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  • 51.
    Landtblom, Anne-Marie
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Fridriksson, Steen
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurokirurgi. Linköpings universitet, Hälsouniversitetet.
    Boivie, Jörgen
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Hillman, Jan
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurokirurgi. Linköpings universitet, Hälsouniversitetet.
    Johansson, G.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Johansson, Ingegerd
    Linköpings universitet, Institutionen för medicin och vård, Radiologi. Linköpings universitet, Hälsouniversitetet.
    Sudden onset headache: a prospective study of features, incidence and causes2002Ingår i: Cephalalgia, ISSN 0333-1024, E-ISSN 1468-2982, Vol. 22, nr 5, s. 354-360Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sudden onset headache is a common condition that sometimes indicates a life- threatening subarachnoid haemorrhage (SAH) but is mostly harmless. We have performed a prospective study of 137 consecutive patients with this kind of headache (thunderclap headache = TCH). The examination included a CT scan, CSF examination and follow-up of patients with no SAH during the period between 2 days and 12 months after the headache attack. The incidence was 43 per 100 000 inhabitants > 18 years of age per year; 11.3% of the patients with TCH had SAH. Findings in other patients indicated cerebral infarction (five), intracerebral haematoma (three), aseptic meningitis (four), cerebral oedema (one) and sinus thrombosis (one). Thus no specific finding indicating the underlying cause of the TCH attack was found in the majority of the patients. A slightly increased prevalence of migraine was found in the non-SAH patients (28%). The attacks occurred in 11 cases (8%) during sexual activity and two of these had an SAH. Nausea, neck stiffness, occipital location and impaired consciousness were significantly more frequent with SAH but did not occur in all cases. Location in the temporal region and pressing headache quality were the only features that were more common in non-SAH patients. Recurrent attacks of TCH occurred in 24% of the non-SAH patients. No SAH occurred later in this group, nor in any of the other patients. It was concluded that attacks caused by a SAH cannot be distinguished from non-SAH attacks on clinical grounds. It is important that patients with their first TCH attack are investigated with CT and CSF examination to exclude SAH, meningitis or cerebral infarction. The results from this and previous studies indicate that it is not necessary to perform angiography in patients with a TCH attack, provided that no symptoms or signs indicate a possible brain lesion and a CT scan and CSF examination have not indicated SAH.

  • 52.
    Landtblom, Anne-Marie
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Riise, T
    Kurtzke, JF
    Further considerations on the distribution of multiple sclerosis in Sweden2005Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 111, nr 4, s. 238-246Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives - The geographic distribution of multiple sclerosis (MS) in Sweden over time was compared in order to analyze homogeneity. Methods - The distribution of MS was compared among three nationwide resources: 1301 hospital cases 1925-1934, 5425 deaths 1952-1992, and 11,371 disability pension recipients 1971-1994. Results - Distributions by county (län) were markedly non-homogenous, with greatest variations in the early prevalence series (16-232% of the national mean), less within the death data (75-170%), and least for the disability series (87-128%). Maximal rates for MS in the early prevalence series were found for the cluster of seven counties surrounding the two major lakes of south central Sweden, as well as for one region on the northern shore of the Bay of Bothnia, and another also off the Bay north of Stockholm. Conclusion - Though the epidemiologic sources are quite different, they are internally consistent and thus provide three consecutive cross-sectional views of the distribution over time. When considered together the data may be compatible with a thesis of the origin and spread of MS within Sweden from the south-central inland lake regions of the country. Such spread within a half century is too rapid for a genetic cause, including HLA patterns. Copyright © Blackwell Munksgaard 2005.

  • 53.
    Landtblom, Anne-Marie
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Tondel, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Yrkes- och miljömedicin. Östergötlands Läns Landsting, Smärt- och yrkesmedicinskt centrum, Yrkes- och miljömedicinskt centrum.
    Hjalmarsson, Peter
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Socialmedicin och folkhälsovetenskap.
    Flodin, Ulf
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Yrkes- och miljömedicin. Östergötlands Läns Landsting, Smärt- och yrkesmedicinskt centrum, Yrkes- och miljömedicinskt centrum.
    Axelson, Olav
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Yrkes- och miljömedicin. Östergötlands Läns Landsting, Smärt- och yrkesmedicinskt centrum, Yrkes- och miljömedicinskt centrum.
    The risk for multiple sclerosis in female nurse anaesthetists: A register based study2006Ingår i: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 63, nr 6, s. 387-389Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Previous studies have suggested that exposure to organic solvents, including volatile anaesthetic agents, may be a risk factor for multiple sclerosis (MS), possibly in combination with genetic and other environmental factors. Aims: To further investigate the role of volatile anaesthetic agents having similar acute toxic effects to other organic solvents. Methods: Female nurse anaesthetists, other female nurses, and female teachers from middle and upper compulsory school levels were identified and retrieved from the 1985 census, Statistics Sweden. By means of the unique personal identity number in Sweden, these individuals were linked with the disability pension registers at The National Social Insurance Board and also with data on hospital care 1985-2000 at The National Board of Health and Welfare. Results: The cumulative incidence rate ratio of MS was found to be increased in female nurse anaesthetists in relation to other nurses (statistically not significant) and teachers (statistically significant), respectively. Conclusions: These findings give some support to previous findings of an increased risk for MS in nurse anaesthetists. This is interesting in the context of previous observations of organic solvents in general as a potential risk factor in MS.

  • 54.
    Larsson, Barbro
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Rehabiliteringsmedicin. Linköpings universitet, Hälsouniversitetet.
    Kadi, Fawzi
    Department of Physical Education and Health, Örebro University, Örebro, Sweden.
    Lindvall, Björn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Gerdle, Björn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Rehabiliteringsmedicin. Östergötlands Läns Landsting, Smärt- och yrkesmedicinskt centrum, Smärt- och rehabiliteringscentrum. Linköpings universitet, Hälsouniversitetet.
    Surface electromyography and peak torque of repetitive maximum isokinetic plantar flexions in relation to aspects of muscle morphology2006Ingår i: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 16, nr 3, s. 281-290Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study investigates the relationships between surface electromyography (EMG [Mean frequency of the power spectrum (MNF)]) and peak torque variables obtained during 100 maximum concentric plantar flexions with the right limb at 60° s−1 and different muscle morphological variables. Surface EMG was recorded from the right gastrocnemius lateralis and muscle biopsies were taken from the same site as the EMG electrodes were positioned. Muscle fibre area and fibre type composition were determined on serial muscle cross sections using both histochemistry (myofibrillar adenosine triphosphatase) and immunohistochemistry (monoclonal antibodies against specific myosin heavy chain isoforms). Forty-three female and nine male students participated in the study. Gastrocnemius lateralis contained predominantly type I fibres (50%) and type IIA fibres (40%) in both sexes and large individual differences were found. Principal component analysis (PCA) was used for the intercorrelation analyses, and projection to latent structures (PLS) was used for the multivariate regression analysis. MNF correlated positively with different fibre areas and with the proportion of type I fibres. Fibre areas and sex were the most important factors in the regression of maximum peak torque. High proportion of type I fibres and sex were the most important regressors of peak torque endurance normalised for lean body mass.

    More studies are needed to understand the complex interrelationships between intrinsic muscle properties and the frequency content of the surface EMG before theoretical models can be formulated that incorporate both fibre areas and fibre type proportions.

  • 55. Leerbeck, K
    et al.
    Caceres, R
    Landtblom, Anne-Marie
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Effect of antiepileptic drugs on blood levels of homocysteine2005Ingår i: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, s. 845-845Artikel i tidskrift (Övrigt vetenskapligt)
  • 56.
    Lindgren, Arne
    et al.
    Lund.
    Ansved, Tor
    Solna.
    Aquilonius, Sten-Magnus
    Uppsala.
    Fredrikson, Sten
    Huddinge.
    Malm, Jan
    Umeå.
    Mattsson, Peter
    Uppsala.
    Petersson, Jesper
    Malmö.
    Rönnbäck, Lars
    Göteborg.
    Söderfeldt, Birgitta
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Wägner, Anna
    Solna.
    Nationellt core curriculum i neurologi för läkarutbildningen2004Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, s. 2261-2263Artikel i tidskrift (Övrigt vetenskapligt)
  • 57.
    Lindvall, Björn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk immunologi. Linköpings universitet, Hälsouniversitetet.
    Immunohistological studies on muscle biopsies: clinical and pathogenetic aspects on inflammatory myopathies2002Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Inflammatory myopathies constitute a heterogeneous group of disorders comprising polymyositis (PM), dermatomyositis (DM), inclusion body myositis (IBM), as well as overlap syndromes where inflammatory myopathy is associated with different inflammatory systemic diseases, e.g, Sjögren's syndrome. Immunohistochemical methods are increasingly used in the diagnostic evaluation of muscle biopsies, as well as in the search for pathogenetic mechanisms in neuromuscular diseases. The aim of the present thesis was to evaluate immunological markers in the context of diagnostic use and pathogenetic mechanisms in patients with inflammatory myopathies (IM).

    In the first paper, the expression of inflammatory markers was investigated in muscle biopsies from 58 healthy subjects, since no large studies on normal expression have been reported previously. MHC class I stained capillaries but not muscle fibres. No capillary or muscle fibre staining was found of MHC class II, complement activation marker MAC, or the regeneration marker neonatal myosin heavy chain, whereas the adhesion molecule ICAM-I was constitutively expressed on capillary endothelial cells. The expression was similar in morphologically completely normal muscle biopsies obtained from clinical routine, justifying the use of such biopsies as normal reference, although some caution is warranted because of individuals with higher expression of inflammatory markers.

    Adhesion molecules regulate cell to cell interactions, e.g. they are involved in recruiting cells into inflammatory lesions in muscles. In a group of consecutive patients (n=22) with inflammatory infiltrates pairs of adhesion molecules were examined on infiltrating cells and vascular endothelial cells. VLA-4, known to be important in chronic inflammation, was found to be expressed mostly on infiltrating cells in definite PM, whereas LFA-1 was expressed in all types of IM. These findings suggest a diagnostic potential of the LFA-1/VLA-4 ratio, and a role for VLA-4/VCAM-1 in the pathogenesis of PM.

    In a large study of patients (n=48) with primary Sjögren's syndrome (pSS), we described muscle histology and immunohistochemical findings in relation to muscle pain (n=36), a common complaint of patients with pSS. Morphological changes, as perivascular inflammation was common in pSS. A surprisingly high proportion of patients displayed IBM-Iike changes, such as rimmed vacuoles, inflammation and atrophic fibres. Immunohistochemically, MHC class I and MAC showed increased expression, but no single finding showed any relation to muscle pain. MAC expression indicates a role for complement activation in pSS associated myositis.

    The finding of IBM-Iike changes in pSS, resulted in a subsequent comparative study of cytoplasmic and vacuolar proteins in classical IBM and pSS. Although more frequently found in IBM, the same vacuolar proteins were found in muscle biopsies from patients with pSS. Clinical symptoms differed between IBM and pSS associated myositis, indicating that these diseases represent different entities. The similarity in histological findings suggests that non-specific mechanisms may operate and lead to the same end result. We therefore propose that vacuolar myositis in pSS should be regarded as a separate entity, different from classical IBM and suggest the term aIBM (autoimmune associated) for patients with IBM-Iike changes and associated autoimmune disease.

