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  • 1.
    Alping, P.
    et al.
    Danderyd Hosp, Karolinska Inst, Clin Neurosci, Stockholm, Sweden..
    Svenningsson, A.
    Danderyd Hosp, Karolinska Inst, Clin Sci, Stockholm, Sweden..
    Salzer, J.
    Umea Univ, Pharmacol & Clin Neurosci, Umea, Sweden..
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology. Uppsala Univ, Neurosci, Uppsala, Sweden..
    Dahle, C.
    Linkoping Univ, Clin & Expt Med, Linkopin, Sweden..
    Fink, K.
    Danderyd Hosp, Karolinska Inst, Clin Neurosci, Stockholm, Sweden..
    Hillert, J.
    Danderyd Hosp, Karolinska Inst, Clin Neurosci, Stockholm, Sweden..
    Lycke, J.
    Univ Gothenburg, Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, A-M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Martin, C.
    Danderyd Hosp, Karolinska Inst, Clin Sci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Neurol, Lund, Sweden..
    Walentin, F.
    Orebro Univ Hosp, Neurol, Orebro, Sweden..
    Olsson, T.
    Danderyd Hosp, Karolinska Inst, Clin Neurosci, Stockholm, Sweden..
    Frisell, T.
    Karolinska Inst, Med Solna, Stockholm, Sweden..
    Piehl, F.
    Danderyd Hosp, Karolinska Inst, Clin Neurosci, Stockholm, Sweden..
    Rituximab in multiple sclerosis; data from the swedish MS registry.2016In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 22, no suppl. 3, p. 49-49Article in journal (Refereed)
  • 2.
    Berntsson, Shala G.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Kristoffersson, A
    Boström, I
    Feresiadou, Amalia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Rapidly increasing off-label use of rituximab in multiple sclerosis in Sweden - Outlier or predecessor?2018In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Off-label use of rituximab to treat MS patients in Sweden is high, and the need for long-term safety data may not be met. Our objectives were to assess the rate of rituximab prescription in patients with multiple sclerosis in Sweden and, in addition, to evaluate the safety of rituximab in a single centre for patients with multiple sclerosis.

    MATERIAL AND METHODS: Review of the Swedish MS register was performed to study the number of MS patients treated with rituximab during the last 6 years. Investigation also included a retrospective review of medical files in search for possible side effects/adverse events in all adult patients with MS treated with rituximab at Uppsala University Hospital.

    RESULTS: Presently, in Sweden the rate of rituximab prescriptions in relation to other annually started of disease- modifying drugs in MS is 53.5%.

    CONCLUSIONS: The share of MS patients in Sweden who are treated with rituximab is very high, and also rapidly increasing. Taken into account the off-label use, cases with adverse medical conditions that could possibly be related to rituximab use should be reported thoroughly.

  • 3.
    Berntsson, Shala G.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology. Univ Linkoping, Med Fac, Dept Clin & Expt Med, Neurol, Linkoping, Sweden.
    Flensner, Gullvi
    Univ West, Dept Hlth Sci, Trollhattan, Sweden.
    Cerebellar ataxia and intrathecal baclofen therapy: Focus on patients' experiences2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 6, article id e0180054Article in journal (Refereed)
    Abstract [en]

    Elucidating patients' experiences of living with chronic progressive hereditary ataxia and the symptomatic treatment with intrathecal baclofen (ITB) is the objective of the current study. A multicenter qualitative study with four patients included due to the rare combination of hereditary ataxia and ITB therapy was designed to elucidate participants' experiences through semi-structured interviews. The transcribed text was analyzed according to content analysis guidelines. Overall we identified living in the present/ taking one day at a time as the main theme covering the following categories: 1) Uncertainty about the future as a consequence of living with a hereditary disease; The disease; 2) Impact on life as a whole, 3) Influence on personal life in terms of feeling forced to terminate employment, 4) Limiting daily activities, and 5) ITB therapy, advantages, and disadvantages. Uncertainty about the future was the category that affected participants' personal life, employment, and daily activities. The participants' experience of receiving ITB therapy was expressed in terms of improved quality of life due to better body position and movement as well as better sleep and pain relief.

  • 4. Bjørnevik, Kjetil
    et al.
    Riise, Trond
    Bostrom, Inger
    Casetta, Llaria
    Cortese, Marianna
    Granieri, Enrico
    Holmøy, Trygve
    Kampman, Margitta T
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology. Division of Neurology, Department of Clinical and Experimental Medicine, University of Linköping.
    Magalhaes, Sandra
    Pugliatti, Maura
    Wolfson, Christina
    Myhr, Kjell-Morten
    Negative interaction between smoking and EBV in the risk of multiple sclerosis: The EnvIMS study2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, no 7, p. 1018-1024Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Results from previous studies on a possible interaction between smoking and Epstein-Barr virus (EBV) in the risk of multiple sclerosis (MS) are conflicting.

    OBJECTIVES: To examine the interaction between smoking and infectious mononucleosis (IM) in the risk of MS.

    METHODS: Within the case-control study on Environmental Factors In Multiple Sclerosis (EnvIMS), 1904 MS patients and 3694 population-based frequency-matched healthy controls from Norway, Italy, and Sweden reported on prior exposure to smoking and history of IM. We examined the interaction between the two exposures on the additive and multiplicative scale.

    RESULTS: Smoking and IM were each found to be associated with an increased MS risk in all three countries, and there was a negative multiplicative interaction between the two exposures in each country separately as well as in the pooled analysis (p = 0.001). Among those who reported IM, there was no increased risk associated with smoking (odds ratio (OR): 0.95, 95% confidence interval (CI): 0.66-1.37). The direction of the estimated interactions on the additive scale was consistent with a negative interaction in all three countries (relative excess risk due to interaction (RERI): -0.98, 95% CI: -2.05-0.15, p = 0.09).

    CONCLUSION: Our findings indicate competing antagonism, where the two exposures compete to affect the outcome.

  • 5. Bjørnevik, Kjetil
    et al.
    Riise, Trond
    Casetta, Ilaria
    Drulovic, Jelena
    Granieri, Enrico
    Holmøy, Trygve
    Kampman, Margitta T
    Landtblom, Anne-Marie
    Division of Neurology, Department of Clinical and Experimental Medicine, UHL, County Council, Linköping University, Sweden .
    Lauer, Klaus
    Lossius, Andreas
    Magalhaes, Sandra
    Myhr, Kjell-Morten
    Pekmezovic, Tatjana
    Wesnes, Kristin
    Wolfson, Christina
    Pugliatti, Maura
    Sun exposure and multiple sclerosis risk in Norway and Italy: The EnvIMS study2014In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 20, no 8, p. 1042-1049Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objective of this paper is to estimate the association between multiple sclerosis (MS) and measures of sun exposure in specific age periods in Norway and Italy.

    METHODS: A total of 1660 MS patients and 3050 controls from Italy and Norway who participated in a multinational case-control study (EnvIMS) reported sun habits during childhood and adolescence.

