SwePub
Sök i SwePub databas

  Utökad sökning

Träfflista för sökning "L773:1600 5449 OR L773:0001 6314 srt2:(2020-2024)"

Sökning: L773:1600 5449 OR L773:0001 6314 > (2020-2024)

  • Resultat 1-50 av 88
Sortera/gruppera träfflistan
   
NumreringReferensOmslagsbildHitta
1.
  • Aked, Joseph, et al. (författare)
  • Completeness of case ascertainment in Swedish hospital-based stroke registers
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:2, s. 148-155
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: There is a worldwide development toward using data from hospital-based stroke registers to estimate epidemiological trends. However, incomplete case ascertainment may cause selection bias. We examined the completeness of case ascertainment and selection bias in two hospital-based Swedish stroke registers. Methods: First-ever stroke cases between March 2015 and February 2016 in the catchment area of Skåne University Hospital, Lund, Sweden, were included from multiple overlapping sources: two hospital-based stroke registers, Riksstroke-Lund and Lund Stroke Register (LSR); local outpatient and inpatient registers; primary care registers; and autopsy registers. The resulting population-based cohort was used as reference to assess completeness of case ascertainment and patient characteristics in Riksstroke-Lund and LSR. Results: In total, 400 stroke patients were identified. Riksstroke-Lund detected 328 (82%) patients, whereas LSR detected 363 (91%). Patients undetected by hospital-based registers had higher 28-day case fatality than those detected (44% vs 9%; P =.001). Patients only detected in primary care (n = 11) more often lived in healthcare facilities compared with those detected by hospital-based registers (57% vs 7%; P =.001). Patients not detected by Riksstroke-Lund, but detected by population-based sources, had less severe strokes (median NIHSS 3 vs 5; P =.013). Conclusions: Some first-ever stroke patients, such as those with high early case fatality and those with mild stroke, may go undetected with hospital-based screening used in clinical stroke registers. This can result in selection bias due to not identifying specific groups of patients including some with high early case fatality and those living in healthcare facilities.
  •  
2.
  • Andersson, Klara, et al. (författare)
  • Valproic acid and socioeconomic associations in Swedish women with epilepsy 2010-2015
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 143:4, s. 383-388
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective We investigated the correlation between socioeconomic status and the prescription of Valproic acid (VPA) in women of fertile age in Sweden. Methods This is a registered-based cohort study including all women living in Sweden aged 18-45 years in the years 2010-2015, with a diagnosis of epilepsy and no intellectual disability (n = 9143). Data were collected from the National Patient Register, the Drug Prescription Register, and the Longitudinal integration database for health insurance and labor market studies (LISA). Results Women with only 9 years of school were more often prescribed VPA than women with a University degree (12.9% compared to 10.7% in 2015 [p = 0.015]). Similar differences were seen between the lowest and highest income group (16.6% compared to 12.7% in 2015 [p < 0.001]). The odds of having a VPA prescription in 2015 was 1.59 (p < 0.001) in women with 9 years of school compared to women with a University degree, and 1.60 (p < 0.001) in the lowest income group relative to the highest income group after adjusting for age. From 2010 to 2015, the proportion with VPA prescription in the whole cohort diminished with an absolute reduction of -2.2% (p < 0.001). The decrease was similar among the different education and income groups (p = 0.919 and p = 0.280). Significance The results indicate that the increased knowledge on VPA teratogenicity was implemented across socioeconomic strata in the Swedish healthcare system. Women with lower income or education level remained more frequent VPA users. Whether this difference reflects epilepsy type or severity, or socioeconomic disparities, merit further study.
  •  
3.
  • Apostolaki-Hansson, Trine, et al. (författare)
  • Patient factors associated with receiving reversal therapy in oral anticoagulant-related intracerebral hemorrhage
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146:5, s. 590-597
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: We aimed to describe baseline characteristics of patients with oral anticoagulant-related intracerebral hemorrhage (OAC-ICH) in Sweden and to identify predictive variables associated with receiving hemostatic treatment in the event of OAC-ICH. Methods: We performed an observational study based on data from Riksstroke and the Swedish Causes of Death Register to define baseline characteristics of patients with OAC-ICH who received reversal treatment compared with patients who did not receive reversal treatment during 2017–2019. Predictive analysis was performed using multivariable logistic regression to identify odds ratios for factors associated with receiving OAC reversal treatment. Results: We included 1902 patients ((n = 1146; OAC reversal treatment) (n = 756; no OAC reversal treatment)). The proportion of non-Vitamin K oral anticoagulant associated ICH (NOAC-ICH) patients who received reversal treatment was 48.4% and the proportion of Vitamin K antagonist-associated ICH (VKA-ICH) patients was 72.9%. Factors associated with a lower odds of receiving reversal treatment were increased age (OR = 0.98; 95% CI: 0.96–0.99), previous stroke (OR = 0.78; 95% CI: 0.62–0.98), comatose LOC (OR = 0.36;95%CI: 0.27–0.48; ref. = alert), pre-stroke dependency (OR = 0.72; 95% CI: 0.58–0.91), and NOAC treatment (OR = 0.34; 95% CI: 0.28–0.42). Care at a university hospital was not associated with higher odds of receiving reversal treatment compared to treatment at a county hospital. Conclusion: Treatment with a reversal agent following OAC-ICH was related to several patient factors including type of OAC drug. We identified that only 48% of patients with NOAC-ICH received hemostatic treatment despite an increase in these cases. Further studies are required to guide the use of reversal therapies more precisely, particularly in NOAC-ICH.
  •  
4.
  • Appelros, Peter, et al. (författare)
  • Ethical issues in stroke thrombolysis revisited
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Munksgaard Forlag. - 0001-6314 .- 1600-0404. ; 144:6, s. 611-615
  • Tidskriftsartikel (refereegranskat)
  •  
5.
  • Appelros, Peter, et al. (författare)
  • Stroke prevalence in a medium-sized Swedish municipality
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Munksgaard Forlag. - 0001-6314 .- 1600-0404. ; 143:2, s. 210-216
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Many patients who have had stroke survive with functional disability for years. Stroke prevalence is a fundamental measure of the impact of stroke in society. Stroke prevalence has never been evaluated in Sweden.MATERIALS & METHODS: 2019 with respect to stroke survivors (ICD-10 I60-I69) living in Kumla (population 21,738), a municipality well representative of Sweden.RESULTS: 330 individuals with stroke were found, of which 42% were women. The mean age was 74.1 years in men and 75.1 years in women. 11.5% of the patients had more than one stroke. The mean duration since the first stroke was 8.3 years. The crude prevalence per 100,000 was 1754 in men, 1281 in women and 1518 in both sexes. Adjusted to the European population, the ratio was 1570 per 100,000, and to the World population 936 per 100,000.CONCLUSIONS: In spite of a declining stroke incidence in Sweden, the stroke prevalence in Kumla, Sweden, is relatively high. Comparisons with other studies indicate that a decline in prevalence may have occurred since the early 2000s. Modern registers can support data collection, but the index stroke may have occurred almost forty years back in time.
  •  
6.
  • Asp, Amanda, et al. (författare)
  • Impaired procedural memory in narcolepsy type 1
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146:2, s. 186-193
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives Sleep enhances the consolidation of memories. Here, we investigated whether sleep-dependent memory consolidation differs between healthy subjects and narcolepsy type 1 (NT1) patients. Material and Methods We recruited 18 patients with NT1 and 24 healthy controls. The consolidation of spatial (declarative memory; 2-dimensional object location) and procedural (non-declarative memory; finger sequence tapping) memories was examined across one night of at-home sleep. Sleep was measured by an ambulatory sleep recording device. Results The overnight gain in the number of correctly recalled sequences in the finger-tapping test was smaller for NT1 patients than healthy subjects (+8.1% vs. +23.8% from pre-sleep learning to post-sleep recall, p = .035). No significant group differences were found for the overnight consolidation of spatial memory. Compared to healthy subjects, the sleep of NT1 patients was significantly more fragmented and shallow. However, no significant correlations were found between sleep parameters and overnight performance changes on the memory tests in the whole group. Conclusion The sleep-dependent consolidation of procedural but not spatial memories may be impaired among patients with NT1. Therefore, future studies are warranted to examine whether sleep improvement, for example, using sodium oxybate, can aid the sleep-dependent formation of procedural memories among NT1 patients.
  •  
7.