    Delarbeten
    1. Immunohistochemical markers MHC class I, MHC class II, ICAM-1, MAC and neonatal myosin heavy chain in muscle biopsies: Expression in healthy subjects, normal muscle biopsies and inflammatory myopathies
    Öppna denna publikation i ny flik eller fönster >>Immunohistochemical markers MHC class I, MHC class II, ICAM-1, MAC and neonatal myosin heavy chain in muscle biopsies: Expression in healthy subjects, normal muscle biopsies and inflammatory myopathies
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Although immunohistochemistry on muscle biopsies is widely used scientifically and clinically, information is limited regarding the expression in normal healthy subjects. In the present study we investigated the expression of relevant immune markers in a large material (n=58) of healthy subjects and compared with the expression in morphologically normal muscle biopsies (n=46) obtained from clinical routine. As a reference of inflammation, muscle biopsies from idiopathic inflammatmy myopathies (IIM) were used (n=22).

    We found that the expression in healthy subjects was not significantly different from that in morphologically normal biopsies, although a few individuals with minimal morphological aberrations also showed higher expression of immune markers. The IIM group showed significantly higher expression of all markers. In brief, major histocompatibility complex (MHC) class I was nmmally not, or very weakly, expressed on muscle fibres, MHC class II was not expressed on capillary endothelial cells, whereas intercellular adhesion molecule (ICAM)-1 was constitutively expressed to a ce1tain degree on capillmy endothelial cells. The complement activation marker membrane attack complex (MAC) was merely absent in nonnal biopsies. Neonatal myosin heavy chain was normally present only in a very few regenerating fibres. A constructed grading scale was found useful, based on normal occun·ence as well as intensity and distribution of expression.

    In conclusion we demonstrate the nmmal expression of MHC class I, MHC class II, ICAM-1, MAC and neonatal myosin as found in healthy subjects. The expression was similar in morphologically completely normal muscle biopsies obtained from clinical routine, justifyhtg the use of such biopsies as normal reference. Some caution is warranted for using biopsies with minimal morphological changes, since these showed increased expression of some inflammatory markers.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-81622 (URN)
    Tillgänglig från: 2012-09-19 Skapad: 2012-09-19 Senast uppdaterad: 2012-09-19Bibliografiskt granskad
    2. The expression of adhesion molecules in muscle biopsies: the LFA-1/VLA-4 ratio in polymyositis
    Öppna denna publikation i ny flik eller fönster >>The expression of adhesion molecules in muscle biopsies: the LFA-1/VLA-4 ratio in polymyositis
    Visa övriga...
    2003 (Engelska)Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 107, nr 2, s. 134-141Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objectives– The expression of three pairs of adhesion receptors and ligands was examined in 22 consecutive muscle biopsies showing morphological signs of inflammation.

    Material and methods– The following groups were studied: patients with polymyositis (PM) (n=7), patients with myositis that did not fulfil criteria for PM, i.e. suspected PM (n=5), patients with other diseases, with no clinical signs of inflammatory myopathy (n=6), and a small group of non-PM inflammatory myopathies (n=4). The endothelial expression of ICAM-1, VCAM-1 and E-selectin was evaluated, as was the cellular expression of LFA-1, VLA-4 and SLex. In addition, the expression of MHC class I and II was studied.

    Results– The ratio between the number of cells expressing LFA-1 and VLA-4 showed significant differences between the groups, with the lowest values in PM.

    Conclusion– The LFA-1/VLA-4 ratio should be suitable for diagnostic purposes. Our findings also indicate that the VLA-4/VCAM-1 system is important for chronic T cell inflammation in muscle, in line with findings in other “hidden” organs like joints and the central nervous system.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-26433 (URN)10.1034/j.1600-0404.2003.02062.x (DOI)10976 (Lokalt ID)10976 (Arkivnummer)10976 (OAI)
    Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    3. Subclinical myositis is common in primary Sjögren's syndrome and is not related to muscle pain
    Öppna denna publikation i ny flik eller fönster >>Subclinical myositis is common in primary Sjögren's syndrome and is not related to muscle pain
    2002 (Engelska)Ingår i: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 29, nr 4, s. 717-725Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: Although muscle pain is common in primary Sjögren's syndrome (SS), the underlying mechanisms are mainly unknown. We studied all patients with SS at our rheumatology unit with respect to muscle pain in general and to fibromyalgia (FM), and correlated clinical data to muscle biopsy findings.

    METHODS: We investigated 48 patients with SS according to the modified European diagnostic criteria. The ACR criteria for FM were used to subgroup the patients. Muscle biopsy was performed in 36 patients. Light microscope morphology and immunohistochemical expression of MHC class I, MHC class II, and membrane attack complex (MAC) were studied.

    RESULTS: We found 44% of patients complained of muscle pain; 27% fulfilled the ACR criteria for FM, whereas 17% had other forms of myalgia. Muscle pain could not be related to histopathological findings. Signs of inflammation were found in 26 of 36 biopsies (72%), and inflammation combined with degeneration/regeneration (i.e., histological signs of polymyositis) in 17 biopsies (47%). However, only 5 patients (14%) had clinical as well as histological signs of polymyositis. Eight muscle biopsies (22%) showed histological features of inclusion body myositis (IBM). However, no patient had clinical symptoms suggestive of this disease. Abnormal expression of MHC class I, MHC class II, and MAC was found in 18 (50%), 16 (44%), and 27 (75%) patients, respectively.

    CONCLUSION: Muscle pain, especially FM, is common in SS. Histopathological signs of myositis are very common in SS. However, muscle symptoms are not related to histological signs of muscle inflammation. IBM-like findings may represent vacuolar myopathic degeneration due to previous subclinical muscle inflammation rather than a specific clinical entity.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-26377 (URN)10911 (Lokalt ID)10911 (Arkivnummer)10911 (OAI)
    Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    4. Inclusion body myopathy in Primary Sjögren's syndrome: clinical and histopathological features in relation to sporadic inclusion body myositis
    Öppna denna publikation i ny flik eller fönster >>Inclusion body myopathy in Primary Sjögren's syndrome: clinical and histopathological features in relation to sporadic inclusion body myositis
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Inclusion body myositis (IBM) is a chronic, acquired inflammatory myopathy with typical clinical symptoms and characteristic histopathological features in muscle biopsy. However, there are still uncertainties in diagnostic criteria, implying that disorders of potentially different origin may be classified as IBM. In particular, muscle biopsy findings of vacuolar myopathy in Sjögren's syndrome have indicated an association with IBM, and so far vacuolar Sjögren myopathy is included in the IBM entity.

    We therefore compared clinical and histopathological features in a group of patients with sporadic-IBM (s-IBM, n=11) with a group of patients with primary Sjögren's syndrome (pSS) with IBM-like findings in their muscle biopsies (n=10). Biopsies from s-IBM but not from Sjögren patients stained for Congo-red, whereas no other obvious differences were fonnd concerning morphological or biochemical fmdings of vacuolar content (hyperphosphorylated tau-protein: SMI 31 and SMI 310, ubiquitin, tau-protein, ß-amyloid, ß-amyloid precursor protein). Striking differences were fonnd in the clinical picture, age of onset and gender preponderance (females in pSS and males in s-IBM).

    Based on the different clinical features and the difference in Congo-red staining, we suggest that vacuolar myopathy in pSS should be regarded as a separate entity, not to be included in the classical s-IBM group. IBM-like fmdings in muscle biopsy are observed in different types of systemic inflammatory diseases, and could preferably be designated as autoimmune associated IBM (a-IBM).

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-81623 (URN)
    Tillgänglig från: 2012-09-19 Skapad: 2012-09-19 Senast uppdaterad: 2013-10-25Bibliografiskt granskad
  • 58.
    Lindvall, Björn
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Bengtsson, Ann
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Reumatologi. Linköpings universitet, Hälsouniversitetet.
    Ernerudh, Jan
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk immunologi. Linköpings universitet, Hälsouniversitetet.
    Eriksson, Per
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Reumatologi. Linköpings universitet, Hälsouniversitetet.
    Subclinical myositis is common in primary Sjögren's syndrome and is not related to muscle pain2002Ingår i: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 29, nr 4, s. 717-725Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Although muscle pain is common in primary Sjögren's syndrome (SS), the underlying mechanisms are mainly unknown. We studied all patients with SS at our rheumatology unit with respect to muscle pain in general and to fibromyalgia (FM), and correlated clinical data to muscle biopsy findings.

    METHODS: We investigated 48 patients with SS according to the modified European diagnostic criteria. The ACR criteria for FM were used to subgroup the patients. Muscle biopsy was performed in 36 patients. Light microscope morphology and immunohistochemical expression of MHC class I, MHC class II, and membrane attack complex (MAC) were studied.

    RESULTS: We found 44% of patients complained of muscle pain; 27% fulfilled the ACR criteria for FM, whereas 17% had other forms of myalgia. Muscle pain could not be related to histopathological findings. Signs of inflammation were found in 26 of 36 biopsies (72%), and inflammation combined with degeneration/regeneration (i.e., histological signs of polymyositis) in 17 biopsies (47%). However, only 5 patients (14%) had clinical as well as histological signs of polymyositis. Eight muscle biopsies (22%) showed histological features of inclusion body myositis (IBM). However, no patient had clinical symptoms suggestive of this disease. Abnormal expression of MHC class I, MHC class II, and MAC was found in 18 (50%), 16 (44%), and 27 (75%) patients, respectively.

    CONCLUSION: Muscle pain, especially FM, is common in SS. Histopathological signs of myositis are very common in SS. However, muscle symptoms are not related to histological signs of muscle inflammation. IBM-like findings may represent vacuolar myopathic degeneration due to previous subclinical muscle inflammation rather than a specific clinical entity.

  • 59.
    Lindvall, Björn
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Dahlbom, K.
    Department of Neurology, County Hospital in Örebro, Sweden.
    Henriksson, Karl-Gösta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Srinivas, U.
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Linköpings universitet, Hälsouniversitetet.
    Ernerudh, Jan
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Institutionen för biomedicin och kirurgi, Klinisk kemi. Linköpings universitet, Hälsouniversitetet.
    The expression of adhesion molecules in muscle biopsies: the LFA-1/VLA-4 ratio in polymyositis2003Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 107, nr 2, s. 134-141Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives– The expression of three pairs of adhesion receptors and ligands was examined in 22 consecutive muscle biopsies showing morphological signs of inflammation.

    Material and methods– The following groups were studied: patients with polymyositis (PM) (n=7), patients with myositis that did not fulfil criteria for PM, i.e. suspected PM (n=5), patients with other diseases, with no clinical signs of inflammatory myopathy (n=6), and a small group of non-PM inflammatory myopathies (n=4). The endothelial expression of ICAM-1, VCAM-1 and E-selectin was evaluated, as was the cellular expression of LFA-1, VLA-4 and SLex. In addition, the expression of MHC class I and II was studied.

    Results– The ratio between the number of cells expressing LFA-1 and VLA-4 showed significant differences between the groups, with the lowest values in PM.

