3 min, p < 0.01), predominantly in females. Twenty-eight percent of MSLTs had at least one nap with a shortened REM latency (mean 0.1 min ± 0.2, p < 0.01). Only two MSLTs changed their REM latency to <5 min and none to <6 min with the new rules.
    Conclusions: The criterion to define REM sleep onset significantly influences its latency and should be considered when comparing studies performed before or after version 2.1 modification. The clinical relevance of this scoring change is probably minimal.
    MeSH term(s) Female ; Humans ; Narcolepsy/diagnosis ; Polysomnography ; Sleep ; Sleep Latency ; Sleep, REM
    Language English
    Publishing date 2022-01-31
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2012041-2
    ISSN 1878-5506 ; 1389-9457
    ISSN (online) 1878-5506
    ISSN 1389-9457
    DOI 10.1016/j.sleep.2022.01.019
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  4. Article ; Online: Temporal distribution of sleep onset REM periods and N3 sleep in the MSLT and night polysomnogram of narcolepsy type 1 and other hypersomnias.

    Mayà, Gerard / Gaig, Carles / Iranzo, Alex / Santamaria, Joan

    Sleep medicine

    2022  Volume 102, Page(s) 32–38

    Abstract: Introduction: The presence of ≥2 sleep onset REM periods (SOREMP) in the Multiple Sleep Latency Test (MSLT) and the previous night polysomnogram (PSG) is part of the diagnostic criteria of narcolepsy, with every SOREMP having the same diagnostic value, ... ...

    Abstract Introduction: The presence of ≥2 sleep onset REM periods (SOREMP) in the Multiple Sleep Latency Test (MSLT) and the previous night polysomnogram (PSG) is part of the diagnostic criteria of narcolepsy, with every SOREMP having the same diagnostic value, despite evidence suggesting that time of SOREMP appearance and their preceding sleep stage might be relevant. We studied the temporal distribution of SOREMPs and associated sleep stages in the MSLT of patients with narcolepsy type 1 (NT1) and other hypersomnias (OH).
    Methods: We reviewed consecutive five-nap MSLTs and their preceding PSG from 83 untreated adult patients with hypersomnolence and ≥1 SOREMPs. Wake/N1(W/N1)-SOREMPs, N2-SOREMPs, and N3 sleep presence and time of appearance were analyzed.
    Results: Thirty-nine patients had NT1 and 44 OH. There were 183 (78%) SOREMPs in patients with NT1 and 83 (31%) in OH. Sixty-seven percent of SOREMPs in NT1 were from W/N1, and 20% -none from wake-in OH (p < 0.001). Most patients (94%) with ≥2 W/N1-SOREMPs had NT1 (specificity 95%, sensitivity 82%). In patients with NT1 but not in OH, W/N1-SOREMPs decreased throughout the day (from 79% in the 1st nap to 33% in the preceding night, p < 0.001), whereas N2-SOREMPs did not change. N3 sleep frequency in the 5th nap was higher in NT1 than in OH (28% vs. 7%, p:0.009). Nocturnal-SOREMP plus ≥4 daytime SOREMPs, Wake-REM transitions, and REM followed by N3 were only seen in NT1.
    Conclusion: Measuring the sleep stage sequence and temporal distribution of SOREMP helps to identify patients with narcolepsy in the MSLT.
    MeSH term(s) Adult ; Humans ; Disorders of Excessive Somnolence/diagnosis ; Narcolepsy/diagnosis ; Polysomnography ; Sleep, Slow-Wave
    Language English
    Publishing date 2022-12-21
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2012041-2
    ISSN 1878-5506 ; 1389-9457
    ISSN (online) 1878-5506
    ISSN 1389-9457
    DOI 10.1016/j.sleep.2022.12.018
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  5. Article ; Online: Prior exposure to concussions in patients with isolated REM sleep behavior disorder.

    Roig-Uribe, Mónica / Serradell, Mònica / Muñoz-Lopetegi, Amaia / Gaig, Carles / Iranzo, Alex

    Sleep medicine

    2023  Volume 110, Page(s) 254–257

    Abstract: Objective: Traumatic brain injury is associated with the late development of neurodegenerative diseases such as the synucleinopathies. Isolated REM sleep behavior disorder (IRBD) constitutes an early manifestation of the synucleinopathies. We assessed ... ...