  • Balogh, Nora, et al. (författare)
  • The five-items memory screen-extended variant: A tool for assessing memory
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:2, s. 162-167
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and purpose The detection of memory impairment is an important part of dementia screening. However, the scope of memory measures in current screening batteries is limited. There is a need for a short yet sensitive instrument for early detection of memory impairment that could serve as a complement to existing globally oriented screening tests, for example, Mini-Mental State Examination (MMSE). To that end, the current study investigates the sensitivity and psychometric properties of the memory screening instrument The Five-Items Memory Screen -Extended Variant (FIMS-XV). Methods Hundred and forty-five participants included in the Gothenburg Mild Cognitive Impairment Study-27 patients with subjective cognitive impairment (SCI), 73 with mild cognitive impairment (MCI), and 45 with mild dementia-underwent cognitive screening including the MMSE and FIMS-XV. Ninety participants also underwent extensive neuropsychological testing. Results The FIMS-XV showed high internal consistency and strong correlations with established neuropsychological memory tests. Both the FIMS-XVdelayed recall score and the FIMS-XV total score differentiated mild dementia patients from patients with SCI and MCI. Conclusions The FIMS-XV shows promise as a sensitive tool for screening for memory impairment in all putative phases of dementia.
  •  
8.
  • Banote, Rakesh Kumar, et al. (författare)
  • Blood biomarkers in epilepsy
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146, s. 362-368
  • Tidskriftsartikel (refereegranskat)abstract
    • Robust and accessible biomarkers are greatly needed in epilepsy. Diagnostic and prognostic precision in the clinic needs to improve, and there is a need for objective quantification of seizure burden. In recent years, there have been advances in the development of accessible and cost-effective blood-based biomarkers in neurology, and these are increasingly studied in epilepsy. However, the field is in its infancy and specificity and sensitivity for most biomarkers in most clinical situations are not known. This review describes advancements regarding human blood biomarkers in epilepsy. Examples of biochemical markers that have been shown to have higher blood concentrations in study subjects with epilepsy include brain proteins like S100B or neuronal specific enolase, and neuroinflammatory proteins like interleukins, and tumor necrosis factor-alpha. Some of the blood biomarkers also seem to reflect seizure duration or frequency, and levels decrease in response to treatment with antiseizure medication. For most biomarkers, the literature contains seemingly conflicting results. This is to be expected in an emerging field and could reflect different study populations, sampling or analysis techniques, and epilepsy classification. More studies are needed with emphasis put on the classification of epilepsy and seizure types. More standardized reporting could perhaps decrease result heterogeneity and increase the potential for data sharing and subgroup analyses.
  •  
9.
  • Barro, Christian, et al. (författare)
  • Neurological symptoms and blood neurofilament light levels.
  • 2021
  • Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 144:1, s. 13-20
  • Tidskriftsartikel (refereegranskat)abstract
    • Neurofilament light chain (NfL) is an incredibly specific marker of neuronal injury that is not specific for cause or location of the neuronal damage. NfL is increasingly considered as possible biomarker of disease activity in neurological conditions. Several works reviewed the utility of NfL in the different diseases. Nonetheless, NfL is a universal marker of neuronal damage, which interpretation spaces beyond the single disease. Because of this, the interpretation of NfL may benefit by also considering how neurological symptoms relate to its blood concentration. Here, we review how different neurological symptoms can be associated with blood NfL levels with a practical interpretation of it.
  •  
10.
  • Bhan, Alok, et al. (författare)
  • Neurofilament and Brain Atrophy and Their Association with Cognition in Multiple Sclerosis: A 10-Year Follow-Up Study
  • 2023
  • Ingår i: ACTA NEUROLOGICA SCANDINAVICA. - 0001-6314 .- 1600-0404. ; 2023
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction. Cognitive impairment is an important contributor to disability in multiple sclerosis (MS). Disconnection of neuronal circuits due to axonal injury is probably an important underlying mechanism for this disability. Neurofilament light chain (NfL) is a neuron-specific constituent of axons and has gained increasing attention as a biomarker of axonal injury. Objective. To assess the association between NfL in serum (sNfL) and cerebrospinal fluid (cNfL) and cognitive function over 10 years and compare these associations with volumetric brain magnetic resonance imaging (MRI) measurements. Methods. Newly diagnosed MS patients were followed prospectively with baseline NfL and MRI as well as with clinical and cognitive assessments for up to 10 years. Results. Forty-one patients were included. Baseline sNfL correlated negatively with symbol digit modalities test (SDMT) at baseline (r=-0.45, p=0.005), year 5 (r=-0.41, p=0.017), and at year 10 (r=-0.52, p=0.008). Baseline cNfL correlated with baseline SDMT (r=-0.34, p=0.030) and SDMT at year 10 (r=-0.44, p=0.037). Baseline volumes of whole brain (r=0.476, p=0.002), gray matter (r=0.467, p=0.002), T1 (r=-0.627, p<0.001), and T2 lesion volumes (r=-0.475, p=0.002) correlated significantly with baseline SDMT. Longitudinal analyses showed that both MRI volumes and EDSS were associated with the rate of SDMT decline, whereas sNfL and cNfL were not. Conclusion. NfL levels measured in serum and cerebrospinal fluid were both associated with cognitive functioning in MS patients over a 10-year period from diagnosis. However, MRI volumes correlated strongly in addition to the rate of cognitive decline.
  •  
11.
  • Bjerkne Wenneberg, Sandra, et al. (författare)
  • Association between inflammatory response and outcome after subarachnoid haemorrhage.
  • 2021
  • Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 143:2, s. 195-205
  • Tidskriftsartikel (refereegranskat)abstract
    • Recent reports suggest an association between the inflammatory response after aneurysmal subarachnoid haemorrhage (aSAH) and patients' outcome. The primary aim of this study was to identify a potential association between the inflammatory response after aSAH and 1-year outcome. The secondary aim was to investigate whether the inflammatory response after aSAH could predict the development of delayed cerebral ischaemia (DCI).This prospective observational pilot study included patients with an aSAH admitted to Sahlgrenska University Hospital, Gothenburg, Sweden, between May 2015 and October 2016. The patients were stratified according to the extended Glasgow Outcome Scale (GOSE) as having an unfavourable (score: 1-4) or favourable outcome (score: 5-8). Furthermore, patients were stratified depending on development of DCI or not. Patient data and blood samples were collected and analysed at admission and after 10days.Elevated serum concentrations of inflammatory markers such as tumour necrosis factor-α and interleukin (IL)-6, IL-1Ra, C-reactive protein and intercellular adhesion molecule-1 were detected in patients with unfavourable outcome. When adjustments for Glasgow coma scale were made, only IL-1Ra remained significantly associated with poor outcome (p=0.012). The inflammatory response after aSAH was not predictive of the development of DCI.Elevated serum concentrations of inflammatory markers were associated with poor neurological outcome 1-year after aSAH. However, inflammatory markers are affected by many clinical events, and when adjustments were made, only IL-1Ra remained significantly associated with poor outcome. The robustness of these results needs to be tested in a larger trial.
  •  
12.
  • Bjerkne Wenneberg, Sandra, et al. (författare)
  • Long-term outcomes after aneurysmal subarachnoid hemorrhage: A prospective observational cohort study
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146:5, s. 525-536
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The survival rates for patients affected by aneurysmal subarachnoid hemorrhage (aSAH) have increased in recent years; however, many patients continue to develop cognitive dysfunctions that affect their quality of life. The commonly used outcome measures often fail to identify these cognitive dysfunctions. This study aimed to evaluate the long-term outcomes at 1 and 3 years after aSAH to assess changes over time and relate outcomes to patient characteristics and events during the acute phase. Materials and Methods This prospective observational study included patients that experienced aSAH. Patients were assessed according to the extended Glasgow Outcome Scale, Life Satisfaction Questionnaire, Mayo-Portland Adaptability inventory-4, and Mental Fatigue scale. Results Patients were assessed after 1 year (n = 62) and 3 years (n = 54). At 3 years, the extended Glasgow Outcome Scale score improved in 15% and worsened in 12% of the patients. Mental fatigue was observed in 57% of the patients at 1 year. Patients <60 years of age at the time of aSAH had more self-assessed problems, including pain/headache (p < .01), than patients >60 years of age. Patients with delayed cerebral ischemia during the acute phase reported more dissatisfaction at 3 years, whereas no significant result was seen at 1 year. Conclusions Cognitive dysfunction, especially mental fatigue, is common in patients with aSAH, which affects quality of life and recovery. Patient outcome is a dynamic process developing throughout years after aSAH, involving both improvement and deterioration. This study indicates the importance of longer follow-up periods with broad outcome assessments.
  •  
13.
  • Bolin, Kristian, et al. (författare)
  • The cost utility of pitolisant as narcolepsy treatment
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:4, s. 301-310
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The cost-effectiveness of available pharmacological treatments for narcolepsy is largely
  •  
14.
