Professor Philip Smith

FRCP MD FAcadMEd

2025

• Wild, J. M. , Smith, P. E. and Knupp, C. 2025. Machine-learning algorithms for the identification of visual field loss associated with the antiseizure medication vigabatrin-a proof of concept. British Journal of Ophthalmology 109 (8), pp.932-940. (10.1136/bjo-2024-325804)

2024

• Bassetti, C. L. A. et al., 2024. General neurology: Current challenges and future implications. European Journal of Neurology 31 (6) e16237. (10.1111/ene.16237)
• Epi4K Consortium, and Smith, P. E. 2024. The role of copy number variants in the genetic architecture of common familial epilepsies. Epilepsia 65 (3), pp.792-804. (10.1111/epi.17860)

2023

• Stevelink, R. et al., 2023. GWAS meta-analysis of over 29,000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture. Nature Genetics 55 (9), pp.1471-1482. (10.1038/s41588-023-01485-w)

2022

• Kinney, M. O. , Smith, P. E. M. and Craig, J. J. 2022. Preventing Teratogenicity in women with epilepsy. Seminars in Neurology 42 (05), pp.679-692. (10.1055/s-0042-1759579)

2021

• Goldstein, L. H. et al., 2021. Psychological and demographic characteristics of 368 patients with dissociative seizures: data from the CODES cohort. Psychological Medicine 51 (14), pp.2433-2445. (10.1017/S0033291720001051)
• Marson, A. et al., 2021. The SANAD II study of the effectiveness and cost-effectiveness of levetiracetam, zonisamide, or lamotrigine for newly diagnosed focal epilepsy: an open-label, non-inferiority, multicentre, phase 4, randomised controlled trial. Lancet 397 (10282), pp.1363-1374. (10.1016/S0140-6736(21)00247-6)
• Marson, A. et al., 2021. The SANAD II study of the effectiveness and cost-effectiveness of valproate versus levetiracetam for newly diagnosed generalised and unclassifiable epilepsy: an open-label, non-inferiority, multicentre, phase 4, randomised controlled trial. Lancet 397 (10282), pp.1375-1386. (10.1016/S0140-6736(21)00246-4)
• Smith, P. E. M. 2021. Initial management of seizure in adults. New England Journal of Medicine 385 , pp.251-263. (10.1056/NEJMcp2024526)

2020

• Balabanova, S. et al., 2020. Study protocol for a pragmatic randomised controlled trial comparing the effectiveness and cost-effectiveness of levetiracetam and zonisamide versus standard treatments for epilepsy: a comparison of standard and new antiepileptic drugs (SANAD-II). BMJ Open 10 (8) e040635. (10.1136/bmjopen-2020-040635)
• Cochrane, E. and Smith, P. 2020. 'Lurker' to learner: Encouraging collaborative learning using a scaffolding and peer assisted learning approach. The British Student Doctor Journal 4 (3), pp.22-24. (10.18573/bsdj.195)
• Esposito, M. et al., 2020. Prison epilepsy clinic. Practical Neurology 20 (3), pp.265-267. (10.1136/practneurol-2019-002403)

2019

• Ellis, C. A. et al., 2019. The “maternal effect” on epilepsy risk: analysis of familial epilepsies and reassessment of prior evidence. Annals of Neurology 87 (1), pp.132-138. (10.1002/ana.25625)
• Goldstein, L. H. et al., 2019. Characteristics of 698 patients with dissociative seizures: a UK multicenter study. Epilepsia 60 (11), pp.2182-2193. (10.1111/epi.16350)
• Popkirov, S. et al., 2019. Hiding in plain sight: functional neurological disorders in the news. Journal of Neuropsychiatry and Clinical Neurosciences 31 (4), pp.361-367. (10.1176/appi.neuropsych.19010025)
• Smith, P. E. 2019. Management of established status epilepticus. New England Journal of Medicine 381 (22), pp.2171-2172. (10.1056/NEJMe1913775)
• Wild, J. , Smith, P. E. M. and Knupp, C. 2019. Objective derivation of the morphology and staging of visual field loss associated with long-term vigabatrin therapy. CNS Drugs 33 (8), pp.817-829. (10.1007/s40263-019-00634-2)
• Wild, J. M. et al. 2019. The topographical relationship between visual field loss and peripapillary retinal nerve fibre layer thinning arising from long-term exposure to vigabatrin. CNS Drugs 33 , pp.161-173. (10.1007/s40263-018-0583-8)

