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Flink, Roland
Publications (10 of 30) Show all publications
Jensson, D., Enghag, S., Bylund, N., Jonsson, L., Wikström, J., Grindlund, M. E., . . . Rodriguez-Lorenzo, A. (2018). Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve.. Plastic and reconstructive surgery (1963), 141(4), 582e-585e
Open this publication in new window or tab >>Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve.
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2018 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 141, no 4, p. 582e-585eArticle in journal (Refereed) Published
Abstract [en]

In reanimation surgery, effortless smile can be achieved by a nonfacial donor nerve. The underlying mechanisms for this smile development, and which is the best nonfacial neurotizer, need further clarification. The aim of the present study was therefore to further explore the natural coactivation between facial mimic muscles and muscles innervated by the most common donor nerves used in smile reanimation. The study was conducted in 10 healthy adults. Correlation between voluntary facial muscle movements and simultaneous electromyographic activity in muscles innervated by the masseter, hypoglossal, and spinal accessory nerves was assessed. The association between voluntary movements in the latter muscles and simultaneous electromyographic activity in facial muscles was also studied. Smile coactivated the masseter and tongue muscles equally. During the seven mimic movements, the masseter muscle had fewer electromyographically measured coactivations compared with the tongue (two of seven versus five of seven). The trapezius muscle demonstrated no coactivation during mimic movements. Movements of the masseter, tongue, and trapezius muscles induced electromyographically recorded coactivation in the facial muscles. Bite resulted in the strongest coactivation of the zygomaticus major muscle. The authors demonstrated coactivation between voluntary smile and the masseter and tongue muscles. During voluntary bite, strong coactivation of the zygomaticus major muscle was noted. The narrower coactivation pattern in the masseter muscle may be advantageous for central relearning and the development of a spontaneous smile. The strong coactivation between the masseter muscle and the zygomaticus major indicates that the masseter nerve may be preferred in smile reanimation.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-347468 (URN)10.1097/PRS.0000000000004235 (DOI)000428668900014 ()29595736 (PubMedID)
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2018-06-20Bibliographically approved
Backman, S., Rosen, I., Blennow, M., Andersson, T., Englund, M., Flink, R., . . . Thordstein, M. (2018). Swedish consensus reached on recording, interpretation and reporting of neonatal continuous simplified electroencephalography that is supported by amplitude-integrated trend analysis. Acta Paediatrica, 107(10), 1702-1709
Open this publication in new window or tab >>Swedish consensus reached on recording, interpretation and reporting of neonatal continuous simplified electroencephalography that is supported by amplitude-integrated trend analysis
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 10, p. 1702-1709Article in journal (Refereed) Published
Abstract [en]

Continuous monitoring of electroencephalography (EEG), with a focus on amplitude-integrated EEG (aEEG), has been used in neonatal intensive care for decades. A number of systems have been suggested for describing and quantifying aEEG patterns. Extensive full-montage EEG monitoring is used in specialised intensive care units. The American Clinical Neurophysiology Society published recommendations for defining and reporting EEG findings in critically ill adults and infants. Swedish neonatologists and clinical neurophysiologists collaborated to optimise simplified neonatal continuous aEEG and EEG recordings based on these American documents. Conclusion: This paper describes the Swedish consensus document produced by those meetings.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
Amplitude-integrated electroencephalography, Consensus document, Electroencephalography, Monitoring, Neonatal intensive care
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-365283 (URN)10.1111/apa.14460 (DOI)000444224300011 ()29897141 (PubMedID)
Available from: 2018-11-13 Created: 2018-11-13 Last updated: 2018-11-13Bibliographically approved
Amandusson, Å. (2017). Comparison between adaptive and fixed stimulus paired-pulsetranscranial magnetic stimulation (ppTMS) in normal subjects. Clinical Neurophysiology Practice, 91-97
Open this publication in new window or tab >>Comparison between adaptive and fixed stimulus paired-pulsetranscranial magnetic stimulation (ppTMS) in normal subjects
2017 (English)In: Clinical Neurophysiology Practice, ISSN 2467-981X, p. 91-97Article in journal (Refereed) Published
Abstract [en]

Objectives

Paired-pulse TMS (ppTMS) examines cortical excitability but may require lengthy test procedures and fine tuning of stimulus parameters due to the inherent variability of the elicited motor evoked potentials (MEPs) and their tendency to exhibit a ‘ceiling/floor effects’ in inhibition trials. Aiming to overcome some of these limitations, we implemented an ‘adaptive’ ppTMS protocol and compared the obtained excitability indices with those from ‘conventional’ fixed-stimulus ppTMS.

