Publications by authors named "Nils Erik Gilhus"

114 Publications

Perinatal Depression and Anxiety in Women With Multiple Sclerosis: A Population-Based Cohort Study.

Neurology 2021 06 21;96(23):e2789-e2800. Epub 2021 Apr 21.

From the Departments of Clinical Medicine (K.E., Ø.F.T., K.-M.M., C.F.T., N.E.G., M.-H.B.) and Global Public Health and Primary Care (T.R.), University of Bergen; Neuro-SysMed (Ø.F.T., J.A., K.-M.M., T.R., S.W.), The Norwegian Multiple Sclerosis Registry and Biobank (J.A., S.W.), and The Norwegian Multiple Sclerosis Competence Centre (J.A., T.R.), Department of Neurology (K.E., S.W., N.E.G., M.-H.B.), Haukeland University Hospital, Bergen; Department of Neurology (H.Ø.F.), Telemark Hospital Trust, Skien; Department of Neurology (T.H.), Akershus University Hospital, Lørenskog; Institute of Clinical Medicine (T.H., C.S.), University of Oslo; Department of Neurology and The Norwegian National Advisory Unit on Tick-borne Diseases (Å.R.L.), Sørlandet Hospital, Kristiansand; Department of Neurology (J.S.W.), Møre og Romsdal Hospital Trust, Molde; Department of Neurology (N.Ø.), Nordland Hospital Trust, Bodø; Department of Neurology (C.S.), Vestre Viken Hospital Trust, Drammen; Department of Obstetrics and Gynecology (C.F.T.), Stavanger University Hospital; and Department of Neuromedicine and Movement Science (J.S.W.), Norwegian University of Science and Technology, Trondheim, Norway.

Objective: To assess the occurrence of perinatal depression and anxiety in women before and after diagnosis of multiple sclerosis (MS).

Methods: A total of 114,629 pregnant women were included in the Norwegian Mother, Father and Child Cohort study (1999-2008). We assessed depression and anxiety by questionnaires during and after pregnancy. Women with MS were identified from national health registries and hospital records and grouped into (1) MS diagnosed before pregnancy (n = 140) or MS diagnosed after pregnancy with (2) symptom onset before pregnancy (n = 98) or (3) symptom onset after pregnancy (n = 308). Thirty-five women were diagnosed with MS in the postpartum period. The reference group (n = 111,627) consisted of women without MS.

Results: Women with MS diagnosed before pregnancy had an adjusted odds ratio of 2.0 (95% confidence interval, 1.2-3.1) for depression in the third trimester. Risk factors were adverse socioeconomic factors and history of psychiatric disease and physical/sexual abuse. The risk of anxiety was not increased. Women diagnosed with MS in the postpartum period had especially high risk of postpartum depression. Women with MS symptom onset within 5 years after pregnancy had increased risk of both depression and anxiety during pregnancy, whereas women with more than 5 years until symptom onset did not.

Conclusion: Women diagnosed with MS have increased risk of perinatal depression. Women with MS symptom onset within 5 years after pregnancy have increased risk of both depression and anxiety during pregnancy.
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http://dx.doi.org/10.1212/WNL.0000000000012062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205461PMC
June 2021

Physical training and exercise in myasthenia gravis.

Authors:
Nils Erik Gilhus

Neuromuscul Disord 2021 03 24;31(3):169-173. Epub 2020 Dec 24.

Department of Clinical Medicine, University of Bergen, Norway; Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway. Electronic address:

Myasthenia gravis is characterized by muscle weakness and fatigue. As sustained muscle use increases the weakness, the value of physical training programs has previously been questioned. This is a review to clarify the safety and usefulness of systematic training in myasthenia gravis, based on a systematic search in available databases using the relevant key words. Ten intervention studies including 159 patients with generalized disease have been published regarding the effect of systematic physical training, three of them on respiratory muscles. Muscle strength improved, and in the majority of the studies also daily function and quality of life. The feeling of fatigue not directly related to actual muscle weakness was less influenced by physical training. Continuous training was necessary to maintain the improved function. Physical training and exercise are safe in myasthenia gravis. This can improve both muscle strength and daily function. Type and intensity of systematic training should be adapted in the individual patient. A minimum of 150 min of exercise per week is recommended for myasthenia gravis patients with mild and moderate disease.
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http://dx.doi.org/10.1016/j.nmd.2020.12.004DOI Listing
March 2021

International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update.

Neurology 2021 01 3;96(3):114-122. Epub 2020 Nov 3.

From the Beth Israel Deaconess Medical Center/Harvard Medical School (P.N.), Boston, MA; Department of Neurology (D.B.S., J.M.), Duke University Medical Center, Durham, NC; Department of Neurology (G.W.), Univ. at Buffalo Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY; Department of Neurology (M.B.), University of Miami, Miller School of Medicine. Miami, FL; Gabriel Cea (G.C.), Departamento de Ciencias Neurologicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile; Dipartimento di Neuroscienze (A.E.), Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy; Department of Clinical Medicine (N.E.G.), University of Bergen, Norway; Isabel Illa (I.I.), Department of Neurology, Hospital Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, ERN EURO-NMD and CIBERER U762, Spain; Departments of Pediatrics and Neurology (N.L.K.), Northwestern Feinberg School of Medicine, Chicago, IL; Neurology (A.M.), University of Tübingen Medical Centre, Tübingen, Germany; Department of Neurology (H.M.), International University of Health and Welfare, Narita, Japan; Department of Clinical Neurological Sciences (M.N.), Western University, London, ON, Canada; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK; Department of Neurology (D.R.), University of California, Davis, Davis, CA; and Department of Neurology (J.V.), Leiden University Medical Centre, Leiden, the Netherlands.