  • Borgström, Max, et al. (författare)
  • Changes in Retinal Thickness and Brain Volume during 6.8-Year Escalating Therapy for Multiple Sclerosis
  • 2023
  • Ingår i: Acta Neurologica Scandinavica. - : WILEY. - 0001-6314 .- 1600-0404. ; 2023
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Different disease-modifying therapies (DMT) for multiple sclerosis (MS) have disparate effects on disability outcomes. Sweden has a leading position globally in initiating high-efficacy DMT instead of escalating DMT from 1(st)-line to high-efficacy DMT. With optical coherence tomography (OCT), retinal changes can be measured at a few micrometer level. OCT has been increasingly applied in diagnosing MS and monitoring disease course and therapeutic effect. Objective. We investigate the effects of 1(st)-line versus high-efficacy DMT for MS on retinal and brain atrophy and on functional outcomes during 6.8 years of escalating DMT. Materials and Methods. In this prospective longitudinal observational study, 18 MS patients were followed up for 6.8 years. Twelve of the patients were untreated at baseline. All patients underwent 1(st)-line DMT for median duration of 2.4 years and then switched to high-efficacy DMT for a median duration of 2.9 years. Findings from neurological examinations, MRI, and OCT measures were registered 2-4 times per year. Results. Ganglion cell-inner plexiform layer (GCIPL) thickness was significantly reduced during 1(st)-line DMT (73.75 mu m, p < 0.01) compared to baseline (76.38 mu m). During high-efficacy DMT, thickness reduction was slower (73.27 mu m, p < 0.05), and MRI contrast-loading lesions vanished (p < 0.01). However, brain parenchymal fraction (BPF) decreased during high-efficacy DMT compared to 1(st)-line DMT. Estimated models showed similar results. Conclusion. GCIPL decline was most profound during 1(st)-line DMT and diminished during high-efficacy DMT. MRI contrast lesions vanished during high-efficacy DMT. However, brain atrophy continued regardless of high-efficacy DMT.
  •  
15.
  •  
16.
  • Borgström, Max, et al. (författare)
  • Retinal thinning and brain atrophy in early MS and CIS
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Wiley-Blackwell Publishing Inc.. - 0001-6314 .- 1600-0404. ; 142:5, s. 418-427
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Optical coherence tomography (OCT) could be complementary to magnetic resonance imaging (MRI) of the brain in monitoring course of multiple sclerosis (MS) and clinically isolated syndrome (CIS). Thinning of neurons in ganglion cell-inner plexiform layer (GCIPL) measured by OCT is assumed to be associated with brain atrophy. Objectives To evaluate association of GCIPL with brain parameters detected by quantitative MRI (qMRI) and MR-spectroscopy (MRS) in early MS and CIS. Methods Seventeen newly diagnosed MS and 18 CIS patients were prospectively included. The patients were assessed at baseline as well as at 1 year follow-up by OCT, qMRI and MRS. Brain parenchymal and myelin volumes (BPV, MYV respectively) and the corresponding fractions (BPF, MYF) were measured with qMRI. Metabolites including myo-inositol (myo-Ins) were measured in the normal-appearing white matter (NAWM) using MRS. T-tests and ANOVA were used to analyze group differences, and linear regression models to evaluate association of GCIPL with BPV, MYV and myo-Ins after correlation analysis. Results Disease activity reflected by lesions on MRI and presence of CSF oligoclonal IgG bands were more prominent in MS compared to CIS. GCIPL, BPV, MYV, BPF and MYF were reduced, while concentration of myo-Ins was increased in MS compared to CIS. Follow-up showed consistency of thinner GCIPL in MS compared to CIS. GCIPL thinning correlated with reduced BPV and MYV (P < .05 for both), but with increased myo-Ins (P < .01). Conclusions Significant GCIPL thinning occurs in early MS and is associated with enhanced brain inflammation and atrophy.
  •  
17.
  • Braathen, G., et al. (författare)
  • Long-term seizure and psychosocial outcome in childhood epilepsy of unknown cause
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 143:6, s. 653-660
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The purpose was to investigate long-term prognosis of epilepsy of unknown cause with onset between ages 2 and 16 in children without any major disability, by evaluation of a previously described prognostic model and long-term follow-up of a study on the impact of duration of initial antiseizure medication (ASM) treatment. Methods: Patients included in a randomized controlled trial (RCT) of either one or three years of ASM therapy prior to withdrawal (if seizure-free for at least 6months) were contacted after 29–35years and asked to complete a survey. Potential prognostic factors were evaluated: duration of initial ASM treatment, seizure type, seizure frequency, and score in a prognostic model developed in the initial publication. Results: One hundred and forty-nine subjects answered the questionnaire (response rate 65%). Seizure freedom without treatment was found in 110 responders (77%, 95%CI: 73–81). There was no significant difference in score in the prognostic model between responders with and without epilepsy at follow-up. Those with active epilepsy were unemployed significantly more often and perceived their mental health significantly more affected than those seizure-free without treatment. Conclusions: Duration of initial ASM treatment was not associated with any difference in subsequent epilepsy risk. This indicates that the timing of withdrawal attempts is unlikely to alter the long-term prognosis of uncomplicated childhood epilepsy. The failure of the prognostic model from the initial study to predict long-term outcome argues that although prediction of relapse risk in the shorter term may be possible, the bearing of such models on long-term epilepsy risk is more questionable. © 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
  •  
18.
  • Bruhn, Helena, et al. (författare)
  • Initial cognitive impairment predicts shorter survival of patients with glioblastoma
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Wiley. - 0001-6314 .- 1600-0404. ; 145:1, s. 94-101
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives Seizures as presenting symptom of glioblastoma (GBM) are known to predict prolonged survival, whereas the clinical impact of other initial symptoms is less known. Our main objective was to evaluate the influence of different presenting symptoms on survival in a clinical setting. We also assessed lead times, tumour size and localization. Methods Medical records of 189 GBM patients were reviewed regarding the first medical appointment, presenting symptom/s, date of diagnostic radiology and survival. Tumour size, localization and treatment data were retrieved. Overall survival was calculated using Kaplan-Meier and Mann-Whitney U test. Cox regression was used for risk estimation. Results Cognitive impairment as the initial symptom was often misinterpreted in primary health care leading to a delayed diagnosis. Initial global symptoms (66% of all patients) were associated with reduced survival compared to no global symptoms (median 8.4 months vs. 12.6 months). Those with the most common cognitive dysfunctions: change of behaviour, memory impairment and/or disorientation had a reduced median survival to 6.4 months. In contrast, seizures (32%) were associated with longer survival (median 11.2 months vs. 8.3 months). Global symptoms were associated with larger tumours than seizures, but tumour size had no linear association with survival. The setting of the first medical appointment was evenly distributed between primary health care and emergency units. Conclusion Patients with GBM presenting with cognitive symptoms are challenging to identify, have larger tumours and reduced survival. In contrast, epileptic seizures as the first symptom are associated with longer survival and smaller tumours.
  •  
19.
  • Bådagård, Henrik, et al. (författare)
  • Negative predictors of shunt surgery outcome in normal pressure hydrocephalus
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Wiley. - 0001-6314 .- 1600-0404. ; 141:3, s. 219-225
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesThe prevalence of idiopathic normal pressure hydrocephalus (iNPH) and vascular comorbidity increases with age. It has not been clarified if high age and vascular disease are negative predictors of shunt surgery outcome in patients with iNPH. The aim of this study was to investigate the impact of high age and vascular comorbidity on outcome after shunt surgery in patients with iNPH.MethodsAll 332 patients with iNPH who were treated with shunts between 2011 and 2015 at a single centre were consecutively included. Hellström iNPH scale, without the neuropsychological tests, was calculated preoperatively and at follow‐up 12 months after shunt surgery. Outcome was defined as the difference between the post‐operative and preoperative iNPH scale scores. A multivariable model was used to investigate the predictive effects of age and vascular comorbidity on shunt surgery outcome.ResultsIn a multivariable analysis of covariance (ANCOVA) with post‐operative outcome as the dependent variable, increasing age (years, B = −0.63, P < .001) and history of ischaemic stroke (B = −10.06, P = .0038) were negative predictors of shunt surgery outcome after controlling for waiting time for surgery, symptom severity at preoperative control, presence of diabetes mellitus, hypertension, hyperlipidaemia, history of myocardial infarction, duration of symptoms and shunt complications.ConclusionsHigh age and established cerebrovascular disease are associated with less favourable outcome after shunt surgery in patients with iNPH.
  •  
20.