    RESULTS: A significant association between infrequent summer outdoor activity and increased MS risk was found in Norway and in Italy. The association was strongest between the ages of 16 and 18 years in Norway (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.30-2.59), and between birth and age 5 years in Italy (OR 1.56, 95% CI 1.16-2.10). In Italy a significant association was also found during winter (OR 1.42, 95% CI 1.03-1.97). Frequent sunscreen use between birth and the age of 6 years was associated with MS in Norway (OR 1.44, 95% CI 1.08-1.93) after adjusting for outdoor activity during the same period. Red hair (OR 1.67, 95% CI 1.06-2.63) and blonde hair (OR 1.36, 95% CI 1.09-1.70) were associated with MS after adjusting for outdoor activity and sunscreen use.

    CONCLUSION: Converging evidence from different measures underlines the beneficial effect of sun exposure on MS risk.

  • 6. Bolin, K
    et al.
    Berggren, F
    Berling, P
    Morberg, S
    Gauffin, H
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Patterns of antiepileptic drug prescription in Sweden: A register-based approach2017In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 136, no 5, p. 521-527Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine drug utilization pathways from the incident healthcare visit due to epilepsy and three years onward.

    MATERIAL AND METHODS: Anti-epileptic drug utilization was calculated using individual information on inpatient- and outpatient care utilization and drug sales. Throughout, we used national register information pertaining to pharmaceutical sales linked to diagnosis-related healthcare utilization. Information on pharmaceutical sales was collected for the 2007-2013 period.

    RESULTS: For the entire studied period, a majority of new patients with epilepsy were initiated on anti-epileptic drug treatment with a monotherapy (98%); most of these patients remained on that first treatment (64%). The three most frequently prescribed drugs accounted for 72% of the initiated AED treatments. Patients with epilepsy (ICD-10: G40/41) were most commonly prescribed carbamazepine, lamotrigine and valproate. The most common second-line monotherapy was levetiracetam. About 12% of new patients with epilepsy who were initiated on AED treatment during the period eventually switched to an add-on therapy. The proportion of patients who were initiated on treatment with carbamazepine or valproate decreased, and the proportion of patients who remained on their initial monotherapy increased between 2007 and 2013.

    CONCLUSIONS: A limited number of anti-epileptic drugs accounted for the treatment of a majority of new patients with epilepsy (carbamazepine, lamotrigine and valproate accounted for more than 70%). Add-on therapies showed the same pattern, as the most frequently prescribed add-on regimens were the same ones that accounted for most of the monotherapies. There was a tendency towards fewer patients being initiated on AED treatment with either carbamazepine or valproate.

  • 7. Bolin, K
    et al.
    Berggren, F
    Landtblom, Anne-Marie
    Department of Clinical and Experimental Medicine/Neurology, University of Linköping, UHL, County Council, Linköping, Sweden.
    Prevalence and cost of epilepsy in Sweden -: a register-based approach2015In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 131, no 1, p. 37-44Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To estimate the prevalence of epilepsy, costs associated with in- and outpatient care, drug utilization and productivity losses due to epilepsy in Sweden for the years 2005 and 2011.

    METHODS: Cost components were calculated using registry data on inpatient- and outpatient-care utilization, drug sales and early pensions granted due to permanent disability and mortality. Moreover, by cross-identification of information in healthcare and pharmaceutical registries, we were able to distinguish between pharmaceuticals prescribed for epilepsy and non-epilepsy indications.

    RESULTS: The prevalence of epilepsy was estimated at 0.62% in 2005 and 0.88% in 2011. The total cost of epilepsy increased during the same period, while the per-patient cost decreased from €2929 to €1729. Direct medical costs accounted for about 36% of the estimated total cost in 2005 and 60% in 2011. The estimated healthcare cost due to epilepsy as a share of total healthcare costs for all illnesses was about the same in 2005 as in 2011 (0.2%), while the corresponding pharmaceutical cost increased from about 0.5% in 2005 to almost 1% in 2011.

    CONCLUSIONS: The per-patient cost of epilepsy is substantial, implying a significant aggregated cost incurred on society (despite a prevalence < 1%). Our results suggest that the per-patient pharmaceutical utilization increased, while the per-patient physician visits and hospitalizations decreased, between 2005 and 2011. Moreover, we demonstrate that the 2005 prevalence measure was underestimated the true prevalence in 2005.

  • 8. Bolin, K
    et al.
    Berggren, F
    Landtblom, Anne-Marie
    Department of Clinical and Experimental Medicine/Neurology, University of Linköping, UHL County Council, Linköping, Sweden.
    Regional variation in prevalence and healthcare utilization due to epilepsy in Sweden2014In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 130, no 6, p. 354-359Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the regional differences in the prevalence of epilepsy and the associated costs due to inpatient and outpatient care and anti-epileptic drug (AED) utilization for the years 2005 and 2011 in Sweden.

    METHODS: Region-specific estimates of the prevalence of epilepsy were obtained using a method based on a linkage of the healthcare and pharmaceutical registries and the cause of death registry. Regional cost components were estimated using registry data by region on inpatient and outpatient care utilization, AED sales, and mortality. Per-patient utilization and monetary costs were calculated.

    RESULTS: Estimated prevalence of epilepsy varied substantially across the regions in 2011, from 0.76% in Jämtland to 1.08% in Gotland. The national prevalence was 0.88%. The average number of hospitalizations per patient and year decreased at the national level between 2005 and 2011. At the national level, the per-patient specialized care (outpatient) utilization also decreased between 2005 and 2011. However, at the regional level, the decrease was not uniform, and in some counties, the per-patient utilization increased during the period studied. The per-patient utilization of AEDs increased in all counties, except Kronoberg, between 2005 and 2011. Moreover, between-region differences in healthcare and AED utilization, and significant differences between regions and national averages were revealed. Similarly, regional per-patient costs were shown to deviate from the national average in 13 of 21 regions.

    CONCLUSIONS: There is significant variation in the prevalence of epilepsy and the provision of health care for patients with epilepsy across the different regions of Sweden.

  • 9.
    Bostrom, I.
    et al.
    Linkoping Univ, Linkoping, Sweden..
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Landtblom, A-M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Adverse events of rituximab in a Swedish MS population sample.2016In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 22, p. 871-871Article in journal (Refereed)
  • 10. Boström, I
    et al.
    Landtblom, A-M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Does the changing sex ratio of multiple sclerosis give opportunities for intervention?2015In: Acta Neurologica Scandinavica, Supplementum, ISSN 0065-1427, E-ISSN 1600-5449, ISSN 1600-5449, Vol. 132, no 199, p. 42-5Article in journal (Refereed)
    Abstract [en]

    In several international studies, an increasing women-to-men (w/m) ratio in patients with multiple sclerosis (MS) has been reported. Such sex ratios have been analysed by year of onset or by year of birth. In a Swedish study, data from the Swedish MS register (SMSreg) were used to analyse the w/m ratio in Sweden. The sex ratio was analysed both by year of birth (8834 patients) and by year of onset (9098 patients). No increased w/m ratio was seen in this study. The age-specific sex ratio did not demonstrate any significant changes. However, a new investigation of the sex ratio in Sweden, based on data from all available data sources (19,510 patients), showed a significantly increased w/m ratio of MS in Sweden from 1.70 to 2.67. Environmental factors such as cigarette smoking, hormonal factors and nutrition are of interest in this context, but the cause of the increasing w/m ratio in MS is yet not possible to explain.

