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Zelano, Johan
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Publications (10 of 16) Show all publications
Zelano, J., Lundberg, R. G., Baars, L., Hedegård, E. & Kumlien, E. (2015). Clinical course of poststroke epilepsy: a retrospective nested case-control study. Brain and Behavior, 5(9), Article ID e00366.
Open this publication in new window or tab >>Clinical course of poststroke epilepsy: a retrospective nested case-control study
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2015 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 5, no 9, article id e00366Article in journal (Refereed) Published
Abstract [en]

Introduction: Recently, several epidemiological studies have demonstrated that epilepsy develops after approximately 10% of all cerebrovascular lesions. With an aging population, poststroke epilepsy is likely to be of increasing relevance to neurologists and more knowledge on the condition is needed. Patients with poststroke epilepsy are likely to differ from other epilepsy patient populations regarding age, side-effect tolerability, comorbidities, and life expectancy, all of which are important aspects when counselling newly diagnosed patients to make informed treatment decisions. Method: We have here performed a nested case-control study on 36 patients with poststroke epilepsy and 55 controls that suffered stroke but did not develop epilepsy. The average follow-up time was between 3 and 4 years. Results: In our material, two-thirds of patients achieved seizure freedom and 25% experienced a prolonged seizure (status epilepticus) during the follow-up period. Cases consumed more health care following their stroke, but did not suffer more traumatic injuries. Interestingly, the mortality among cases and controls did not differ significantly. This observation needs to be confirmed in larger prospective studies, but indicate that poststroke epilepsy might not infer additional mortality in this patient group with considerable comorbidities. Conclusions: The observations presented can be of value in the counselling of patients, reducing the psychosocial impact of the diagnosis, and planning of future research on poststroke epilepsy.

Keywords
Cerebrovascular diseases, epilepsy, treatment
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-267340 (URN)10.1002/brb3.366 (DOI)000363423200009 ()26445704 (PubMedID)
Funder
Swedish Society of Medicine
Available from: 2015-11-24 Created: 2015-11-20 Last updated: 2017-12-01Bibliographically approved
Halawa, I., Zelano, J. & Kumlien, E. (2015). Hypoglycemia and risk of seizures: A retrospective cross-sectional study. Seizure, 25, 147-149
Open this publication in new window or tab >>Hypoglycemia and risk of seizures: A retrospective cross-sectional study
2015 (English)In: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 25, p. 147-149Article in journal (Refereed) Published
Abstract [en]

Purpose: Few studies have been dedicated to assess neurological symptoms in relations to hypoglycemia. In this study we investigated the association between different levels of hypoglycemia and the occurrence of epileptic seizures in patients without a prior diagnosis of epilepsy. Method: A retrospective cross-sectional study. Results: We identified 388 individuals from a laboratory database in Swedish regional hospital who had been found to have a glucose value of <= 3.5 mM between January and December 2009. Medical records were reviewed. Hypoglycemia was defined at three different categories: 0-2 mM (40 patients), 2.1-3 mM (154 patients) and 3.1-3.5 mM (194 patients). 14 patients had disturbance of consciousness including 3 with seizures. The majority of cases had coma, a generalized tonic-clonic seizure was seen only when s-glucose dropped below 2.0 mM. Two cases with focal seizure were noted, one at s-glucose 2.0 mM, and one at s-glucose 3.3 mM. The absolute risks (95% confidence interval) for having major neurological symptoms at glucose levels of <= 2.0 mM were 0.25 (0.13-0.41), 0.02 (0-0.06) at 2.1-3.0 mM and 0.01 (0-0.03) at 3.1-3.5 mM. Conclusion: Coma is the most common neurological symptom related to hypoglycemia. Epileptic seizures are rare and not as common as previously assumed. 