  • Cedergren Weber, Gustav, et al. (författare)
  • The Impact of COVID-19 on Parkinson's Disease : A Case-Controlled Registry and Questionnaire Study on Clinical Markers and Patients' Perceptions
  • 2023
  • Ingår i: Acta Neurologica Scandinavica. - : John Wiley & Sons. - 0001-6314 .- 1600-0404. ; 2023
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Parkinson's disease (PD) is a neurodegenerative disease with motor and nonmotor symptoms. Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Objectives: To explore how COVID-19 affects motor, nonmotor, and general health aspects of PD and to map how PD patients perceive their change in symptoms since falling ill with COVID-19.Method: The study was descriptive, case-controlled, and based on both registry and questionnaire data. At baseline, the controls were matched on age, sex, and disease severity. Information on the severity of the disease, nonmotor symptoms, motor symptoms, and general health was retrieved from the Swedish Registry for PD. Registry data from a COVID-19 group (n=45) and a control group (n=73), as well as questionnaires from a COVID-19 group (n=24) and a control group (n=42), were compared.Results: We did not find that SARS-CoV-2 infection affects any major aspect of nonmotor symptoms, motor symptoms, general health, and perception of change in PD patients' post-COVID-19. Compared to controls, the COVID-19 group reported a more positive subjective experience of pain and quality of life and a perception of change post-COVID-19 regarding general motor function, sleep quality, and mood (all p<0.05).Conclusion: Although SARS-CoV-2 infection does not seem to affect PD symptoms in any major respect, the subjective experience of several aspects of life in PD patients might be slightly improved post-COVID-19 compared to a control group. The findings warrant further investigations due to the small sample size and possible survivorship bias.
  •  
21.
  • COMPAGNO STRANDBERG, MARIA, et al. (författare)
  • Evidence-based Anti-seizure Monotherapy in Newly Diagnosed Epilepsy: a New Approach
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 142:4, s. 323-332
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesTo describe the process and results of the updated Swedish practice guidelines for monotherapy in epilepsy.Materials and MethodsThe Swedish Medical Products Agency led the process together with medical experts. Evidence rating in accordance with the International League Against Epilepsy (ILAE) template was linked to the Cochrane group's GRADE system. Evidence from recently published trials and meta‐analyses was added. A national expert panel participated in the project and contributed their clinical experience.ResultsIn seizures with focal onset, carbamazepine, lamotrigine, or levetiracetam is recommended for children and adults (ILAE level A‐C for adults/Cochrane level strong for children and adults). Oxcarbazepine is an alternative for children, although its level A evidence, in a single class I trial, could relate to poor phenytoin tolerability. Eslicarbazepine acetate, lacosamide, and zonisamide are alternatives for adults and gabapentin for the elderly (ILAE level A). Carbamazepine is not a first choice for the elderly due to its high potential for interactions. In generalized epilepsy with tonic‐clonic seizures (GTC), lamotrigine, levetiracetam, and sodium valproate are recommended for children and adults (ILAE level C‐D/Cochrane level moderate‐strong) although sodium valproate is contraindicated in girls and women of childbearing age unless special considerations are met. Ethosuximide is the first choice in absence epilepsy without GTC (ILAE level A).ConclusionsLamotrigine and levetiracetam can be used as first choice for focal seizures and generalized epilepsy with GTC, suitable in all age‐groups and for both men and women. Recommendations for GTC seizures have lower evidence than those for focal seizures.
  •  
22.
  • Ehlers, Claas, et al. (författare)
  • Levodopa infusion in Parkinson's disease : Individual quality of life
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 142:3, s. 248-254
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Parkinson's disease (PD) features both motor and non-motor symptoms that substantially impact quality of life (QoL). Levodopa-carbidopa intestinal gel (LCIG) reduces motor complications and improves some non-motor symptoms in advanced PD (APD). Change in patients' health-related quality of life (hrQoL) is a common endpoint in PD trials and has become an important factor in judging overall effect of LCIG. However, hrQoL is considered to be only one dimension of QoL. The primary aim of this prospective observational study was to observe the effects of LCIG on individual quality of life (iQoL) in PD and caregivers. The secondary aim was to investigate its effects on patients' motor and non-motor symptoms as well as effects on caregiver burden. Materials & Methods: Utilizing the Schedule for the Evaluation of Individual Quality of Life-Questionnaire (SEIQoL-Q) and the Personal Wellbeing Index-Adult (PWI-A), twelve patients with advanced PD and their caregivers were followed for six months after initiation of LCIG treatment. Results: At the final follow-up, improvements of iQoL for patients (median SEIQoL index improvement 0.16, P <.05) and caregivers (median SEIQoL index improvement 0.20, P <.05) were seen together with improvements of motor and non-motor symptoms. There were no significant improvements of hrQoL. Conclusions: The study results indicate that LCIG improves iQoL in PD in addition to the improvement of motor and non-motor symptoms. Furthermore, this study signals that LCIG may also contribute to improvement of iQoL in caregivers.
  •  
23.
  • Ekman, Linnéa, et al. (författare)
  • Evaluation of small nerve fiber dysfunction in type 2 diabetes
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:1, s. 38-46
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To assess potential correlations between intraepidermal nerve fiber densities (IENFD), graded with light microscopy, and clinical measures of peripheral neuropathy in elderly male subjects with normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and type 2 diabetes (T2DM), respectively. Materials and methods: IENFD was assessed in thin sections of skin biopsies from distal leg in 86 men (71-77 years); 24 NGT, 15 IGT, and 47 T2DM. Biopsies were immunohistochemically stained for protein gene product (PGP) 9.5, and intraepidermal nerve fibers (IENF) were quantified manually by light microscopy. IENFD was compared between groups with different glucose tolerance and related to neurophysiological tests, including nerve conduction study (NCS; sural and peroneal nerve), quantitative sensory testing (QST), and clinical examination (Total Neuropathy Score; Neuropathy Symptom Score and Neuropathy Disability Score). Results: Absent IENF was seen in subjects with T2DM (n = 10; 21%) and IGT (n = 1; 7%) but not in NGT. IENFD correlated weakly negatively with HbA1c (r = −.268, P =.013) and Total Neuropathy Score (r = −.219, P =.042). Positive correlations were found between IENFD and sural nerve amplitude (r =.371, P =.001) as well as conduction velocity of both the sural (r =.241, P =.029) and peroneal nerve (r =.258, P =.018). Proportions of abnormal sural nerve amplitude became significantly higher with decreasing IENFD. No correlation was found with QST. Inter-rater reliability of IENFD assessment was good (ICC = 0.887). Conclusions: Signs of neuropathy are becoming more prevalent with decreasing IENFD. IENFD can be meaningfully evaluated in thin histopathological sections using the presented technique to detect neuropathy.
  •  
24.
  • Eljas Ahlberg, Eva, et al. (författare)
  • End-of-life care in amyotrophic lateral sclerosis : A comparative registry study
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : John Wiley & Sons. - 0001-6314 .- 1600-0404. ; 143:5, s. 481-488
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Amyotrophic lateral sclerosis (ALS) is a fatal disease requiring palliative care. End‐of‐life care has been well studied in patients with incurable cancer, but less is known about the quality of such care for patients with ALS.Aim: To study whether the quality of end‐of‐life care the last week in life for patients dying from ALS differed compared to patients with cancer in terms of registered symptoms, symptom management, and communication.Design: This retrospective comparative registry study used data from the Swedish Registry of Palliative Care for 2012–2016. Each patient with ALS (n = 825) was matched to 4 patients with cancer (n = 3,300).Results: Between‐group differences in assessments for pain and other symptoms were significant (p < 0.01), and patients with ALS had fewer as‐needed injection drugs prescribed than patients with cancer. Patients with ALS also had dyspnea and anxiety significantly more often than patients with cancer. There was no significant difference in communication about transition to end‐of‐life care between the two groups. Patients dying from ALS received artificial nutrition on their last day of life significantly more often than patients with cancer.Conclusions: The results indicate that patients with ALS receive poorer end‐of‐life care than patients dying from cancer in terms of validated symptom assessments, prescription of as‐needed drugs, and timely cessation of artificial nutrition. Educational efforts seem needed to facilitate equal care of dying patients, regardless of diagnosis.
  •  
25.
  • Frid, Petrea, et al. (författare)
  • Fetal posterior cerebral artery configurations in an ischemic stroke versus an unselected hospital population
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 145:3, s. 297-304
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Few MRA-based studies have systematically evaluated the prevalence and laterality of a fetal configuration of the posterior cerebral artery (FTP) in ischemic stroke populations versus other populations. This common variant is important in the setting of acute stroke and secondary prevention decisions. Objective: To determine the prevalence and laterality of FTP configurations in MRI-DWI verified acute ischemic stroke patients investigated with MRA, and compare the findings with an unselected hospital population investigated with computed tomography angiography (CTA). We also evaluated the association of FTP with posterior cerebral artery (PCA) territory infarctions. Methods: We reviewed the MRAs of 1407 ischemic stroke patients with acute lesions on MRI-DWI sequences and 546 consecutive CTAs of patients investigated on any indication in a tertiary hospital. The MRA and CTA assessments were made by neuroradiologists blinded to original reports on stroke location and vessel anatomy. Results: The prevalence of any FTP was similar in ischemic stroke patients (31%) and unselected patients (32%). Unilateral FTP was significantly more frequent on the right than on the left side in both groups (15% right vs. 8% left). The presence of FTP ipsilateral to stroke side was not associated with involvement of the PCA territory versus no FTP on the stroke side. Conclusions: FTP is present in approximately 30% of ischemic stroke patients and unselected hospital populations and was detected significantly more frequently on the right versus left side in both groups. PCA territory infarction was not associated with the presence of ipsilateral FTP.
