CINXE.COM

<!DOCTYPE html><html lang="en-US"><head><title>Just a moment...</title><meta http-equiv="Content-Type" content="text/html; charset=UTF-8"><meta http-equiv="X-UA-Compatible" content="IE=Edge"><meta name="robots" content="noindex,nofollow"><meta name="viewport" content="width=device-width,initial-scale=1"><style>*{box-sizing:border-box;margin:0;padding:0}html{line-height:1.15;-webkit-text-size-adjust:100%;color:#313131;font-family:system-ui,-apple-system,BlinkMacSystemFont,Segoe UI,Roboto,Helvetica Neue,Arial,Noto Sans,sans-serif,Apple Color Emoji,Segoe UI Emoji,Segoe UI Symbol,Noto Color Emoji}body{display:flex;flex-direction:column;height:100vh;min-height:100vh}.main-content{margin:8rem auto;max-width:60rem;padding-left:1.5rem}@media (width <= 720px){.main-content{margin-top:4rem}}.h2{font-size:1.5rem;font-weight:500;line-height:2.25rem}@media (width <= 720px){.h2{font-size:1.25rem;line-height:1.5rem}}#challenge-error-text{background-image:url(data:image/svg+xml;base64,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);background-repeat:no-repeat;background-size:contain;padding-left:34px}@media (prefers-color-scheme:dark){body{background-color:#222;color:#d9d9d9}}</style><meta http-equiv="refresh" content="390"></head><body class="no-js"><div class="main-wrapper" role="main"><div class="main-content"><noscript><div class="h2"><span id="challenge-error-text">Enable JavaScript and cookies to continue</span></div></noscript></div></div><script>(function(){window._cf_chl_opt={cvId: '3',cZone: "www.neurology.org",cType: 'managed',cRay: '8e938c786f759f6e',cH: '9rua_0pFHfBEMNzxIbK5tSLaO8A_dm00PikvjSUinjo-1732725507-1.2.1.1-c7fxlM1dzRsrBG0PDJXXv68nylOJje3B1iYI4PQCCz6ycjwiGo7ScfmLjzZUE619',cUPMDTk: "\/doi\/10.1212\/WNL.0000000000209843?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub 0pubmed&__cf_chl_tk=ZBcwT5aa8w6XERuxVHZR0eScrPH_UcL_qlaJzxTBEiM-1732725507-1.0.1.1-q6lyW_TedMwbERp47r5qoc0k31QiXL3aaW8f8refGQo",cFPWv: 'b',cITimeS: '1732725507',cTTimeMs: '1000',cMTimeMs: '390000',cTplC: 0,cTplV: 5,cTplB: 'cf',cK: "",fa: "\/doi\/10.1212\/WNL.0000000000209843?