    Conclusion– The LFA-1/VLA-4 ratio should be suitable for diagnostic purposes. Our findings also indicate that the VLA-4/VCAM-1 system is important for chronic T cell inflammation in muscle, in line with findings in other “hidden” organs like joints and the central nervous system.

  • 60.
    Lindvall, Björn
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Eriksson, Per
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Reumatologi. Linköpings universitet, Hälsouniversitetet.
    Ernerudh, Jan
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk immunologi. Linköpings universitet, Hälsouniversitetet.
    Inclusion body myopathy in Primary Sjögren's syndrome: clinical and histopathological features in relation to sporadic inclusion body myositisManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Inclusion body myositis (IBM) is a chronic, acquired inflammatory myopathy with typical clinical symptoms and characteristic histopathological features in muscle biopsy. However, there are still uncertainties in diagnostic criteria, implying that disorders of potentially different origin may be classified as IBM. In particular, muscle biopsy findings of vacuolar myopathy in Sjögren's syndrome have indicated an association with IBM, and so far vacuolar Sjögren myopathy is included in the IBM entity.

    We therefore compared clinical and histopathological features in a group of patients with sporadic-IBM (s-IBM, n=11) with a group of patients with primary Sjögren's syndrome (pSS) with IBM-like findings in their muscle biopsies (n=10). Biopsies from s-IBM but not from Sjögren patients stained for Congo-red, whereas no other obvious differences were fonnd concerning morphological or biochemical fmdings of vacuolar content (hyperphosphorylated tau-protein: SMI 31 and SMI 310, ubiquitin, tau-protein, ß-amyloid, ß-amyloid precursor protein). Striking differences were fonnd in the clinical picture, age of onset and gender preponderance (females in pSS and males in s-IBM).

    Based on the different clinical features and the difference in Congo-red staining, we suggest that vacuolar myopathy in pSS should be regarded as a separate entity, not to be included in the classical s-IBM group. IBM-like fmdings in muscle biopsy are observed in different types of systemic inflammatory diseases, and could preferably be designated as autoimmune associated IBM (a-IBM).

  • 61.
    Lindvall, Björn
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Ernerudh, Jan
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk immunologi. Linköpings universitet, Hälsouniversitetet.
    Immunohistochemical markers MHC class I, MHC class II, ICAM-1, MAC and neonatal myosin heavy chain in muscle biopsies: Expression in healthy subjects, normal muscle biopsies and inflammatory myopathiesManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Although immunohistochemistry on muscle biopsies is widely used scientifically and clinically, information is limited regarding the expression in normal healthy subjects. In the present study we investigated the expression of relevant immune markers in a large material (n=58) of healthy subjects and compared with the expression in morphologically normal muscle biopsies (n=46) obtained from clinical routine. As a reference of inflammation, muscle biopsies from idiopathic inflammatmy myopathies (IIM) were used (n=22).

    We found that the expression in healthy subjects was not significantly different from that in morphologically normal biopsies, although a few individuals with minimal morphological aberrations also showed higher expression of immune markers. The IIM group showed significantly higher expression of all markers. In brief, major histocompatibility complex (MHC) class I was nmmally not, or very weakly, expressed on muscle fibres, MHC class II was not expressed on capillary endothelial cells, whereas intercellular adhesion molecule (ICAM)-1 was constitutively expressed to a ce1tain degree on capillmy endothelial cells. The complement activation marker membrane attack complex (MAC) was merely absent in nonnal biopsies. Neonatal myosin heavy chain was normally present only in a very few regenerating fibres. A constructed grading scale was found useful, based on normal occun·ence as well as intensity and distribution of expression.

    In conclusion we demonstrate the nmmal expression of MHC class I, MHC class II, ICAM-1, MAC and neonatal myosin as found in healthy subjects. The expression was similar in morphologically completely normal muscle biopsies obtained from clinical routine, justifyhtg the use of such biopsies as normal reference. Some caution is warranted for using biopsies with minimal morphological changes, since these showed increased expression of some inflammatory markers.

  • 62. List, Thomas
    et al.
    Leijon, Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Helkimo, Martti
    Öster, Anders
    Svensson, Peter
    Effect of local anesthesia on atypical odontalgia - A randomized controlled trial2006Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 122, nr 3, s. 306-314Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the study was to evaluate the analgesic effect of lidocaine in a double-blind, controlled multi-center study on patients with atypical odontalgia (AO) - a possible orofacial neuropathic pain condition. Thirty-five consecutive AO patients (range 31-81 years) with a mean pain duration of 7.2 years (range 1-30 years) were recruited from four different orofacial pain clinics in Sweden. In a randomized cross-over design, 1.5 ml local anesthesia (20 mg/ml lidocaine and 12.5 μg/ml adrenaline) or 1.5 ml saline (9 mg/ml NaCl solution) (placebo) was injected to block the painful area. The VAS pain scores showed an overall effect of time (ANOVA: P < 0.001) and treatment (ANOVA: P = 0.018) with a significant interaction between the factors (ANOVA: P < 0.001). Overall, VAS pain relief was significantly greater at 15-120 min following the lidocaine injections compared to the placebo injections (Tukey: P < 0.05). All patients demonstrated significant disturbances in somatosensory function on the painful side compared to the non-painful side as revealed by quantitative sensory tests, however, only one significant inverse correlation was found between percentage pain relief and the magnitude of brush-evoked allodynia (Spearman: P < 0.01). In conclusion, AO patients experienced significant, but not complete, pain relief from administration of local anesthetics compared with placebo. The findings indicate that the spontaneous pain in AO patients only to some extent is dependent on peripheral afferent inputs and that sensitization of higher order neurons may be involved in the pathophysiology of AO. © 2006 International Association for the Study of Pain.

  • 63.
    Lundin, Fredrik
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Rousseau, Andreas
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    Kadowaki, Åsa
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för vård och välfärd. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    Risperidon gav avföringsinkontinens som följd av sänkt analsfinktertonus2004Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, s. 4006-4008Artikel i tidskrift (Övrigt vetenskapligt)
  • 64. Murray, Veronica
    et al.
    von Arbin, Magnus
    Bartfai, Aniko
    Berggren, Anna-Lena
    Landtblom, Anne-Marie
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Lundmark, Jöns
    Näsman, Per
    Olsson, Jan-Edvin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Samuelsson, Margareta
    Terént, Andreas
    Varelius, Riitta
    Åsberg, Marie
    Mårtensson, Björn
    Double-blind comparison of sertraline and placebo in stroke patients with minor depression and less severe major depression2005Ingår i: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 66, nr 6, s. 708-716Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Poststroke depression is a frequent condition and important to treat. The aim of this trial was to study the efficacy and tolerability of sertraline. Method: In 4 Swedish stroke centers, 123 patients (aged 70.7 ± 9.9 years) were enrolled during the period September 1998 to January 2001 in a randomized, double-blind, placebo-controlled 26-week trial, at a mean of 128 ± 97 days (range, 3-375 days) after stroke, if they fulfilled DSM-IV criteria of major depressive episode (N = 76) or minor depressive disorder (N = 47). The primary efficacy variable was a change in depression assessed by the Montgomery-Åsberg Depression Rating Scale. The Emotional Distress Scale (EDS) was administered and the occurrence of emotionalism and quality of life (QoL) were assessed, as well as neurologic recovery. Efficacy analyses were intention-to-treat, short-term (week 6) and long-term (week 26). Results: Of the 123 patients, 62 were treated with sertraline (50-100 mg/day) and 61 with placebo. Both groups improved substantially, with no differences between the treatments, either for major depressive episode or minor depressive disorder, or for short- or long-term antidepressant effect and neurologic outcome. EDS revealed a better outcome with sertraline at week 6 (p < .05). At week 26, the improvement in QoL was better in sertraline patients (p < .05) and there was a trend for emotionalism (p = .07). No serious side effects were seen. Conclusion: Poststroke depression as measured by a conventional depression rating scale improved over time irrespective of treatment. Positive effects specific to sertraline were identified in emotional distress, emotionalism, and QoL. The study indicates that poststroke emotional reactions comprise depression and other domains susceptible to pharmacologic therapy.

  • 65. Nyholm, D
    et al.
    Nilsson Remahl, AIM
    Dizdar Segrell, Nil
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Constantinescu, R
    Holmberg, B
    Jansson, R
    Aquilonius, SM
    Askmark, H
    Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced Parkinson disease2005Ingår i: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 64, nr 2, s. 216-223Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To compare daytime intraduodenal levodopa/carbidopa infusion as monotherapy with individually optimized conventional combination therapies in patients with advanced Parkinson disease (PD) for motor fluctuations and quality of life (QoL). Methods: Twenty-four patients with motor fluctuations and dyskinesia were studied in a randomized crossover design to compare individualized conventional treatment and intraduodenal infusion of a levodopa/ carbidopa gel for 3 + 3 weeks. Video scoring of motor function was assessed by blinded assessors on a global Treatment Response Scale from -3 to 0 to +3 (from severe "off" to "on" to "on" with severe dyskinesia). Patient self-assessment of motor performance and QoL was done using an electronic diary. Results: Median percentage of ratings in a functional "on" interval (-1 to +1) was increased from 81 to 100% by infusion therapy (p < 0.01). This improvement was accompanied by a decrease in "off" state (p < 0.01) and no increase in dyskinesia. Median Unified Parkinson's Disease Rating Scale score decreased from 53 to 35 in favor of infusion (p < 0.05). QoL was improved, using the two instruments: Parkinson's Disease Questionnaire-39 and 15D Quality of Life Instrument (p < 0.01). Adverse events were similar for both treatment strategies. Conclusions: Continuous intraduodenal infusion of the levodopa/carbidopa enteral gel as monotherapy is safe and clinically superior to a number of individually optimized combinations of conventional oral and subcutaneous medications in patients with motor fluctuations. Intraduodenal infusion of levodopa offers an important alternative in treating patients with advanced Parkinson disease.

  • 66.
    Olsson, Jan-Edvin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Ny MAO-hämmare vid behandling av Parkinsons sjukdom2005Ingår i: Transmittorn, Vol. 1Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 67.
    Olsson, Jan-Edvin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Ohrvik, J
    Palhagen, S
    "The Swedish Parkinson Kohort Study" : an Interim Analysis after 7 years2005Ingår i: XVIII World Congress of Neurology,2005, 2005, s. 45-45Konferensbidrag (Refereegranskat)
  • 68. Paviour, Dominic C
    et al.
    Revesz, Tamas
    Holton, Janice L
    Evans, Andrew
    Olsson, Jan-Edvin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Lees, Andrew J
    Neuronal intranuclear inclusion disease: Report on a case originally diagnosed as dopa-responsive dystonia with lewy bodies2005Ingår i: Movement Disorders, ISSN 0885-3185, E-ISSN 1531-8257, Vol. 20, nr 10, s. 1345-1349Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Neuronal intranuclear inclusion disease (NIID) is a rare neurodegenerative disorder with a heterogeneous clinical picture characterized by the presence of eosinophilic intranuclear inclusions in neuronal and glial cells. We describe a case, reported 12 years ago as dopa-responsive dystonia (DRD) with Lewy body pathology. Pathological re-examination has led to a revised diagnosis of neuronal intranuclear inclusion disease. This rare condition, which may be diagnosed in life with a full thickness rectal biopsy, needs to be considered in the differential diagnosis of any case presenting as progressive juvenile parkinsonism (JP) or dystonia. © 2005 Movement Disorder Society.

