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Kumlien, Eva
Alternative names
Publications (10 of 37) Show all publications
Kumlien, E. (2018). Comparative risk of major malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry. Lancet Neurology, 17(6)
Open this publication in new window or tab >>Comparative risk of major malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry
2018 (English)In: Lancet Neurology, ISSN 1474-4422, E-ISSN 1474-4465, Vol. 17, no 6Article in journal (Refereed) Published
National Category
Basic Medicine
Identifiers
urn:nbn:se:uu:diva-369451 (URN)
Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2018-12-13
Kumlien, E. (2018). Etiologies and characteristics of refractory status epilepticus cases in different areas of the world: Results from a global audit.. Epilepsia, 9
Open this publication in new window or tab >>Etiologies and characteristics of refractory status epilepticus cases in different areas of the world: Results from a global audit.
2018 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 9Article in journal (Refereed) Published
National Category
Basic Medicine
Identifiers
urn:nbn:se:uu:diva-369450 (URN)
Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2018-12-13
Finnsson, J., Lubberink, M., Savitcheva, I., Fällmar, D., Melberg, A., Kumlien, E. & Raininko, R. (2018). Glucose metabolism in the brain in LMNB1-related autosomal dominant leukodystrophy.. Acta Neurologica Scandinavica
Open this publication in new window or tab >>Glucose metabolism in the brain in LMNB1-related autosomal dominant leukodystrophy.
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2018 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: LMNB1-related autosomal dominant leukodystrophy is caused by an overexpression of the protein lamin B1, usually due to a duplication of the LMNB1 gene. Symptoms start in 5th to 6th decade. This slowly progressive disease terminates with death. We studied brain glucose metabolism in this disease using 18 F-fluorodeoxyglucose positron emission tomography (PET).

METHODS: We examined 8 patients, aged 48-64 years, in varying stages of clinical symptomatology. Two patients were investigated with quantitative PET on clinical indications after which six more patients were recruited. Absolute glucose metabolism was analyzed with the PVElab software in 6 patients and 18 healthy controls. A semiquantitative analysis using the CortexID software was performed in seven investigations, relating local metabolism levels to global glucose metabolism.

RESULTS: The clinical quantitative PET revealed low global glucose metabolism, with the most marked reduction in the cerebellum. In the PVElab analysis, patients presented low mean glucose metabolism in the cerebellum, brainstem and global grey matter. In the semiquantitative analysis, 2 patients showed a decreased metabolism in the cerebellum and 4 patients a relatively higher metabolism in parts of the temporal lobes. Since none of the patients showed an increased metabolism in the quantitative analysis, we interpret these increases as "pseudo-increases" related to a globally reduced metabolism.

CONCLUSIONS: Global reduction of grey matter glucose metabolism in this white matter disease most likely depends on a combination of cortical afferent dysfunction and, in later stages, neuronal loss. The lowest metabolism in the cerebellum is consistent with histopathological findings and prominent cerebellar symptoms.

Keywords
18F-fluorodeoxyglucose, adult-onset leukodystrophy, autosomal dominant leukodystrophy, glucose metabolism, positron emission tomography
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-362200 (URN)10.1111/ane.13024 (DOI)30192380 (PubMedID)
Available from: 2018-10-02 Created: 2018-10-02 Last updated: 2018-11-23Bibliographically approved
Halawa, I., Vlachogiannis, P., Amandusson, Å., Elf, K., Ronne-Engström, E., Zetterberg, H. & Kumlien, E. (2018). Seizures, CSF neurofilament light and tau in patients with subarachnoid haemorrhage. Acta Neurologica Scandinavica, 137(2), 199-203
Open this publication in new window or tab >>Seizures, CSF neurofilament light and tau in patients with subarachnoid haemorrhage
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2018 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 137, no 2, p. 199-203Article in journal (Refereed) Published
Abstract [en]

Objectives

Patients with severe subarachnoid haemorrhage (SAH) often suffer from complications with delayed cerebral ischaemia (DCI) due to vasospasm that is difficult to identify by clinical examination. The purpose of this study was to monitor seizures and to measure cerebrospinal fluid (CSF) concentrations of neurofilament light (NFL) and tau, and to see whether they could be used for predicting preclinical DCI.

Methods

We prospectively studied 19 patients with aneurysmal SAH who underwent treatment with endovascular coiling. The patients were monitored with continuous EEG (cEEG) and received external ventricular drainage (EVD). CSF samples of neurofilament light (NLF) and total tau (T-tau) protein were collected at day 4 and day 10. Cox regression analysis was applied to evaluate whether seizures and protein biomarkers were associated with DCI and poor outcome.