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub 0pubmed&__cf_chl_f_tk=ZBcwT5aa8w6XERuxVHZR0eScrPH_UcL_qlaJzxTBEiM-1732725507-1.0.1.1-q6lyW_TedMwbERp47r5qoc0k31QiXL3aaW8f8refGQo",md: "JCkp9RM2EOMTIOVZnw0hatB2SsXq931OxEpJW7w7qJw-1732725507-1.2.1.1-d9.wb4.bBqjS5zEf9d4qN5yk4fC26tnkggMvI5ouXZ2FDoNXobeUD6stbO47U8vBuxgVvwPMiGvEZhTyfGB3ogEocLdhl.k.1bcP787S2ynB3akD.xkylWcCC73VWPzqu0gsSinkJ6ld84EWox5ZdmPda43LwWQsvSMyYeUCMESXtJHn_Z70fqCV7J2Z07uZAvLJXPtlk0Nv501Ak2OXQgGs6MdhWkGqYBGoltNaZ9seKXyJj1pKrisMygkoxatCXZz_LcbGFXxf9WM_bNpBJdxm5vxssPlOMTTSlZz97fPr36P1A7CrfuONZuG5obaMuXo9Ok_Oq.nphjQdaGfmP88_a7B.K5EbChC_zvc8u9fUeVLTLOJ5NowxpMzp2yWngCNZW9B4xYlHP5838VLxvEa2AXKLnsDNhFxfyeMHa.Cf8d.Bb0oriWW9kZ2DDEzs0dQL3mPikbcL2aEeHrqDY3OyguRQVwcUFTxxPiFpajybM7oPerMQvi3IPPwgsTWHXExfn5z7VQYB9XWbuvboBjl2DPjMjax0BzRFMvcVj1HlX4wFTtrH_QQ0Hvs8AQ3aakEgh_GisE4g3HoGdPsaZd12ZSHm3ysWeXcoKFSoCLyLcQG8RmdexaDEo1POvyd2gZfM5EFlCWAxs04IawYlSIxu8fSuSUJHxnp2oMH63tY6MwJfH7mGm5.sdzk9dlSCET8Bq9_9IKcal2j8DCjkk1Z754iwQljdgLlF1Vu_wA53zqcZFm_gZT3Gd.Z92071S6HVsVk.wyklpg6329.eLwWZJG2zaFSAzad.caKKiXoktOqzAo8lcl1S_PyR.pAdgZsPWT4vEDycdr7ScTWrfXFrW.ycgBzI.mM_9sMlOdpv3CuMGv7i9aH431XhsTeXVINTuSS6sPHfsDqbKHi9uaa8Pajh.Noku.AR56BEojbSLDbBdSAj7W0lLASjVxuwajVkNlDKTnk9qx4kwyenIc0_Oyqcmh3Ui1X1GyjLLHuaz3jKgoIfgOWfq8XIUIegsP2KITZYBv3oiPiMMfOnwV65SrgYiks4xQwU2XKJ6_Y3eYXC9Yef67k2FtetG1I4w1WhwEHMACqV6ruBruNW1Vk59Pe85Yx55TwkrHbSwvKnCM8DRTJH.hFfqOTI18oHtfosUOs0hEh.2_iu5aWb_n1I6dh2V8gAkgJ.0xc2LsGFFDpc6Si8p41CmuDrQmcXua0Ro.b8gQ1ci5H31dmrgziuTryz.zil4enn7VcqwUUkYIcUNKABGgNxFqHMiWSoNG7AgRLkwtoLzts5TmPFExobA8nLxny2TMR_F6mWvCKytdcRorWlVPbxRbF3M8V3e_yhGsmF3k83TVVhVqMlwBeGPgCCP06OHU33j6h0zJ3fzSdZKDVPX89tODMU9e2BDw4CKhS5WgklZb_ojU1qzgSPieomA6hSjElsNJo5uff.mVL.DFa420gMCKPMTzz4olUzeI_bm6KRJ8LuJMxjt4g0iYDGNHsXTIAmwOmT0pW4h2.ASc6tG1UDPzSO2zw25UG82FGjd.kp46RceA89TKJQGYCgUWZeCWP2zl0ezPK2Zs8eAOoKdoaAJEjoYRUsYH.hVxZ1DiI.66tTvTEtpXkd7xziJZnHg_5l3i7oSwBzBdnMb7ah5BBUXWO9pNSnEFIeYPKNfcremCDNUjmOrYQZkn_AuxOEgSTj26n2epaliFkJNU0GiepriUWOwkOUDDehBDxjKYM2i0SqNLmnkOdvtdV5SnS9I2_VAM5YOdFYjpFisHA3PdsloBlOT3uO83MnFITl8tG8Djng4YiIcqlaj10oESMqqnO1okZh3PLbFBATYIo0h3IZ0jaJiS8K.mt_ELL4hGt1xOzk6yPHWAIkPXqTdEVO6d0f3xu2XyQSb5C_EMuyADXc4_EXMuvftz7ojVWwl1_j1N2qFzGx4.jt6GeiGgbaV4