Methods

Short- and long interval intracortical inhibition (SICI and LICI) as well as intracortical facilitation (ICF) were examined in 20 healthy subjects by adaptive ppTMS and fixed-stimulus ppTMS. The test stimulus intensity was either adapted to produce 500 μV MEPs (by a maximum likelihood strategy in combination with parameter estimation by sequential testing) or fixed to 120% of resting motor threshold (rMT). The conditioning stimulus was 80% rMT for SICI and ICF and 120% MT for LICI in both tests.

Results

There were significant (p < 0.05) intraindividual correlations between the two methods for all excitability measures. There was a clustering of SICI and LICI indices near maximal inhibition (‘ceiling effect’) in fixed-stimulus ppTMS which was not observed for adaptive SICI and LICI.

Conclusions

Adaptive ppTMS excitability data correlates to those acquired from fixed-stimulus ppTMS.

Significance

Adaptive ppTMS is easy to implement and may serve as a more sensitive method to detect changes in cortical inhibition than fixed stimulus ppTMS. Whether equally confident data are produced by less stimuli with our adaptive approach (as already confirmed for motor threshold estimation) remains to be explored.

National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-342567 (URN)10.1016/j.cnp.2017.04.001 (DOI)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-03-15Bibliographically approved
Nilsson, D. T., Malmgren, K., Flink, R. & Rydenhag, B. (2016). Outcomes of multilobar resections for epilepsy in Sweden 1990-2013: a national population-based study. Acta Neurochirurgica, 158(6), 1151-1157
Open this publication in new window or tab >>Outcomes of multilobar resections for epilepsy in Sweden 1990-2013: a national population-based study
2016 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 158, no 6, p. 1151-1157Article in journal (Refereed) Published
Abstract [en]

Reports on outcome after multilobar resection (MLR) are scarce and most are retrospective single-centre studies or case studies with few patients. The aim of this study is to present seizure and complication outcomes 2 years after MLR in a prospective population-based series. The Swedish National Epilepsy Surgery Registry (SNESUR) provides prospective population-based data on outcome and complications after epilepsy surgery. For this study, we have analysed data on seizure outcome and complications after MLR from the SNESUR between 1990 and 2013. Fifty-seven patients underwent MLR; 40/57 surgeries were performed between 1990 and 2000. Sixteen operations were classified as partial hemispherotomy. Resections were right-sided in 33 (58 %) patients. Mean age was 17.3 years (range, 0.3-63.4 years) and mean duration of epilepsy before surgery was 11.0 years (range, 0.2-37 years). Preoperative neurological deficits were seen in 19 patients (33.3 %). Learning disability (LD) was seen in 18 patients (31.6 %), six had severe LD (IQ < 50). Seizure outcome after 2 years was available for 53 patients. Thirteen (24.5 %) were seizure-free and 12 (22.6 %) had > 75 % seizure frequency reduction. Three (5.3 %) patients suffered major complications: infarction of the middle cerebral artery, epidural abscess and hemiparesis. Minor complications were seen in ten patients. There was no mortality. This prospective, population-based study provides data on seizure outcome and complications after MLR. In selected patients MLR can be considered, but expectations for seizure freedom should not be too high and patients and parents should be counselled appropriately.

Keywords
Epilepsy surgery, Multilobar resection, Complications, Seizure outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-298056 (URN)10.1007/s00701-016-2807-3 (DOI)000376096900019 ()27106840 (PubMedID)
Available from: 2016-07-05 Created: 2016-06-29 Last updated: 2017-11-28Bibliographically approved
Bjellvi, J., Flink, R., Rydenhag, B. & Malmgren, K. (2015). Complications of epilepsy surgery in Sweden 1996-2010: a prospective, population-based study. Journal of Neurosurgery, 122(3), 519-525
Open this publication in new window or tab >>Complications of epilepsy surgery in Sweden 1996-2010: a prospective, population-based study
2015 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 122, no 3, p. 519-525Article in journal (Refereed) Published
Abstract [en]