    Abstract Objective: Traumatic brain injury is associated with the late development of neurodegenerative diseases such as the synucleinopathies. Isolated REM sleep behavior disorder (IRBD) constitutes an early manifestation of the synucleinopathies. We assessed whether lifetime history of concussive episodes is common in IRBD and examined its characteristics and clinical significance.
    Methods: Prior exposure to concussions was evaluated by interviewing polysomnographically-confirmed IRBD patients and controls without IRBD, and by the BRAIN-Q questionnaire.
    Results: We recruited 199 IRBD patients aged 73.2 ± 7.7 years and 168 age and sex matched controls. Previous history of concussion was more common in patients than in controls (21.1% versus 10.1%, p = 0.004). In patients, concussions occurred at the age of 24.7 ± 20.6 years. The interval between concussion and IRBD diagnosis was 43.0 ± 19.0 years. There were no differences between patients and controls in the causes of concussions (e.g., traffic accidents, sport practice), and number of events resulting in skull fractures, urgent medical assistance, and hospitalization. After a follow-up of 5.7 ± 4.7 years from IRBD diagnosis, 21.1% patients developed an overt synucleinopathy with an interval of 49.3 ± 24.2 years between concussion and synucleinopathy diagnosis. The risk to develop a synucleinopathy was similar between patients with and without concussions (p = 0.57).
    Conclusions: Previous history of concussion is common in IRBD. Our observations may suggest that in individuals with increased susceptibility, early-life concussions may trigger a slow neurodegenerative process leading four decades later to IRBD. This study highlights the need for head injury prevention, particularly in early life.
    MeSH term(s) Humans ; REM Sleep Behavior Disorder/epidemiology ; REM Sleep Behavior Disorder/etiology ; Synucleinopathies ; Brain Concussion/complications ; Brain Concussion/epidemiology ; Brain Injuries, Traumatic ; Brain
    Language English
    Publishing date 2023-09-01
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2012041-2
    ISSN 1878-5506 ; 1389-9457
    ISSN (online) 1878-5506
    ISSN 1389-9457
    DOI 10.1016/j.sleep.2023.08.006
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  6. Article ; Online: Neurological profiles beyond the sleep disorder in patients with anti-IgLON5 disease.

    Gaig, Carles / Compta, Yaroslau

    Current opinion in neurology

    2019  Volume 32, Issue 3, Page(s) 493–499

    Abstract: Purpose of review: Anti-IgLON5 disease is a novel entity characterized by a distinctive sleep disorder associated with a variety of neurological symptoms, antibodies against IgLON5, and pathological findings of neuronal tauopathy. The characteristic ... ...

    Abstract Purpose of review: Anti-IgLON5 disease is a novel entity characterized by a distinctive sleep disorder associated with a variety of neurological symptoms, antibodies against IgLON5, and pathological findings of neuronal tauopathy. The characteristic sleep disorder occurs in most patients, but other neurological symptoms are also important because they can be the presenting and most disabling problem and mimic other conditions. This review focuses on nonsleep neurological symptoms and presentations of anti-IgLON5 disease.
    Recent findings: Apart from sleep problems, the most frequent neurological symptoms in anti-IgLON5 disease are bulbar dysfunction and gait abnormalities. Other symptoms include movement disorders like chorea or abnormal orofacial movements, oculomotor abnormalities, cognitive impairment, and symptoms of nervous system hyperexcitability. All these symptoms can present in different combinations and severity leading to distinct clinical phenotypes beyond the sleep disorder: bulbar syndrome; syndrome resembling progressive supranuclear palsy; cognitive impairment, sometimes with chorea, mimicking Huntington disease; gait ataxia; and stiff-person-like syndrome.
    Summary: These clinical presentations may suggest degenerative or other neurological disorders, but anti-IgLON5 disease has to be considered, and confirmed by the detection of IgLON5 antibodies, when the criteria for the diagnosis of the initially suspected disorders are not fulfilled, confirmatory laboratory tests are negative, and significant sleep problems are present.
    MeSH term(s) Autoimmune Diseases/complications ; Autoimmune Diseases/diagnosis ; Autoimmune Diseases/immunology ; Autoimmune Diseases/pathology ; Cell Adhesion Molecules, Neuronal/immunology ; Humans ; Sleep Wake Disorders/etiology
    Chemical Substances Cell Adhesion Molecules, Neuronal ; IgLON5 protein, human
    Language English
    Publishing date 2019-01-29
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1182686-1
    ISSN 1473-6551 ; 1350-7540
    ISSN (online) 1473-6551
    ISSN 1350-7540
    DOI 10.1097/WCO.0000000000000677
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  7. Article ; Online: Abnormal sleep behavior caused by hypoglycemia.