  • 11. Boström, Inger
    et al.
    Riise, Trond
    Landtblom, Anne-Marie
    Division of Neuroscience, Department of Clinical and Experimental Medicine, Linköping University.
    Mortality statistics for multiple sclerosis and amyotrophic lateral sclerosis in Sweden2012In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 38, no 4, p. 245-249Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) are chronic neurologic diseases for which distinct explanations of the pathogenesis are lacking. Two large Swedish register studies have rather unexpectedly detected a correlation between MS and ALS. The aim of this study was to investigate if an association between ALS and MS could be demonstrated as has been shown earlier.

    MATERIAL AND METHODS: Data on mortality from ALS and MS, 1990-2010, were collected from the Swedish National Statistics Office. In all there were 5,696 deaths due to ALS and 3,941 deaths due to MS. Age- and sex-adjusted mortality rates were calculated.

    RESULTS: There was no correlation between the mortality rates of ALS and MS in the 21 counties of Sweden for the period 1990-2010 (Spearman's rho = -0.052; p = 0.822; n = 21). The national mean mortality rate for ALS throughout the period of 1990-2010 was 2.98 per 100,000 person-years (95% CI 2.87-3.08). For MS the national mean mortality rate was 2.04 per 100,000 person-years (95% CI 1.95-2.12).

    CONCLUSION: This study did not confirm the previously shown association between MS and ALS in Sweden.

  • 12. Boström, Inger
    et al.
    Stawiarz, Leszek
    Landtblom, Anne-Marie
    epartment of Clinical and Experimental Medicine, Division of Neurology, UHL, Linköping University.
    Age-specific sex ratio of multiple sclerosis in the National Swedish MS Register (SMSreg)2014In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 20, no 4, p. 513-514Article in journal (Refereed)
  • 13. Boström, Inger
    et al.
    Stawiarz, Leszek
    Landtblom, Anne-Marie
    Department of Clinical and Experimental Medicine, Division of Neuroscience, Linköping University, Sweden.
    Sex ratio of multiple sclerosis in the National Swedish MS Register (SMSreg)2013In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 19, no 1, p. 46-52Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sex ratio in multiple sclerosis has been reported from several geographical areas. The disease is more common in women. In Europe the female-to-male ratio varies from 1.1 to 3.4. A recent study from Canada has reported a significant increase, with time, in female-to-male ratio in multiple sclerosis over the last 100 years.

    OBJECTIVE: The aim of this study was to analyse any change in sex ratio in multiple sclerosis in the Swedish population.

    METHODS: Data from the Swedish MS Register and data from the Swedish National Statistics Office were used to estimate sex ratio by year of birth and year of onset.

    RESULTS: In the analysis of sex ratio by year of birth there were 8834 patients (6271 women and 2563 men) born between 1931 and 1985. The mean women-to-men ratio was 2.62. No clear trend was noted for the women-to-men ratio by year of birth (Spearman's rho = 0.345, p = 0.298, n = 11). The number of patients analysed by year of onset was 9098 during the time period 1946 until 2005. The mean women-to-men ratio was 2.57. No significant change in women-to-men ratio (Spearman's rho = -0.007, p = 0.983, n = 12) with time was observed.

    CONCLUSION: There is no evidence for an increasing women-to-men ratio with time amongst Swedish multiple sclerosis patients.

  • 14.
    Bostöm, I.
    et al.
    Linköping Univ, Neurol, Linköping, Sweden.
    Ghaderi Berntsson, Shala
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Zheliba, N.
    Vrinnevi Hosp, Paediat, Norrköping, Sweden.
    Gauffin, H.
    Linköping Univ, Neurol & Clin Expt Med, Linköping, Sweden.
    Kristoffersson, A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Niemelä, Valter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Narcolepsy as a side effect of swine flu vaccination2017In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 381, no Supplement, p. 189-189Article in journal (Other academic)
  • 15.
    Drissi, Natasha M.
    et al.
    Linkoping Univ, Dept Med & Hlth Sci IMH, Linkoping, Sweden; Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden.
    Szakács, Attila
    Univ Gothenburg, Sahlgrenska Acad, Dept Paediat, Inst Clin Sci, Gothenburg, Sweden.
    Witt, Suzanne T
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden.
    Wretman, Anna
    Linkoping Univ, Dept Behav Sci & Learning, Linkoping, Sweden.
    Ulander, Martin
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Ståhlbrandt, Henriettae
    Darin, Niklas
    Univ Gothenburg, Sahlgrenska Acad, Dept Paediat, Inst Clin Sci, Gothenburg, Sweden.
    Hallböök, Tove
    Univ Gothenburg, Sahlgrenska Acad, Dept Paediat, Inst Clin Sci, Gothenburg, Sweden.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology. Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden.
    Engström, Maria
    Linkoping Univ, Dept Med & Hlth Sci IMH, Linkoping, Sweden; Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden.
    Altered Brain Microstate Dynamics in Adolescents with Narcolepsy2016In: Frontiers in Human Neuroscience, ISSN 1662-5161, E-ISSN 1662-5161, Vol. 10, article id 369Article in journal (Refereed)
    Abstract [en]

    Narcolepsy is a chronic sleep disorder caused by a loss of hypocretin-1 producing neurons in the hypothalamus. Previous neuroimaging studies have investigated brain function in narcolepsy during rest using positron emission tomography (PET) and single photon emission computed tomography (SPECT). In addition to hypothalamic and thalamic dysfunction they showed aberrant prefrontal perfusion and glucose metabolism in narcolepsy. Given these findings in brain structure and metabolism in narcolepsy, we anticipated that changes in functional magnetic resonance imaging (fMRI) resting state network (RSN) dynamics might also be apparent in patients with narcolepsy. The objective of this study was to investigate and describe brain microstate activity in adolescents with narcolepsy and correlate these to RSNs using simultaneous fMRI and electroencephalography (EEG). Sixteen adolescents (ages 13-20) with a confirmed diagnosis of narcolepsy were recruited and compared to age-matched healthy controls. Simultaneous EEG and fMRI data were collected during 10 min of wakeful rest. EEG data were analyzed for microstates, which are discrete epochs of stable global brain states obtained from topographical EEG analysis. Functional MRI data were analyzed for RSNs. Data showed that narcolepsy patients were less likely than controls to spend time in a microstate which we found to be related to the default mode network and may suggest a disruption of this network that is disease specific. We concluded that adolescents with narcolepsy have altered resting state brain dynamics.