Results

Seven patients developed DCI (37%), and 4 patients (21%) died within the first 2months. Six patients (32%) had clinical seizures, and electrographic seizures were noted in one additional patient (4.5%). Increased tau ratio (proportion tau10/tau4) was significantly associated with DCI and hazard ratio [HR=1.33, 95% confidence interval (CI) 1.055-1.680. P=.016].

Conclusion

Acute symptomatic seizures are common in SAH, but their presence is not predictive of DCI. High values of the tau ratio in the CSF may be associated with development of DCI.

Keywords
acute symptomatic seizures, cerebrospinal biomarkers, continuous EEG monitoring, NFL and tau, non-convulsive seizures, subarachnoid haemorrhage
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-341480 (URN)10.1111/ane.12873 (DOI)000419583500007 ()29164612 (PubMedID)
Available from: 2018-02-28 Created: 2018-02-28 Last updated: 2018-02-28Bibliographically approved
Dagiasi, L., Vall, V., Kumlien, E., Burman, J. & Zelano, J. (2018). Treatment of epilepsy in multiple sclerosis. Seizure, 58, 47-51
Open this publication in new window or tab >>Treatment of epilepsy in multiple sclerosis
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2018 (English)In: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 58, p. 47-51Article in journal (Refereed) Published
Abstract [en]

Purpose: The prevalence of epilepsy is increased in multiple sclerosis (MS), but information on AED treatment and seizure outcome is scarce. We describe epilepsy characteristics including the use of AEDs and proportion of seizure-free patients at two tertiary hospitals in Sweden. Method: We retrospectively studied electronic medical records of all patients with a diagnosis of MS and seizures at Sahlgrenska university hospital and Uppsala university hospital. Clinical data were reviewed until 2017. Results: We identified a total of 62 MS patients with at least one seizure. Median age at the first seizure (before or after MS) was 41 years (range 0-80). The most common MS disease course at the first seizure was secondary progressive MS, the neurological disability was considerable, and most patients had several MRI lesions at their first seizure. The first EEG demonstrated epileptiform discharges in 38% and unspecific pathology in 40%. Current seizure status could be determined for 37 patients. Out of these, 46% had been seizure free for more than one year at last follow-up. The majority of patients (65%) were on monotherapy at last follow-up. Carbamazepine was the most commonly used first AED, with a retention rate of 52%. No individual AED was associated with a particularly high rate of seizure freedom. The most common reason for discontinuation of the first AED was side-effects. Conclusion: Seizure freedom rates were low, perhaps indicating a need for higher ambitions in management. Side effects of AEDs may be a particular concern when treating epilepsy in patients with MS.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2018
Keywords
Epilepsy, Multiple sclerosis, Seizures
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-360997 (URN)10.1016/j.seizure.2018.04.001 (DOI)000436884500010 ()29656097 (PubMedID)
Funder
Swedish Society of MedicineMagnus Bergvall Foundation
Available from: 2018-09-26 Created: 2018-09-26 Last updated: 2018-09-26Bibliographically approved
Hansen, J., Åsberg, S., Kumlien, E. & Zelano, J. (2017). Cause of death in patients with poststroke epilepsy: Results from a nationwide cohort study. PLoS ONE, 12(4), Article ID e0174659.
Open this publication in new window or tab >>Cause of death in patients with poststroke epilepsy: Results from a nationwide cohort study
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 4, article id e0174659Article in journal (Refereed) Published
Abstract [en]