  • 69.
    Pålhagen, Sven
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Geriatrik. Linköpings universitet, Hälsouniversitetet.
    Lorefält, Birgitta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Geriatrik. Linköpings universitet, Institutionen för medicin och vård, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Carlsson, M.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Geriatrik. Linköpings universitet, Hälsouniversitetet.
    Ganowiak, Wojchiec
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Geriatrik. Linköpings universitet, Hälsouniversitetet.
    Toss, Göran
    Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Linköpings universitet, Hälsouniversitetet.
    Unosson, Mitra
    Linköpings universitet, Institutionen för medicin och vård, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Granerus, Ann-Kathrine
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Geriatrik. Linköpings universitet, Hälsouniversitetet.
    Does l-dopa treatment contribute to reduction in body weight in elderly patients with Parkinson's disease?2005Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 111, nr 1, s. 12-20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective –  Many patients with Parkinson's disease (PD) lose weight also early during the disease. The objective of the study was to investigate possible causative factors for this loss.

    Materials and methods –  In this report, 28 PD patients and 28 age- and sex-matched controls were repeatedly assessed with the focus on body weight, body fat mass, dysphagia, olfaction, physical activity, PD symptomatology and drug treatment.

    Results –  Weight loss was seen in PD patients both before and during l-dopa treatment.

    Conclusion –  The underlying disease could play a role, but our results also suggest that l-dopa per se could contribute to the weight loss.

  • 70.
    Ragnehed, Mattias
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk radiologi. Linköpings universitet, Hälsouniversitetet.
    Friman, Ola
    Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska högskolan.
    Lundberg, Peter
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk radiologi.
    Söderfeldt, Birgitta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Knutsson, Hans
    Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska högskolan.
    Comparing CCA and SPM992003Konferensbidrag (Refereegranskat)
  • 71.
    Räty, Lena
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Living with epilepsy: young people with uncomplicated epilepsy and adults with newly debuted epilepsy2002Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The aim of this thesis was to illuminate experiences of living with uncomplicated epilepsy, i.e. epilepsy without any associated neurological impainnents. The focus was on young people, aged 13- 22 (II, III, IV), and adults, aged 18-65 (I), with newly debuted epilepsy, i.e. an epilepsy diagnosis registered within the last 15 months.

    Thirty-seven adult patients reported their experienced quality of life (QOL) with newly debuted epilepsy by the "Quality of Life Index" (QLT) questionnaire. The lowest QOL was reported in relation to the psychological/spiritual domain and the highest to the family domain. Women reported having a lower QOL than men. Most of the participants (70%) experienced a negative change of their life situation with the debut of epilepsy and all of them reported feelings of restricted personal freedom. Negative perceptions of epilepsy, high seizure frequency and side effects of antiepileptic drugs (AED) were related to a low QOL.

    Psychological and social aspects of HRQOL were compared between young people with epilepsy (n = 151) and a random sample of controls (n = 282) by the questionnaires "I think i am" (ITIA), "Youth Self Report" (YSR), "Sense of Coherence" (SOC) and "Family APGAR". Both groups had a positive self-esteem, but the epilepsy group reported having lower competence socially, and also in relation to activity and school. Older adolescents and post adolescents scored less favourably than younger adolescents, and females scored in general less favourably than males. Males with epilepsy did however faring worse compared to controls of their own sex.

    The medlcal situation (seizures and therapy) of young people (n = 151) with epilepsy was described. Data were collected by self-reporting using the questionnaire "National Hospital Seizure Severity Scale" (NHS3) and by obtaining information from medical records. The dominant seizure types were primary generalized tonic-clonic seizures and complex partial seizures, 7.9% could not be specified. Ninety percent were on AED treatment, 42% with continuing seizures. More than half of the patients experienced some side effects from AED therapy.

    Finally the relationship between the epilepsy condition (illness severity), sociodemographic factors, general self-concept and own attitude towards the epilepsy was studied in young people (n = 149). Data were collected by questionnaires (ITIA, SOC and the "'Child Attitude Toward lllness Scale"), and using the "lllness Severity Index" (ISI) designed for this study on the basis of seizure type, seizure frequency and AED including side effects. The patients' illness severity was related both to their self-concept and their attitudes towards the epilepsy. According to the lSI females suffered from more severe epilepsy.

    ln conclusion, uncomplicated epilepsy in adults, within the first 15 months from the diagnosis was confirmed, was associated with negative experiences in psychological and social areas, i.e. areas with increased problems in the epilepsy population. Many young people with uncomplicated epilepsy continue to have seizures and high rates of side effects despite treatment at epilepsy centres. Compared to controls young people with epilepsy experienced a lower competence socially, and in relation to activity and schooL Older youth and females scored less favourably in psychological and social areas. 1t was suggested that young males with epilepsy could be more affected by an uncomplicated epilepsy condition than young females. Finally, the severity of the epilepsy condition was related to self-concept and the attitude of young people with uncomplicated epilepsy towards illness.

    Delarbeten
    1. Quality of life in newly-debuted epilepsy: an empirical study
    Öppna denna publikation i ny flik eller fönster >>Quality of life in newly-debuted epilepsy: an empirical study
    1999 (Engelska)Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 100, nr 4, s. 221-226Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objectives - This study aimed to illuminate adult's experienced quality of life in newly-debuted epilepsy and to test the American instrument Quality of Life Index (QLI) for the first time on an epilepsy population. A second aim was to find appropriate questions to measure patient perceptions in epilepsy.

    Material and methods - All persons 18–65 fulfilling criteria (n=41) and diagnosed during a 15-month period at 2 Swedish hospitals, answered questionnaires (n= 37/41) on quality of life and perceptions of epilepsy.

    Results - Patients experienced the highest quality in the “Family” domain and the lowest in the “Psychological/ spiritual”. Significant correlations were found between quality of life and experienced change of life situation, own perceptions of epilepsy, seizure frequency after diagnosis, gender and side effects from antiepileptic drugs. The QLI was well applicable on people with epilepsy.

    Conclusions - Data indicates that debut of epilepsy has an evident impact on quality of life and a more extensive study is required.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-26923 (URN)10.1111/j.1600-0404.1999.tb00384.x (DOI)11547 (Lokalt ID)11547 (Arkivnummer)11547 (OAI)
    Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    2. Health-related quality of life in youth: a comparison between adolescents and young adults with uncomplicated epilepsy and healthy controls
    Öppna denna publikation i ny flik eller fönster >>Health-related quality of life in youth: a comparison between adolescents and young adults with uncomplicated epilepsy and healthy controls
    2003 (Engelska)Ingår i: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 33, nr 4, s. 252-258Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose

    To describe health-related quality of life (HRQOL) in adolescents and young adults with uncomplicated epilepsy and to compare it with a random sample of the general population.

    Methods

    Young people, aged 13–22 years, meeting the criteria and registered in four Swedish hospitals answered questionnaires (n = 158/193) on HRQOL together with 282 (n = 282/390) random controls living in the same areas in Sweden. The instruments used were “I think I am,” “Youth Self Report,” “Sense of coherence,” and “Family APGAR.” Data were analyzed by using factorial analysis of variance.

    Results

    Girls had a poorer HRQOL than boys. The epilepsy group reported lower competence (i.e., they were less active, had lower social competence and poorer school achievement). Both groups had an overall positive self-esteem. Differences between girls in the epilepsy and control groups were small, whereas differences among boys were more evident. Older age was related to poorer HRQOL in both groups.

    Conclusions

    This study points out the importance of being observant of signs of stigmatization in adolescents with epilepsy.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-27930 (URN)10.1016/S1054-139X(03)00101-0 (DOI)12691 (Lokalt ID)12691 (Arkivnummer)12691 (OAI)
    Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    3. Seizures and therapy in adolescents with uncomplicated epilepsy
    Öppna denna publikation i ny flik eller fönster >>Seizures and therapy in adolescents with uncomplicated epilepsy
    2003 (Engelska)Ingår i: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 12, nr 4, s. 229-236Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose: This study aimed to describe seizures and their therapy among Swedish adolescents, aged 13–22, with active but uncomplicated epilepsy.

    Method: The adolescents answered questionnaires (158/193). Data were also obtained from medical records.

    Results: Epileptic seizure types could be specified in 92.1% of the cases. Predominant types were Primary Generalised Tonic–Clonic Seizures and Partial Complex Seizures with Secondary Generalisation. Clinical diagnoses by physicians were unspecified in 25.8%. Ninety percent were on antiepileptic drugs (AEDs), most commonly valproate and carbamazepine. New AEDs were used in 9.3% of the cases and polytherapy in 13.9%. More than 40% of the respondents had seizures despite AED treatment. Side effects of AEDs were experienced by 61%, most commonly tiredness, concentration difficulties and headache. Patients on polytherapy experienced significantly more side effects. The choice of a new AED over a traditional one was not related to seizure type or seizure control.

    Conclusions: Many adolescents had persistent seizures despite treatment at a specialist regional epilepsy centre. This, plus the high reported rate of side effects of AED treatment, suggests that treatment is not optimal for the group studied. As traditional AEDs strongly dominated treatment possibly newly marketed AEDs are underused in this group.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-27929 (URN)10.1016/S1059-1311(02)00227-3 (DOI)12690 (Lokalt ID)12690 (Arkivnummer)12690 (OAI)
    Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    4. The relationship between illness severity, sociodemographic factors, general self-concept, and illness-specific attitude in Swedish adolescents with epilepsy
    Öppna denna publikation i ny flik eller fönster >>The relationship between illness severity, sociodemographic factors, general self-concept, and illness-specific attitude in Swedish adolescents with epilepsy
    2004 (Engelska)Ingår i: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 13, nr 6, s. 375-382Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose: The aim of this study was to describe the relationship between the epilepsy condition (illness severity), sociodemographic factors, general self-concept, and illness-specific attitude in adolescents with uncomplicated epilepsy.

    Methods: Adolescents, aged 13–22, fulfilling criteria registered in four Swedish hospitals, answered questionnaires (n=149). The instruments “I think I am” and “Sense of coherence” measured the patients’ general self-concept. The “Child Attitude Toward Illness Scale” measured illness-specific attitude. A summary score (index) calculated from seizure frequency, seizure type, and antiepileptic drug (AED) with side effects measured “Illness Severity”.

    Results: Illness severity was significantly related to the participants’ general self-concept, as well as to their attitude toward their condition; i.e. higher illness severity scores were correlated with lower sense of coherence (SOC), poorer self-esteem, and a more negative attitude towards the epilepsy condition. Females had more severe illness according to the Illness Severity Index, with almost 80% found in the moderate and high severity groups as compared to 63% of males in the moderate/high severity groups.