2018

• Sen, A. et al., 2018. The phenotype of bilateral hippocampal sclerosis and its management in “real life” clinical settings. Epilepsia 59 (7), pp.1410-1420. (10.1111/epi.14436)
• The International League Against Epilepsy Consortium on Complex, and Smith, P. E. 2018. Genome-wide mega-analysis identifies 16 loci and highlights diverse biological mechanisms in the common epilepsies. Nature Communications 9 (1) 5269. (10.1038/s41467-018-07524-z)
• Walsh, J. L. et al. 2018. Formative student-authored question bank: perceptions, question quality and association with summative performance. Postgraduate Medical Journal 94 (1108), pp.97-103. (10.1136/postgradmedj-2017-135018)

2017

• Bergin, P. S. et al., 2017. EpiNet as a way of involving more physicians and patients in epilepsy research: validation study and accreditation process. Epilepsia Open 2 (1), pp.20-31. (10.1002/epi4.12033)
• Fonferko-Shadrach, B. et al., 2017. Validating epilepsy diagnoses in routinely collected data. Seizure 52 , pp.195-196. (10.1016/j.seizure.2017.10.008)
• Leach, J. P. et al., 2017. Epilepsy and pregnancy: for healthy pregnancies and happy outcomes. Suggestions for service improvements from the multispecialty UK epilepsy mortality group. Seizure - European Journal of Epilepsy 50 , pp.67-72. (10.1016/j.seizure.2017.05.004)
• Smith, P. and Thomas, R. 2017. Phenotypic analysis of 303 multiplex families with common epilepsies. Brain 140 (8), pp.2144-2156. (10.1093/brain/awx129)
• Walsh, J. L. , Harris, B. and Smith, P. 2017. Single best answer question-writing tips for clinicians. Postgraduate Medical Journal 93 (1096), pp.76-81. (10.1136/postgradmedj-2015-133893)

2016

• Smith, P. E. M. and Mucklow, J. C. 2016. Writing clinical scenarios for clinical science questions. Clinical Medicine Journal 16 (2) 142. (10.7861/clinmedicine.16-2-142)
• Walsh, J. et al., 2016. Student-written single-best answer questions predict performance in finals. Clinical Teacher 13 (5), pp.352-356. (10.1111/tct.12445)

2015

• Bergin, P. S. et al., 2015. Invitation to participate in the EpiNet-Firsttrials. Epilepsia 56 (5) 807. (10.1111/epi.12964)
• Harris, B. H. L. et al., 2015. A novel student-led approach to multiple-choice question generation and online database creation, with targeted clinician input. Teaching and Learning in Medicine 27 (2), pp.182-188. (10.1080/10401334.2015.1011651)
• Pickrell, W. O. et al., 2015. Epilepsy and deprivation, a data linkage study. Epilepsia 56 (4), pp.585-591. (10.1111/epi.12942)
• Preece, R. et al., 2015. Peer-assisted teaching of basic surgical skills. Medical Education Online 20 (1) 27579. (10.3402/meo.v20.27579)
• Thomas, R. H. and Smith, P. E. M. 2015. Etiology of epilepsy. Seminars in Neurology 35 (03), pp.191-192. (10.1055/s-0035-1552626)

2014

• Anney, R. et al. 2014. Genetic determinants of common epilepsies: a meta-analysis of genome-wide association studies. The Lancet Neurology 13 (9), pp.893-903. (10.1016/S1474-4422(14)70171-1)
• Johnston, A. and Smith, P. E. M. 2014. Epilepsy in the elderly. Expert Review of Neurotherapeutics 10 (12), pp.1899-1910. (10.1586/ern.10.170)
• Johnston, A. J. et al., 2014. A Novel GABRG2 mutation, p.R136*, in a family with GEFS+ and extended phenotypes. Neurobiology of Disease 64 , pp.131-141. (10.1016/j.nbd.2013.12.013)
• Pickrell, W. O. et al., 2014. Trends in the first antiepileptic drug prescribed for epilepsy between 2000 and 2010. Seizure - European Journal of Epilepsy 23 (1), pp.77-80. (10.1016/j.seizure.2013.09.007)
• Seal, R. P. et al., 2014. Using an option grid in shared decision making. Practical Neurology 14 (1), pp.54-56. (10.1136/practneurol-2013-000666)
• Speed, D. et al., 2014. A genome-wide association study and biological pathway analysis of epilepsy prognosis in a prospective cohort of newly treated epilepsy. Human Molecular Genetics 23 (1), pp.247–258. (10.1093/hmg/ddt403)