Keywords
Acute symptomatic epilepsy, Hypoglycemia, Seizures
National Category
Neurology Neurosciences
Identifiers
urn:nbn:se:uu:diva-248645 (URN)10.1016/j.seizure.2014.10.005 (DOI)000349881100025 ()25455725 (PubMedID)
Note

Erratum in Seizure 45 p. 132-132 DOI: 10.1016/j.seizure.2016.12.010

Available from: 2015-04-12 Created: 2015-04-06 Last updated: 2018-01-11Bibliographically approved
Halawa, I., Zelano, J. & Kumlien, E. (2014). Hypoglycaemia and Risk of Seizures: a Retrospective Cross-Sectional Study. Paper presented at 11th European Congress on Epileptology, JUN 29-JUL 03, 2014, Stockholm, SWEDEN. Epilepsia, 55, 231-231
Open this publication in new window or tab >>Hypoglycaemia and Risk of Seizures: a Retrospective Cross-Sectional Study
2014 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 55, p. 231-231Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-229373 (URN)000337979300697 ()
Conference
11th European Congress on Epileptology, JUN 29-JUL 03, 2014, Stockholm, SWEDEN
Available from: 2014-08-06 Created: 2014-08-06 Last updated: 2017-12-05Bibliographically approved
Zelano, J., Moller, F., Dobesberger, J., Trinka, E. & Kumlien, E. (2014). Infections in status epilepticus: A retrospective 5-year cohort study. Seizure, 23(8), 603-606
Open this publication in new window or tab >>Infections in status epilepticus: A retrospective 5-year cohort study
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2014 (English)In: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 23, no 8, p. 603-606Article in journal (Refereed) Published
Abstract [en]

Purpose: Status epilepticus (SE) has attracted renewed interest lately, and efforts are made to optimize every treatment stage. For refractory SE, optimal supporting care involves mechanical ventilation and intensive care unit (ICU) admission. Infections often complicate SE and recently a single-centre observational study demonstrated an association between infections and poor short-term outcome of SE in a cohort of severely ill patients. We have here attempted to replicate those findings in a different cohort. Method: We performed a retrospective observational study and included all patients with a diagnosis of SE during 2008-2012 at a Swedish tertiary referral centre. Results: The cohort consisted of 103 patients (53% female, 47% male, median age 62 years, range 19-87 years). In house mortality was less than 2 and 70% of the patients' were discharged home. The most common aetiologies of SE were uncontrolled epilepsy (37%) and brain tumours (16%). A total of 39 patients suffered infections during their stay. Presence of infection was associated with mechanical ventilation (OR 3.344, 95% Cl 1.44-7.79) as well as not being discharged home (OR2.705, 95% Cl 1.14-6.44), and duration of SE was significantly longer in patients with infection (median 1 day vs. 2.5 days, p < 0.001). Conclusion: We conclude that the previously described association between infections, a longer SE duration, and an unfavourable outcome of SE seems valid also in SE of less severe aetiology.  

Keywords
Status epilepticus, Infection, ICU
National Category
Neurosciences Neurology
Identifiers
urn:nbn:se:uu:diva-235095 (URN)10.1016/j.seizure.2014.04.012 (DOI)000341558600004 ()
Available from: 2014-10-29 Created: 2014-10-28 Last updated: 2018-01-11Bibliographically approved
Zelano, J., Moller, F., Dobesberger, J., Trinka, E. & Kumlien, E. (2014). Infections in Status Epilepticus: A Retrospective 5-Year Cohort Study. Paper presented at 11th European Congress on Epileptology, JUN 29-JUL 03, 2014, Stockholm, SWEDEN. Epilepsia, 55, 37-38
Open this publication in new window or tab >>Infections in Status Epilepticus: A Retrospective 5-Year Cohort Study
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2014 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 55, p. 37-38Article in journal, Meeting abstract (Other academic) Published
National Category
Neurology Neurosciences
Identifiers
urn:nbn:se:uu:diva-229369 (URN)000337979300098 ()
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
Berg, A., Zelano, J., Pekna, M., Wilhelmsson, U., Pekny, M. & Cullheim, S. (2013). Axonal Regeneration after Sciatic Nerve Lesion Is Delayed but Complete in GFAP- and Vimentin-Deficient Mice. PLoS ONE, 8(11), e79395
Open this publication in new window or tab >>Axonal Regeneration after Sciatic Nerve Lesion Is Delayed but Complete in GFAP- and Vimentin-Deficient Mice
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2013 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11, p. e79395-Article in journal (Refereed) Published
Abstract [en]