    Conclusions: It was concluded that the severity of the epilepsy condition was related to the adolescents’ general self-concept and illness-specific attitude, but further research is needed to understand the causality of the relationship. The brief assessment of illness severity, constructed and used in this study should be addressed and developed further.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-24145 (URN)10.1016/j.seizure.2003.09.011 (DOI)3728 (Lokalt ID)3728 (Arkivnummer)3728 (OAI)
    Tillgänglig från: 2009-10-07 Skapad: 2009-10-07 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
  • 72.
    Räty, Lena
    et al.
    Department of Health and Caring Sciences. Karlstads University, Karlstad.
    Hamrin, Elisabeth
    Linköpings universitet, Institutionen för medicin och vård, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    Söderfeldt, Birgitta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Quality of life in newly-debuted epilepsy: an empirical study1999Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 100, nr 4, s. 221-226Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives - This study aimed to illuminate adult's experienced quality of life in newly-debuted epilepsy and to test the American instrument Quality of Life Index (QLI) for the first time on an epilepsy population. A second aim was to find appropriate questions to measure patient perceptions in epilepsy.

    Material and methods - All persons 18–65 fulfilling criteria (n=41) and diagnosed during a 15-month period at 2 Swedish hospitals, answered questionnaires (n= 37/41) on quality of life and perceptions of epilepsy.

    Results - Patients experienced the highest quality in the “Family” domain and the lowest in the “Psychological/ spiritual”. Significant correlations were found between quality of life and experienced change of life situation, own perceptions of epilepsy, seizure frequency after diagnosis, gender and side effects from antiepileptic drugs. The QLI was well applicable on people with epilepsy.

    Conclusions - Data indicates that debut of epilepsy has an evident impact on quality of life and a more extensive study is required.

  • 73.
    Räty, Lena K.A
    et al.
    Division for Health and Caring Sciences, Karlstad University, Karlstad, Sweden.
    Söderfeldt, Birgitta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Larsson, Gerry
    Department of Leadership and Management, Swedish, National Defence College, Karlstad, Sweden.
    Wilde Larsson, Bodil M
    Division for Health and Caring Sciences, Department of Nursing Science, Karlstad University, Karlstad, Sweden.
    The relationship between illness severity, sociodemographic factors, general self-concept, and illness-specific attitude in Swedish adolescents with epilepsy2004Ingår i: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 13, nr 6, s. 375-382Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim of this study was to describe the relationship between the epilepsy condition (illness severity), sociodemographic factors, general self-concept, and illness-specific attitude in adolescents with uncomplicated epilepsy.

    Methods: Adolescents, aged 13–22, fulfilling criteria registered in four Swedish hospitals, answered questionnaires (n=149). The instruments “I think I am” and “Sense of coherence” measured the patients’ general self-concept. The “Child Attitude Toward Illness Scale” measured illness-specific attitude. A summary score (index) calculated from seizure frequency, seizure type, and antiepileptic drug (AED) with side effects measured “Illness Severity”.

    Results: Illness severity was significantly related to the participants’ general self-concept, as well as to their attitude toward their condition; i.e. higher illness severity scores were correlated with lower sense of coherence (SOC), poorer self-esteem, and a more negative attitude towards the epilepsy condition. Females had more severe illness according to the Illness Severity Index, with almost 80% found in the moderate and high severity groups as compared to 63% of males in the moderate/high severity groups.

    Conclusions: It was concluded that the severity of the epilepsy condition was related to the adolescents’ general self-concept and illness-specific attitude, but further research is needed to understand the causality of the relationship. The brief assessment of illness severity, constructed and used in this study should be addressed and developed further.

  • 74.
    Räty, Lena
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Wilde-Larsson, Bodil
    Division for Health and Care, Karlstad University, Karlstad, Sweden.
    Söderfeldt, Birgitta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Seizures and therapy in adolescents with uncomplicated epilepsy2003Ingår i: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 12, nr 4, s. 229-236Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: This study aimed to describe seizures and their therapy among Swedish adolescents, aged 13–22, with active but uncomplicated epilepsy.

    Method: The adolescents answered questionnaires (158/193). Data were also obtained from medical records.

    Results: Epileptic seizure types could be specified in 92.1% of the cases. Predominant types were Primary Generalised Tonic–Clonic Seizures and Partial Complex Seizures with Secondary Generalisation. Clinical diagnoses by physicians were unspecified in 25.8%. Ninety percent were on antiepileptic drugs (AEDs), most commonly valproate and carbamazepine. New AEDs were used in 9.3% of the cases and polytherapy in 13.9%. More than 40% of the respondents had seizures despite AED treatment. Side effects of AEDs were experienced by 61%, most commonly tiredness, concentration difficulties and headache. Patients on polytherapy experienced significantly more side effects. The choice of a new AED over a traditional one was not related to seizure type or seizure control.

    Conclusions: Many adolescents had persistent seizures despite treatment at a specialist regional epilepsy centre. This, plus the high reported rate of side effects of AED treatment, suggests that treatment is not optimal for the group studied. As traditional AEDs strongly dominated treatment possibly newly marketed AEDs are underused in this group.

  • 75.
    Räty, Lena
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Wild-Larsson, Bodil
    Division for Health and Caring Sciences, Department of Nursing Science, Karlstad University, Karlstad, Sweden.
    Söderfeldt, Birgitta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Health-related quality of life in youth: a comparison between adolescents and young adults with uncomplicated epilepsy and healthy controls2003Ingår i: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 33, nr 4, s. 252-258Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    To describe health-related quality of life (HRQOL) in adolescents and young adults with uncomplicated epilepsy and to compare it with a random sample of the general population.

    Methods

    Young people, aged 13–22 years, meeting the criteria and registered in four Swedish hospitals answered questionnaires (n = 158/193) on HRQOL together with 282 (n = 282/390) random controls living in the same areas in Sweden. The instruments used were “I think I am,” “Youth Self Report,” “Sense of coherence,” and “Family APGAR.” Data were analyzed by using factorial analysis of variance.

    Results

    Girls had a poorer HRQOL than boys. The epilepsy group reported lower competence (i.e., they were less active, had lower social competence and poorer school achievement). Both groups had an overall positive self-esteem. Differences between girls in the epilepsy and control groups were small, whereas differences among boys were more evident. Older age was related to poorer HRQOL in both groups.

    Conclusions

    This study points out the importance of being observant of signs of stigmatization in adolescents with epilepsy.

  • 76.
    Rüdhmer-Dahle, Charlotte
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk immunologi. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Studies on T cells and cytokines in Guillain-Barré syndrome and experimental allergic neuritis2001Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Guillain-Barrésyndrome (GBS) is an inflammatory disease of peripheral nerves, characterised by muscle weakness. The nerves are attacked and destroyed by the immune system. The symptoms usually progress over a few weeks and many patients become severely disabled. However, in contrast to many other organspecific autoimmune diseases, GBS is self-limiting and most patients recover. Individuals of all ages can be affected. The incidence is about 1/100 000 per year. An infection often precedes the onset of neurological symptoms and probably triggers the immune-mediated attack.

    Activation of T cells and the resulting release of cytokines are decisive for the regulation of antigen-specific inflammation. Different cytokine patterns promote different types of responses. Interferon-y (lFN-γ) has a key role in Th type 1 responses, and is thought to be a driving force in many organ-specific autoimmune diseases. Interleukin-4 (IL-4) promotes Th type 2 responses, characterised by the production of certain antibodies and activation of mastcells and eosinophils. Th type 1 and Th type 2 responses down-regulate one another and the balance between them is important for the immune homeostasis. TGF-ß is an important cytokine with strong down-regulatory properties.

    Flow cytometry studies showed that circulating T cells were activated in patients with GBS as determined by expression of HLA-DR on T cells, increased proportion of activated memory phenotype (CD4+CD29+), and decreased proportion of naive phenotype (CD4+CD45RA+). A sensitive Ell-spot method was used to determine cytokine secretion from circulating mononuclear cells with or without stimulation with immunogenic peptides from myelin proteins P2 and PO. Both spontaneous and myelin-specific cytokine secretion were increased in patients compared with controls. Increased numbers of myelin-specific cells secreting IL-4 and TGF-ß were found in the majority of the patients, indicating a Th2 type and down-regulatory cytokine profile, in line with the self-limiting character of the disease.

    An animal model of GBS, experimental allergic neuritis (EAN), is known to be inducible by myelin-specific T cells, supporting the pathogenetic role of T cells. A Th1 deviated, IFN-y-producing cell population from EAN, was in vitro stimulated with autoantigen and IL-4, thereby obtaining a Th2 cytokine profile. These myelin-specific cells were subsequently transferred to rats with EAN, and were found to ameliorate the disease course.

    In conclusion, Circulating T cells are activated in patients with GBS. Most patients have myelin-specific T cells that mainly secrete down-regulatory cytokines such as IL-4 and TGF-ß, which probably have a beneficial role in regulating the disease process. In vitro deviation of myelin-specific T cells into Th2 phenotype and subsequent transfer of these cells ameliorated the disease course in EAN.

    Delarbeten
    1. T lymphocyte subset abnormalities in peripheral blood from patients with the Guillain-Barré syndrome
    Öppna denna publikation i ny flik eller fönster >>T lymphocyte subset abnormalities in peripheral blood from patients with the Guillain-Barré syndrome
    1994 (Engelska)Ingår i: Journal of Neuroimmunology, ISSN 0165-5728, E-ISSN 1872-8421, Vol. 53, nr 2, s. 219-225Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    T lymphocytes are probably of pathogenic importance in many autoimmune diseases. Recently, deviations of circulating T-helper (CD4+) subpopulations have been noticed. Blood samples from 12 patients with Guillain-Barré syndrome (GBS) were studied with flow cytometry during their disease to define circulating T cell populations. The proportion of T-helper cells (CD4+) was decreased (mean value 41±15%, P = 0.01) and the proportion of T cytotoxic/suppressor cells (CD8+) was increased (35±18%, P = 0.0006) as compared to the control group of healthy blood donors (47±8% and 26±7% respectively). The CD4+ population is divided into the helper/inducer (CD4+ CD29+) and suppressor/inducer (CD4+ CD45RA+) subsets. which normally are equally distributed (mean values in our control group were 45±15% and 44±15%, respectively). In patients with GBS, the helper/inducer (CD4+ CD29+) subset was increased (54±10%, P = 0.05) and the suppressor/inducer (CD4+ CD45RA+) subset was decreased (31±9, P = 0.005) compared to the controls. The proportion of activated HLA-DR-expressing T cells was increased (7±8%, P = 0.005) as compared to control (3±3%). The total proportions of T cells (CD2+), B cells (CD19+) and natural killer (NK) cells (CD56+) were similar in pateints and controls. The CD4+ and CD8+ populations, as well as the activated HLA-DR+ T cells, normalized during the disease course. The derivations within the CD4+ population also tended to normalize, but even at follow up after 6–33 (mean 23) months, some abnormalities remained. In conclusion, we confirm previous reports of T cell activation in peripheral blood from patients with GBS. A new finding is the derivation of T helper subpopulations with an increased helper/inducer (CD4+ CD29+) subset and a decreased suppressor/inducer (CD4+ CD45RA+) subset, which indicates a possible autoimmune character of GBS.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-80191 (URN)10.1016/0165-5728(94)90032-9 (DOI)
    Tillgänglig från: 2012-08-22 Skapad: 2012-08-22 Senast uppdaterad: 2017-12-07Bibliografiskt granskad
    2. T helper type 2 like cytokine responses to peptides from P0 and P2 myelin proteins during the recovery phase of Guillain-Barré syndrome
    Öppna denna publikation i ny flik eller fönster >>T helper type 2 like cytokine responses to peptides from P0 and P2 myelin proteins during the recovery phase of Guillain-Barré syndrome
    Visa övriga...
    1997 (Engelska)Ingår i: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 153, nr 1, s. 54-60Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    T-lymphocytes are probably involved in the pathogenesis of Guillain-Barré syndrome (GBS). T-helper-1 (Th1) cytokines activate macrophages and induce a delayed type hypersensitivity (DTH) inflammatory response, consistent with the morphology of the demyelination in GBS. Th2 cytokines encourage antibody production and downregulate Th1 responses. To study the Th1/Th2 cytokines in relation to the clinical course of GBS an ELISPOT method for determination of single cells secreting interferon-γ, IFN-γ (Th1) or interleukin-4, IL-4 (Th2) was used. We serially investigated antigen-induced cytokine secretion from circulating T-cells stimulated with human peptides from the P0 and P2 proteins in seven patients and compared to results from seven serially investigated healthy controls. Most patients (five of seven) showed IL-4 responses during the plateau- or recovery-phase as compared to controls. One patient with a prolonged disease course, on the other hand, had an IFN-γ dominated reactivity. We suggest that the IL-4 responses are beneficial in GBS, and may have a role in terminating the disease process in this self-limiting inflammatory disease.