  •  
26.
  • Gauffin, Helena, et al. (författare)
  • Narcolepsy treatment in Sweden: An observational study
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 145:2, s. 185-192
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives To describe the pharmacological treatments (2005-2017) and the healthcare utilization (1997-2016) for patients with narcolepsy in Sweden in order to create a framework for future organizational and economic analyses. Material & Methods Patients of all ages with a diagnosis of narcolepsy registered in the National Patient Registry in specialist care in Sweden were included and information on treatments for narcolepsy was retrieved from The Swedish Prescribed Drug Register. Results We collected 2508 patients with narcolepsy, 43,3% men and 56,7% women and 47,9% were prescribed modafenil, 33,8% metylphenidate and 26,2% amphetamine. In total, 3817 treatments were initiated. Patients treated with amphetamine had a higher mean age. More women than men used modafinil, methylphenidate, amphetamine and antidepressants. The narcolepsy population had more outpatient than inpatient healthcare. Patients treated with sodium oxybate had more outpatient visits than other narcolepsy patients, before and during treatment (p = .00). Conclusions This study gives valuable information on pharmaceutical treatments and healthcare utilization for patients with narcolepsy and can be used to estimate the healthcare cost in the future. Patients with sodium oxybate treatment had more outpatient visits than other patients before and during treatment which may be due to the need to monitor potentially severe side-effects or may indicate that patients with sodium oxybate treatment have a severe disease. The number of included patients was less than expected; however, this may depend on patients escaping our collection of data, which does not contain information from primary care.
  •  
27.
  • Gerafi, Joel, et al. (författare)
  • The presence and prediction of lateralized inattention 7 years post-stroke
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:5, s. 423-430
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective Lateralized inattention is a typical sign of neglect and related to poor functional outcome. Knowledge of the long-term course of this phenomenon is limited. The purpose of this study was to investigate presence and predictors for signs of lateralized inattention 7 years after stroke. Methods From a cohort of acute ischemic stroke patients, aged 18-69 years (n = 297), a consecutive series of 188 survivors without recurrent stroke at follow-up 7 years later were included. Within the first week after stroke onset, stroke severity was assessed according to the Scandinavian Stroke Scale. Target omissions, asymmetry of omissions, and perceptual speed according to Star- and Letter Cancellation Tests were also assessed. Presence of lateralized inattention at the 7-year follow-up was investigated with the Star- and Letter Cancellation Tests and with the neglect item in the National Institutes of Health Stroke Scale. Results At the follow-up, 22 (11.7%) participants had lateralized inattention and the multivariable regression showed that independent significant baseline predictors were total omissions in target cancellations (P < .001) and inferior baseline performance on visual processing speed (P = .008). Conclusion About one of ten individuals exhibited signs of lateralized inattention 7 years after stroke. Baseline performance in perceptual processing speed and target omissions independently predicted presence of late signs of lateralized inattention. This is the first time processing speed is recognized as a significant predictor of lateralized inattention several years after the stroke incidence, indicating that the longitudinal course of processing speed following stroke is a critical subject for future research.
  •  
28.
  • Grönberg, Angelina, et al. (författare)
  • Accuracy of NIH Stroke Scale for diagnosing aphasia
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 143:4, s. 375-382
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The National Institutes of Health Stroke Scale (NIHSS) has not been validated to diagnose aphasia in the stroke population. We therefore examined the diagnostic accuracy of NIHSS for detecting aphasia in acute ischemic stroke. Methods Consecutive patients with acute first-ever ischemic stroke were included prospectively in Lund Stroke Register Study at Skane University Hospital, Sweden. Exclusion criteria were: (a) non-native Swedish; (b) obtundation (c) dementia or psychiatric diagnosis. Patients were assessed with NIHSS item 9 (range 0-3, where 1-3 indicate aphasia) by a NIHSS certified research nurse in the acute phase after stroke onset (median 3 days). Within 24 h after this assessment, a speech therapist evaluated the patients' language function with the comprehensive language screening test (LAST, range 0-15 where 0-14 indicates aphasia). Data were analyzed using LAST as 'reference standard'. Results We examined 221 patients. Among these, 23% (n = 50) had aphasia according to NIHSS (distribution of scores 0, 1, 2, 3 were n = 171, n = 29, n = 12, n = 9) compared to 26% (n = 58) with aphasia according to LAST (score <= 14; median = 11). Assuming LAST as reference standard, NIHSS gave 16 false negatives (NIHSS item 9 = 0) for aphasia (LAST scores range 8-14), and 8 false positives (NIHSS item 9 score = 1) for aphasia, yielding a sensitivity of 72% (0.59-0.83) and a specificity of 95% (0.91-0.98). Conclusions When using NIHSS for screening and diagnosing aphasia in adults with acute ischemic stroke, patients with severe aphasia can be detected, however, some mild aphasias might be misclassified. Given the 72% sensitivity, absence of aphasia on the NIHSS should not be used to guide stroke treatment.
  •  
29.
  • Hagberg, Lars, 1951, et al. (författare)
  • Blood biomarkers for HIV infection with focus on neurologic complications-A review.
  • 2022
  • Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 146:1, s. 56-60
  • Tidskriftsartikel (refereegranskat)abstract
    • Although clinical examinations, neuroimaging, and cerebrospinal fluid analyses are the most important ways to evaluate the impact of HIV infection on the brain and in diagnosis of opportunistic infections, several blood biomarkers including HIV RNA concentrations, CD4 +T-cell count, and neurofilament light chain protein (NfL) concentration, along with tests for opportunistic infections can provide important information for clinical decisions.
  •  
30.
  •  
31.
  • Hellgren, Johan, et al. (författare)
  • Rituximab in multiple sclerosis at general hospital level
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 141:6, s. 491-499
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The use of rituximab (RTX) in multiple sclerosis (MS) is a rapidly increasing choice of disease-modifying therapy. Efficacy outside specialized university hospital-based care is not yet systematically investigated. Our aim was to evaluate off-label RTX treatment for MS at a general hospital in Sweden. Materials and Methods: Subjects with definite MS with at least one rituximab infusion were eligible for inclusion in this retrospective, observational study. Effect was evaluated by monitoring clinical disability, annual relapse rate, new lesions on MRI, and safety by the incidence and severity of adverse events. Results: Among the 83 included subjects, 15 had clinical worsening of disease during the median 23.5 (1-76) months of follow-up after RTX initiation: 7/66 with relapsing-remitting multiple sclerosis (RRMS) and 8/17 with progressive subtypes (PMS). Cumulative survival without worsening was 86% in RRMS and 30% in PMS. The annual relapse rate before RTX vs follow-up dropped from 0.38 to 0.05 (P < .00001). Subjects with new enhancing lesions on MRI during the first year before RTX initiation vs the year after dropped from 0.94 to 0.024 (P < .00001) and was only seen in RRMS (1.05-0.31, P = .00003). Adverse events were mainly mild. Thirty-six out of 53 non-infusion–related adverse events were infections, of which four were serious, including a case of pneumonia with concomitant late-onset neutropenia. Conclusions: Rituximab was as effective and safe when given at a general hospital outpatient clinic compared with results from previous university hospital-based studies. Vigilance is required concerning severe adverse events.
  •  
32.
  • Hjalte, Frida, et al. (författare)
  • Parkinson’s disease in Sweden—resource use and costs by severity
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 144:5, s. 592-599
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To estimate resource use and costs, including direct and indirect costs, in relation to levels of severity in individuals with Parkinson's disease (PD) in a Swedish setting. Materials and methods: Patients with idiopathic PD registered in the National Parkinson's Disease Patient Registry (PARKreg), with registrations of Hoehn and Yahr (H&Y) and “off time” in the Skåne Region, were included. Annual costs of healthcare contacts, drugs, formal and informal care, and productivity loss associated with PD were estimated using data from PARKreg linked with regional and national healthcare registers between 2013 and 2019. Results: In total, 960 patients and 1324 observations (patient-years) were included. Total average cost per patient-year was SEK 168,982 (EUR 15,958) and ranged from SEK 62,404 (EUR 5893) for H&Y stage I to SEK 1,056,324 (EUR 99,755) in H&Y stage V. The dominating part of total costs for early stages were indirect costs accounting for 50–60% while formal care made up for 55% and 81% of total costs in H&Y IV and V, respectively. Total mean costs for formal care, informal care, and productivity loss also increased with increasing off-time. Conclusion: Advanced and late stages of PD are associated with significant societal costs as patients in those stages often require resource-intensive and costly formal care. Thus, there are potential savings to be made, by optimizing the pharmacological and surgical symptomatic treatment of patients with advanced disease.