2013

• Mayor, R. et al., 2013. A feasibility study of a brief psycho-educational intervention for psychogenic nonepileptic seizures. Seizure - European Journal of Epilepsy 22 (9), pp.760-765. (10.1016/j.seizure.2013.06.008)
• Thomas, R. H. et al. 2013. The importance of the experiences of initial diagnosis and treatment failure when switching antiepileptic drugs. Epilepsy & Behavior 29 (3), pp.492-6. (10.1016/j.yebeh.2013.08.025)
• Trinka, E. et al., 2013. KOMET: an unblinded, randomised, two parallel-group, stratified trial comparing the effectiveness of levetiracetam with controlled-release carbamazepine and extended-release sodium valproate as monotherapy in patients with newly diagnosed epilepsy. Journal of Neurology, Neurosurgery & Psychiatry 84 (10), pp.1138-1147. (10.1136/jnnp-2011-300376)
• Wild, J. M. et al. 2013. Modelling the risk of visual field loss arising from long-term exposure to the antiepileptic drug vigabatrin: a cross-sectional approach. CNS Drugs 27 (10), pp.841-849. (10.1007/s40263-013-0100-z)

2012

• Baxter, S. et al., 2012. Understanding patient perceptions following a psycho-educational intervention for psychogenic non-epileptic seizures. Epilepsy and Behavior 23 (4), pp.487-493. (10.1016/j.yebeh.2011.12.002)
• Lacey, A. et al., 2012. SUDEP following status epilepticus [Conference Abstract]. Epilepsia 53 , pp.27-27. (10.1111/j.1528-1167.2012.03677.x)
• Mayor, R. et al., 2012. Short-term outcome of psychogenic non-epileptic seizures after communication of the diagnosis. Epilepsy and Behavior 25 (4), pp.676-681. (10.1016/j.yebeh.2012.09.033)
• Morrison, N. , Thomas, R. H. and Smith, P. E. M. 2012. Juvenile myoclonic epilepsy. British Medical Journal 344 e360. (10.1136/bmj.e360)
• Pickrell, W. O. et al., 2012. Weight change associated with antiepileptic drugs. Journal of Neurology, Neurosurgery & Psychiatry 84 (7), pp.796-799. (10.1136/jnnp-2012-303688)
• Smith, P. E. M. 2012. Epilepsy: mimics, borderland and chameleons. Practical Neurology 12 (5), pp.299-307. (10.1136/practneurol-2012-000304)
• Smith, P. E. M. 2012. Introduction: the causes of epilepsy. Epilepsia 53 (s4), pp.1-2. (10.1111/j.1528-1167.2012.03607.x)
• Solomon, T. et al., 2012. Management of suspected viral encephalitis in adults - Association of British Neurologists and British Infection Association National Guidelines. Journal of Infection 64 (4), pp.347-373. (10.1016/j.jinf.2011.11.014)
• Thomas, R. H. et al. 2012. SUDEP and familial epilepsy [Conference Abstract]. Epilepsia 53 , pp.40-40. (10.1111/j.1528-1167.2012.03677.x)

2011

• Cardoza, B. et al. 2011. Epilepsy in Rett syndrome: association between phenotype and genotype, and implications for practice. Seizure - European Journal of Epilepsy 20 (8), pp.646-649. (10.1016/j.seizure.2011.06.010)
• Mayor, R. , Smith, P. and Reuber, M. 2011. Management of patients with nonepileptic attack disorder in the United Kingdom: A survey of health care professionals. Epilepsy & Behavior 21 (4), pp.402-406. (10.1016/j.yebeh.2011.05.019)
• Thomas, R. H. et al. 2011. Genetic epilepsy with febrile seizures plus: definite and borderline phenotypes. Journal of Neurology, Neurosurgery & Psychiatry 83 (3), pp.336-338. (10.1136/jnnp-2011-300405)
• Thomas, R. H. and Smith, P. E. M. 2011. Epilepsy is different [Editorial]. Journal of the Royal Society of Medicine 104 (4), pp.141-143. (10.1258/jrsm.2011.100412)