  • 16. Engström, Maria
    et al.
    Flensner, Gullvi
    Landtblom, Anne-Marie
    Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
    Ek, Anna-Christina
    Karlsson, Thomas
    Thalamo-striato-cortical determinants to fatigue in multiple sclerosis2013In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 3, no 6, p. 715-728Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim was to explore the thalamo-striato-cortical theory of central fatigue in multiple sclerosis (MS) patients with self-reported fatigue. If the theory correctly predicted fatigue based on disruptions of the thalamo-striato-cortical network, we expected altered brain activation in this network in MS participants while performing a complex cognitive task that challenged fatigue.

    METHODS: MS participants with self-reported fatigue were examined by functional magnetic resonance imaging (fMRI) during the performance of a complex working memory task. In this task, cognitive effort was challenged by a parametric design, which modeled the cerebral responses at increasing cognitive demands. In order to explore the theory of central fatigue in MS we also analyzed the cerebral responses by adding perceived fatigue scores as covariates in the analysis and by calculating the functional connectivity between regions in the thalamo-striatocortical network. The main findings were that MS participants elicited altered brain responses in the thalamo-striato-cortical network, and that brain activation in the left posterior parietal cortex and the right substantia nigra was positively correlated to perceived fatigue ratings. MS participants had stronger cortical-to-cortical and subcortical-to-subcortical connections, whereas they had weaker cortical-to-subcortical connections.

    CONCLUSIONS: The findings of the present study indicate that the thalamo-striato-cortical network is involved in the pathophysiology of fatigue in MS, and provide support for the theory of central fatigue. However, due to the limited number of participants and the somewhat heterogeneous sample of MS participants, these results have to be regarded as tentative, though they might serve as a basis for future studies.

  • 17.
    Engström, Maria
    et al.
    Linkoping Univ, Dept Med & Hlth Sci IMH, Div Radiol Sci, Linkoping, Sweden; Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden.
    Hallböök, Tove
    Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Pediat, Gothenburg, Sweden.
    Szakacs, Attila
    Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Pediat, Gothenburg, Sweden; Halmstad Cty Hosp, Dept Pediat, Halmstad, Sweden.
    Karlsson, Thomas
    Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden; Linkoping Univ, Div Disabil Res, Linkoping, Sweden; Linkoping Univ, Linnaeus Ctr HEAD, Dept Behav Sci & Learning, Linkoping, Sweden.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology. Linkoping Univ, Ctr Med Image Sci & Visualizat CMIV, Linkoping, Sweden; Linkoping Univ, Dept Neurol, Dept Clin & Expt Med IKE, Linkoping, Sweden; Linkoping Univ, Dept Med & Hlth Sci, Dept Med Specialist, Motala, Sweden.
    Functional magnetic resonance imaging in narcolepsy and the Kleine-Levin syndrome2014In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 5, article id 105Article in journal (Refereed)
    Abstract [en]

    This work aims at reviewing the present state of the art when it comes to understanding the pathophysiology of narcolepsy and the Kleine-Levin syndrome (KLS) from a neuroimaging point of view. This work also aims at discussing future perspectives of functional neuroimaging in these sleep disorders. We focus on functional magnetic resonance imaging (fMRI), which is a technique for in vivo measurements of brain activation in neuronal circuitries under healthy and pathological conditions. fMRI has significantly increased the knowledge on the affected neuronal circuitries in narcolepsy and the Kleine-Levin syndrome. It has been shown that narcolepsy is accompanied with disturbances of the emotional and the closely related reward systems. In the Kleine Levin syndrome, fMRI has identified hyperactivation of the thalamus as a potential biomarker that could be used in the diagnostic procedure. The fMRI findings in both narcolepsy and the Kleine-Levin syndrome are in line with previous structural and functional imaging studies. We conclude that fMRI in combination with multi-modal imaging can reveal important details about the pathophysiology in narcolepsy and the Kleine-Levin syndrome. In the future, fMRI possibly gives opportunities for diagnostic support and prediction of treatment response in individual patients.

  • 18. Engström, Maria
    et al.
    Karlsson, Thomas
    Landtblom, Anne-Marie
    Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
    Reduced thalamic and pontine connectivity in kleine-levin syndrome2014In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 5, p. 42-Article in journal (Refereed)
    Abstract [en]

    The Kleine-Levin syndrome (KLS) is a rare sleep disorder, characterized by exceptionally long sleep episodes. The neuropathology of the syndrome is unknown and treatment is often inadequate. The aim of the study was to improve understanding of the underlying neuropathology, related to cerebral networks, in KLS during sleep episodes. One patient with KLS and congenital nystagmus was investigated by resting state functional magnetic resonance imaging during both asymptomatic and hypersomnic periods. Fourteen healthy subjects were also investigated as control samples. Functional connectivity was assessed from seed regions of interest in the thalamus and the dorsal pons. Thalamic connectivity was normal in the asymptomatic patient whereas the connectivity between the brain stem, including dorsal pons, and the thalamus was diminished during hypersomnia. These results suggest that the patient's nystagmus and hypersomnia might have their pathological origin in adjacent dorsal pontine regions. This finding provides additional knowledge of the cerebral networks involved in the neuropathology of this disabling disorder. Furthermore, these findings regarding a rare syndrome have broad implications, and results could be of interest to researchers and clinicians in the whole field of sleep medicine.

  • 19. Engström, Maria
    et al.
    Karlsson, Thomas
    Landtblom, Anne-Marie
    Department of Clinical and Experimental Medicine (IKE), Division of Neurology, Linköping University, UHL, LiM, Linköping, Sweden.
    Thalamic activation in the Kleine-Levin syndrome2014In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 37, no 2, p. 379-386Article in journal (Refereed)
    Abstract [en]

    STUDY OBJECTIVES: The objective of this study was to investigate if combined measures of activation in the thalamus and working memory capacity could guide the diagnosis of Kleine-Levin Syndrome (KLS). A second objective was to obtain more insight into the neurobiological causes of KLS.

    DESIGN: Matched group and consecutive recruitment.

    SETTING: University hospital neurology department and imaging center.

    PATIENTS OR PARTICIPANTS: Eighteen patients with KLS diagnosed according to the International Classification of Sleep Disorders and 26 healthy controls were included.

    INTERVENTIONS: N/A.

    MEASUREMENTS AND RESULTS: Working memory capacity was assessed by the listening span task. A version of this task (reading span) was presented to the participants during functional magnetic resonance imaging (fMRI). Activation in the thalamus was measured in a region of interest analysis. A combination of the working memory capacity and the thalamic activation measures resulted in 80% prediction accuracy, 81% sensitivity, and 78% specificity regarding the ability to separate KLS patients from healthy controls. The controls had an inverse relation between working memory capacity and thalamic activation; higher performing participants had lower thalamic activation (r = -0.41). KLS patients showed the opposite relationship; higher performing participants had a tendency to higher thalamic activation (r = -0.35).

    CONCLUSIONS: This study shows that functional neuroimaging of the thalamus combined with neuropsychological assessment of working memory function provides a means to guide diagnosis of Kleine-Levin Syndrome. Results in this study also indicate that imaging of brain function and evaluation of cognitive capacity can give insights into the neurobiological mechanisms of Kleine-Levin Syndrome.