    Nyckelord
    Guillain-Barré syndrome, Myelin, P0, P2, T cells, IFN-γ, IL-4
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-80193 (URN)10.1016/S0022-510X(97)00178-0 (DOI)
    Tillgänglig från: 2012-08-22 Skapad: 2012-08-22 Senast uppdaterad: 2017-12-07Bibliografiskt granskad
    3. Elevated number of cells secreting transforming growth factor β in Guillain-Barré syndrome
    Öppna denna publikation i ny flik eller fönster >>Elevated number of cells secreting transforming growth factor β in Guillain-Barré syndrome
    Visa övriga...
    2003 (Engelska)Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 111, nr 12, s. 1095-1104Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    We used ELISPOT and cell ELISA to study secretion of IL-4, IFN-γ, TGF-β, IL-6, and TNF-α by circulating mononuclear cells during the course of Guillain-Barré syndrome (GBS). Compared to healthy controls, patients with GBS had higher numbers of TGF-β-secreting cells and the number of individuals with myelin-peptide-induced IL-4 and TGF-β secretion was higher in the GBS group. No significant differences were seen concerning the predominantly pro-inflammatory cytokines IFN-γ, IL-6 or TNF-α. Our findings indicate a down-regulatory role for TGF-β and IL-4 in GBS.

    Nyckelord
    Cytokines, ELISPOT, Guillain-Barré, IL-4, Syndrome, TGF-ß
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-46369 (URN)10.1111/j.1600-0463.2003.apm1111204.x (DOI)
    Tillgänglig från: 2009-10-11 Skapad: 2009-10-11 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    4. Transfer of myelin-specific cells deviated in vitro towards IL-4 production ameliorates ongoing experimental allergic neuritis
    Öppna denna publikation i ny flik eller fönster >>Transfer of myelin-specific cells deviated in vitro towards IL-4 production ameliorates ongoing experimental allergic neuritis
    Visa övriga...
    2001 (Engelska)Ingår i: Clinical and Experimental Immunology, ISSN 0009-9104, E-ISSN 1365-2249, Vol. 123, nr 1, s. 112-118Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    A causal role of IL-4 (Th2) production for recovery in experimental allergic neuritis (EAN) was indicated by experiments where Th1-like autoreactive cell populations, taken from the induction phase of the disease, were deviated to extensive secretion of IL-4 in a selective fashion, by ex vivo stimulation with autoantigen in the presence of IL-4. The deviated cells were adoptively transferred to EAN rats at a time just prior to the onset of clinical signs. This treatment ameliorated EAN compared with sham treatment. This therapeutic approach, with generation of autoreactive IL-4-secreting cells ex vivo followed by subsequent adoptive transfer, may become a new selective treatment of organ-specific autoimmune diseases since, in contrast to previous attempts, it is done in a physiological and technically easy way.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-25887 (URN)10.1046/j.1365-2249.2001.01424.x (DOI)10328 (Lokalt ID)10328 (Arkivnummer)10328 (OAI)
    Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
  • 77. Sprigg, Nikola
    et al.
    Gray, Laura J
    Bath, Philip M W
    Boysen, Gudrun
    De Deyn, Peter Paul
    Friis, Pal
    Leys, Didier
    Marttila, Reijo
    Olsson, Jan-Edvin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    O´Neill, Desmond
    Ringelstein, Bernd
    van der Sande, Jan- Jacob
    Lindenström, Ewa
    elationship between outcome and baseline blood pressure and other haemodynamic measures in acute ischaemic stroke: Data from the TAIST trial2006Ingår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 24, nr 7, s. 1413-1417Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A poor outcome after stroke is associated independently with high blood pressure during the acute phase, however, relationships with other haemodynamic measures [heart rate (HR), pulse pressure (PP), rate-pressure product (RPP)] remain less clear. METHODS: The Tinzaparin in Acute Ischaemic Stroke Trial is a randomised, controlled trial assessing the safety and efficacy of tinzaparin versus aspirin in 1484 patients with acute ischaemic stroke. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR measurements taken immediately prior to randomization were averaged, and the mid-blood pressure (MBP), PP, mean arterial pressure (MAP), pulse pressure index, and RPP were calculated. The relationship between these haemodynamic measures and functional outcome (death or dependency, modified Rankin Scale > 2) and early recurrent stroke, were studied with adjustment for baseline prognostic factors and treatment group. Odds ratios (OR) and 95% confidence intervals (CI) refer to a change in haemodynamic measure by 10 points. RESULTS: A poor functional outcome was associated with SBP (adjusted OR, 1.11, 95% CI, 1.03-1.21), HR (adjusted OR, 1.15, 95% CI, 1.00-1.31), MBP (adjusted OR, 1.15, 95% CI, 1.03-1.29), PP (adjusted OR, 1.14, 95% CI, 1.02-1.26), MAP (adjusted OR, 1.15, 95% CI, 1.02-1.31) and RPP (adjusted OR, 1.01, 95% CI, 1.00-1.02). Early recurrent stroke was associated with SBP, DBP, MBP and MAP. CONCLUSIONS: A poor outcome is independently associated with elevations in blood pressure, HR and their derived haemodynamic variables, including PP and the RPP. Agents that modify these measures may improve functional outcome after stroke. © 2006 Lippincott Williams & Wilkins.

  • 78. Sprigg, Nikola
    et al.
    Gray, Laura J
    Bath, Philip MS
    Lindenström, Ewa
    Boysen, Gudrun
    De Deyn, Peter Paul
    Friis, Pal
    Leys, Didier
    Marttila, Reijo
    Olsson, Jan-Edvin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    ONeil, Desmond
    Ringelstein, Erich Bernd
    van der Sande, Jan-Jacob
    Turpie, Alexander GG
    Early recovery and functional outcome are related with causal stroke subtype: Data from the tinzaparin in acute ischemic stroke trial.2007Ingår i: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 16, nr 4, s. 180-184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

        

  • 79.
    Thyberg, Mikael
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Rehabiliteringsmedicin. Linköpings universitet, Hälsouniversitetet.
    Gerdle, Björn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Rehabiliteringsmedicin. Linköpings universitet, Hälsouniversitetet.
    Samuelsson, Kersti
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Rehabiliteringsmedicin. Linköpings universitet, Hälsouniversitetet.
    Larsson, Harriet
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Wheelchair seating intervention: Results from a client-centred approach2001Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 23, nr 15, s. 677-682Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose : The aim of this study was to analyse the effects of wheelchair intervention from a client-centred perspective.

    Method : Results from 38 consecutive active wheelchair users visiting the wheelchair-seating department at the University Hospital in Linköping, Sweden, were analysed and described. All clients had defined problems related to wheelchair seating. Back pain was estimated before intervention and at follow-up, using a Visual Analogue Scale. The effect of intervention on different aspects of wheelchair functionality, seating and occupational performance was estimated by the clients at follow-up.

    Results : Two initial main problem areas were identified among the group; seating discomfort (87% ) and back pain (63% ). Back pain was significantly reduced at follow-up (p<0.001). Problems initially defined by the clients, e.g. seating discomfort, were affected positively, in 79% of all clients, as estimated by the clients at follow-up. No significant correlation was found between the initial cause of intervention or the highest ranked wheelchair functionality aspect and final acceptance of intervention.

    Conclusions : The results from this study confirm the possibility of reducing, or even eliminating, common secondary problems such as back pain and discomfort, related to wheelchair seating by individually adjusted measures. Further research and development in this field is both necessary and cost-effective.

  • 80.
    Valladares, Carlos
    et al.
    Kardiologiska kliniken Hjärtcentrum.
    Broqvist, Mats
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Nylander, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Callander, Margarita
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Var det paradoxal embolism? Cerebellär infarkt, öppetstående foramen ovale och APC-resistens - en kontroversiell kombination och terapeutisk utmaning2006Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, s. 845-848Artikel i tidskrift (Övrigt vetenskapligt)
  • 81.
    Vrethem, Magnus
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Polyneuropathy associated with monoclonal gammopathy: A clinical, neurophysiological and immunological study1994Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    This thesis is based upon clinical, neurophysiological, and immunological studies of polyneuropathy (symmetrical impairment of sensory and motor nerve function) in patients with monoclonal gammopathies, that is, patients characterized by proliferation of a plasma-cell clone secreting homogeneous immWloglobulins (M-component), which in some patients has serum antibody reactivity against peripheral nerve myelin.

    The prevalence of clinical polyneuropathy in patients with monoclonal gammopathy (n=3) was 36%, and the prevalence of all forms of polyneuropathy including patients with neurophysiological signs only andpatients with probable polyneuropathy (signs but no symptoms) was 58%. IgM isotype of the M-component was associated with a high risk of clinical polyneuropathy (5 of 6; 83%). 3 patients, all with a demyelinating polyneuropathy, had antibodies against peripheral nerve myelin. It is concluded that polyneuropathy is common in patients with monoclonal gammopathy, but that only some polyneuropathies are of the demyelinating type and associated with circulating antibodies against peripheral nerve myelin.

    Immunofixation was superior to plasma agarose electrophoresis in detecting M-components in patients investigated for polyneuropathy (n=83). The prevalence of M-components was 7% (3 of 42 patients without obvious associated disease). The prevalence of M-components in the subgroup of patients with demyelinating polyneuropathy was even higher (21 %). Hence, patients with polyneuropathy should be screened for Mcomponents by a sensitive technique, not only to reveal a possible pathogenetie factor, but also because of the possibility of successful immunosuppressive treatment in some of them.