2010

• Hall-Patch, L. et al., 2010. Acceptability and effectiveness of a strategy for the communication of the diagnosis of psychogenic nonepileptic seizures. Epilepsia 51 (1), pp.70-78. (10.1111/j.1528-1167.2009.02099.x)
• Hilditch, C. A. et al., 2010. POE06 The teenage epilepsy clinic: an observational study [Conference Abstract]. Journal of Neurology, Neurosurgery & Psychiatry 81 (11), pp.e47-e47. (10.1136/jnnp.2010.226340.120)
• Johnston, J. A. et al., 2010. PATH42 Lineage, clinical, genetic, structural and cellular characterisation of a novel epilepsy mutation [Conference Abstract]. Journal of Neurology, Neurosurgery & Psychiatry 81 (11), pp.e19-e19.
• Johnston, J. A. et al., 2010. POE08 Generalised (or genetic) epilepsy with febrile seizures plus phenotypes of definite and borderline UK families [Conference Abstract]. Journal of Neurology, Neurosurgery & Psychiatry 81 (11), pp.e48-e48. (10.1136/jnnp.2010.226340.122)
• Taylor, J. et al., 2010. Patients with epilepsy: Cognitively compromised before the start of antiepileptic drug treatment?. Epilepsia 51 (1), pp.48-56. (10.1111/j.1528-1167.2009.02195.x)
• Thomas, R. H. et al. 2010. Identifying and prioritising epilepsy treatment uncertainties. Journal of Neurology, Neurosurgery & Psychiatry 81 (8), pp.918-921. (10.1136/jnnp.2009.192716)
• Walker, C. , Thomas, R. H. and Smith, P. E. M. 2010. POC10 The dark night: a family diagnosis [Conference Abstract]. Journal of Neurology, Neurosurgery & Psychiatry 81 (11), pp.e37-e37. (10.1136/jnnp.2010.226340.80)
• Walker, C. , Thomas, R. H. and Smith, P. E. M. 2010. The dark night. Practical Neurology 10 (5), pp.290-294. (10.1136/jnnp.2010.224113)

2009

• Johnston, J. A. , Rees, M. I. and Smith, P. E. M. 2009. Epilepsy genetics: clinical beginnings and social consequences. QJM 102 (7), pp.497-499. (10.1093/qjmed/hcp019)
• Lawthom, C. , Smith, P. E. M. and Wild, J. M. 2009. In utero exposure to vigabatrin: No indication of visual field loss. Epilepsia 50 (2), pp.318-321. (10.1111/j.1528-1167.2008.01700.x)
• Lawthom, C. , Smith, P. E. M. and Wild, J. M. 2009. Nasal retinal nerve fiber layer attenuation: A biomarker for vigabatrin toxicity. Ophthalmology 116 (3), pp.565-571. (10.1016/j.ophtha.2008.09.047)
• Thomas, R. H. et al. 2009. Occurrence of wake seizures after pure sleep epilepsy: a systematic review and implications for driving law [Cpmference Abstract]. Journal of Neurology, Neurosurgery & Psychiatry 80 , pp.e1-e1. (10.1136/jnnp.2009.195172o)
• Thomas, R. H. and Smith, P. E. M. 2009. Encephalitis guidelines: a recipe for success?. Clinical Medicine 9 (3), pp.210-211. (10.7861/clinmedicine.9-3-210)

2008

• Chadwick, D. W. et al., 2008. What is the optimal management of partial epilepsy uncontrolled by a first choice anticonvulsant?. British Medical Journal (BMJ) 337 a2199. (10.1136/bmj.a2199)
• Kerr, M. P. et al. 2008. Epilepsy in Retts syndrome: a study of the association between phenotype and genotype [Abstract]. Journal of Intellectual Disability Research 52 (8-9), pp.658. (10.1111/j.1365-2788.2008.01084.x)
• Marsh, E. , O'Callaghan, P. and Smith, P. E. M. 2008. The humble electrocardiogram. Practical Neurology 8 (1), pp.46-59. (10.1136/jnnp.2007.140988)
• Smith, P. E. M. 2008. The bare essentials: Epilepsy. Practical Neurology 8 (3), pp.195-202. (10.1136/pn.2007.134031)
• Smith, P. E. M. et al. 2008. Goya's deafness. Practical Neurology 8 (6), pp.370-377. (10.1136/jnnp.2008.161349)
• Thomas, R. H. and Smith, P. E. M. 2008. Epilepsy in older adults. Geriatric Medicine 38 (2), pp.16-23.