Objective: To update the 2016 formal consensus-based guidance for the management of myasthenia gravis (MG) based on the latest evidence in the literature.

Methods: In October 2013, the Myasthenia Gravis Foundation of America appointed a Task Force to develop treatment guidance for MG, and a panel of 15 international experts was convened. The RAND/UCLA appropriateness method was used to develop consensus recommendations pertaining to 7 treatment topics. In February 2019, the international panel was reconvened with the addition of one member to represent South America. All previous recommendations were reviewed for currency, and new consensus recommendations were developed on topics that required inclusion or updates based on the recent literature. Up to 3 rounds of anonymous e-mail votes were used to reach consensus, with modifications to recommendations between rounds based on the panel input. A simple majority vote (80% of panel members voting "yes") was used to approve minor changes in grammar and syntax to improve clarity.

Results: The previous recommendations for thymectomy were updated. New recommendations were developed for the use of rituximab, eculizumab, and methotrexate as well as for the following topics: early immunosuppression in ocular MG and MG associated with immune checkpoint inhibitor treatment.

Conclusion: This updated formal consensus guidance of international MG experts, based on new evidence, provides recommendations to clinicians caring for patients with MG worldwide.
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http://dx.doi.org/10.1212/WNL.0000000000011124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884987PMC
January 2021

Immunoactive treatment for myasthenia gravis; a Chinese experience.

Authors:
Nils Erik Gilhus

CNS Neurosci Ther 2020 12 26;26(12):1203-1204. Epub 2020 Oct 26.

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

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http://dx.doi.org/10.1111/cns.13466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702226PMC
December 2020

AChR antibodies show a complex interaction with human skeletal muscle cells in a transcriptomic study.

Sci Rep 2020 07 8;10(1):11230. Epub 2020 Jul 8.

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Acetylcholine receptor (AChR) antibodies are the most important pathogenic marker in patients with myasthenia gravis (MG). The antibodies bind to AChRs on the postsynaptic membrane, and this leads to receptor degradation, destruction, or functional blocking with impaired signal at the neuromuscular junction. In this study, we have explored the effects of AChR antibodies binding to mature human myotubes with agrin-induced AChR clusters and pathways relevant for AChR degradation using bulk RNA sequencing. Protein-coding RNAs and lncRNAs were examined by RNA sequencing analysis. AChR antibodies induced marked changes of the transcriptomic profiles, with over 400 genes differentially expressed. Cholesterol metabolic processes and extracellular matrix organization gene sets were influenced and represent AChR-trafficking related pathways. Muscle contraction and cellular homeostasis gene sets were also affected, and independently of AChR trafficking. Furthermore, we found changes in a protein-coding RNA and lncRNA network, where expression of lncRNA MEG3 correlated closely with protein-coding genes for cellular homeostasis. We conclude that AChR antibodies induce an active response in human skeletal muscle cells which affects key intra- and extracellular pathways.
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http://dx.doi.org/10.1038/s41598-020-68185-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343820PMC
July 2020

Myasthenia Gravis Can Have Consequences for Pregnancy and the Developing Child.

Authors:
Nils Erik Gilhus

Front Neurol 2020 12;11:554. Epub 2020 Jun 12.

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Myasthenia gravis (MG) with onset below 50 years, thymic hyperplasia and acetylcholine receptor (AChR) antibodies is more common in females than in males. For a relatively large group of MG patients, pregnancy represents therefore an important question. The muscle weakness, the circulating autoantibodies, the hyperplastic thymus, the MG drug treatment, and any autoimmune comorbidity may all influence both mother and child health during pregnancy and also during breastfeeding in the postpartum period. Mother's MG remains stable in most patients during pregnancy. Pyridostigmine, prednisolone, and azathioprine are regarded as safe during pregnancy. Mycophenolate, methotrexate and cyclophosphamide are teratogenic and should not be used by women with the potential to become pregnant. Rituximab should not be given during the last few months before conception and not during pregnancy. Intravenous immunoglobulin and plasma exchange can be used for exacerbations or when need for intensified therapy. Pregnancies in MG women are usually without complications. Their fertility is near normal. Vaginal delivery is recommended. MG patients have an increased rate of Cesarean section, partly due to their muscle weakness and to avoid exhaustion, partly as a precaution that is often unnecessary. Around 10% of the newborn develop neonatal myasthenia during the first few days after birth. This is transient and usually mild with some sucking and swallowing difficulties. In rare cases, transplacental transfer of AChR antibodies leads to permanent muscle weakness in the child, and arthrogryposis with joint contractures. Repeated spontaneous abortions have been described due to AChR antibodies. MG women should always give birth at hospitals with experience in newborn intensive care. MG does not represent a reason for not having children, and the patients should be supported in their wish of becoming pregnant.
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http://dx.doi.org/10.3389/fneur.2020.00554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304249PMC
June 2020

Evaluation of Self-reported Symptoms in 1,457 Dizzy Patients and Associations With Caloric Testing and Posturography.