    Antibodies against peripheral nerve myelin were also shown to occur in healthy blood donors (25 of255; 10%). Only 2 of them had clinical and neurophysiological evidence of mild polyneuropathy. Their antibodies were shown to react with several proteins in peripheral nerve myelin, in contrast to patients with monoclonal gammopathy and polyneuropathy whose antibodies reacted with low molecular weight glycoproteins (14-30 kDa) in peripheral nerve myelin. The study confirms previous findings of autoantibodies in healthy persons.

    A positive correlation emerged between the amount of antibodies against peripheral nerve myelin and the proportion of circulating B-1 lymphocytes, known to be responsible for autoantibody production, in patients with polyneuropathy associated with monoclonal gammopathy. The findings suggest that B-1 cells produce antimyelin antibodies and support the idea of an autoinunune mechanism for the pathogenesis of polyneuropathy in some patients.

    Soluble interleukin-2 receptor (siL-2R) is secreted by activated T cells, and was elevated in 7 of 19 patients with monoclonal gammopathy and demyelinating polyneuropathy, as compared to 2 of 19 patients withmonoclonal ganuuopathy without polyneuropathy and in 1 of 15 healthy controls. The finding supports the hypothesis that T cells may have a regulatory role in the M-component production.

    Genomic typing for human leukocyte antigen (HLA) -DR and -DQ genes was done in 55 patients with monoclonal gammopathy. A polyneuropathy of demyelinating type was established in26 patients. Among these people an association was found with the presence of a tryptophan amino acid residue at position 9 of the DRB chain. This position is part of the first hypervariable region of the DRB chain, and may be of importance in detennining preferential peptide-binding capacity of the HLA-DR molecule. Anti-myelin-associated glycoprotein (MAG) antibodies were fmmd in 15 of 17 patients with an IgM M-component and demyelinating polyneuropathy (14 of these 15 people carried a tryptophan at position 9), supporting the pathogenctic role of an autoimmune response against MAG. The finding of an HLA class II association may indicate a pathogenic role ofT cell immunity in this condition.

    3 of 5 patients with monoclonal IgM and antibodies against peripheral nerve myelin responded to immunosuppressive treatment. In 3 patients the clinical response and the antibody concentration correlated, but in2 patients there was no clear correlation, because 1 patient improved despite increasing antibody concentration and 1 patient did hot improve despite a lowered antibody concentration. It is possible that mechanisms other than anti-peripheral-nerve myelin antibodies may contribute to the effect of treatment.

    In summary, it emerged that polyneuropathy is common in monoclonal gammopathy and that the method used to uncover an M-component is important. Both B cell and T cell responses may be involved in the pathogenesis, and a genetic susceptibility to develop polyneuropathy is possible. It is important to establish the diagnosis in these patients because immunosuppressive treatment may prove useful in some cases.

  • 82.
    Vrethem, Magnus
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Fernlund, Ingrid
    Ernerudh, Jan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk immunologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk immunologi och transfusionsmedicin.
    Öhman, Sten
    Prognostic value of cerebrospinal fluid IgA and IgG in multiple sclerosis2004Ingår i: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 10, nr 4, s. 469-471Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IgA antibodies do not activate complement and may compete with and protect against myelin degradation caused by IgM and IgG in multiple sclerosis (MS). We retrospectively evaluated cerebrospinal fluid (CSF) IgA and IgG (as indices and extended indices) from 1980 to 1988 in 68 patients with definitive MS. Sixty-one of them had survived since the time of sampling (11 - 19 years). IgA Extended Index was significantly higher for surviving patients (median 0.65) than for the dead patients (median 0.33). CSF IgA or IgG indices did not correlate with disability, walking distance, or time from onset of symptoms to the need of walking aid. The retrospective experimental design allowed an unusually long follow-up time, but it also had the disadvantages of such a study. Thus the results warrant a prospective study to verify the prognostic vale of CSF IgA in MS.

  • 83.
    Widhe, Mona
    et al.
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Infektionsmedicin. Östergötlands Läns Landsting, LMÖ - Laboratoriemedicin i Östergötland, Transfusionsmedicin och klinisk immunologi. Linköpings universitet, Hälsouniversitetet.
    Ekerfelt, Christina
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Forsberg, Pia
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Infektionsmedicin. Linköpings universitet, Hälsouniversitetet.
    Bergström, S.
    Department of Microbiology, University of Umeå, Umeå, Sweden.
    Ernerudh, Jan
    Östergötlands Läns Landsting, LMÖ - Laboratoriemedicin i Östergötland, Transfusionsmedicin och klinisk immunologi. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    IgG subclasses in Lyme borreliosis: a study of specific IgG subclass distribution in an interferon-γ-predominated disease1998Ingår i: Scandinavian Journal of Immunology, ISSN 0300-9475, E-ISSN 1365-3083, Vol. 47, nr 6, s. 575-581Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Lyme borreliosis has shown a T helper type 1 (Th1)-like immune response with high production of interferon-gamma. Since the cytokine environment seems to be important in the regulation of immunoglobulin production and in the switch between different isotypes and subclasses, and since the subclasses of IgG have different functions, we wanted to examine the IgG subclass distribution in Lyme borreliosis. We have developed an ELISA measuring flagellin-specific antibodies of the different IgG subclasses in serum and cerebrospinal fluid (CSF). Thirty-five seropositive patients with varying manifestations of Lyme borreliosis were included in the study. According to the results, the predominating subclasses in both serum and CSF were IgG1 and IgG3. In samples taken early in disease this pattern was more pronounced in patients with a subacute disease, defined as recovery within 3 months, compared to patients that later on developed chronic borreliosis. The levels of IgG2 were generally low and IgG4 was below detection level. Thus, in the IFN-gamma-predominated immune response seen in Lyme borreliosis, mainly IgG1 and IgG3 were found, i.e. the subclasses that are complement activating as well as opsonizing in humans. Increased levels of these two subclasses early in disease might contribute to recovery and counteract the development of chronicity. The absence of IgG4 is in accordance with the presumed Th1-like situation of Lyme borreliosis.

  • 84.
    Österberg, Anders
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Central pain in multiple sclerosis: clinical characteristics, sensory abnormalities and treatment2005Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    In the present research programme the occurrence of pain in MS was investigated, with special emphasis on central pain (CP). Questionnaires were sent to all 429 patients with definite MS in the patient register at our neurology department. All admitting to pain were interviewed by telephone and offered an extended interview and examination at the out patient department. 364 patients replied (86%), of whom 58% reported pain during the course of their disease (21% nociceptive, 2% peripheral neuropathic and 1% related to spasticity). 1 DO patients (27,5%) had CP, including 18 patients (4,9%) with trigeminal neuralgia (TN). Non-trigeminal CP was, in 87%, located in the lower extremities and in 31% in the upper. lt was mostly bilateral (76%) and constant, with 88% experiencing daily pain. Only 2% had paroxysmal attacks. Aching, burning and pricking were the commonest qualities. The pain was intense with little to moderate spontaneous variation. In 5,5% of all patients (20% of the patients with CP), pain was a presenting symptom, alone or in combination with other symptoms. Trigeminal neuralgia in our MS patients started later in life and after longer disease duration than did nontrigeminal pain. Both types of CP existed either chronically or as a feature of relapse.

    Somatosensory abnormalities were analysed in detail using traditional neurological tests and quantitative methods for sensory tests (QST) in 62 patients with non-trigeminal CP and in a control group of 16 patients with MS and sensory symptoms, but without pain. 97 per cent of the CP patients had abnormal sensibility to temperature and pain, compared to 81% in the control group (p<0.05), whereas there was a tendency towards the opposite regarding sensibility to touch, which was decreased in 66% vs. 87% (n.s), vibration (81% vs. 55%; n.s) and to joint movement (32% vs. 62%; p<0.04).

    Comparison between painful and non-painful regions showed significantly more abnormal sensibility, in the CP regions, for warmth (p<0.001 ), cold (p<0.05), difference limen (innoxious warmth and cold, p<0.01), cold pain (p<0.01), and heat pain/cold pain combined (p<0.001). There were similar differences between CP regions and regions with sensory symptoms, in the controls, for warmth (p<0.05), cold (p<0.01), difference limen (innoxious warmth and cold, p<0.01) and heat pain/cold pain combined (p<0.001).

    These results indicate that MS patients with CP have lesions affecting the spinothalamo-cortical pathways (temperature and pain), and that the lesions affect the mediallemniscal pathways (touch, position sense and vibration) to a lesser degree. The opposite was found in the control group.

    The results support the general hypothesis that only patients who have lesions affecting the spinothalamo-cortical pathways run the risk of developing CP.

    23 MS patients with non-trigeminal CP participated in a double-blind 3-phase, crossover, placebo-controlled study on the pain-relieving effect of amitriptyline and carbamazepine. Each drug was given in randomised order, for a period of 4 weeks, separated by a one-week washout. The target dose was 75 mg for amitriptyline and 600 mg for carbamazepine (reduced from 800 mg because of side-effects). The effect of treatment was assessed by daily ratings of pain using a 10-step verbal rating scale and at the end of each treatment period by a global rating 5-step verbal scale. Due to the high incidence of side-effects 12 and 7 patients discontinued carbamazepine and amitriptyline, respectively. For carbamazepine, these occurred at unexpectedly small doses; 100-200 mg. Amitriptyline, but not carbamazepine, showed a statistically significant pain reduction compared to placebo (p<0.05). According to the global rating, nine of 14 patients were responders. The effect was already noticed during the second week of treatment and it appeared to be correlated to the plasma concentration. Two of 9 patients treated with carbamazepine reported some pain relief, but the effect did not reach statistical significance compared to placebo, and no correlation was found between effect and plasma concentration.

    14 opioid-free patients with non-trigeminal CP caused by MS were investigated. Placebo (normal saline), morphine and naloxone were given intravenously in a standardised manner. The design was a non-randomised, single blind, placebo-controlled trial. For pain assessment a visual analogue scale (0-100 mm) was used. Four patients were opioid-responders, i.e. experienced minimal or no effect on pain with placebo, >50% pain reduction after morphine, and >25% pain increase when naloxone was given after morphine. However, the response was obtained only after high doses of morphine (mean 41 mg). Thus, in contrast to nociceptive pain, only a minority of the patients with CP due to MS responded to morphine and only at high doses. These results are in accordance with experimental studies indicating that neuropathic pain is poorly responsive, but not totally unresponsive to opioids.

    Delarbeten
    1. Central pain in multiple sclerosis: prevalence and clinical characteristics
    Öppna denna publikation i ny flik eller fönster >>Central pain in multiple sclerosis: prevalence and clinical characteristics
    2005 (Engelska)Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 9, nr 5, s. 531-542Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Pain is more common in multiple sclerosis (MS) than has previously been recognised. In the present study we have investigated the occurrence of central pain (CP) in MS and defined its characteristics. Questionnaires were sent to all 429 patients with definite MS in the patient register at our neurology department. All admitting to pain were interviewed and offered an extended interview and examination. Three hundred and sixty four patients responded (86%), of whom 57.5% reported pain during the course of their disease (21% nociceptive, 2% peripheral neuropathic and 1% related to spasticity). One hundred patients (27.5%) had CP, including 18 patients (4.9%) with trigeminal neuralgia.

