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  • 1.
    Elf, Kristin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rostedt Punga: Klinisk neurofysiologi.
    Ronne-Engström, Elisabeth
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Enblad: Neurokirurgi.
    Semnic, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Rostami-Berglund, Elham
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Enblad: Neurokirurgi.
    Sundblom, Jimmy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Enblad: Neurokirurgi.
    Zetterling, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Enblad: Neurokirurgi.
    Continuous EEG monitoring after brain tumor surgery2019Inngår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 161, nr 9, s. 1835-1843Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Prolonged seizures generate cerebral hypoxia and increased intracranial pressure, resulting in an increased risk of neurological deterioration, increased long-term morbidity, and shorter survival. Seizures should be recognized early and treated promptly.

    The aim of the study was to investigate the occurrence of postoperative seizures in patients undergoing craniotomy for primary brain tumors and to determine if non-convulsive seizures could explain some of the postoperative neurological deterioration that may occur after surgery.

    Methods

    A single-center prospective study of 100 patients with suspected glioma. Participants were studied with EEG and video recording for at least 24 h after surgery.

    Results

    Seven patients (7%) displayed seizure activity on EEG recording within 24 h after surgery and another two patients (2%) developed late seizures. One of the patients with early seizures also developed late seizures. In five patients (5%), there were non-convulsive seizures. Four of these patients had a combination of clinically overt and non-convulsive seizures and in one patient, all seizures were non-convulsive. The non-convulsive seizures accounted for the majority of total seizure time in those patients. Non-convulsive seizures could not explain six cases of unexpected postoperative neurological deterioration. Postoperative ischemic lesions were more common in patients with early postoperative seizures.

    Conclusions

    Early seizures, including non-convulsive, occurred in 7% of our patients. Within this group, non-convulsive seizure activity had longer durations than clinically overt seizures, but only 1% of patients had exclusively non-convulsive seizures. Seizures were not associated with unexpected neurological deterioration.

  • 2.
    Rostedt Punga, Anna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rostedt Punga: Klinisk neurofysiologi. Uppsala Univ Hosp, Uppsala, Sweden.
    Jabre, Joe F.
    Univ Calif Los Angeles, David Geffen Sch Med, Dept Neurol, Los Angeles, CA 90095 USA.
    Amandusson, Åsa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rostedt Punga: Klinisk neurofysiologi. Uppsala Univ Hosp, Uppsala, Sweden.
    Facing the challenges of electrodiagnostic studies in the very elderly (>80 years) population2019Inngår i: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 130, nr 7, s. 1091-1097Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Studies on electrodiagnostic (EDX) methods usually exclude the very elderly. This also holds true for studies of normal EDX values. We analyzed the outcome and diagnostic value of EDX and collected reference data in a large cohort of patients >= 80 years of age. Methods: Referral information, ICD-10 diagnoses and EDX data were retrieved from all patients >= 80 years of age referred for EDX studies at our department in 1995-2015. Normative data, including reference ranges, were obtained using the extrapolated norms (e-norms) method. Results: 1966 unique patients (2335 examinations) were included. Only 11% were considered to have normal findings. 66% had pathological EDX findings in accordance with the indication for referral. Carpal tunnel syndrome was by far the most common diagnosis. Normative data retrieved using e-norms were similar to those of reference values from healthy subjects regarding EMG multiMUP data, but typically provided a wider normality window when applied to nerve conduction parameters. Conclusions: EDX studies are valuable in the diagnostic work-up of very elderly patients. Using the e-norms method may be a useful alternative when obtaining reference values in this age group. Significance: Our findings provide additional insights to the challenges of evaluating very elderly patients with neuromuscular disease and underline the importance of including this growing part of the patient population in EDX research.