  • 20. Engström, Maria
    et al.
    Karlsson, Thomas
    Landtblom, Anne-Marie
    Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
    Craig, A D Bud
    Evidence of Conjoint Activation of the Anterior Insular and Cingulate Cortices during Effortful Tasks2015In: Frontiers in Human Neuroscience, ISSN 1662-5161, E-ISSN 1662-5161, Vol. 8, article id 1071Article in journal (Refereed)
    Abstract [en]

    The ability to perform effortful tasks is a topic that has received considerable interest in the research of higher functions of the human brain. Neuroimaging studies show that the anterior insular and the anterior cingulate cortices are involved in a multitude of cognitive tasks that require mental effort. In this study, we investigated brain responses to effort using cognitive tasks with task-difficulty modulations and functional magnetic resonance imaging (fMRI). We hypothesized that effortful performance involves modulation of activation in the anterior insular and the anterior cingulate cortices, and that the modulation correlates with individual performance levels. Healthy participants performed tasks probing verbal working memory capacity using the reading span task, and visual perception speed using the inspection time task. In the fMRI analysis, we focused on identifying effort-related brain activation. The results showed that working memory and inspection time performances were directly related. The bilateral anterior insular and anterior cingulate cortices showed significantly increased activation during each task with common portions that were active across both tasks. We observed increased brain activation in the right anterior insula and the anterior cingulate cortex in participants with low working memory performance. In line with the reported results, we suggest that activation in the anterior insular and cingulate cortices is consistent with the neural efficiency hypothesis (Neubauer).

  • 21. Engström, Maria
    et al.
    Landtblom, Anne-Marie
    Neurology, Department of Clinical and Experimental Medicine, Linköping University and UHL, County Council, Linköping, Sweden.
    Karlsson, Thomas
    Brain and effort: brain activation and effort-related working memory in healthy participants and patients with working memory deficits2013In: Frontiers in Human Neuroscience, ISSN 1662-5161, E-ISSN 1662-5161, Vol. 7, article id 140Article in journal (Refereed)
    Abstract [en]

    Despite the interest in the neuroimaging of working memory, little is still known about the neurobiology of complex working memory in tasks that require simultaneous manipulation and storage of information. In addition to the central executive network, we assumed that the recently described salience network [involving the anterior insular cortex (AIC) and the anterior cingulate cortex (ACC)] might be of particular importance to working memory tasks that require complex, effortful processing.

    METHOD: Healthy participants (n = 26) and participants suffering from working memory problems related to the Kleine-Levin syndrome (KLS) (a specific form of periodic idiopathic hypersomnia; n = 18) participated in the study. Participants were further divided into a high- and low-capacity group, according to performance on a working memory task (listening span). In a functional magnetic resonance imaging (fMRI) study, participants were administered the reading span complex working memory task tapping cognitive effort.

    PRINCIPAL FINDINGS: The fMRI-derived blood oxygen level dependent (BOLD) signal was modulated by (1) effort in both the central executive and the salience network and (2) capacity in the salience network in that high performers evidenced a weaker BOLD signal than low performers. In the salience network there was a dichotomy between the left and the right hemisphere; the right hemisphere elicited a steeper increase of the BOLD signal as a function of increasing effort. There was also a stronger functional connectivity within the central executive network because of increased task difficulty.

    CONCLUSION: The ability to allocate cognitive effort in complex working memory is contingent upon focused resources in the executive and in particular the salience network. Individual capacity during the complex working memory task is related to activity in the salience (but not the executive) network so that high-capacity participants evidence a lower signal and possibly hence a larger dynamic response.

  • 22. Engström, Maria
    et al.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Karlsson, Thomas
    New hypothesis on pontine-frontal eye field connectivity in Kleine-Levin syndrome2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, no 6, p. 716-719Article in journal (Refereed)
    Abstract [en]

    Previous studies have indicated involvement of the thalamus and the pons in Kleine-Levin syndrome. In the present study, functional connectivity of the thalamus and the pons was investigated in asymptomatic patients with Kleine-Levin syndrome and healthy controls. Twelve patients and 14 healthy controls were investigated by functional magnetic resonance imaging during rest. Resting state images were analysed using seed regions of interest in the thalamus and the pons. The results showed significantly lower functional connectivity between the pons and the frontal eye field in persons with Kleine-Levin syndrome compared with healthy controls. There were no connectivity differences involving the thalamus. Based on these findings, a relation is proposed between the sleep disorder Kleine-Levin syndrome and cerebral control of eye movements, which in turn is related to visual attention and working memory. This hypothesis has to be tested in future studies of oculomotor control in Kleine-Levin syndrome.

  • 23. Engström, Maria
    et al.
    Warntjes, Jan B M
    Tisell, Anders
    Landtblom, Anne-Marie
    Division of Radiation Physics, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Lundberg, Peter
    Multi-parametric representation of voxel-based quantitative magnetic resonance imaging2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 11, article id e111688Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to explore the possibilities of multi-parametric representations of voxel-wise quantitative MRI data to objectively discriminate pathological cerebral tissue in patients with brain disorders. For this purpose, we recruited 19 patients with Multiple Sclerosis (MS) as benchmark samples and 19 age and gender matched healthy subjects as a reference group. The subjects were examined using quantitative Magnetic Resonance Imaging (MRI) measuring the tissue structure parameters: relaxation rates, R[Formula: see text] and R[Formula: see text], and proton density. The resulting parameter images were normalized to a standard template. Tissue structure in MS patients was assessed by voxel-wise comparisons with the reference group and with correlation to a clinical measure, the Expanded Disability Status Scale (EDSS). The results were visualized by conventional geometric representations and also by multi-parametric representations. Data showed that MS patients had lower R[Formula: see text] and R[Formula: see text], and higher proton density in periventricular white matter and in wide-spread areas encompassing central and sub-cortical white matter structures. MS-related tissue abnormality was highlighted in posterior white matter whereas EDSS correlation appeared especially in the frontal cortex. The multi-parameter representation highlighted disease-specific features. In conclusion, the proposed method has the potential to visualize both high-probability focal anomalies and diffuse tissue changes. Results from voxel-based statistical analysis, as exemplified in the present work, may guide radiologists where in the image to inspect for signs of disease. Future clinical studies must validate the usability of the method in clinical practice.

  • 24. Flensner, Gullvi
    et al.
    Landtblom, Anne-Marie
    Department of Clinical and Experimental Medicine (IKE), Division of Neurology, Faculty of Health Sciences, Linköping University, UHL and LiM, County Council of Östergötland, Linköping, SE-581 83, Sweden .
    Söderhamn, Olle
    Ek, Anna-Christina
    Work capacity and health-related quality of life among individuals with multiple sclerosis reduced by fatigue: a cross-sectional study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, article id 224Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Among individuals diagnosed with the chronic neurologic disease, multiple sclerosis (MS), a majority suffers from fatigue, which strongly influences their every-day-life. The aim of this study was to investigate work capacity and health-related quality of life (HRQoL) in a group of MS patients and also to investigate if work capacity and HRQoL could be predicted by background factors, fatigue, heat sensitivity, cognitive dysfunction, emotional distress or degree of disability.