    The non-trigeminal CP was, in 87%, located in the lower and in 31% in the upper extremities. It was mostly bilateral (76%) and constant, with 88% experiencing daily pain. Only 2% had paroxysmal attacks. Aching, burning, pricking were the commonest qualities. The pain was intense with small to moderate spontaneous variation. In 5.5% of all patients (20% of the patients with CP), pain was a presenting symptom, alone or in combination with other symptoms.

    The most common neurological symptoms/signs besides CP were sensory abnormalities (98%, dominated by abnormal sensibility to painful stimulus and temperature). Trigeminal neuralgia in MS started later in life and after longer disease duration than non-trigeminal pain. Both types of CP existed either chronically or as a feature of relapse. Central pain is thus an important symptom in MS (around 30%) and causes much suffering.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-31877 (URN)10.1016/j.ejpain.2004.11.005 (DOI)17705 (Lokalt ID)17705 (Arkivnummer)17705 (OAI)
    Tillgänglig från: 2009-10-09 Skapad: 2009-10-09 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    2. Central pain in multiple sclerosis: sensory abnormalities
    Öppna denna publikation i ny flik eller fönster >>Central pain in multiple sclerosis: sensory abnormalities
    2010 (Engelska)Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, nr 1, s. 104-110Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Many patients with multiple sclerosis (MS) develop central neuropathic pain (CP). In the present study somatosensory abnormalities have been analysed in detail in 62 patients with MS and CP (42 women, 20 men; mean age 52 years) and in a control group of 10 women and 6 men (mean age 47 years) with MS and sensory symptoms, but without pain.

    Assessment included clinical testing and quantitative methods (QST) for the measurement of perception thresholds for touch, vibration, and temperatures.

    All CP patients except two (97%) had abnormal thresholds for innoxious and/or noxious temperatures, compared to 81% in the control group (p < 0.05). There was a tendency towards the opposite regarding sensibility to touch, which was decreased in 66% vs. 87% (n.s.), vibration (55% vs. 81%; n.s.) and to joint movement (32% vs. 62%; p < 0.04).

    Comparisons between painful and non-painful regions showed both the absolute threshold values and the index values to be significantly more abnormal, in the CP regions, for warmth (p < 0.001), cold (p < 0.05), difference limen (innoxious warmth and cold, p < 0.01), cold pain (p < 0.01) and heat pain/cold pain combined (p < 0.001).

    Also the comparisons between regions with central pain and regions with sensory symptoms in the controls showed significantly more abnormal thresholds in the CP patients for warmth (p < 0.05), cold (p < 0.01), difference limen (innoxious warmth and cold, p < 0.01) and heat pain/cold pain combined (p < 0.001).

    The results support the general hypothesis that only patients who have lesions affecting the spinothalamo-cortical pathways run the risk of developing central pain.

    Nyckelord
    Multiple sclerosis, Central neuropathic pain, Sensibility, Quantitative sensory test (QST)
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-54155 (URN)10.1016/j.ejpain.2009.03.003 (DOI)000274481800017 ()
    Tillgänglig från: 2010-02-26 Skapad: 2010-02-26 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
    3. Central pain in multiple sclerosis: a double-blind placebo-controlled trial of amitriptyline and carbamazepine
    Öppna denna publikation i ny flik eller fönster >>Central pain in multiple sclerosis: a double-blind placebo-controlled trial of amitriptyline and carbamazepine
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Approximately 23% of all MS patients suffer from non-trigeminal, nonparoxysmal central pain (CP). This pain is generally considered difficult to treat effectively; tricyclic antidepressants, anti epileptic drugs or analgesics are most commonly used. In this study, the pain relieving effects of amitriptyline and carbamazepine were investigated.

    The design was a randomised double-blind, three-phase, crossover, placebo-controlled trial. Twenty-three patients with definitive MS entered the study (mean age 55 year, range 40-79 years), all had been thoroughly investigated in a project on CP in MS, and no one showed signs of depression. The treatment phases lasted four weeks, and were separated by a one-week washout. The final doses were 75 mg for amitriptyline and 600 mg for carbamazepine (adjusted from 800 mg, because of side-effects). The effect of treatment was assessed by two daily ratings of pain using a 10- step verbal rating scale (VRS), and at the end of each treatment period using a 5-step global rating scale. For the assessment of depression the Comprehensive Psychopathological Rating Scale (CPRS) was used.

    Originally 23 patients were included in the study, but due to side-effects 7 patients discontinued during the amitriptyline phase, and 12 during the carbamazepine phase. With carbamazepine this occurred at low doses (100-200 mg).

    The results show that amitriptyline significantly reduced non-paroxysmal CP in MS, compared to placebo (VRS 4.2 vs. 5.3; p<0.05) and according to the global rating; nine of 14 patients were responders (64%). The effect could already be seen during the second week of treatment. The plasma concentrations of amitriptyline and its active metabolite nortriptyline were higher in the responders (329 nmol/l) that in the non-responders (252 nmol/l, n.s). CPRS scores for depression were normal, and were not altered by the medication.

    Two of nine patients treated with carbamazepine reported some pain relief, but the effect did not reach significance when compared with placebo. No correlation was found between effect and plasma concentration.

    It is concluded that amitriptyline, but not carbamazepine, has a weak effect on non-paroxysmal CP in MS, and that MS patients appear to be particularly sensitive to the side-effects of the two drugs.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-81949 (URN)
    Tillgänglig från: 2012-09-26 Skapad: 2012-09-26 Senast uppdaterad: 2012-09-26Bibliografiskt granskad
    4. Morphine responsiveness in a group of well-defined multiple sclerosis patients: a study with i.v. morphine
    Öppna denna publikation i ny flik eller fönster >>Morphine responsiveness in a group of well-defined multiple sclerosis patients: a study with i.v. morphine
    Visa övriga...
    2002 (Engelska)Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 6, nr 1, s. 69-80Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Pain in multiple sclerosis (MS) is more common than has previously been believed. About 28% of all MS patients suffer from central pain (CP), a pain that is difficult to treat. In the present study we have investigated the responsiveness of this pain to morphine. Fourteen opioid-free patients (eight woman and six men) with constant, non-fluctuating, long-lasting CP caused by MS were investigated. Placebo (normal saline), morphine and naloxone were given intravenously in a standardized manner. The study design was non-randomized, single blind and placebo controlled. Ten patients experienced less than 50% pain reduction by placebo and less than 50% pain reduction by morphine. Four patients were opioid responders, i.e. had minimal or no effect on pain by placebo, >50% pain reduction after morphine and >25% pain increase after naloxone, given intravenously following morphine. However, this response was obtained after high doses of morphine (43 mg, 47 mg, 50 mg and 25 mg; mean 41 mg). Thus, compared with nociceptive pain, only a minority of the patients with CP due to MS responded to morphine and only at high doses. The present results are in accord with experimental studies indicating that neuropathic pain is poorly responsive but not totally unresponsive to opioids. The results do not support the routine use of strong opioids in MS patients with CP.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-26814 (URN)10.1053/eujp.2001.0307 (DOI)11425 (Lokalt ID)11425 (Arkivnummer)11425 (OAI)
    Tillgänglig från: 2009-10-08 Skapad: 2009-10-08 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
  • 85.
    Österberg, Anders
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Boivie, Jörgen
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Central pain in multiple sclerosis: a double-blind placebo-controlled trial of amitriptyline and carbamazepineManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Approximately 23% of all MS patients suffer from non-trigeminal, nonparoxysmal central pain (CP). This pain is generally considered difficult to treat effectively; tricyclic antidepressants, anti epileptic drugs or analgesics are most commonly used. In this study, the pain relieving effects of amitriptyline and carbamazepine were investigated.

    The design was a randomised double-blind, three-phase, crossover, placebo-controlled trial. Twenty-three patients with definitive MS entered the study (mean age 55 year, range 40-79 years), all had been thoroughly investigated in a project on CP in MS, and no one showed signs of depression. The treatment phases lasted four weeks, and were separated by a one-week washout. The final doses were 75 mg for amitriptyline and 600 mg for carbamazepine (adjusted from 800 mg, because of side-effects). The effect of treatment was assessed by two daily ratings of pain using a 10- step verbal rating scale (VRS), and at the end of each treatment period using a 5-step global rating scale. For the assessment of depression the Comprehensive Psychopathological Rating Scale (CPRS) was used.

    Originally 23 patients were included in the study, but due to side-effects 7 patients discontinued during the amitriptyline phase, and 12 during the carbamazepine phase. With carbamazepine this occurred at low doses (100-200 mg).

    The results show that amitriptyline significantly reduced non-paroxysmal CP in MS, compared to placebo (VRS 4.2 vs. 5.3; p<0.05) and according to the global rating; nine of 14 patients were responders (64%). The effect could already be seen during the second week of treatment. The plasma concentrations of amitriptyline and its active metabolite nortriptyline were higher in the responders (329 nmol/l) that in the non-responders (252 nmol/l, n.s). CPRS scores for depression were normal, and were not altered by the medication.

    Two of nine patients treated with carbamazepine reported some pain relief, but the effect did not reach significance when compared with placebo. No correlation was found between effect and plasma concentration.

    It is concluded that amitriptyline, but not carbamazepine, has a weak effect on non-paroxysmal CP in MS, and that MS patients appear to be particularly sensitive to the side-effects of the two drugs.

  • 86.
    Österberg, Anders
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Boivie, Jörgen
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Neurologi. Linköpings universitet, Hälsouniversitetet.
    Thoumas, K-Å
    Linköpings universitet, Institutionen för medicin och vård, Radiologi. Linköpings universitet, Hälsouniversitetet.
    Central pain in multiple sclerosis: prevalence and clinical characteristics2005Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 9, nr 5, s. 531-542Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Pain is more common in multiple sclerosis (MS) than has previously been recognised. In the present study we have investigated the occurrence of central pain (CP) in MS and defined its characteristics. Questionnaires were sent to all 429 patients with definite MS in the patient register at our neurology department. All admitting to pain were interviewed and offered an extended interview and examination. Three hundred and sixty four patients responded (86%), of whom 57.5% reported pain during the course of their disease (21% nociceptive, 2% peripheral neuropathic and 1% related to spasticity). One hundred patients (27.5%) had CP, including 18 patients (4.9%) with trigeminal neuralgia.

    The non-trigeminal CP was, in 87%, located in the lower and in 31% in the upper extremities. It was mostly bilateral (76%) and constant, with 88% experiencing daily pain. Only 2% had paroxysmal attacks. Aching, burning, pricking were the commonest qualities. The pain was intense with small to moderate spontaneous variation. In 5.5% of all patients (20% of the patients with CP), pain was a presenting symptom, alone or in combination with other symptoms.

    The most common neurological symptoms/signs besides CP were sensory abnormalities (98%, dominated by abnormal sensibility to painful stimulus and temperature). Trigeminal neuralgia in MS started later in life and after longer disease duration than non-trigeminal pain. Both types of CP existed either chronically or as a feature of relapse. Central pain is thus an important symptom in MS (around 30%) and causes much suffering.

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