2007

• Johnston, A. and Smith, P. E. M. 2007. Sudden unexpected death in epilepsy. Expert Review of Neurotherapeutics 7 (12), pp.1751-1761. (10.1586/14737175.7.12.1751)
• Marson, A. G. et al., 2007. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. The Lancet 369 (9566), pp.1000-1015.
• Marson, A. G. et al., 2007. The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial. The Lancet 369 (9566), pp.1016-1026.
• Wiles, C. et al., 2007. Clinical skills evaluation of trainees in a neurology department. Clinical Medicine 7 (4), pp.365-369. (10.7861/clinmedicine.7-4-365)

2006

• Wild, J. M. et al. 2006. Detecting vigabatrin toxicity by imaging of the retinal nerve fiber layer. Investigative Ophthalmology and Visual Science 47 (3), pp.917-924. (10.1167/iovs.05-0854)
• Williams, J. et al., 2006. Variability of antiepileptic medication taking behaviour in sudden unexplained death in epilepsy: hair analysis at autopsy. Journal of Neurology, Neurosurgery & Psychiatry 77 (4), pp.481-484. (10.1136/jnnp.2005.067777)

2005

• Hadjikoutis, S. et al., 2005. Ocular complications of neurological therapy. European Journal of Neurology 12 (7), pp.499-507. (10.1111/j.1468-1331.2005.01025.x)

2004

• Kumar, S. P. and Smith, P. E. M. 2004. Levetiracetam as add-on therapy in generalised epilepsies. Seizure 13 (7), pp.475-477. (10.1016/j.seizure.2003.06.001)
• Smith, P. E. M. , Fuller, G. and Dunstan, F. D. J. 2004. Scoring posters at scientific meetings: first impressions count. Journal of the Royal Society of Medicine 97 (7), pp.340-341. (10.1177/014107680409700714)
• Smith, P. E. and Cossburn, M. D. 2004. Seizures: assessment and management in the emergency unit. Clinical Medicine 4 (2), pp.118-122. (10.7861/clinmedicine.4-2-118)

2003

• Beghi, E. et al., 2003. Adjunctive therapy versus alternative monotherapy in patients with partial epilepsy failing on a single drug: a multicentre, randomised, pragmatic controlled trial. Epilepsy Research 57 (1), pp.1-13. (10.1016/j.eplepsyres.2003.09.007)
• Ravzi, S. , Pascual Nadal, J. and Smith, P. E. M. 2003. Tilt table testing in patients referred from an epilepsy clinic. Seizure - European Journal of Epilepsy 12 (5), pp.295-299. (10.1016/S1059-1311(02)00294-7)
• Smith, P. E. M. et al. 2003. Palinopsia. The Lancet 361 (9363), pp.1098-1098. (10.1016/S0140-6736(03)12896-6)

2002

• Smith, P. E. M. et al. 2002. Using simulated consultations to develop communications skills for neurology trainees. European Journal of Neurology 9 (1), pp.83-87. (10.1046/j.1468-1331.2002.00339.x)
• Smith, P. E. M. , Myson, V. and Gibbon, F. 2002. A teenager epilepsy clinic: observational study. European Journal of Neurology 9 (4), pp.373-376. (10.1046/j.1468-1331.2002.00418.x)
• Swallow, R. A. , Hillier, C. E. M. and Smith, P. E. M. 2002. Sudden unexplained death in epilepsy (SUDEP) following previous seizure-related pulmonary oedema: case report and review of possible preventative treatment. Seizure 11 (7), pp.446-448. (10.1053/seiz.2002.0683)
• Williams, J. et al., 2002. Self-discontinuation of antiepileptic medication in pregnancy: detection by hair analysis. Epilepsia 43 (8), pp.824-831. (10.1046/j.1528-1157.2002.38601.x)