The risk of death is increased for persons with epilepsy. The literature on causes of death in epilepsy is based mainly on cohorts with epilepsy of mixed aetiologies. For clinical purposes and improved understanding of mortality in different epilepsies, more information is needed on mortality in epilepsies of specific causes. In poststroke epilepsy (PSE), seizures occur in a setting of vascular disease and high mortality rates. The extent to which epilepsy contributes to mortality in this patient group is poorly understood. We therefore aimed to describe causes of death (COD) in PSE on a national scale. A previously identified cohort of 7740 patients with epilepsy or seizures after a stroke in 2005-2010 was investigated. A total of 4167 deaths occurred before the end of 2014. The standardized mortality ratio for the study cohort was 3.56 (95% CI: 3.45-3.67). The main underlying causes of death were disorders of the circulatory system (60%) followed by neoplasms (12%). Diseases of the nervous system were the sixth leading underlying COD (3%), and epilepsy or status epilepticus was considered the underlying COD in approximately a similar proportion of cases as neurodegenerative disorders (0.9% and 1.1%, respectively). Epilepsy was considered a contributing COD in 14% of cases. Our findings highlight the importance of optimal management of vascular morbidity in patients with PSE. The large proportion of patients with epilepsy as a contributing COD indicate the need of high ambitions also regarding the management of seizures in patients with PSE.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2017
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-322192 (URN)10.1371/journal.pone.0174659 (DOI)000399353500056 ()28380003 (PubMedID)
Available from: 2017-05-17 Created: 2017-05-17 Last updated: 2017-11-29Bibliographically approved
Fahlström, M., Lindskog, K., Appel, L., Engström, M., Antoni, G., Kumlien, E., . . . Lubberink, M. (2017). Correlation between regional cerebral blood flow based on simultaneously acquired arterial spin labelling MRI and 15O-water-PET using zero-echo-time-based attenuation correction. Paper presented at Annual Meeting of the Society-of-Nuclear-Medicine-and-Molecular-Imaging (SNMMI), JUN 10-14, 2017, Denver, CO. Journal of Nuclear Medicine, 58(S1), Article ID 362.
Open this publication in new window or tab >>Correlation between regional cerebral blood flow based on simultaneously acquired arterial spin labelling MRI and 15O-water-PET using zero-echo-time-based attenuation correction
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2017 (English)In: Journal of Nuclear Medicine, ISSN 0161-5505, E-ISSN 1535-5667, Vol. 58, no S1, article id 362Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Objectives: Arterial spin labelling (ASL) MRI promises clinical value in several common neurological disorders. Its quantitative accuracy and reproducibility, however, need to be further validated, ideally using simultaneously acquired measurements with 15O-water-PET on an integrated PET-MR scanner. However, so far, few studies have attempted this and the inclusion of bone in MR-based attenuation correction for PET has thus far been a challenge, compromising the quantitative accuracy of PET-MR based 15O-water PET data. The aim of the present work was to assess the correlation of ASL- and 15O-water-PET based regional cerebral blood flow (rCBF) values based on simultaneously acquired data, using zero-echo-time (ZTE)-based attenuation correction, as well as to assess the reproducibility of ASL-based rCBF.

Methods: Six subjects underwent 10 min PET scans after automated bolus injection of 400 MBq 15O-water (1 mL/s during 5 s followed by 35 mL saline at 2 mL/s) on a time-of-flight integrated PET-MR scanner (Signa PET-MR, GE Healthcare). Arterial blood radioactivity concentrations were monitored using continuous sampling from the radial artery (Swisstrace Twilite Two). Simultaneously, a 3D FSE pseudo-continuous ASL (3D pCASL) with a spiral read-out as supplied by the scanner manufacturer in the commercial software were acquired using an 8 channel head coil (Invivo Hi-Res Head Coil). In addition, 3D T1-w, ZTE and Dixon fat-water MRI were acquired. The ASL procedure was repeated after 2 h (patients remained in the scanner). Quantifiable ASL-based CBF maps were generated. PET images were reconstructed into 26 frames of increasing durations using time-of-flight OSEM (2 iterations, 28 subsets) and a 5 mm post-filter, with ZTE-based attenuation correction. Blood sampler data were corrected for delay and dispersion and 15O-water-based CBF maps were calculated using a basis function implementation of the single tissue compartment model including a fitted blood volume parameter. CBF maps were co-registered to each patient's T1-w image. 3D T1-w images were segmented and normalised to MNI space using SPM12, and anterior, middle and posterior flow territory volumes of interest (VOIs) were created from a standard template in MNI space and inversely transformed for each patient. In addition, a 45-VOI probabilistic template was applied using PVElab software. Correlations between PET- and ASL-based rCBF values were assessed using regression analysis, and reproducibility of ASL using a paired t-test.

Results: Mean (CI) total brain grey matter CBF values were 67.2 (48.0-86.5) mL/min/100 g for 15O-water-PET and 65.5 (55.7-75.5) mL/min/100 g for ASL. Although correlation and agreement between 15O-water and ASL-based rCBF for individual VOIs in the 45-VOI template were generally poor, significant correlations were found on a grey matter flow territory basis, with R2 ranging from 0.70 in the anterior flow territory to 0.86 in the middle flow territory. rCBF values were significantly reduced between second and first ASL for all flow territories (p<0.01), with a mean decrease of 10%.