    METHODS: A descriptive, cross-sectional, designed survey was undertaken A questionnaire was sent to 323 individuals diagnosed with MS, aged between 20 and 65 years, with physical disability on the expanded disability status score (EDSS) in the interval 0 ≥ EDSS ≤ 6.5, living in Östergötland county in eastern Sweden. Questions on background factors, occupation and work, together with the health-related quality of life short form instrument (SF-36), the fatigue severity scale (FSS), the perceived deficit questionnaire (PDQ) and the hospital anxiety depression scale (HAD) were posed. Associations between variables were analyzed using Pearson's and Spearman's correlations. Differences between groups were tested using the Chi-square test, the Mann Whitney U-test, and the Student's t-test. Predictive factors were analyzed using multiple linear and multiple logistic regression analysis.

    RESULTS: Of those who completed the questionnaire (n = 257, 79.6%), 59.8% were working. Work capacity was found significantly more among men (p < 0.005), those with a higher level of education (p < 0.001), those reporting less fatigue (p < 0.001), and those having no heat sensitivity (p = 0.004). For work capacity, significant predictors were low physical disability (EDSS), low fatigue, higher level of education, male sex and lower age. Those with work capacity showed significantly higher HRQoL than those who had no work capacity (p < 0.001). Levels of fatigue, cognition and emotional distress were found to be major contributing factors for HRQoL.

    CONCLUSIONS: Work capacity and HRQoL among individuals diagnosed with MS are highly influenced by fatigue which can be considered as a key symptom. Work capacity was influenced by heat-sensitivity, cognitive difficulties and emotional distress and significant predictive factors besides fatigue, were physical disability (EDSS), age, sex, and level of education. Remaining at work also gives a better HRQoL.

  • 25.
    Forsberg, L.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Johansson, S.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Frisell, T.
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Clin Sci, Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Sveningsson, A.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, A-M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Real world experience of fingolimod after switching multiple sclerosis (MS) therapy; focus on natalizumab naive and experienced persons with MS, respectively2016In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 22, no Suppl. 3, p. 647-648Article in journal (Refereed)
  • 26.
    Forsberg, L.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Johansson, S.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Neurol, Dept Clin Sci, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Sveningsson, A.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, A-M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology. Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    A Swedish nationwide pharmaco-epidemiological and genetic study of the long-term safety and effectiveness of dimethyl fumarate (IMSE 5)2016In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 22, no Suppl. 3, p. 338-339Article in journal (Refereed)
  • 27.
    Forsberg, L.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Johansson, S.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nordin, N.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Svenningsson, A.
    Umea Univ, Pharmacol & Clin Neurosci, Umea, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    A Swedish nationwide pharmaco-epidemiological and genetic study (IMSE) of the long-term safety and efficacy of dimethyl fumarate2015In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 21, p. 286-287Article in journal (Other academic)
  • 28.
    Forsberg, L.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Kagstrom, S.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Leandersson, A.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Berglund, A.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Biogen, Med Dept, Upplandsvasby, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Sveningsson, A.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    A Swedish nationwide pharmaco-epidemiological study of the long-term safety and effectiveness of dimethyl fumarate (IMSE 5)2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, p. 884-885Article in journal (Other academic)
  • 29.
    Forsberg, L.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Leandersson, A.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Kagstrom, S.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Sveningsson, A.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    A Swedish nationwide pharmaco-epidemiological study of the long-term safety and effectiveness of teriflunomid (IMSE 4)2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, p. 635-636Article in journal (Other academic)
  • 30. Gauffin, Helena
    et al.
    Flensner, Gullvi
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Being parents with epilepsy: thoughts on its consequences and difficulties affecting their children2015In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 11, p. 1291-1298Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Parents with epilepsy can be concerned about the consequences of epilepsy affecting their children. The aim of this paper is to describe aspects of what it means being a parent having epilepsy, focusing the parents' perspectives and their thoughts on having children.

    METHODS: Fourteen adults aged 18-35 years with epilepsy and subjective memory decline took part in focus-group interviews. The interviews were conducted according to a semi-structured guideline. Material containing aspects of parenthood was extracted from the original interviews and a secondary analysis was done according to a content-analysis guideline. Interviews with two parents for the Swedish book Leva med epilepsi [To live with epilepsy] by AM Landtblom (Stockholm: Bilda ide; 2009) were analyzed according to the same method.

    RESULTS: Four themes emerged: (1) a persistent feeling of insecurity, since a seizure can occur at any time and the child could be hurt; (2) a feeling of inadequacy - of not being able to take full responsibility for one's child; (3) acknowledgment that one's children are forced to take more responsibility than other children do; and (4) a feeling of guilt - of not being able to fulfill one's expectations of being the parent one would like to be.

    CONCLUSION: The parents with epilepsy are deeply concerned about how epilepsy affects the lives of their children. These parents are always aware that a seizure may occur and reflect on how this can affect their child. They try to foresee possible dangerous situations and prevent them. These parents were sad that they could not always take full responsibility for their child and could not live up to their own expectations of parenthood. Supportive programs may be of importance since fear for the safety of the child increases the psychosocial burden of epilepsy. There were also a few parents who did not acknowledge the safety issue of their child - the authors believe that it is important to identify these parents and provide extra information and support to them.

  • 31. Gauffin, Helena
    et al.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Epilepsy and violence: case series concerning physical trauma in children of persons with epilepsy2014In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 10, p. 2183-2189Article in journal (Refereed)
    Abstract [en]

    Historically, epilepsy has been associated with violence, but more recent studies have emphasized genetic and psychosocial factors as more important. The case series presented here aim to highlight the difficult situation the affected children are in. We report on three cases when children have been traumatized and, in one case, even been killed by their parent who was diagnosed with epilepsy. In the first case, we describe a woman with juvenile myoclonic epilepsy who was sentenced to forensic psychiatry care for killing her child. She lived under difficult psychosocial circumstances and a suicide attempt contributed to what happened. The second case describes a man with post-traumatic seizures who was sentenced for child abuse. Ictal or postictal violence was considered in these two cases but a causal link between the violence and epilepsy has not been established. In the third case, we describe a woman with focal epilepsy and psychogenic non-epileptic seizures (PNESs). Her child was hurt and frightened in relation to violent seizures, which were regarded as PNESs. This case series demonstrates that children of parents with epilepsy can be in a vulnerable situation. No causality has been established between the seizures and these events, so consequently other factors such as psychosocial stress, low cognitive function, and a suicide attempt must also be considered as important. When a child is hurt by a parent with epilepsy the patient must be closely examined to determine the role of the seizures. Children can also be affected by PNESs. It is essential to notice especially those children of parents with epilepsy who live under difficult psychosocial circumstances and offer extra support when necessary.