bxYX4jGdVL7WrWC_uMbgkH6PMKxqEH_TRyGZ4ch1fQXZK9MgOXNqtxr1NzxKo0nVYObSL7NajMDjkkLw5w_.mNkha9UBLk7maNw5svCdEx.wQ5fdkLTPSDciMHAu7vRm07gfrhLoxyKS6cFVsuJyqQ8K4j3C0woK2mu9ruoUEISu_x_5X7vy.OoF3gBF.oXHGVwvDultijMRTd7J3EU42dcW1.zylplzn8Ax_HDmqF60nZyz7PWe39A09MXFNtsuEIGjUdzdSwDtyVbyWb_57TwxmmRiqX_fXRQ9TuvYDdpKkI6zI8AnYZBUAEIA25xlUyzzw9CRiHovSa689BTsHwLHEMOlNiWsnnxtiHKA9u9IVgV4e5OU7ZFDHL3gObFFwfz0c1zmKnUhE0HTrbBNGsrZBXVLDVPRFanq2X48c14TZcHfstprI1TjlEbUo9nQhF2uT8vevD4YNeHlyGrtM0NAgdQLwbiYwCQKz7.S3QRwpO9lZBxaGg_g_4MbUAyfD3LbENkt_9ZCjUNYFXiK66n7EapcH7bZeY9Hm0jKqjKu4xm6U5p1vbkeBzBlwcjrGde4VeiC8CvZIaYfnYSE7iHAJv2P7EaN8nlv0QcKCdIUBK1lEtPJqa4xE9CrNEc4XyuUlbc8ZgEpBtclP2PC57q_lkeh1IYfGXRIJCoFv16uy76vzuJDQrAZ9HhnHFApdZVrj8f4D28cvNyFOw3xVEvP_G6MJMqdYq9xRI2o7uXPyTl7H9AcCphUDefACx5xM3BWYSGakRpqcGe5luUuQk8WZKIk_S5u5pYd2lDsgIJiuiV.QFeYd0hOruPDY0lpizzu6L4ok3Xn1iUMsBvPBG6Saxvu5GYWtWvTHgh_XcpBsPf7Kq2PgYQ4JnXzOpJsA6p92HC.cSJHnU2HaGGCW49fX.Qu0zuT05DqnGuUq8C0brVJefF5iDd0Xda5rrR4DJRf.CupMXVIMugjw10AJ0Y.lzflhdN7QCdkYpMNE5p3SrmnsPHeCKXSMfwcnvXi9McGAE7.J5lr3Xy34h.ktGiuOfvXKeIOcw1y.m0AcKm8T3YGNbyq7_C60zrnW0J9_AdnFPdTjXaYy0in1MQRTb9SeOoGX9rhVLsHkiC.bm5lblQrCMthmLQ_rzvay1TDEuREJxdb5JpM7eKSM._w4GBC7KPVNu32fN.0H5guVhN9HwRmUc6FXFwp2R9t1Ev6U0y0zDOO1.k2wZi_FprnQuCy3P_F49",mdrd: "W6v9pKcSxr8151.nEpaAFkdYfpnmULvbOrTl1D7Kiic-1732725507-1.2.1.1-gc9cuKuw4Uae6us3WprBVbbZgp92RfPLZV.k_nwfek8nWxM3IGUUhCp3w18Z.1EuxbintGa6pEMN3GabiP8QHIVE6lv5W5Byz9tH9zmaELW4fo_s7E6S05wKFvJqJMJJ.7go1c46r2RLLdXFBPcI81IOgmqCWqMNTv8sV8XLMvBvmOoIZDpQiUvcz_HGkYPQeRT918IJ19Ff.zIq.KwpmIa99nhUhnBLF0or9689ivVMcYrOm92NrjctQHeDZftRg_MNZQVNxMKxlOLAUX6WVwtHNYw97V5OfHkAIS8na01tXYEQ46bnv_hyf.CIMKEjov2ix7QuNyN3oM2AP4p1bT3Ub55ffUwfEUWp43.8OEDdpSFpN_.E1OtPg5bqpfKcrhZtioHEp6gNtyw3llmMdxiwoewLEwK218xRK.LBdYIXX25Y6zNdIsbUC3JkmAEpsZArAG9XUV4u_Z0F0m61d1w8idcegRrDH5EEkhteCaPAJC2zy1FyQh819LiiCficFEBRQnf5gqTKUY1hmSxhJuGK.KomHFUnHujwKaWNwMhnDOYvpZuhIctp2GkUHrUWDmTniKZ_Z_kSIJ7cKSeU5Y18W9bSQrdhJe.HMatx8HIwV5lWOIFKHvN4h0mSJjuBti.A1grqesyRcOOofzlBRXUeZmxtppjYDaZIFZvWNed.ZeJQ_q4Quswd9B1CFR6cP9WUmNwTuYIkrP2V8nV.aHwbwBC7M70dkPFAPssBXoJkG2MPs3b0tuzdsOC5hPUicw3oFG0rhl5gB5T_9Ck8G9kBCcYrtV4b8YxXqwNSL7osU8b2VfDmgxVb3YH96eBm02Uf81