Peripheral axotomy of motoneurons triggers Wallerian degeneration of injured axons distal to the lesion, followed by axon regeneration. Centrally, axotomy induces loss of synapses (synaptic stripping) from the surface of lesioned motoneurons in the spinal cord. At the lesion site, reactive Schwann cells provide trophic support and guidance for outgrowing axons. The mechanisms of synaptic stripping remain elusive, but reactive astrocytes and microglia appear to be important in this process. We studied axonal regeneration and synaptic stripping of motoneurons after a sciatic nerve lesion in mice lacking the intermediate filament (nanofilament) proteins glial fibrillary acidic protein (GFAP) and vimentin, which are upregulated in reactive astrocytes and Schwann cells. Seven days after sciatic nerve transection, ultrastructural analysis of synaptic density on the somata of injured motoneurons revealed more remaining boutons covering injured somata in GFAP(-/-)Vim(-/-) mice. After sciatic nerve crush in GFAP(-/-)Vim(-/-) mice, the fraction of reinnervated motor endplates on muscle fibers of the gastrocnemius muscle was reduced 13 days after the injury, and axonal regeneration and functional recovery were delayed but complete. Thus, the absence of GFAP and vimentin in glial cells does not seem to affect the outcome after peripheral motoneuron injury but may have an important effect on the response dynamics.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-212333 (URN)10.1371/journal.pone.0079395 (DOI)000326499300080 ()
Available from: 2013-12-10 Created: 2013-12-09 Last updated: 2017-12-06Bibliographically approved
Brunell, A., Ridefelt, P. & Zelano, J. (2013). Differential diagnostic yield of lumbar puncture in investigation of suspected subarachnoid haemorrhage: a retrospective study. Journal of Neurology, 260(6), 1631-1636
Open this publication in new window or tab >>Differential diagnostic yield of lumbar puncture in investigation of suspected subarachnoid haemorrhage: a retrospective study
2013 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 260, no 6, p. 1631-1636Article in journal (Refereed) Published
Abstract [en]

The diagnostic algorithm of computerized tomography (CT) and lumbar puncture (LP) for suspected subarachnoid haemorrhage (SAH) has lately been challenged by the advancement of radiological techniques, such as higher resolution offered by newer generation CT-scanners and increased availability of CT-angiography. A purely radiological workup of suspected SAH offers great advantages for both patients and the health care system, but the risks of abandoning LP in this setting are not well investigated. We have characterized the differential diagnostic yield of LP in the investigation of suspected SAH by a retrospective study. From the hospital laboratory database, we analyzed the medical records of all patients who had undergone CSF-analysis in search of subarachnoid bleeding during 2009-2011. A total of 453 patients were included. In 14 patients (3 %) the LP resulted in an alternative diagnosis, the most common being aseptic meningitis. Two patients (0.5 %) received treatment for herpes meningitis. Five patients (1 %) with subarachnoid haemorrhages were identified. Among these, the four patients presenting with thunderclap headache had non-aneurysmal bleedings and did not require surgical intervention. We conclude that the differential diagnostic yield of LP in investigation of suspected SAH is low, which indicates that alternative diagnoses is not a reason to keep LP in the workup when a purely radiological strategy has been validated. However, algorithms should be developed to increase the recognition of aseptic meningitis. One hundred and fifty-three patients (34 %) were admitted to undergo LP, which estimates the number of hospital beds that might be made available by a radiological diagnostic algorithm.