Otol Neurotol 2020 08;41(7):956-963

Norwegian National Advisory Unit on Vestibular Disorders.

Objective: To determine if symptoms regarding timing and triggers of dizziness are useful for categorizing patients with dizziness, and to evaluate how patient-reported symptoms predict vestibular asymmetry, postural sway, and vestibular diagnoses.

Study Design: Retrospective chart review.

Setting: Tertiary referral center.

Patients: Patients referred for suspected vestibular disease.

Interventions: Patients completed a symptom questionnaire before laboratory testing with static posturography and bithermal caloric tests.

Main Outcome Measure: Evaluate whether responses from a symptom questionnaire predict caloric asymmetry, postural balance, and diagnoses.

Results: One thousand four hundred fifty seven patients, 60.1% women, mean age 49.9 (±16.6) years were included. Vomiting was the strongest predictor for caloric asymmetry in adjusted analysis, odds ratio (OR): 1.60 (95% confidence interval [CI]: 1.24-2.06), followed by chronic hearing loss OR: 1.59 (1.19-2.13). Patients who reported constant dizziness had impaired postural balance, quantified as 15% increase in postural sway in adjusted analyses (7.25-24.6%). We found no association between caloric asymmetry and postural instability with eyes closed.

Conclusion: Most patients were able to describe the timing of their symptoms and a categorization based on timing seems feasible. There seemed to be an over-reporting of triggers and confirmatory testing of triggers is therefore advocated. Vomiting, but not nausea, was a strong indicator of vestibular disease in this primarily outpatient population. Caloric asymmetry and postural balance were not associated, and assessment of fall risk may be warranted in patients who reports constant dizziness, visual disturbances or dizziness triggered by light, darkness or sounds.
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http://dx.doi.org/10.1097/MAO.0000000000002670DOI Listing
August 2020

Complications and mortality after acute traumatic spinal cord injury in Saint Petersburg, Russia.

Spinal Cord 2020 Sep 14;58(9):970-979. Epub 2020 Apr 14.

Department of Neurology, Haukeland University Hospital, Bergen, Norway.

Study Design: Retrospective cohort study.

Objectives: We studied complications during early rehabilitation and their relation to length of stay (LOS) in the hospital as well as to survival in people with traumatic spinal cord injury (TSCI).

Setting: All specialized hospitals of Saint Petersburg.

Methods: We analysed all charts of patients admitted with acute TSCI to the city hospitals, 2012-2016. Patient characteristics, complications, time and cause of death, and LOS were recorded. Mean values with standard deviations and t-tests were used. We analysed mortality rate using the Kaplan-Meier method and calculated relative risks (RRs).

Results: A total of 311 patients with TSCI were included. Complications occurred in 34% of patients; most were respiratory complications and pressure ulcers. Complications occurred more often in those with concomitant traumatic brain injury (TBI) (RR = 1.4, 95% CI: 1.2-1.8). All complications prolonged LOS (median, 11 days) and increased mortality in the acute phase (p < 0.001). In the early phase, 15% died, with a median time to death of 13 days. Respiratory complications markedly increased the death rate (RR = 18, 95% CI: 15-22). Mortality rate correlated also with age, TSCI severity and level, and concomitant TBI. Alcohol/drug consumption before TSCI increased the likelihood for complications (RR = 1.7, 95% CI: 1.3-2.1) and mortality (RR = 2.2, 95% CI: 1.6-3.1).

Conclusion: Focus on prevention as well as early and optimal treatment of complications, together with no or low alcohol/drug consumption may reduce mortality in the early phase after TSCI and at the same time shorten LOS.
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http://dx.doi.org/10.1038/s41393-020-0458-yDOI Listing
September 2020

Epilepsy and autoimmune diseases: Comorbidity in a national patient cohort.

Seizure 2020 Feb 23;75:89-95. Epub 2019 Dec 23.

Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Purpose: To examine if autoimmune disorders occur with an increased frequency in patients with epilepsy. An autoimmune etiology of epilepsies has been suggested. By using data from The Norwegian Prescription Database (NorPD) we have surveyed a national cohort of patients with active epilepsy treated with antiepileptic drugs.

Methods: NorPD contains all prescriptions of drugs dispensed at pharmacies in Norway since 2004. We received data of all drugs prescribed January 2004 - June 2014 for patients receiving an antiepileptic drug.79 751 patients receiving at least two prescriptions of antiepileptic drugs with the reimbursement code for epilepsy were included. To examine autoimmune comorbidity, medications specific for autoimmune diseases were retrieved. Standardized Incidence Ratios (SIR) with 95 % confidence interval (CI) were used to determine whether the occurrence of the prescribed autoimmune drugs in the epilepsy group deviated from the general population. Subgroups stratified for sex and age were examined.

Results: The epilepsy patients were more often treated with insulin and insulin analogs, SIR 1.8 (95 % CI 1.7-1.9); thyroid substitution, SIR 1.7 (95 % CI 1.7-1.8); pyridostigmine, SIR 1.5 (95 % CI 1.1-2.1); multiple sclerosis (MS) medications, SIR 4.9 (95 % CI 4.6-5.3); and immunosuppressive drugs SIR 1.2 (95 % CI 1.1-1.2). All epilepsy subgroups were more often than expected treated with thyroid substitution.