Conclusion: A good correlation between regional flow territory CBF values based on ASL and 15O-water-PET was found, using ZTE-based attenuation correction for PET data which takes bone tissue into account. ASL values for regional flow territories may have potential applications in patients with dementia or cerebrovascular diseases affecting blood flow such as moya moya. The decrease of ASL-based rCBF values in the reproducibility study needs to be investigated further to assess whether this is a methodological issue or reflects a true decrease in rCBF. Research Support: Uppsala County Council

National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-333332 (URN)000404949901169 ()
Conference
Annual Meeting of the Society-of-Nuclear-Medicine-and-Molecular-Imaging (SNMMI), JUN 10-14, 2017, Denver, CO
Note

Title in WoS: Correlation between regional cerebral blood flow based on simultaneously acquired arterial spin labelling MRI and O-15-water-PET using zero-echo-time-based attenuation correction

Available from: 2017-11-15 Created: 2017-11-15 Last updated: 2017-11-15Bibliographically approved
Knight, A., Pauksen, K., Nordmark, G. & Eva, K. (2017). Fatal outcome of tick-borne encephalitis in two patients with rheumatic disease treated with rituximab.. Rheumatology, 56(5), 855-856
Open this publication in new window or tab >>Fatal outcome of tick-borne encephalitis in two patients with rheumatic disease treated with rituximab.
2017 (English)In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 56, no 5, p. 855-856Article in journal (Refereed) Published
National Category
Rheumatology and Autoimmunity
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-318795 (URN)10.1093/rheumatology/kew495 (DOI)28130421 (PubMedID)
Available from: 2017-03-28 Created: 2017-03-28 Last updated: 2017-12-07Bibliographically approved
Zelano, J., Larsson, D., Kumlien, E. & Åsberg, S. (2017). Pre-stroke seizures: A nationwide register-based investigation. Seizure, 49, 25-29
Open this publication in new window or tab >>Pre-stroke seizures: A nationwide register-based investigation
2017 (English)In: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 49, p. 25-29Article in journal (Refereed) Published
Abstract [en]

Purpose: The relationship between cerebroyascular disease and seizures is clearly illustrated by poststroke epilepsy. Seizures can also be the first manifestation of cerebrovascular disease and case control studies have demonstrated that seizures carry an increased risk of subsequent stroke. Thus, seizures could serve as a marker for vascular risk that merits intervention, but more data is needed before proper trials can be conducted. The occurrence of pre-stroke seizures has not been assessed on a national scale. We asked what proportion of strokes in middle-aged and elderly patients was preceded by seizures. Methods: All patients over 60 years of age with first-ever stroke in 2005-2010 (n = 92,596) were identified in the Swedish stroke register (Riksstroke) and cross-sectional data on a history of a first seizure or epilepsy diagnosis in the ten years preceding stroke were collected from national patient registers with mandatory reporting. Results: 1372 patients (1.48%) had a first seizure or epilepsy diagnosis registered less than ten years prior to the index stroke. The mean latency between seizure and stroke was 1474 days (SD 1029 days). Conclusions: Seizures or epilepsy preceded 1.48% of strokes in patients > 60 years of age. Based on recent national incidence figures, 5-20% of incident cases of seizures or epilepsy after 60 years of age could herald stroke, depending on age group. These proportions are of a magnitude that merit further study on how to reduce the risk of stroke in patients with late-onset seizures or epilepsy.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2017
Keywords
Seizure, Stroke, Epilepsy, Prevention, Epidemiology
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-330041 (URN)10.1016/j.seizure.2017.05.010 (DOI)000404821200006 ()28544888 (PubMedID)
Funder
Swedish Society of MedicineAstraZenecaSwedish Research Council
Available from: 2017-09-28 Created: 2017-09-28 Last updated: 2017-09-28Bibliographically approved
Lubberink, M., Appel, L., Lindskog, K., Danfors, T., Sprycha, M., Daging, J., . . . Antoni, G. (2017). Quantitative assessment of synaptic density using the SV2A ligand C-11-UCBA in humans. Paper presented at 28th International Symposium on Cerebral Blood Flow, Metabolism and Function / 13th International Conference on Quantification of Brain Function with PET, APR 01-04, 2017, Int Soc Cerebral Blood Flow & Metab, Berlin, Germany. Journal of Cerebral Blood Flow and Metabolism, 37, 74-74
Open this publication in new window or tab >>Quantitative assessment of synaptic density using the SV2A ligand C-11-UCBA in humans
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2017 (English)In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016, Vol. 37, p. 74-74Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Sage Publications, 2017
National Category
Endocrinology and Diabetes Hematology Neurology
Identifiers
urn:nbn:se:uu:diva-331031 (URN)000400157400107 ()
Conference
28th International Symposium on Cerebral Blood Flow, Metabolism and Function / 13th International Conference on Quantification of Brain Function with PET, APR 01-04, 2017, Int Soc Cerebral Blood Flow & Metab, Berlin, Germany
Available from: 2017-10-11 Created: 2017-10-11 Last updated: 2017-10-11
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