    Muñoz-Lopetegi, Amaia / Pujol, Montserrat / Giménez, Marga / Gaig, Carles / Brieva, Luis / Santamaria, Joan

    Sleep medicine

    2021  Volume 85, Page(s) 268–270

    MeSH term(s) Humans ; Hypoglycemia/complications ; Polysomnography ; Sleep
    Language English
    Publishing date 2021-07-24
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2012041-2
    ISSN 1878-5506 ; 1389-9457
    ISSN (online) 1878-5506
    ISSN 1389-9457
    DOI 10.1016/j.sleep.2021.07.029
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  8. Article ; Online: Scoring sleep in neurodegenerative diseases: A pilot study in the synucleinopathies.

    Montini, Angelica / Iranzo, Alex / Cortelli, Pietro / Gaig, Carles / Muñoz-Lopetegi, Amaia / Provini, Federica / Santamaria, Joan

    Sleep medicine

    2023  Volume 110, Page(s) 268–286

    Abstract: Background: Neurodegenerative diseases often alter sleep architecture, complicating the application of the standard sleep scoring rules. There are no recommendations to overcome this problem. Our aim was to develop a scoring method that incorporates the ...

    Abstract Background: Neurodegenerative diseases often alter sleep architecture, complicating the application of the standard sleep scoring rules. There are no recommendations to overcome this problem. Our aim was to develop a scoring method that incorporates the stages previously applied in dementia with Lewy Bodies (DLB), anti-IgLON5 disease, and fatal insomnia, and to test it in patients with alpha-synucleinopathies.
    Methods: Video-polysomnographies (VPSG) of nine patients (DLB:3, Parkinson's disease (PD):3, and multiple system atrophy (MSA):3) selected for their difficulty in applying standard rules were scored independently by two authors, using additional Sleep/Wake stages. These included Abnormal Wake, Subwake, Undifferentiated NREM sleep (UNREM), Poorly structured N2 (P-S N2) and abnormal REM sleep including REM without atonia (RWA), REM without low-amplitude, mixed-frequency EEG activity (RWL) and REM without rapid eye movements (RWR).
    Results: Patients (4 females) had a median age of 74 (range 63-85). Six patients (all with PD or DLB) had abnormal EEG awake and Subwake stage. UNREM sleep was present in all patients, typically at sleep onset, and was the most common sleep stage in five. P-S N2 was recorded only in the three patients with MSA. Periods of normal and abnormal NREM coexisted in three patients. RWA was the predominant REM subtype, RWR occurred mainly in patients with MSA and RWL in those with DLB. Six patients had brief REM episodes into NREM sleep which we termed "Encapsulated RBD".
    Conclusion: Our scoring system allows an accurate description of the complex sleep-wake changes in patients with alpha-synucleinopathies.
    MeSH term(s) Female ; Humans ; Synucleinopathies ; Pilot Projects ; Sleep ; Parkinson Disease/complications ; Multiple System Atrophy ; Parasomnias ; Muscle Hypotonia
    Language English
    Publishing date 2023-08-28
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2012041-2
    ISSN 1878-5506 ; 1389-9457
    ISSN (online) 1878-5506
    ISSN 1389-9457
    DOI 10.1016/j.sleep.2023.08.022
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  9. Article ; Online: Former participation in professional football as an occupation in patients with isolated REM sleep behavior disorder leading to a synucleinopathy: a case-control study.

    Collía, Alejandra / Iranzo, Alex / Serradell, Mónica / Muñoz-Lopetegi, Amaia / Mayà, Gerard / Santamaría, Joan / Sánchez-Valle, Raquel / Gaig, Carles

    Journal of neurology

    2023  Volume 270, Issue 6, Page(s) 3234–3242

    Abstract: Background: Contact sports such as football are associated with late development of neurodegenerative diseases, in part due to the deleterious effect of repetitive head impacts during participation. Isolated REM sleep behavior disorder (IRBD) represents ...