  •  
33.
  • Hofgren, Caisa, 1952, et al. (författare)
  • Cognitive screen and employment long-term after infratentorial stroke
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 145:5, s. 610-618
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Motor problems are well-described neurological deficits that occur commonly after an infratentorial ischemic stroke. However, the brain stem and cerebellum are also part of the neural interconnections responsible for cognition, emotions, and behavioral responses. We lack studies on long-term cognitive outcomes and patient employment after an infratentorial stroke. In the present study, we described and compared long-term poststroke cognitive outcomes and employment between patients that experienced infratentorial and supratentorial ischemic strokes. Materials and Methods: We included consecutive patients that experienced an acute ischemic stroke at <= 58 years of age. Patients were classified according to the stroke location. At seven years poststroke, surviving participants were assessed for neurological deficits (National Institutes of Health Stroke Scale [NIHSS]), functional outcome (modified Rankin Scale [mRS]), cognitive function Barrow Neurological Institute Screen (BNIS), and employment. Results: Among 141 participants, 25 (18%) had infratentorial and 116 (82%) had supratentorial strokes. At the 7-year poststroke follow-up, there was no significant difference in BNIS total scores; with a median of 43 (IQR 40.5-46) and 41 (IQR 38-46) in the infratentorial and supratentorial groups, respectively. This result indicated that cognitive dysfunction occurred frequently in both groups. Similar employment rates were observed in the infratentorial (48%) and supratentorial (55%) groups. Both groups had a median NIHSS score of 0 and a median mRS score of 2 at the 7-year follow-up. Conclusion: Patients who survived an infratentorial or supratentorial ischemic stroke had similar rates of long-term cognitive dysfunction and difficulties in returning and/or remaining at work.
  •  
34.
  • Holmegaard, Lukas, et al. (författare)
  • Proinflammatory protein signatures in cryptogenic and large artery atherosclerosis stroke
  • 2021
  • Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 143:3, s. 303-312
  • Tidskriftsartikel (refereegranskat)abstract
    • The cause of ischemic stroke remains unknown, cryptogenic, in 25% of young and middle-aged patients. We hypothesized that if atherosclerosis is prominent in cryptogenic stroke, it would have a similar proinflammatory protein signature as large artery atherosclerosis (LAA) stroke.Blood was collected in the acute phase and after 3months from cryptogenic (n=162) and LAA (n=73) stroke patients aged 18-69years and once from age-matched controls (n=235). Cryptogenic stroke was divided into Framingham Risk Score (FRS) quartiles to compare low and high risk of atherosclerosis. Plasma concentrations of 25 proteins were analyzed using a Luminex multiplex assay. The discriminating properties were assessed with discriminant analysis and C-statistics.We identified proteins that separated cryptogenic and LAA stroke from controls (area under the curves, AUCs≥0.85). For both subtypes, RANTES, IL-4, and IFN-γ contributed the most at both time points. These associations were independent of risk factors of atherosclerosis. We also identified proteins that separated cryptogenic strokes in the lowest quartile of FRS from those in the highest, and from LAA stroke (AUCs≥0.76), and here eotaxin and MCP-1 contributed the most.The protein signature separating cases from controls was different from the signature separating cryptogenic stroke with low risk of atherosclerosis from those with high risk and from LAA stroke. This suggests that increased RANTES, IL-4, and IFN-γ in stroke may not be primarily related to atherosclerosis, whereas increased eotaxin and MCP-1 in cryptogenic stroke may be markers of occult atherosclerosis as the underlying cause.
  •  
35.
  • Holtback, Charlotte, et al. (författare)
  • Mid-life extrapyramidal symptoms predict cognitive impairment 23 years later
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 145:3, s. 305-313
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The prevalence of dementia is growing rapidly worldwide. The early identification and treatment of cognitive decline could reduce the burden on the health care system. Our objective was to investigate whether factors measured at an examination at age 50 predict cognitive impairment (CI) 23 years later. Materials & Methods In 1993 we enrolled a randomly selected sample of 798 men, 50 years of age, from the general population. They all underwent a physical examination, provided blood samples and filled out questionnaires addressing lifestyle and psychosocial factors. Cognitive testing was offered to all participants still alive in 2016, at age 73. Results A total of 333 men participated in the cognitive study, of which 80 (24.0%) performed at a level corresponding to mild cognitive impairment, and four (1.2%) at a level consistent with severe cognitive impairment. After the first step in the multivariable analysis, hypertension, heavy smoking, high intake of alcohol, financial stress, difficulty falling asleep, and cogwheel rigidity were associated with cognitive impairment. After further adjustment, only wide waist circumference measured in cm (OR 1.04, 95% CI 1.00-1.08, p = .04), leg pendulousness (OR 41.97, 95% CI 3.27-538.62, p = .004) and self-assessed hidden irritability (OR 2.18, 95% CI 1.10-4.32, p = .03) at baseline, remained as being associated with cognitive impairment 23 years later. Conclusions Extrapyramidal symptoms such as leg pendulousness, at the age of 50, may be an indicator for very early identification of future cognitive decline.
  •  
36.
  • Jacobsson, Lars, et al. (författare)
  • Functioning and disability from 10 to 16 years after traumatic brain injury
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : John Wiley & Sons. - 0001-6314 .- 1600-0404. ; 141:2, s. 115-122
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesWith increased long‐term survival after traumatic brain injury (TBI), there is a need to understand the life situation many years after the injury. In this study, we have assessed persons on average 16 years after their injury and determined changes over 6 years in overall outcome, living condition, marital status and vocational situation, and in their functioning and disability.Materials & MethodsIndividuals (n = 49, mean age 45 years, 28‐70 years) who were assessed 6‐15 years (average 10 years) post‐TBI were reassessed 12‐21 years after their injury (average 16 years) using internationally established TBI outcome measures.ResultsFrom the first to the second assessment, overall outcome using the Glasgow Outcome Scale (GOS) was stable for a large majority and no significant changes in marital status or vocational situation was found. There was some significant, but very small, decline regarding cognitive function, home integration and social integration. In the multiple regression analysis, there was a small significant decline in the Mayo‐Portland Adaptability Inventory (MPAI‐4) Adjustment subscale score for women with a moderate‐to‐severe injury.ConclusionsThe very small changes over 6 years imply that persons with a TBI can reach and maintain a stable level of functioning many years post‐TBI. Women with a moderate‐to‐severe TBI seem to be more vulnerable and may experience a small decline in some aspects of their functioning related to anxiety, depression, irritability, pain and headache and fatigue. The relatively small sample requires further studies to confirm these findings.
  •  
37.
  • Johansson, Kalle, et al. (författare)
  • Fatigue, insomnia and daytime sleepiness in multiple sclerosis versus narcolepsy
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 144:5, s. 566-575
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives In multiple sclerosis (MS), fatigue is the most prevalent cause of impaired ability to work. In narcolepsy, daytime sleepiness is the main symptom but some studies indicate fatigue being present. We aimed to assess fatigue and associated features in patients with MS or narcolepsy and healthy controls and to assess whether clinical parameters separate fatigued (MS-F) and non-fatigued MS patients (MS-NoF). Materials & Methods In this non-interventional cross-sectional study, we recruited 34 MS patients, 15 narcolepsy type 1 patients and 17 healthy controls. An interviewer administered the Fatigue Severity Scale (FSS), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale, the Patient Health Questionnaire-9 and the Saltin-Grimby Physical Activity Level Scale. Information about clinical parameters and current treatments was collected. Results In its fatigue profile, MS-F resembled the narcolepsy group rather than MS-NoF, which resembled the healthy control group. ISI alone was significantly associated with FSS, and only in MS-NoF and healthy controls; in MS-F and the narcolepsy group, no variable was associated with FSS. Months since diagnosis was the only clinical variable significantly separating MS-F from MS-NoF. In MS, disease duration correlated with fatigue. No clinical variables correlated with fatigue in the narcolepsy group. Conclusions Fatigued MS patients resemble narcolepsy patients more than they resemble non-fatigued MS patients, who resemble healthy controls. Insomnia is the main factor associated with fatigue in MS, while disease duration is the only clinical variable separating fatigued and non-fatigued MS patients. In fatigued patients, variance in fatigue cannot be explained by insomnia, daytime sleepiness, depression or level of exercise.
  •  
38.