OBJECT Detailed risk information is essential for presurgical patient counseling and surgical quality assessments in epilepsy surgery. This study was conducted to investigate major and minor complications related to epilepsy surgery in a large, prospective series. METHODS The Swedish National Epilepsy Surgery Register provides extensive population-based data on all patients who were surgically treated in Sweden since 1990. The authors have analyzed complication data for therapeutic epilepsy surgery procedures performed between 1996 and 2010. Complications are classified as major (affecting daily life. and lasting longer than 3 months) or minor (resolving within 3 months). RESULTS A total of 865 therapeutic epilepsy surgery procedures were performed between 1996 and 2010, of which 158 were reoperations. There were no postoperative deaths. Major complications occurred in 26 procedures (3%), and minor complications in 65 (7.5%). In temporal lobe resections (n = 523), there were 15 major (2.9%) and 41 minor complications (7.8%); in extratemporal resections (n = 275) there were 9 major (3.3%) and 22 minor complications (8%); and in nonresective procedures (n = 67) there were 2 major (3%) and 2 minor complications (3%). The risk for any complication increased significantly with age (OR 1.26 per 10-year interval, 95% Cl 1.09-1.45). Compared with previously published results from the same register, there is a trend toward lower complication rates, especially in patients older than 50 years. CONCLUSIONS This is the largest reported prospective series of complication data in epilepsy surgery. The complication rates comply well with published results from larger single centers, confirming that epilepsy surgery performed in the 6 Swedish centers is safe. Patient age should be taken into account when counseling patients before surgery.

Keywords
epilepsy, epilepsy surgery, neurosurgery, adverse effects, multicenter study
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-248822 (URN)10.3171/2014.9.JNS132679 (DOI)000350266600005 ()25361484 (PubMedID)
Available from: 2015-04-09 Created: 2015-04-08 Last updated: 2017-12-04Bibliographically approved
Malmgren, K., Rydenhag, B., Olsson, I., Kumlien, E., Mattsson, P. & Flink, R. (2015). Epilepsy Surgery Trends In Sweden 1990-2013. Paper presented at 31st International Epilepsy Congress, SEP 05-09, 2015, Istanbul, TURKEY. Epilepsia, 56, 145-145
Open this publication in new window or tab >>Epilepsy Surgery Trends In Sweden 1990-2013
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2015 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 56, p. 145-145Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-276109 (URN)000365756500440 ()
Conference
31st International Epilepsy Congress, SEP 05-09, 2015, Istanbul, TURKEY
Available from: 2016-02-09 Created: 2016-02-09 Last updated: 2017-11-30Bibliographically approved
Edelvik, A., Flink, R. & Malmgren, K. (2015). Prospective and longitudinal long-term employment outcomes after resective epilepsy surgery. Neurology, 85(17), 1482-1490
Open this publication in new window or tab >>Prospective and longitudinal long-term employment outcomes after resective epilepsy surgery
2015 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 85, no 17, p. 1482-1490Article in journal (Refereed) Published
Abstract [en]

Objective:To investigate long-term employment outcomes after resective epilepsy surgery in a national population-based cohort of adults.Methods:In the Swedish National Epilepsy Surgery Register, all adults who were operated with resective epilepsy surgery from 1995 to 2010 were identified. Two-year follow-up was available for 473/496, 5-year follow-up for 220/240, 10-year follow-up for 240/278, and 15-year follow-up for 85/109 patients.Results:There were no significant changes in employment outcome over time at group level, but for those with full-time employment at baseline, 79%, 79%, 57%, and 47% of seizure-free patients were in full-time work at 2-, 5-, 10-, and 15-year follow-up, compared to patients with benefits at baseline, where 16%, 27%, 31%, and 33% of seizure-free patients worked full time at these time points (p = 0.018 at 10 years). More patients with full-time work had ability to drive, a family of their own, and higher educational status than patients in part-time work or on benefits. Univariate predictors for employment at long term were having employment preoperatively, higher education, favorable seizure outcome, male sex, and younger age at surgery. Multivariate predictors were having employment preoperatively, favorable seizure outcome, and younger age.Conclusions:The best vocational outcomes occurred in seizure-free patients who were employed or students at baseline, which may reflect a higher general psychosocial level of function. Younger age also predicted better employment outcomes and it therefore seems plausible that early referral for surgery could contribute to better vocational outcomes.