    Abstract Background: Contact sports such as football are associated with late development of neurodegenerative diseases, in part due to the deleterious effect of repetitive head impacts during participation. Isolated REM sleep behavior disorder (IRBD) represents an early manifestation of neurodegenerative diseases including Parkinson disease (RBD) and dementia with Lewy bodies (DLB). We hypothesized that former professional football participation would be overrepresented in IRBD.
    Objective: To assess former participation in professional football as an occupation in IRBD.
    Methods: In a case-control retrospective study, having played football as a professional occupation in the Spanish Football Professional Leagues was examined interviewing polysomnographically confirmed IRBD patients and matched controls without IRBD.
    Results: Among 228 Caucasian Spanish IRBD patients with 68.5 ± 7.2 years, six (2.63%) were retired professional footballers. Length professional football career ranged between 11 and 16 years. Interval between football retirement and IRBD diagnosis was 39.5 ± 6.4 years. At IRBD diagnosis, the six footballers had synucleinopathy biomarkers including pathologic synuclein in the CSF and tissues, nigrostriatal dopaminergic deficit and hyposmia. Follow-up showed that three footballers developed PD and two DLB. None of the controls was a professional footballer. The percentage of professional footballers was higher in IRBD patients than in controls (2.63% versus 0.00%; p = 0.030) and among the general Spanish population (2.63% versus 0.62%; p < 0.0001).
    Conclusion: We found an overrepresentation of former professional footballers in IRBD patients who later developed PD and DLB after four decades from professional retirement. In professional footballers the development of a neurodegenerative disease may be first manifested by IRBD. Screening for IRBD in former footballers might identify individuals with underlying synucleinopathies. Further studies with larger samples are needed to confirm our observations.
    MeSH term(s) Humans ; Synucleinopathies/pathology ; REM Sleep Behavior Disorder/epidemiology ; REM Sleep Behavior Disorder/diagnosis ; Neurodegenerative Diseases/epidemiology ; Football ; Case-Control Studies ; Retrospective Studies ; Occupations
    Language English
    Publishing date 2023-03-20
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 187050-6
    ISSN 1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    ISSN (online) 1432-1459
    ISSN 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    DOI 10.1007/s00415-023-11591-8
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  10. Article ; Online: Development of a Composite Score for the Clinical Assessment of Anti-IgLON5 Disease.

    Gaig, Carles / Grüter, Thomas / Heidbreder, Anna / Sabater, Lidia / Iranzo, Alex / Santamaria, Joan / Leypoldt, Frank / Dalmau, Josep O / Ayzenberg, Ilya / Graus, Francesc

    Neurology

    2024  Volume 102, Issue 7, Page(s) e208101

    Abstract: Background and objectives: To develop a composite score to assess the severity of the multiple symptoms present in anti-IgLON5 disease.: Methods: The anti-IgLON5 disease composite score (ICS) was designed to evaluate 17 symptoms divided into 5 ... ...

    Abstract Background and objectives: To develop a composite score to assess the severity of the multiple symptoms present in anti-IgLON5 disease.
    Methods: The anti-IgLON5 disease composite score (ICS) was designed to evaluate 17 symptoms divided into 5 clinical domains (bulbar, sleep, movement disorders, cognition, and others). Each symptom was scored from 0 (absent/normal) to 3 or 6 (severe) depending on the contribution of the symptom to neurologic disability with a maximum ICS of 69. The ICS was tested in patients from 2 cohorts (Barcelona, Spain, and GENERATE, Germany) that included cases personally seen by the authors (internal) and patients whose ICS was obtained from information of questionnaires completed by the referring neurologists (external). Test-retest and interrater reliabilities of the ICS were assessed by the intraclass coefficient (ICC) and the correlation between the ICS and modified Rankin scale (mRS) with the nonparametric Spearman rank coefficient. The Wilcoxon signed rank test was used to compare the ICS at diagnosis of anti-IgLON5 disease and follow-up in a subset of patients with available clinical information.
    Results: A total of 86 patients (46 from Barcelona cohort; 40 from GENERATE cohort) were included. The median ICS was 15 (range 2-31). The ICS was higher in the Barcelona cohort than in the German cohort (18 vs 12,
    Discussion: The ICS is a valid method to assess the extension and severity of the different clinical manifestations of anti-IgLON5 disease.
    MeSH term(s) Humans ; Parasomnias ; Hashimoto Disease ; Sleep Apnea, Obstructive ; Encephalitis ; Movement Disorders
    Language English
    Publishing date 2024-03-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207147-2
    ISSN 1526-632X ; 0028-3878
    ISSN (online) 1526-632X
    ISSN 0028-3878
    DOI 10.1212/WNL.0000000000208101
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