Conclusions: Based on a large, unselected patient cohort we find that epilepsy patients more often are prescribed medications used to treat type 1 diabetes mellitus, hypothyroidism, myasthenia gravis and MS. This was true for both men and women, and in most age-groups.
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http://dx.doi.org/10.1016/j.seizure.2019.12.015DOI Listing
February 2020

Maternal complications in pregnancy and childbirth for women with epilepsy: Time trends in a nationwide cohort.

PLoS One 2019 25;14(11):e0225334. Epub 2019 Nov 25.

Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.

Objective: Obstetric trends show changes in complication rates and maternal characteristics such as caesarean section, induced labour, and maternal age. To what degree such general time trends and changing patterns of antiepileptic drug use influence pregnancies of women with epilepsy (WWE) is unknown. Our aim was to describe changes in maternal characteristics and obstetric complications in WWE over time, and to assess changes in complication risks in WWE relative to women without epilepsy.

Methods: This was a nationwide cohort study of all first births in the Medical Birth Registry of Norway, 1999-2016. We estimated maternal characteristics, complication rates, and risks for WWE compared to women without epilepsy. Main maternal outcome measures were hypertensive disorders, bleeding in pregnancy, induction of labour, caesarean section, postpartum hemorrhage, preterm birth, small for gestational age, and epidural analgesia. Time trends were analyzed by logistic regression and comparisons made with interaction analyses.

Results: 426 347 first births were analyzed, and 3077 (0.7%) women had epilepsy. In WWE there was an increase in proportions of induced labour (p<0.005) and use of epidural analgesia (p<0.005), and a reduction in mild preeclampsia (p = 0.006). However, the risk of these outcomes did not change over time. Only the risk of severe preeclampsia increased significantly over time relative to women without epilepsy (p = 0.006). In WWE, folic acid supplementation increased significantly over time (p<0.005), and there was a decrease in smoking during pregnancy (p<0.005), but these changes were less pronounced than for women without epilepsy (p<0.005).

Conclusions: During 1999-2016 there were important changes in maternal characteristics and complication rates among WWE. However, outcome risks for WWE relative to women without epilepsy did not change despite changes in antiepileptic drug use patterns. The relative risk of severe preeclampsia increased in women with epilepsy.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225334PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876881PMC
March 2020

Interictal epileptiform discharges vary across age groups.

Clin Neurophysiol 2020 01 4;131(1):25-33. Epub 2019 Nov 4.

Section for Clinical Neurophysiology, Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway. Electronic address:

Objective: To investigate whether the occurrence and morphology of interictal epileptiform discharges (IEDs) in scalp-EEG change by age.

Methods: 10,547 patients who had a standard or sleep deprived EEG recording reported using the SCORE standard were included. 875 patients had at least one EEG with focal IEDs. Focal IED morphology was analyzed by age using quantitative measures in EEGLAB and by visual classification based on the SCORE standard. We present distributions of IED measures by age group, with medians, interquartiles, 5th and 95th percentiles.

Results: Focal IEDs occurred most frequently in children and elderly. IED morphology and localization depended on age (p < 0.001). IEDs had higher amplitudes, sharper peaks, larger slopes, shorter durations, larger slow-wave areas and wider distributions in children. These morphological characteristics diminished and the IEDs became more lateralized with increasing age. Spike asymmetry was stable across all age groups.

Conclusions: IEDs have age-dependent characteristics. A spike detector, human or computer, should not operate with the same set of thresholds for patients at various age. With increasing age, focal IEDs are less sharp, have lower amplitudes, have less prominent slow-waves and they become more lateralized. Our findings can help EEG readers in detecting and correctly describing IEDs in patients of various age.

Significance: EEG readers should always consider patient age when interpreting interictal epileptiform discharges.
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http://dx.doi.org/10.1016/j.clinph.2019.09.017DOI Listing
January 2020

Polio and post-polio syndrome in non-Western immigrants: A new challenge for the healthcare system in Norway.

J Rehabil Med 2019 Dec;51(11):861-868

Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, NO-1450 Nesoddtangen, Norway.

Objective: To explore the health situation and identify specific health challenges in non-Western immigrants with polio in Norway, by comparing their status with Western immigrants with polio and native Norwegians with polio.

Design: A questionnaire covering demographics, polio history, life satisfaction, medical, psychological and social conditions was answered by 1,408 persons with polio, among them 34 immigrants from non-Western countries and 32 immigrants from Western countries.

Results: The non-Western immigrant polio group had a mean age of 46 years, were highly educated, reported high frequency of mental health problems and only one-third was working. Mean age for contracting polio was 2.8 years. Only 30% was hospitalized in the acute phase and 80% reported severe leg weakness. Use of a powered wheelchair was reported by 72%. Post-polio symptoms had started at a mean age of 31 years. The non-Western immigrant group reported more fatigue, pain and loneliness, and a high proportion reported insufficient assistance from the public health system.

Conclusion: The group of non-Western immigrants with polio in Norway reported more health and social problems than the group of Western immigrants with polio or the native Norwegian group with polio, even though they were younger and more highly educated. Their complex psychological and social situation requires active intervention from the health system, and health professionals need extra skills to deal most effectively with their situation.
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http://dx.doi.org/10.2340/16501977-2624DOI Listing
December 2019

Neuroinflammation - a common thread in neurological disorders.