xpRn38vbGbETapxjHpYrMhjcTJNv5YUMcS8sLR94xbrz8LQefuZ.1I0wRXQxjmyUh2HyMeUyl6wv2N.S3IXcQMirlLm17av6nxtpi0Mg78EXnawLdCRrWEzSc66V.yq2vWoRZy8WLzF25qvXM1EtLRrlHrCooiF9jTT5XOJiAYBQzwBmOrXqKxwpLXwlOkUsuf3hndTj5PriYrqAZPbC9eVYYAuFEJR4EE2I6XAhZ9RzwY11QIItDZj3w6s6gWscwUORTu2r6C5h5rtlF1XBh_ICvTP0bK_CxwkzS4CuQjuUJdYpN294VPYRwGs8x4qdzgYAzTAgaS2AdF80Oqvy.YfgJhp4ph3IZUukh5MIkMN_7efAiAKUVOsXg5OTpbsJEqqcQ6aiJmlnvbx1NR8X2viZN9tfiUj.R85qDtaAXL1wDHxZ2.xDsMPK2bmPD1pT53w_DMHFGHRBGcNRs2tf4mZTQUM975_aftBMLyconP_6ut0C4JmMtTXqHDa3iWltLjjMuuuJgi9G_IMbyMyeUkxCBQww4HgWGwDXaDXCLoW0Xvk3vj1rlMeUBzyGewPd5Lw6nt9LukyTUIL7vwZsSzpiuyJsHPI0CDWamKWaoBIouRI.wKCxVCnMFSIgmAiKnT_h43qBJ5OdEWW4c3m32xMd1QpxjfVD8GddmPbqNq9uBanRH2bCN_j5CQmkpfq9ks89TwVE2mF7vDimxUGEcY2mzbYmwX7Kt54xAqe12HLi6EdMnp53K0MqK2pLGqoFxEXVNHu04.w7yrmJ1ZOiqEimdCI8QFMe1VS_4._tvDh5F1BAU.kem_Z1qIv_loR66.ojrEUHNzQceRLHLzaXfBM63ZVC9ASLCUWVuF1Ps0NId3oUNID6yBZKJNAPFxhtgwVUAuQTwJonnuDODTEKPkznbNGOyhv07vcLoP4lxvROxC_9T2_qZ4dMOXaXof9wre6C0SGkH7B8ti_R__EYqic37VqhC6GM9H6F8wqZdkSx4nHuRl2dTbe1zxkTSAUfyVSfwLhHVvd_ZMMAkhz_Y2In_bONac5Vy4XGchvvUUlmfiX53l56nNL67EpMNLrFGosj7FJVh7oW7bqTb69aqdne95MxMRwA4xK2o2fs7paAypDX9cXp9CzEC."};var cpo = document.createElement('script');cpo.src = '/cdn-cgi/challenge-platform/h/b/orchestrate/chl_page/v1?ray=8e938c786f759f6e';window._cf_chl_opt.cOgUHash = location.hash === '' && location.href.indexOf('#') !== -1 ? '#' : location.hash;window._cf_chl_opt.cOgUQuery = location.search === '' && location.href.slice(0, location.href.length - window._cf_chl_opt.cOgUHash.length).indexOf('?') !== -1 ? '?' : location.search;if (window.history && window.history.replaceState) {var ogU = location.pathname + window._cf_chl_opt.cOgUQuery + window._cf_chl_opt.cOgUHash;history.replaceState(null, null, "\/doi\/10.1212\/WNL.0000000000209843?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub 0pubmed&__cf_chl_rt_tk=ZBcwT5aa8w6XERuxVHZR0eScrPH_UcL_qlaJzxTBEiM-1732725507-1.0.1.1-q6lyW_TedMwbERp47r5qoc0k31QiXL3aaW8f8refGQo" + window._cf_chl_opt.cOgUHash);cpo.onload = function() {history.replaceState(null, null, ogU);}}document.getElementsByTagName('head')[0].appendChild(cpo);}());</script></body></html>