2001

• Smith, P. E. 2001. If it's not epilepsy. Journal of Neurology, Neurosurgery & Psychiatry 70 (2), pp.9-14. (10.1136/jnnp.70.suppl_2.ii9)
• Smith, P. 2001. Clinical recommendations for oxcarbazepine. Seizure - European Journal of Epilepsy 10 (2), pp.87-91. (10.1016/S1059-1311(01)90536-9)
• Taylor, R. W. et al., 2001. Progressive mitochondrial disease resulting from a novel missense mutation in the mitochondrial DNA ND3 gene. Annals of Neurology 50 (1), pp.104-107. (10.1002/ana.1084)

1999

• Phillips, M. F. et al., 1999. Nocturnal oxygenation and prognosis in Duchenne muscular dystrophy. American Journal of Respiratory and Critical Care Medicine 160 (1), pp.198–202. (10.1164/ajrccm.160.1.9805055)
• Smith, P. E. M. et al. 1999. Intractable seizures in pregnancy. The Lancet 354 (9189), pp.1522-1522. (10.1016/S0140-6736(99)09164-3)

1998

• Smith, P. E. M. 1998. The teenager with epilepsy. BMJ 317 (7164) 960. (10.1136/bmj.317.7164.960)
• Smith, P. E. M. and Wiles, C. M. 1998. Cough responsiveness in neurogenic dysphagia. Journal of Neurology, Neurosurgery and Psychiatry 64 (3), pp.385-388. (10.1136/jnnp.64.3.385)

1995

• Smith, P. E. M. et al. 1995. Creutzfeldt-Jakob disease in a dairy farmer. Lancet 346 (8979) 898. (10.1016/S0140-6736(95)92734-4)

1989

• Smith, P. E. , Edwards, R. H. and Calverley, P. M. 1989. Oxygen treatment of sleep hypoxaemia in Duchenne muscular dystrophy. Thorax 44 (12), pp.997-1001. (10.1136/thx.44.12.997)
• Smith, P. E. M. , Edwards, R. H. T. and Calverley, P. M. A. 1989. Ventilation and breathing pattern during sleep in Duchenne muscular dystrophy. Chest 96 (6), pp.1346-1351. (10.1378/chest.96.6.1346)
• Smith, P. E. M. et al. 1989. Profiles of instant heart rate during partial seizures. Electroencephalography and clinical neurophysiology 72 (3), pp.207-217. (10.1016/0013-4694(89)90245-9)

1988

• Smith, P. E. M. et al. 1988. Letters to the Editor. Muscle and Nerve 11 (7), pp.784-787. (10.1002/mus.880110716)
• Smith, P. E. M. , Calverley, P. M. A. and Edwards, R. H. T. 1988. Hypoxemia during sleep in Duchenne muscular dystrophy. American Review of Respiratory Disease 137 (4), pp.884–888. (10.1164/ajrccm/137.4.884)

1987

• Dietrichson, P. et al., 1987. Conchotome and needle percutaneous biopsy of skeletal muscle. Journal of Neurology, Neurosurgery and Psychiatry 50 (11), pp.1461-1467. (10.1136/jnnp.50.11.1461)
• Helliwell, T. R. et al., 1987. The morphology and morphometry of the normal human tibialis anterior muscle. Neuropathology and Applied Neurobiology 13 (4), pp.297-307. (10.1111/j.1365-2990.1987.tb00069.x)
• Smith, P. E. M. et al. 1987. Practical problems in the respiratory care of patients with muscular dystrophy. New England Journal of Medicine 316 (19), pp.1197-1205. (10.1056/NEJM198705073161906)

1986

• Blumhardt, L. D. , Smith, P. E. M. and Owen, L. 1986. Electrocardiographic accompaniments of temporal lobe epileptic seizures. Lancet 327 (8489), pp.1051-1056. (10.1016/S0140-6736(86)91328-0)
• Luksza, A. R. et al., 1986. Acute severe asthma treated by mechanical ventilation: 10 years' experience from a district general hospital. Thorax 41 (6), pp.459-463. (10.1136/thx.41.6.459)