Nat Rev Neurol 2019 Aug;15(8):429-430

Department of Neurology, University Hospital Schleswig Hostein, Kiel Campus, Christian-Albrechts-University, Kiel, Germany.

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http://dx.doi.org/10.1038/s41582-019-0227-8DOI Listing
August 2019

Myasthenia gravis.

Nat Rev Dis Primers 2019 05 2;5(1):30. Epub 2019 May 2.

Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.

Myasthenia gravis (MG) is an autoimmune disease caused by antibodies against the acetylcholine receptor (AChR), muscle-specific kinase (MuSK) or other AChR-related proteins in the postsynaptic muscle membrane. Localized or general muscle weakness is the predominant symptom and is induced by the antibodies. Patients are grouped according to the presence of antibodies, symptoms, age at onset and thymus pathology. Diagnosis is straightforward in most patients with typical symptoms and a positive antibody test, although a detailed clinical and neurophysiological examination is important in antibody-negative patients. MG therapy should be ambitious and aim for clinical remission or only mild symptoms with near-normal function and quality of life. Treatment should be based on MG subgroup and includes symptomatic treatment using acetylcholinesterase inhibitors, thymectomy and immunotherapy. Intravenous immunoglobulin and plasma exchange are fast-acting treatments used for disease exacerbations, and intensive care is necessary during exacerbations with respiratory failure. Comorbidity is frequent, particularly in elderly patients. Active physical training should be encouraged.
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http://dx.doi.org/10.1038/s41572-019-0079-yDOI Listing
May 2019

Retraction Note to: Juvenile-onset myasthenia gravis: autoantibody status, clinical characteristics and genetic polymorphisms.

J Neurol 2019 Jun;266(6):1555

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

The Joint Editors-in-Chief have retracted this article [1] at the request of the University of Bergen and the Norwegian Board of Health Supervision.
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http://dx.doi.org/10.1007/s00415-019-09292-2DOI Listing
June 2019

Traumatic vs non-traumatic spinal cord injury: A comparison of primary rehabilitation outcomes and complications during hospitalization.

J Spinal Cord Med 2019 11 3;42(6):695-701. Epub 2019 Apr 3.

Department of Neurology, Haukeland University Hospital, Bergen, Norway.

To compare outcome for patients with traumatic (TSCI) and non-traumatic spinal cord injuries (NTSCI) after primary rehabilitation regarding neurological improvement measured by the American Spinal Injury Association Impairment Scale (AIS), length of stay and complications.: Retrospective comparative cohort study on patients with TSCI and NTSCI, hospitalized during a ten-year period at Haukeland University Hospital, Norway. Impairment, length of stay and complications during first in-patient rehabilitation period were analyzed. Uni- and multivariate analysis was performed. Spinal Cord Rehabilitation Unit, Haukeland University Hospital, Norway A total of 174 persons with a spinal cord injury (SCI) were included; 102 with TSCI and 72 with NTSCI. Neurological improvement measured by AIS from admission to discharge, number of weeks in the hospital, frequency and significance of complications were compared. Improvement in AIS after primary rehabilitation did not differ between TSCI and NTSCI. Length of stay was in average 3.4 weeks longer for TSCI. Urinary tract infections and pressure ulcers significantly influenced length of stay in both groups. Urinary tract infections were more frequent in TSCI (67%) vs NTSCI (42%). Pressure ulcers were more frequent among NTSCI (24%) vs TSCI (14%). Pneumonia and neuropathic pain did not depend on etiology and did not influence length of stay. Patients with SCI have a rehabilitation potential regardless of etiology. Complications are frequent in both groups and often prolong hospitalization. Complication patterns differ in the two groups, and specific prevention and optimal treatment will shorten and optimize the length of primary rehabilitation.
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http://dx.doi.org/10.1080/10790268.2019.1598698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830275PMC
November 2019

Myelomeningocele: need for long-time complex follow-up-an observational study.

Scoliosis Spinal Disord 2019 8;14. Epub 2019 Mar 8.

2Department of Neurology, Haukeland University Hospital, Postbox 1400, 5020 Bergen, Norway.

Background: Myelomeningocele (MMC) is a congenital disorder that causes a variety of acute as well as late complications. Numerous health problems in adulthood have been described by the persons with MMC but not studied in clinical setting. This study gives implications for organization of the follow-up in adulthood.

Objectives: To investigate the need for follow-up from different medical specialists as well as the need for organized focused rehabilitation among adults with MMC.

Methods: Retrospective cohort study on adults with MMC including multiple departments in a university hospital in Norway. The number and cause of specialized hospital consultations were recorded for every patient. Correlation between childhood health condition related to MMC and the need for specialized consultations in adulthood as well as correlations between number of consultations and anatomical level of MMC, age, and observation time was performed for the whole group.

Results: In total, 38 patients had 672 consultations related to MMC. The most frequent departments were neurology, neurosurgery, urology, gastroenterology, and orthopedics. Most consultations were planned. Complexity of MMC-related health condition correlated to number of specialist consultations (rho = 0.420,  = 0.009). Anatomical level of MMC, age, and length of observation time did not correlate with consultations. Pain and shunt failure were the most common reasons for consultations.