Keywords
Lumbar puncture, Subarachnoid haemorrhage, Thunderclap headache
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-204289 (URN)10.1007/s00415-013-6846-x (DOI)000320046600023 ()
Available from: 2013-07-30 Created: 2013-07-29 Last updated: 2017-12-06Bibliographically approved
Zelano, J., Halawa, I., Clausen, F. & Kumlien, E. (2013). Hyponatremia augments kainic-acid induced status epilepticus in the mouse: A model for dysmetabolic status epilepticus. Paper presented at 4th London-Innsbruck-Colloquium on Status Epilepticus, APR 04-06, 2013, Salzburg, AUSTRIA. Epilepsia, 54(SI), 106-106
Open this publication in new window or tab >>Hyponatremia augments kainic-acid induced status epilepticus in the mouse: A model for dysmetabolic status epilepticus
2013 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 54, no SI, p. 106-106Article in journal, Meeting abstract (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-209225 (URN)000323826600032 ()
Conference
4th London-Innsbruck-Colloquium on Status Epilepticus, APR 04-06, 2013, Salzburg, AUSTRIA
Available from: 2013-10-15 Created: 2013-10-15 Last updated: 2017-12-06Bibliographically approved
Zelano, J., Halawa, I., Clausen, F. & Kumlien, E. (2013). Hyponatremia augments kainic-acid induced status epilepticus in the mouse: A model for dysmetabolic status epilepticus. Epilepsy Research, 106(1-2), 29-34
Open this publication in new window or tab >>Hyponatremia augments kainic-acid induced status epilepticus in the mouse: A model for dysmetabolic status epilepticus
2013 (English)In: Epilepsy Research, ISSN 0920-1211, E-ISSN 1872-6844, Vol. 106, no 1-2, p. 29-34Article in journal (Refereed) Published
Abstract [en]

Status epilepticus (SE) is a dreaded neurological emergency. A reignited interest in SE has resulted in a more adaptive use of treatment protocols. More knowledge on SE of various aetiologies is therefore needed. We are interested in treatment of SE under hyponatremia, and have here evaluated whether SE induced by systemic kainic acid could be a suitable platform for such studies. Acute hyponatremia was induced in C57/BL6 mice by intraperitoneal injection of dDAVP and water loading. Hyponatremic mice displayed an increased frequency of epileptiform spikes on EEG and 5/9 hyponatremic mice displayed electrographic seizures. After kainic acid (20mg/kg) treatment, hyponatremic mice displayed significantly longer time with electrographic seizure activity, which was also seen after treatment with diazepam (20mg/kg). We conclude that hyponatremia augments kainic acid-induced SE, This model might be a valuable platform for studies on treatment of SE in hyponatremia.

National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-206196 (URN)10.1016/j.eplepsyres.2013.05.010 (DOI)000324665600003 ()23790965 (PubMedID)
Available from: 2013-09-11 Created: 2013-08-29 Last updated: 2018-01-11Bibliographically approved
Plantman, S., Zelano, J., Novikova, L. N., Novikov, L. N. & Cullheim, S. (2013). Neuronal myosin-X is upregulated after peripheral nerve injury and mediates laminin-induced growth of neurites. Molecular and Cellular Neuroscience, 56, 96-101
Open this publication in new window or tab >>Neuronal myosin-X is upregulated after peripheral nerve injury and mediates laminin-induced growth of neurites
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2013 (English)In: Molecular and Cellular Neuroscience, ISSN 1044-7431, E-ISSN 1095-9327, Vol. 56, p. 96-101Article in journal (Refereed) Published
Abstract [en]

The successful outcome of peripheral neuronal regeneration is attributed both to the growth permissive milieu and the intrinsic ability of the neuron to initiate appropriate cellular responses such as changes in gene expression and cytoskeletal rearrangements. Even though numerous studies have shown the importance of interactions between the neuron and the extracellular matrix (ECM) in axonal outgrowth, the molecular mechanisms underlying the contact between ECM receptors and the cellular cytoskeleton remain largely unknown. Unconventional myosins constitute an important group of cytoskeletal-associated motor proteins. One member of this family is the recently described myosin-X. This protein interacts with several members of the axon growth-associated ECM receptor family of integrins and could therefore be important in neuronal outgrowth. In this study, using radioactive in situ hybridization, we found that expression of myosin-X mRNA is upregulated in adult rat sensory neurons and spinal motoneurons after peripheral nerve injury, but not after central injury. Thus, myosin-X was upregulated after injuries that can-be followed by axonal regeneration. We also found that the protein is localized to neuronal growth cones and that silencing of myosin-X using RNA interference impairs the integrin-mediated growth of neurites on laminin, but has no effect on non-integrin mediated growth on N-cadherin.

Keywords
Extracellular matrix, axon regeneration, peripheral neuron, cell culture, lesion models
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-210739 (URN)10.1016/j.mcn.2013.04.001 (DOI)000325834100010 ()
Available from: 2013-11-14 Created: 2013-11-14 Last updated: 2017-12-06Bibliographically approved
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