  • 3.
    Sabre, Liis
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rostedt Punga: Klinisk neurofysiologi.
    Evoli, Amelia
    Catholic Univ, Dept Neurol, Rome, Italy.
    Rostedt Punga, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rostedt Punga: Klinisk neurofysiologi.
    Cognitive dysfunction in mice with passively induced MuSK antibody seropositive myasthenia gravis2019Inngår i: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 399, s. 15-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recent reports on cognitive dysfunction, in addition to skeletal muscle fatigue, in muscle-specific tyrosine kinase antibody seropositive (MuSK+) myasthenia gravis (MG) patients led us to study cognition in mice with MuSK+passive transfer MG (PTMG). Twelve 7-week-old female wild-type C57BL/6J mice were passively immunized with IgG from MuSK+ MG patients and 12 control mice received intraperitoneal saline injections. Mice were evaluated with clinical, neurophysiological and behavioral tests (Barnes maze (BM) and novel object recognition (NOR)), and the muscles were immunostained to evaluate the neuromuscular junction in the end of the study. Two-thirds of the immunized mice developed clinically distinct MuSK + PTMG. MuSK + PTMG mice spent less time exploring the novel object in the NOR test (MuSK+ mice 36.4% +/- 14.0 vs controls 52.4% +/- 13.0, p = .02), unrelated to the muscle weakness and regardless of rodents' innate preference of novelty. In the BM test, control mice were more eager to use the direct strategy than the MuSK+ mice (MuSK+ 17.3% vs controls 29.5%, p = .02). Our findings shed new light on cognition dysfunction in human MuSK + MG patients and indicate that recognition memory in the perirhinal cortex could be affected in MuSK + MG.

  • 4.
    Sanders, Donald B.
    et al.
    Duke Univ, Med Ctr, Box 3403, Durham, NC 27710 USA.
    Arimura, Kimiyoshi
    Kagoshima Univ, Grad Sch Med & Dent Sci, Dept Neurol & Geriatr, Kagoshima, Japan.
    Cui, LiYing
    Chinese Acad Med Sci, Peking Union Med Coll Hosp, Beijing, Peoples R China.
    Ertas, Mustafa
    Istanbul Fac Med, Istanbul, Turkey.
    Farrugia, Maria Elena
    Inst Neurol Sci, Glasgow, Lanark, Scotland.
    Gilchrist, James
    Southern Illinois Univ, Sch Med, Springfield, IL USA.
    Kouyoumdjian, Joao Aris
    Fac Med Sao Jose Rio Preto FAMERP, Sao Paulo, Brazil.
    Padua, Luca
    Univ Cattolica Sacro Cuore, Fdn Policlin Univ Agostino Gemelli IRCCS, Dept Geriatr Neurosci & Orthopaed, Rome, Italy.
    Pitt, Matthew
    Great Ormond St Hosp Sick Children, Dept Clin Neurophysiol, London, England.
    Stålberg, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rostedt Punga: Klinisk neurofysiologi.
    Guidelines for single fiber EMG2019Inngår i: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 130, nr 8, s. 1417-1439Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This document is the consensus of international experts on the current status of Single Fiber EMG (SFEMG)and the measurement of neuromuscular jitter with concentric needle electrodes (CNE - CN-jitter). The panel of authors was chosen based on their particular interests and previous publications within a specific area of SFEMG or CN-jitter. Each member of the panel was asked to submit a section on their particular area of interest and these submissions were circulated among the panel members for edits and comments. This process continued until a consensus was reached. Donald Sanders and Erik Stalberg then edited the final document.