Conclusions: Persons with MMC have a need for continuous, life-long multispecialized follow-up and rehabilitation. This is crucial for optimal function, satisfaction with life, and for long-term survival. Systematic follow-up together with rehabilitation will optimize health service.
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http://dx.doi.org/10.1186/s13013-019-0177-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407184PMC
March 2019

Incidence of adult traumatic spinal cord injury in Saint Petersburg, Russia.

Spinal Cord 2019 Aug 6;57(8):692-699. Epub 2019 Mar 6.

Department of Neurology, Haukeland University Hospital, Bergen, Norway.

Study Design: Retrospective population-based cohort study.

Objectives: To characterise the epidemiology of traumatic spinal cord injury (TSCI) among the inhabitants of Saint Petersburg, Russia.

Setting: All hospitals in Saint Petersburg.

Methods: Charts for all individuals admitted to city hospitals from 1st January 1 2012 to 31st December 2016 with acute TSCI were reviewed. Incidence rates were calculated for the whole period and for each year separately. Gender-specific and age-specific incidence rates were calculated, and epidemiological characteristics and possible risk factors were analysed.

Results: A total of 361 people were identified. The average annual incidence rate was 17.6 per million, varying from 21.2 (2013) to 13.6 (2016), and 70.9% were men. Mean age at injury was 42.1 years. Injuries from falls represented 49.8% of cases, and motor vehicle accidents 18.9%. The male:female ratio in the low-falls group was 1.2:1, and among the elderly patients, it was 0.5:1. Lesions at the cervical level were involved in 49.3%, thoracic in 24.7%, and lumbar/sacral in 23.5%. TSCI was complete in 16.9%. Concomitant injuries occurred in 47.2% of cases, and traumatic brain injuries in 37.7%.

Conclusion: TSCI incidence decreased during the observation period and was 2.4 times more common among men than women. In half of the cases, injuries involved the cervical level, and a fall was the most frequent injury cause. Elderly women more often had falls from a low height than men. Multiple injuries-most frequently traumatic brain injuries-were common.
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http://dx.doi.org/10.1038/s41393-019-0266-4DOI Listing
August 2019

Antiepileptic and psychiatric medication in a nationwide cohort of patients with glioma WHO grade II-IV.

J Neurooncol 2018 Dec 23;140(3):739-748. Epub 2018 Nov 23.

Department of Neurology, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.

Introduction: Glioma is the most common intracranial primary brain tumor. Patients with glioma often suffer from epilepsy, anxiety and depression. Aims of this study were to identify risk factors for drug-treated anxiety and depression, and to determine the use of psychiatric medication in a national glioma cohort.

Methods: Data from the Cancer Registry of Norway on all persons diagnosed with glioma WHO grade II-IV 2004-2010 were linked with data from the Norwegian Prescription Database. Cox regression analysis was used to assess risk factors for drug-treated anxiety and depression. Standardized incidence ratios were calculated for psychiatric medication dispensed to glioma patients and compared to the general population.

Results: The glioma cohort consisted of 1056 males and 772 females. Of the 1828 patients, 565 had glioma grade II-III, and 1263 had grade IV. The patients with glioma grade II-III who were treated with levetiracetam had an increased risk for drug-treated anxiety compared to patients without levetiracetam; hazard ratio 2.8 (95% confidence interval 1.7-4.9). Female gender increased the risk for drug-treated anxiety compared to males in patients with glioma grade IV; hazard ratio 1.5 (95% confidence interval 1.2-2.0). Antidepressants were less frequently dispensed to patients with glioma grade II-III and epilepsy than to the general population.

Conclusions: Patients with glioma grade II-III on levetiracetam had an increased risk for drug-treated anxiety. The subgroup of patients with glioma grade II-III and epilepsy received less antidepressants than the general population.
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http://dx.doi.org/10.1007/s11060-018-03007-9DOI Listing
December 2018

Verbal abilities in children of mothers with epilepsy: Association to maternal folate status.

Neurology 2018 08 1;91(9):e811-e821. Epub 2018 Aug 1.

From the Department of Clinical Medicine (E.S.N.H., N.E.G., M.H.B.), Section for Neurology, Department of Clinical Science (B.R.), and Department of Global Public Health and Primary Care (A.K.D.), University of Bergen; Department of Neurology (E.S.N.H., N.E.G., M.H.B.) and Laboratory of Clinical Biochemistry (B.R.), Section of Clinical Pharmacology, Haukeland University Hospital, Bergen; Department of Clinical Pharmacology (O.S.), St. Olav University Hospital; Department of Clinical and Molecular Medicine (O.S.), Norwegian University of Science and Technology, Trondheim; and Department of Health Registries (A.K.D.), Norwegian Institute of Public Health, Bergen, Norway.

Objective: To examine the effect of maternal folic acid supplementation and maternal plasma folate and antiepileptic drug (AED) concentrations on language delay in AED-exposed children of mothers with epilepsy.

Methods: Children of mothers with and without epilepsy enrolled from 1999 to 2008 in the Norwegian Mother and Child Cohort study were included. Information on medical history, AED use, and folic acid supplementation during pregnancy was collected from parent-completed questionnaires. Maternal plasma folate and maternal plasma and umbilical cord AED concentrations were measured in blood samples from gestational weeks 17 to 19 and immediately after birth, respectively. Language development at 18 and 36 months was evaluated by the Ages and Stages Questionnaires.