  • Jons, Daniel, 1974, et al. (författare)
  • Intrathecal immunoreactivity in people with or without previous infectious mononucleosis
  • 2020
  • Ingår i: Acta Neurologica Scandinavica. - : John Wiley & Sons. - 0001-6314 .- 1600-0404. ; 142:2, s. 161-168
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The risk of developing multiple sclerosis (MS) increases (OR: 3.1) after infectious mononucleosis (IM). However, the nature of this link is obscure. We tested the hypothesis that IM might incur long-term sequelae, including low-key inflammatory activity, with characteristics of an MS endophenotype (or presymptomatic trait) and that assays of MS-relevant cyto-/chemokines in the cerebrospinal fluid (CSF) post-IM may show a trend in this direction.Materials and methods: We selected seven CSF cytokines (IL-1b, IL-6, YKL-40, TNF-alpha) or chemokines (IL-8, CCL2, IP-10), representing pro-inflammatory factors previously associated with MS. We assayed the CSF levels of these seven cyto-/chemokines in healthy individuals with a median follow-up time of 10 years after serologically confirmed IM (post-IM group, n = 22), and in healthy controls without a history of IM (n = 19). A group of MS patients (n = 23) were included as reference.Results: The CSF levels of IP-10, YKL-40, and CCL-2 were higher in the post-IM group than in our IM unexposed controls (P = .021, .049, .028). Seven of seven cyto-/chemokine assays showed a trend in the predicted direction (Pof binomial ratio = .008). However, this trend was non-significant in a multivariate test (P = .22). A power analysis indicated that similar studies including a larger cohort would be numerically realistic.Conclusions: These results do not reject the hypothesis that the established epidemiological association between IM and MS results from a stepwise inflammatory propagation from IM sequelae to an MS endophenotype (or presymptomatic trait) in a proportion of IM patients, pending confirmation with adequate power.
  •  
39.
  • Karlstedt, Michaela, et al. (författare)
  • Sense of Coherence in partners to persons with Huntington's disease
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 144:5, s. 576-584
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Huntington's disease (HD) is a progressive neuropsychiatric disease characterized by involuntary movements and behavioural symptoms. This study aimed to explore the association between the level of Sense of Coherence (SOC) and health problems, and psychological distress factors in partners to HD affected persons and their need of support.MATERIALS & METHODS: A cross-sectional, descriptive, correlational design was used. Data was generated from 94 HD partners from almost all networks, outpatient clinics and nursing homes specialized in HD across Sweden. HD partners filled out questionnaires with scales measuring SOC, health problems, psychological distress factors and the Total Functional Capacity Scale (TFC). Non-parametric analysis was used to analyse group differences.RESULTS: Huntington's disease partners with a lower level of SOC experienced more health problems than those with a higher level. Health problems among HD partners were most common among HD affected in TFC stage 3, indicating that the partners need most support during this period. Lower level of SOC was associated with loneliness in the relationship; less possibilities to socialize with friends; worries about the future as well as being subjected to physical aggression. The experience of physical aggression from the HD affected person was common (44.7%) and 28.6% of the partners expressed worries about being subjected to physical aggression.CONCLUSION: Our findings suggest that knowledge about the partners' SOC score may be a helpful indicator identifying HD partners who are more vulnerable and need additional help caring for the person with HD and can be a complementary tool in assessment protocols.
  •  
40.
  •  
41.
  • Kosek, S., et al. (författare)
  • Antibody-Positive Autoimmune Encephalitis and Paraneoplastic Neurological Syndrome: Epidemiology and Outcome of Neuronal Antibody Testing in Sweden
  • 2023
  • Ingår i: ACTA NEUROLOGICA SCANDINAVICA. - : WILEY. - 0001-6314 .- 1600-0404. ; 2023
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To estimate the 5-year incidence rate of autoimmune encephalitis (AE) and paraneoplastic neurological syndrome (PNS) in Sweden. Methods. All patients who were tested for a neuronal antibody in Sweden between 2015 and 2019 were included. Patients in Healthcare region Mid Sweden (population 2.1 million) were invited to participate in a case ascertainment substudy. AE and PNS cases were defined using established diagnostic criteria. Crude and age-adjusted incidence rates of AE and PNS in Healthcare region Mid Sweden were estimated. Results. The number of tests for neuronal antibodies in Sweden increased between 2015 and 2019 from 1867 to 2505 (serum) and 863 to 1376 (CSF) per annum. The frequencies of positive results were stable over the entire study period, and the mean value was 6.1% for serum (CI95% 5.5-6.7) and 4.8% for CSF (CI95% 4.0-5.6). In total, 125 patients tested positive for neuronal antibodies in Healthcare region Mid Sweden between 2015 and 2019. Of these, 94 were included, and after case ascertainment, thirty-one cases of definite AE or PNS could be identified. The 5-year incidence rate of AE and PNS was 3.0 per million person-years (95% CI 1.9-4.1). The yearly incidence rates increased in the study period, from 1.5 per million person-years in 2015 (95% CI 0.0-3.2) to 4.3 per million person-years in 2019 (95% CI 1.5-7.1). Conclusions. In this first epidemiological study of AE and PNS in Sweden, the number of cases doubled from 2015 to 2019. This likely reflects increased availability of testing and awareness of these conditions.
  •  
42.
  •  
43.
  • Landtblom, Anne-Marie, et al. (författare)
  • Multiple sclerosis and COVID-19 : The Swedish experience
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : John Wiley & Sons. - 0001-6314 .- 1600-0404. ; 144:3, s. 229-235
  • Forskningsöversikt (refereegranskat)abstract
    • The COVID-19 pandemic has brought challenges for healthcare management of patients with multiple sclerosis (MS). Concerns regarding vulnerability to infections and disease-modifying therapies (DMTs) and their complications have been raised. Recent published guidelines on the use of DMTs in relation to COVID-19 in MS patients have been diverse between countries with lack of evidence-based facts. In Sweden, there exists a particular interest in anti-CD20 therapy as a possible risk factor for severe COVID-19 due to the large number of rituximab-treated patients off-label in the country. Rapid responses from the Swedish MS Association (SMSS) and the Swedish MS registry (SMSreg) have resulted in national guidelines on DMT use for MS patients and implementation of a COVID-19 module in the SMSreg. Recently updated guidelines also included recommendations on COVID-19 vaccination with regard to the different DMTs. Social distancing policies forced implementation of telemedicine consultation to replace in-person consultations as part of regular MS health care. Patient-reported outcome measures (PROMs) in SMSreg have been useful in this respect. This paper reports our experiences on the progress of national MS health care during the COVID-19 pandemic, in addition to offering an overview of the present scientific context.
  •  
44.
  •  
45.
  • Link, Yumin, et al. (författare)
  • Retinal changes associated with multivitamin deficiency before and after supplementation
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Wiley. - 0001-6314 .- 1600-0404. ; 144:2, s. 209-215
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Nutritional visual defects are apparently uncommon nowadays in developed nations. Retinal change-related visual defects caused by hypovitaminoses may be underdiagnosed. Aim of the study: To investigate the retinal structural and functional changes in a patient with multivitamin deficiency before and during vitamin supplementation. Methods: A 51-year-old female had been on vegetarian diet as a child, and on restrict vegan diet during the last 2 years, developing severe bilateral deterioration of visual function and polyneuropathy. Blood test revealed low levels of vitamin A, B6 and D. The patient underwent examinations with optical coherence tomography (OCT), computerized visual field examination (VF), electroretinography (ERG), visual evoked potentials (VEP) and neurography before and after vitamin supplementation. Results: Visual acuity (VA) was 20/1000 and VF examination showed central scotoma in both eyes. Color vision was significantly affected. Full-field ERG showed normal rod and cone function, but a clearly reduced central peak was registered in multifocal ERG (mf-ERG), indicating impaired fovea function. VEP showed delayed latency and low amplitude of P100 in both eyes. Neurography showed sensory polyneuropathy. OCT showed significant thinning of macular ganglion cell plus inner plexiform layer (GCIPL) with rapid progression. Retinal nerve fiber layer (RNFL) was preserved and normal, which is in contrast to neuroinflammatory conditions. After 2.5 years of multivitamin supplementation, the visual functions were improved. GCIPL thickness was stable without further deterioration. Conclusions: Multivitamin deficiency results in progressive thinning of GCIPL with severe visual deterioration. In contrast to neuroinflammation, RNFL is preserved and normal. Stabilized GCIPL during vitamin supplementation was associated with improved visual function. OCT provides a sensitive and objective measure for differential diagnosis, monitoring retinal change and response to therapy.
  •  
46.