  • 32. Gauffin, Helena
    et al.
    van Ettinger-Veenstra, Helene
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Ulrici, Daniel
    McAllister, Anita
    Karlsson, Thomas
    Engström, Maria
    Impaired language function in generalized epilepsy: inadequate suppression of the default mode network.2013In: Epilepsy & Behavior, ISSN 1525-5050, E-ISSN 1525-5069, Vol. 28, no 1, p. 26-35Article in journal (Refereed)
    Abstract [en]

    We aimed to study the effect of a potential default mode network (DMN) dysfunction on language performance in epilepsy. Language dysfunction in focal epilepsy has previously been connected to brain damage in language-associated cortical areas. In this work, we studied generalized epilepsy (GE) without focal brain damage to see if the language function was impaired. We used functional magnetic resonance imaging (fMRI) to investigate if the DMN was involved. Eleven persons with GE and 28 healthy controls were examined with fMRI during a sentence-reading task. We demonstrated impaired language function, reduced suppression of DMN, and, specifically, an inadequate suppression of activation in the left anterior temporal lobe and the posterior cingulate cortex, as well as an aberrant activation in the right hippocampal formation. Our results highlight the presence of language decline in people with epilepsy of not only focal but also generalized origin.

  • 33.
    Ghaderi Berntsson, Shala
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Hereditary cerebellar ataxia and intrathecal baclofen: A pilot study2017In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 381, no Supplement, p. 309-309Article in journal (Other academic)
  • 34. Gáti, István
    et al.
    Danielsson, Olof
    Gunnarsson, Cecilia
    Vrethem, Magnus
    Häggqvist, Bo
    Fredriksson, Bengt-Arne
    Landtblom, Anne-Marie
    Neurology Clinic, Linköping University, Linköping.
    Bent spine syndrome: a phenotype of dysferlinopathy or a symptomatic DYSF gene mutation carrier2012In: European Neurology, ISSN 0014-3022, E-ISSN 1421-9913, Vol. 67, no 5, p. 300-302Article in journal (Refereed)
  • 35. Hallböök, Tove
    et al.
    Azakacs, Attila
    Bialek, Fatima
    Feltelius, Nils
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Malmgren, Kristina
    Narkolepsi – ovanlig sjukdomsom fått ökad uppmärksamhet: Pandemrixvaccination ledde till fler insjuknanden bland barn och ungdomar2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 41, p. 1770-1773Article in journal (Refereed)
    Abstract [sv]

    Narkolepsi är en ovanlig sjukdom där symtomen beror på störd reglering av sömn och vakenhet. Kardinalsymtom är uttalad dagsömnighet, kataplexiattacker och nattlig dyssomni. 

    Etiologin anses betingad av en autoimmun process hos predisponerade individer, där omgivningsfaktorer är av betydelse för att utlösa sjukdomen.

    Pandemrixvaccinationen ledde till ökat insjuknande hos barn och ungdomar och en viss ökning hos unga vuxna.

    Behandlingen utgör en kombination av läkemedel med effekt på kardinalsymtomen och livsstilsråd, där teamomhändertagande är viktigt.

    Svenska narkolepsiregistret ger möjlighet att följa sjukdomsförlopp och behandling, vilket är viktigt inte minst eftersom dokumentationen av de läkemedel som används är begränsad.

  • 36.
    Imrell, K.
    et al.
    Karolinska Inst, Stockholm, Sweden..
    Masterman, T.
    Karolinska Inst, Stockholm, Sweden..
    Brynedal, B.
    Karolinska Inst, Stockholm, Sweden..
    Lima, I.
    Karolinska Inst, Stockholm, Sweden..
    Hillert, J.
    Karolinska Inst, Stockholm, Sweden..
    Kockum, I.
    Karolinska Inst, Stockholm, Sweden..
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Genetic load in eleven distantly related individuals from an MS high risk area2015In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 21, p. 435-436Article in journal (Other academic)
  • 37.
    Johansson, S.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Forsberg, L.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Svenningsson, A.
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Danderyd, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, A-M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology. Uppsala Univ, Dept Neurosci, Uppsala, Sweden..
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Danderyd, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    A Swedish nationwide pharmaco-epidemiological and genetic study of the long-term safety and effectiveness of natalizumab (IMSE 1)2016In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 22, no suppl. 3, p. 336-337Article in journal (Refereed)
  • 38.
    Johansson, S.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Forsberg, L.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Svenningsson, A.
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    A Swedish nationwide pharmaco-epidemiological and genetic study of the long-term safety and efficacy of natalizumab2015In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 21, p. 285-286Article in journal (Other academic)
  • 39.
    Johansson, S.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Forsberg, L.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nordin, N.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Svenningsson, A.
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    The IMSE 2 study: a Swedish nationwide pharmaco-epidemiological and genetic study focused on long-term safety and efficacy of fingolimod2015In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 21, p. 284-285Article in journal (Other academic)
  • 40. Jonsson, L.
    et al.
    Holmen, C.
    Hillert, J.
    Nilsson, P.
    Dahle, C.
    Feltelius, N.
    Sveningsson, A.
    Lycke, J.
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Walentin, F.
    Martin, C.
    Piehl, F.
    Olsson, T.
    A Swedish nationwide pharmaco-epidemiological and genetic study (IMSE) of the long-term safety and efficacy of natalizumab2014In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 20, p. 166-166Article in journal (Refereed)
  • 41.
    Kagstrom, S.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Leandersson, A.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Forsberg, L.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Berglund, A.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Biogen, Med Dept, Upplandsvasby, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Svenningsson, A.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    A Swedish nationwide pharmaco-epidemiological study of the long-term safety and effectiveness of natalizumab (IMSE 1)2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, p. 365-366Article in journal (Other academic)
  • 42.
    Kagstrom, S.
    et al.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Leandersson, A.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Forsberg, L.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Berglund, A.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Biogen, Med Dept, Upplandsvasby, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Svenningsson, A.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Real-world longitudinal data of peginterferon beta-1a from a Swedish national post-marketing surveillance study (IMSE 6) - efficacy and safety profile2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, p. 626-627Article in journal (Other academic)
  • 43.
    Landtblom, Anne-Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Engström, Maria
    Brain circuitries involved in sleep disorders2015In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 6, article id UNSP 66Article in journal (Refereed)
  • 44.
    Landtblom, Anne-Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology. Linkoping Univ, Div Neurol, Dept Clin & Expt Med, IKE,Cty Council, Linkoping, Sweden; Linkoping Univ, Cty Council, IMM,Neurol Unit, Dept Med Specialties, Motala, Sweden; Linkoping Univ, Dept Med & Hlth Sci, Div Radiol Sci, Linkoping, Sweden.
    Engström, Maria
    Linkoping Univ, Dept Med & Hlth Sci, Div Radiol Sci, Linkoping, Sweden.
    The sleepy teenager: diagnostic challenges OCR V262014In: Frontiers in Neurology, ISSN 1664-2295, E-ISSN 1664-2295, Vol. 5, article id 140Article in journal (Refereed)
    Abstract [en]

    The sleepy teenager puts the doctor in a, often tricky, situation where it must be decided if we deal with normal physiology or if we should suspect pathological conditions. What medical investigations are proper to consider? What differential diagnoses should be considered in the first place? And what tools do we actually have? The symptoms and problems that usually are presented at the clinical visit can be both of medical and psychosocial character - and actually they are often a mixture of both. Subsequently, the challenge to investigate the sleepy teenager often includes the examination of a complex behavioral pattern. It is important to train and develop diagnostic skills and to realize that the physiological or pathological conditions that can cause the symptoms may have different explanations. Research in sleep disorders has shown different pathological mechanisms congruent with the variations in the clinical picture. There are probably also different patterns of involved neuronal circuits although common pathways may exist. The whole picture remains to be drawn in this interesting and challenging area.