Results: A total of 335 AED-exposed children of mothers with epilepsy and 104,222 children of mothers without epilepsy were surveyed. For those with no maternal periconceptional folic acid supplementation, the fully adjusted odds ratio (OR) for language delay in AED-exposed children compared to the controls at 18 months was 3.9 (95% confidence interval [CI] 1.9-7.8, < 0.001) and at 36 months was 4.7 (95% CI 2.0-10.6, < 0.001). When folic supplementation was used, the corresponding ORs for language delay were 1.7 (95% CI 1.2-2.6, = 0.01) and 1.7 (95% CI 0.9-3.2, = 0.13), respectively. The positive effect of folic acid supplement use on language delay in AED-exposed children was significant only when supplement was used in the period from 4 weeks before the pregnancy and until the end of the first trimester.

Conclusion: Folic acid use early in pregnancy may have a preventive effect on language delay associated with in utero AED exposure.
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http://dx.doi.org/10.1212/WNL.0000000000006073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133626PMC
August 2018

Hypertensive pregnancy complications in women with epilepsy and antiepileptic drugs: a population-based cohort study of first pregnancies in Norway.

BMJ Open 2018 04 24;8(4):e020998. Epub 2018 Apr 24.

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Objectives: To estimate the risk of hypertensive pregnancy complications in women with epilepsy, with and without antiepileptic drugs, and assess the risk associated with the four most common antiepileptic drugs.

Design: A population-based cohort study using linked data from the Medical Birth Registry of Norway and the Norwegian Prescription Database. Women with epilepsy with and without antiepileptic drugs were compared with women without epilepsy.

Setting: Norway, 2004-2012.

Participants: All first pregnancies of women with epilepsy and women without epilepsy were included.

Primary And Secondary Outcome Measures: Main outcome measures were hypertensive pregnancy complications: a compound variable of any hypertensive disorder, gestational hypertension, mild pre-eclampsia, severe pre-eclampsia, early onset pre-eclampsia, eclampsia and HELLP syndrome (haemolysis, elevated liver enzymes, low platelets).

Results: In total, 1778 pregnancies in women with epilepsy and 221 662 in women without epilepsy were analysed. 682 of the women with epilepsy used antiepileptic drugs, the most common in monotherapy being: lamotrigine (n=280), carbamazepine (n=94), levetiracetam (n=71) and valproate (n=51). There was an increased risk of any hypertensive disorder in women with epilepsy (adjusted OR (aOR) 1.2, 95% CI 1.0 to 1.5) and in the subcategory using valproat (aOR 2.9, 95% CI 1.3 to 6.4). The most frequent hypertensive complication was mild pre-eclampsia and the risk was increased in women with epilepsy (aOR 1.4, 95% CI 1.1 to 1.8) and women with epilepsy with valproat (aOR 3.3, 95% CI 1.2 to 9.4).

Conclusions: Women with epilepsy have an increased risk of mild pre-eclampsia, but not for the severe types of hypertensive pregnancy complications. Lamotrigine and levetiracetam do not predispose for mild pre-eclampsia, whereas valproate was associated with an increased risk of mild pre-eclampsia.
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http://dx.doi.org/10.1136/bmjopen-2017-020998DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922520PMC
April 2018

Young people with epilepsy have an increased risk of eating disorder and poor quality diet.

Epilepsia Open 2018 03 18;3(1):40-45. Epub 2017 Dec 18.

National Centre for Epilepsy Oslo University Hospital Oslo Norway.

Objective: To investigate whether adolescents with epilepsy are at increased risk of having self-reported eating disorder symptoms and poor quality diet compared to young people from the general population.

Methods: We used data from the Health Profile for Children and Youth in Akershus Study, a cross-sectional population-based study based on a voluntary self-reported questionnaire. There were 19,995 participants (response rate 85%) aged 13-19 years; 247 (1.2%) reported a lifetime diagnosis of epilepsy. Odds ratios (OR) and 95% confidence intervals (CI) for eating disorders, unhealthy diet, dieting, satisfaction with looks, and participation in sports were estimated by using a logistic regression model. All estimates were adjusted for single parents and poor family economy.

Results: Children and adolescents with epilepsy had more eating disorders than their peers (OR 1.8, CI 1.0-3.0, p = 0.03). They were less satisfied with their own appearance (OR 0.7, CI 0.5-0.9, p = 0.02), and they eat more unhealthily (OR 1.7, CI 1.3-2.2, p = 0.001). Males with epilepsy were more likely to have been dieting (OR 3.1, CI 1.2-7.9, p = 0.02) and less satisfied with their own appearance (OR 0.4, CI 0.3-0.7, p < 0.001). Females with epilepsy were more likely to eat unhealthily (OR 1.7, CI 1.1-2.5, p = 0.01).

Significance: Adolescents with epilepsy are at increased risk of having eating disorder symptoms. They eat less healthily and are less satisfied with their looks. Health workers should be aware of this and bring diet and lifestyle into the dialogue with young people with epilepsy.
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http://dx.doi.org/10.1002/epi4.12089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839308PMC
March 2018

Myasthenia gravis and infectious disease.

J Neurol 2018 Jun 25;265(6):1251-1258. Epub 2018 Jan 25.

Department of Neurology, Haukeland University Hospital, 5021, Bergen, Norway.