  • M. Norlin, Jenny, et al. (författare)
  • Quality of life and resource utilization-Swedish data from the Care of Late-Stage Parkinsonism (CLaSP) study
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 145:6, s. 743-752
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Few studies have investigated the health-related quality of life (HRQoL), resource use and costs in patients with late-stage Parkinson's disease (PD), and data from the Swedish setting are scarce. Objectives: First, we analyse the HRQoL in late-stage PD in Sweden. Second, we analyse the resource use and costs per severity level. Third, we analyse the relationship between costs and physician- and patient reported-outcome measures. Materials and methods: The study was based on Swedish data from the Care of Late-Stage Parkinsonism (CLaSP) study. The costs of healthcare contacts, drugs, formal and informal care, and productivity loss were collected over three months. Assessments at baseline were used for outcomes (EQ-5D, Hoehn and Yahr (H&Y), Schwab and England Scale, Unified Parkinson's Disease Rating Scale subscales (UPDRS) and Non-Motor Symptoms Scale (NMSS)). Costs were estimated in € 2016. Results: In total, 106 patients were included. The mean EQ-5D score in the total group was 0.24 (±0.33). The mean total cost excluding informal care per patient in the three-month period was approximately €14,097 (BCa 95% CI €12,007 and €16,039). Professional care accounted for the largest share (75 percent) of the total costs. The EQ-5D, H&Y, Schwab and England Scale, and NMSS were statistically significant predicting factors for total costs. Conclusion: Patients with late-stage PD are a vulnerable patient group that is costly to society and the impairment in patients’ HRQoL is immense. Thus, healthcare decision-makers should optimize the organization and provision of healthcare for these patients.
  •  
47.
  •  
48.
  • Magnusson, Carl, 1976, et al. (författare)
  • Difficulties in the prehospital assessment of patients with TIA/stroke
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 143:3, s. 318-325
  • Tidskriftsartikel (refereegranskat)abstract
    • Background In patients with TIA/stroke, early assessment is critical. Aim To describe patients who were not directly transported to hospital by ambulance after prehospital assessment. Methods Patients hospitalized with TIA/stroke in Gothenburg, Data were obtained from the EMS and hospital case record system. Results There were 7,812 patients with TIA/stroke, of which 4,853 (62%) were candidates for EMS transport. Among them, 176 (3.6%) were not directly transported to hospital by ambulance. In 45% of them, delay from symptom onset to calling for EMS was <= 24 hours. On EMS arrival, common symptom was dizziness (28%), followed by weakness in arm or leg (21%), loss of sensibility (13%), speech disturbances (7%), and facial numbness (4%). The modified National Institute of Health Stroke Score (mNIHSS) was 0 in 80% and >1 in two per cent. The NIHSS at the emergency department was 1-4 in 39% and 5-15 in six per cent. The EMS clinician made the decision not to transport the patient to hospital by the EMS in 84%, the dispatcher in 12% and the patient or relatives in four per cent. Patients were involved in the decision in 51%. Final diagnosis was stroke in 74% and the proportion who were independent in normal daily activities at hospital discharge decreased by 15% compared with before event. Conclusion About 3%-4% of patients with TIA/stroke were not directly transported to hospital by EMS after prehospital assessment. The most common symptom was dizziness. Decision-support tools for EMS to identify time-sensitive conditions are required.
  •  
49.
  • Magnusson, Carl, 1976, et al. (författare)
  • Prehospital recognition of stroke is associated with a lower risk of death
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Publishing Corporation. - 0001-6314 .- 1600-0404. ; 146:2, s. 126-136
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Among patients assessed by the emergency medical service (EMS) and hospitalized with a final diagnosis of stroke, to describe delays, patient characteristics, actions taken and outcome in relation to the early recognition of stroke by the EMS clinician.Methods: Patients admitted to any of six stroke units in Region Västra Götaland, Sweden, with a final diagnosis of stroke from 1 January 2013 to 31 December 2015 were included. Data on follow-up were retrieved from the Swedish Stroke Register.Results: In all, 5467 patients were included. Stroke was recognized by the EMS clinician in 4396 cases (80.4%). The mean difference in the time from dialling 112 until arrival at the stroke unit was 556 min shorter when stroke was recognized, while the mean difference in the time from dialling 112 until a preliminary report from a computed tomography (CT) scan was 219 min shorter as compared with the patients in whom stroke was not recognized. After adjustment for age, sex, neurological deficits and coma, a lack of suspicion of stroke on EMS arrival was associated with an increased risk of death during three months of follow-up (odds ratio 1.66; 95% confidence interval 1.19-2.32; p = .003).Conclusion: Among patients with a stroke, more than 80% were recognized by the EMS clinician. Early recognition of stroke was associated with a markedly shorter time until arrival at the stroke unit and until the preliminary report of a CT scan. A lack of early stroke recognition was associated with an increased risk of death. 
  •  
50.
  • Mahamud, Zamzam, et al. (författare)
  • Temporal trends of epilepsy in multiple sclerosis
  • 2022
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146:5, s. 492-498
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives Epilepsy is associated with advanced multiple sclerosis (MS). We aimed to investigate whether the incidence of epilepsy in MS has been affected by the introduction of disease-modifying treatments (DMT) for MS. Materials and methods This retrospective study included 14,557 patients from the Swedish MS register with MS onset between 1991 and 2018. Incident diagnoses of epilepsy or any seizure were identified through cross-linkage with the National Patient Register. Next, yearly prevalence of epilepsy as well as 5- and 10 years incidence of epilepsy or any seizure for consecutive years of MS onset were estimated, the latter with Kaplan-Meier analysis. Cox regression was used to adjust the association between the year of MS onset and incidence of epilepsy for baseline variables. Results Prevalence of epilepsy in the MS cohort increased from 0.34% in 1991 to 2.54% in 2018 (yearly odds: 1.26 [1.22, 1.29]). The 5 years incidence rate of epilepsy, ranging from 0.4% (95% CI 0.008-0.79%) to 1.3% (95% CI 0.71-1.89%), and the 10 years incidence rate of epilepsy, ranging from 1.1% (95% CI 0.31-1.88%) to 2.6% (95% CI 1.22-3.97%) showed no significant trends (p = .147 and p = .418, respectively). Similarly, no significant trends were found for the incidences of any seizure. The incidence trends of epilepsy remained not significant after adjusting for sex, MS onset type (relapsing or progressive onset), or age at MS onset. Conclusions Our findings do not support the hypothesis that the introduction of novel DMT for MS has reduced the incidence of epilepsy among MS patients.
  •  
Skapa referenser, mejla, bekava och länka
  • Resultat 1-50 av 88
Typ av publikation
tidskriftsartikel (86)
forskningsöversikt (2)
Typ av innehåll
refereegranskat (83)
övrigt vetenskapligt/konstnärligt (5)
Författare/redaktör
Zetterberg, Henrik, ... (9)
Jood, Katarina, 1966 (8)
Odin, Per (6)
Jern, Christina, 196 ... (5)
Zelano, Johan, 1981 (5)
Petersson, Jesper (4)
visa fler...
Blomstrand, Christia ... (4)
Norrving, Bo (4)
Landtblom, Anne-Mari ... (3)
Blennow, Kaj, 1958 (3)
Block, Linda (3)
Stibrant Sunnerhagen ... (3)
Link, Yumin (3)
Lindgren, Arne (3)
Burman, Joachim, 197 ... (3)
Malmeström, Clas, 19 ... (3)
Odenstedt Hergès, He ... (3)
Hansson, Per-Olof, 1 ... (3)
Samuelsson, Hans, 19 ... (3)
Wasling, Pontus, 197 ... (3)
Vrethem, Magnus (3)
Naredi, Silvana, 195 ... (3)
Tatlisumak, Turgut (2)
Fredrikson, Mats (2)
Herlitz, Johan, 1949 (2)
Hillert, J (2)
Sundquist, Kristina (2)
Holmegaard, Lukas (2)
Tomson, T (2)
Compagno Strandberg, ... (2)
Englund, Elisabet (2)
Andersen, Oluf, 1941 (2)
Sundquist, Jan (2)
Axelsson, Markus, 19 ... (2)
Li, Xinjun (2)
Andreasson, Ulf, 196 ... (2)
Carlsson, Axel C. (2)
Magnusson, Carl, 197 ... (2)
Ben-Menachem, Elinor ... (2)
Ullberg, Teresa (2)
Ozanne, Anneli, 1978 (2)
Bolin, Kristian (2)
Wändell, Per (2)
Appelros, Peter (2)
Rydenhag, Bertil, 19 ... (2)
Oldfors Hedberg, Car ... (2)
Berntsson, Shala G., ... (2)
Boström, Inger (2)
Bjerkne Wenneberg, S ... (2)
Sörbo, Ann, 1955 (2)
visa färre...
Lärosäte
Göteborgs universitet (45)
Karolinska Institutet (26)
Lunds universitet (21)
Uppsala universitet (15)
Linköpings universitet (11)
Umeå universitet (7)
visa fler...
Örebro universitet (4)
Högskolan i Borås (2)
Luleå tekniska universitet (1)
Högskolan i Skövde (1)
Marie Cederschiöld högskola (1)
visa färre...
Språk
Engelska (88)
Forskningsämne (UKÄ/SCB)
Medicin och hälsovetenskap (79)

År

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

 
pil uppåt Stäng

Kopiera och spara länken för att återkomma till aktuell vy