  • 5.
    Stålberg, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rostedt Punga: Klinisk neurofysiologi.
    van Dijk, Hans
    Univ Ulm, Dept Orthodont, Ulm, Germany;Maastricht Univ, Acad Ctr Epileptol, Dept Neurol, Med Ctr,Kempenhaeghe, Heeze, Netherlands.
    Falck, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rostedt Punga: Klinisk neurofysiologi.
    Kimura, Jun
    Univ Iowa Hlth Care, Dept Neurol, Iowa City, IA USA.
    Neuwirth, Christoph
    Cantonal Hosp St Gallen, Neuromuscular Dis Unit ALS Clin, St Gallen, Switzerland.
    Pitt, Matthew
    Great Ormond St Hosp Sick Children, Dept Clin Neurophysiol, London, England.
    Podnar, Simon
    Univ Med Ctr Ljubljana, Div Neurol, Ljubljana, Slovenia.
    Rubin, Devon, I
    Mayo Clin, Dept Neurol, Jacksonville, FL 32224 USA.
    Rutkove, Seward
    Harvard Med Sch, Boston, MA 02115 USA.
    Sanders, Donald B.
    Duke Univ, Dept Neurol, Sch Med, Durham, NC 27706 USA.
    Sonoo, Masahiro
    Teikyo Univ, Dept Neurol, Sch Med, Tokyo, Japan.
    Tankisi, Hatice
    Aarhus Univ Hosp, Dept Neurophysiol, Aarhus, Denmark.
    Zwarts, Machiel
    Maastricht Univ, Acad Ctr Epileptol, Dept Neurol, Med Ctr,Kempenhaeghe, Heeze, Netherlands.
    Standards for quantification of EMG and neurography2019Inngår i: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 130, nr 9, s. 1688-1729Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    This document is an update and extension of ICCN Standards published in 1999. It is the consensus of experts on the current status of EMG and Neurography methods. A panel of authors from different countries with different approach to routines in neurophysiological methods was chosen based on their particular interest and previous publications. Each member of the panel submitted a section on their particular area of interest and these submissions were circulated among the panel members for edits and comments. This process continued until a consensus was reached. The document covers EMG topics such as conventional EMG, Macro EMG, applications of surface EMG and electrical impedance myography. Single Fiber EMG is not included, since it is the topic in a separate IFCN document. A neurography section covers topics such as motor and sensory neurography, F wave recordings, H-reflex, short segment recordings, CMAP scan and motor unit number methods. Other sections cover repetitive nerve stimulation and Pediatric electrodiagnostic testing. Each method includes a description of methodologies, pitfalls, and the use of reference values. Clinical applications accompany some of these sections.

  • 6.
    Westerberg, Elisabet
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Klinisk neurofysiologi.
    Landtblom, Anne-Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Landtblom: Neurologi.
    Rostedt Punga, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Rostedt Punga: Klinisk neurofysiologi.
    Lifestyle factors and disease-specific differences in subgroups of Swedish Myasthenia Gravis2018Inngår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 138, nr 6, s. 557-565Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To evaluate disease-specific differences between Myasthenia Gravis (MG) subgroups and compare patterns of lifestyle between MG patients and population controls.

    METHODS: All MG patients (n=70) in Jönköping County, Sweden, were invited to answer a disease-specific questionnaire, containing questions about disease-specific data, lifestyle, co-morbidity and mental fatigue. The patients were clinically evaluated. Four hundred age- and gender matched population controls were invited to answer the non-disease-specific part of the questionnaire. Disease-specific issues were compared between MG subgroups. Lifestyle related factors and concomitant conditions were compared to the population controls.

    RESULTS: Forty MG patients and 188 population controls participated in the study. In the late onset MG (LOMG; N=18) subgroup, the male predominance was higher than previously reported. In the early onset MG (EOMG; N=17) subgroup, time to diagnosis was longer, fatigue was higher and bulbar weakness was the dominant symptom (65%). Compared to their matched population controls, LOMG patients were more obese (OR 13.7, p=0.015), ate less fish (OR 4.1, p=0.012), tended to smoke more (OR 4.1, p=0.086) and tended to be employed as manual laborers more often (OR 2.82, p=0.083). Mental health problems and sickness benefits were more common among MG patients than in controls and MG patients were less regularly doing focused physical activity.

    CONCLUSIONS: It is important to consider disease-specific differences when tailoring the management of individual MG patients. There is a need for improved knowledge on how to apply primary and secondary prevention measures to lifestyle disorders in MG patients without risk of deterioration.

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