  • 45.
    Landtblom, Anne-Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Guala, D.
    Merck GmbH, Stockholm, Sweden..
    Hau, S.
    Malmo Hosp, Malmo, Sweden..
    Jansson, L.
    UAS, Akad Hosp, Neurol Clin, Uppsala, Sweden..
    Martin, C.
    Danderyd Hosp, Neurol, Danderyd, Sweden..
    Fredrikson, S.
    Karolinska Inst, Neurosci, Stockholm, Sweden..
    RebiQoL: A telemedicine patient support program on health related quality of life and adherence in MS patients treated with Rebif2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, p. 425-425Article in journal (Other academic)
  • 46.
    Landtblom, Anne-Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Kristoffersson, A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. Univ Linkoping, Gen Hosp, Neurol Policlin, Motala, Sweden..
    Jansson, L.
    UAS, Neurol Clin, Akad Hosp, Uppsala, Sweden..
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Bostrom, I.
    Linkoping Univ, Clin & Expt Med, Linkoping, Sweden..
    Berntsson, S. Ghaderi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. UAS, Neurol Clin, Akad Hosp, Uppsala, Sweden..
    The diagnosis of OCB-negative MS-patients - an inventory of the Swedish MS register in Uppsala, Sweden2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, p. 439-439Article in journal (Other academic)
  • 47.
    Leandersson, A.
    et al.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    Kagstrom, S.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    Forsberg, L.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Svenningsson, A.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    A Swedish nationwide pharmaco-epidemiological study of the long-term safety and effectiveness of alemtuzumab (IMSE 3)2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, p. 888-889Article in journal (Other academic)
  • 48.
    Leandersson, A.
    et al.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    Kagstrom, S.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    Forsberg, L.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    Hillert, J.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    Nilsson, P.
    Lund Univ, Dept Neurol, Lund, Sweden..
    Dahle, C.
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Svenningsson, A.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Lycke, J.
    Univ Gothenburg, Dept Clin Neurosci & Rehabil, Gothenburg, Sweden..
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Walentin, F.
    Orebro Univ Hosp, Orebro, Sweden..
    Martin, C.
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Piehl, F.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    Olsson, T.
    Karolinska Inst, Dept Neurosci, Stockholm, Sweden..
    A Swedish nationwide pharmaco-epidemiological study of the long-term safety and effectiveness of fingolimod (IMSE 2)2017In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 23, p. 374-375Article in journal (Other academic)
  • 49. Lossius, Andreas
    et al.
    Riise, Trond
    Pugliatti, Maura
    Bjørnevik, Kjetil
    Casetta, Ilaria
    Drulovic, Jelena
    Granieri, Enrico
    Kampman, Margitta T
    Landtblom, Anne-Marie
    Department of Clinical and Experimental Medicine, Linköping University, Sweden .
    Lauer, Klaus
    Magalhaes, Sandra
    Myhr, Kjell-Morten
    Pekmezovic, Tatjana
    Wesnes, Kristin
    Wolfson, Christina
    Holmøy, Trygve
    Season of infectious mononucleosis and risk of multiple sclerosis at different latitudes;: the EnvIMS Study2014In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 20, no 6, p. 669-674Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Seasonal fluctuations in solar radiation and vitamin D levels could modulate the immune response against Epstein-Barr virus (EBV) infection and influence the subsequent risk of multiple sclerosis (MS).

    METHODS: Altogether 1660 MS patients and 3050 controls from Norway and Italy participating in the multinational case-control study of Environmental Factors In Multiple Sclerosis (EnvIMS) reported season of past infectious mononucleosis (IM).

    RESULTS: IM was generally reported more frequently in Norway (p=0.002), but was associated with MS to a similar degree in Norway (odds ratio (OR) 2.12, 95% confidence interval (CI) 1.64-2.73) and Italy (OR 1.72, 95% CI 1.17-2.52). For all participants, there was a higher reported frequency of IM during spring compared to fall (p<0.0005). Stratified by season of IM, the ORs for MS were 1.58 in spring (95% CI 1.08-2.31), 2.26 in summer (95% CI 1.46-3.51), 2.86 in fall (95% CI 1.69-4.85) and 2.30 in winter (95% CI 1.45-3.66).

    CONCLUSIONS: IM is associated with MS independently of season, and the association is not stronger for IM during spring, when vitamin D levels reach nadir. The distribution of IM may point towards a correlation with solar radiation or other factors with a similar latitudinal and seasonal variation.

  • 50. Magalhaes, Sandra
    et al.
    Pugliatti, Maura
    Casetta, Ilaria
    Drulovic, Jelena
    Granieri, Enrico
    Holmøy, Trygve
    Kampman, Margitta T
    Landtblom, Anne-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Lauer, Klaus
    Myhr, Kjell-Morten
    Parpinel, Maria
    Pekmezovic, Tatjana
    Riise, Trond
    Wolfson, David
    Zhu, Bin
    Wolfson, Christina
    The EnvIMS Study: Design and Methodology of an International Case-Control Study of Environmental Risk Factors in Multiple Sclerosis2015In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 44, no 3, p. 173-181Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Multiple sclerosis (MS) is a chronic disease of the central nervous system, often resulting in significant neurological disability. The causes of MS are not known; however, the incidence of MS is increasing, thereby suggesting that changes in lifestyle and/or environmental factors may be responsible. On this background, the Environmental Risk Factors in MS Study or EnvIMS study was designed to further explore the etiology of MS. The design and methodology are described, providing details to enable investigators to (i) use our experiences to design their own studies; (ii) take advantage of, and build on the methodological work completed for, the EnvIMS study; (iii) become aware of this data source that is available for use by the research community.

    METHODS: EnvIMS is a multinational case-control study, enrolling 2,800 cases with MS and 5,012 population-based controls in Canada, Italy, Norway, Serbia and Sweden. The study was designed to investigate the most commonly implicated risk factors for MS etiology using a self-report questionnaire.

    RESULTS/CONCLUSIONS: The use of a common methodology to study MS etiology across several countries enhances the comparability of results in different geographic regions and research settings, reduces the resources required for study design and enhances the opportunity for data harmonization.

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