National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-268433 (URN)10.1212/WNL.0000000000002069 (DOI)000363968900010 ()26408490 (PubMedID)
Funder
Swedish Research Council, 521-2011-169
Available from: 2015-12-04 Created: 2015-12-04 Last updated: 2017-12-01Bibliographically approved
Flink, R., Hedegård, E., Bjellvi, J., Edelvik, A., Rydenhag, B. & Malmgren, K. (2014). Complications to invasive epilepsy surgery workup with subdural and depth electrodes: a prospective population based observational study. Journal of Neurology, Neurosurgery and Psychiatry, 85(7), 716-720
Open this publication in new window or tab >>Complications to invasive epilepsy surgery workup with subdural and depth electrodes: a prospective population based observational study
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2014 (English)In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 85, no 7, p. 716-720Article in journal (Refereed) Published
National Category
Neurology
Research subject
Clinical Neurophysiology
Identifiers
urn:nbn:se:uu:diva-221686 (URN)10.1136/jnnp-2013-306465 (DOI)000337919300005 ()
Available from: 2014-04-03 Created: 2014-04-03 Last updated: 2017-12-05Bibliographically approved
Edelvik, A., Rydenhag, B., Flink, R. & Malmgren, K. (2014). Employment Outcome after Resective Epilepsy Surgery in Sweden 1995-2010 - a Longitudinal Observational Study. Paper presented at 11th European Congress on Epileptology, JUN 29-JUL 03, 2014, Stockholm, SWEDEN. Epilepsia, 55, 174-174
Open this publication in new window or tab >>Employment Outcome after Resective Epilepsy Surgery in Sweden 1995-2010 - a Longitudinal Observational Study
2014 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 55, p. 174-174Article in journal, Meeting abstract (Other academic) Published
National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-229370 (URN)000337979300524 ()
Conference
11th European Congress on Epileptology, JUN 29-JUL 03, 2014, Stockholm, SWEDEN
Available from: 2014-08-06 Created: 2014-08-06 Last updated: 2018-01-11Bibliographically approved
Stigsdotter-Broman, L., Olsson, I., Flink, R., Rydenhag, B. & Malmgren, K. (2014). Long-term follow-up after callosotomy: A prospective, population based, observational study. Epilepsia, 55(2), 316-321
Open this publication in new window or tab >>Long-term follow-up after callosotomy: A prospective, population based, observational study
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2014 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 55, no 2, p. 316-321Article in journal (Refereed) Published
Abstract [en]

Objective

Analyze the long-term outcome of callosotomies with regard to seizure types and frequencies and antiepileptic drug treatment.

Methods

This longitudinal observational study is based on data from the prospective Swedish National Epilepsy Surgery Register. Thirty-one patients had undergone callosotomy in Sweden 1995-2007 and had been followed for 2 and 5 or 10years after surgery. Data on their seizure types and frequencies, associated impairments, and use of antiepileptic drugs have been analyzed.

Results

The median total number of seizures per patient and month was reduced from 195 before surgery to 110 twoyears after surgery and 90 at the long-term follow-up (5 or 10years). The corresponding figures for drop attacks (tonic or atonic) were 190 before surgery, 100 2years after surgery, and 20 at the long-term follow-up. Ten (56%) of the 18 patients with drop attacks were free from drop attacks at long-term follow-up. Three of the remaining eight patients had a reduction of >75%. At long-term follow-up, four were off medication. Only one of the 31 patients had no neurologic impairment.

Significance

The present population-based, prospective observational study shows that the corpus callosotomy reduces seizure frequency effectively and sustainably over the years. Most improvement was seen in drop attacks. The improvement in seizure frequency over time shown in this study suggests that callosotomy should be considered at an early age in children with intractable epilepsy and traumatizing drop attacks.

Keywords
Long-term, Outcome, Callosotomy, Epilepsy surgery
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-222206 (URN)10.1111/epi.12488 (DOI)000331026400016 ()
Available from: 2014-04-09 Created: 2014-04-08 Last updated: 2017-12-05Bibliographically approved
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