Background And Purpose: Myasthenia gravis (MG) is an autoimmune disease with muscular weakness as the only symptom, and often with immunosuppressive treatment. All these aspects could have relevance for the risk of infections as well as their prophylactic and curative treatment.

Methods: This is a review article, where Web of Science has been searched for relevant key words and key word combinations. Full papers were selected first by title and then by abstract.

Results And Conclusions: MG can be triggered and worsened by infections. No virus or other pathogen has been proven to have a specific link to MG. Treatment with immunosuppressive drugs and thymectomy implies a slightly increased risk for infections. Infections should be actively treated, but a few antibiotics are avoided due to potential interference with neuromuscular transmission. Hospitalization and intensive care may be necessary during infections because of MG deterioration and risk of insufficient respiration. Vaccinations are generally recommended in MG, but live microorganisms should be avoided if possible in immunosuppressed patients.
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http://dx.doi.org/10.1007/s00415-018-8751-9DOI Listing
June 2018

Association of Folic Acid Supplementation During Pregnancy With the Risk of Autistic Traits in Children Exposed to Antiepileptic Drugs In Utero.

JAMA Neurol 2018 02;75(2):160-168

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Importance: Strategies to prevent autism in children exposed to antiepileptic drugs (AEDs) during pregnancy are important.

Objective: To explore whether folic acid supplementation and folate status in pregnancy are associated with reduced risk of autistic traits owing to in utero AED exposure.

Design, Setting, And Participants: The population-based, prospective Norwegian Mother and Child Cohort Study approached Norwegian-speaking women attending routine ultrasonographic examinations from June 1999 through December 31, 2008 (163 844 of 277 702 women refused). No exclusion criteria were applied beyond language. Questionnaires during and after pregnancy, analysis of blood samples, and linkage to the Medical Birth Registry of Norway were performed. Children aged 18 to 36 months of women with available information on use of AEDs and of folic acid supplementation (n = 104 946) were included in the analysis from March 1, 2016, through June 13, 2017.

Exposures: Maternal folic acid supplementation 4 weeks before to 12 weeks after conception. Plasma folate concentration was analyzed at gestational weeks 17 to 19.

Main Outcomes And Measures: Autistic traits were evaluated using the Modified Checklist for Autism in Toddlers and Social Communication Questionnaire. Odds ratios (ORs) for autistic traits in children by maternal use vs nonuse of folic acid supplements were adjusted for maternal health and socioeconomic factors. Folate concentrations and folic acid doses were associated with the degree of autistic traits.

Results: The overall mean (SD) age of the 104 946 mothers of participating children was 29.8 (4.6) years, with complete information available for analysis in 103 868. Mean (SD) age of women with epilepsy who received AED treatment was 29.4 (4.9); women with epilepsy who did not receive AED treatment, 29.1 (4.9); and without epilepsy, 29.8 (4.6) years. In the 335 children exposed to AEDs, the risk for autistic traits was significantly higher at 18 months of age (adjusted OR [AOR], 5.9; 95% CI, 2.2-15.8) and 36 months of age (AOR, 7.9; 95% CI, 2.5-24.9) when their mothers had not used folic acid supplements compared with children of mothers who had used supplements. Among women without epilepsy, the corresponding risks were lower at 18 months of age (AOR, 1.3; 95% CI, 1.2-1.4) and 36 months of age (AOR, 1.7; 95% CI, 1.5-1.9); among the 389 children of women with untreated epilepsy, the corresponding risks were not significant at 18 months of age (AOR, 1.0; 95% CI, 0.4-3.0) and 36 months of age (AOR, 2.5; 95% CI, 0.4-16.6). Degree of autistic traits was inversely associated with maternal plasma folate concentrations (β = -0.3; P = .03) and folic acid doses (β = -0.5; P < .001). Concentrations of AEDs were not associated with the degree of autistic traits.

Conclusions And Relevance: Risk of autistic traits in children exposed to AEDs in utero may be mitigated by periconceptional folic acid supplementation and folate status. Fertile women using AEDs should take folic acid supplements continuously.
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http://dx.doi.org/10.1001/jamaneurol.2017.3897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838632PMC
February 2018

Cognitive function after status epilepticus versus after multiple generalized tonic-clonic seizures.

Epilepsy Res 2018 02 28;140:39-45. Epub 2017 Nov 28.

Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine (K1), Section for Neurology, University of Bergen, Norway.

Objectives: Status epilepticus (SE) is considered a risk for cognitive impairment. Studies have indicated that SE cause more cognitive decline than multiple lifetime generalized tonic clonic (GTC) seizures. The aim of the study was to investigate whether patients suffering from SE or from multiple lifetime GTC seizures have cognitive dysfunction, and if the disabilities differ between these groups.

Materials And Methods: Patients suffering from SE were evaluated shortly after the clinical post-ictal phase and again after one year. Their follow-up results were compared to results from patients with ≥10 GTC seizures and a group of control subjects. Tests from Cambridge Neuropsychological Test Automated Battery (CANTAB) were used. Motor Screening Test (MOT) assessed motor speed, Delayed Matching to Sample (DMS) and Paired Associates Learning (PAL) assessed memory, and Stockings of Cambridge (SOC) assessed executive function. Estimated premorbid IQ and radiologically visible brain lesions were controlled for in adjusted results. Outcome measures were z-scores, the number of standard deviations a score deviates from the mean of a norm population. Negative z-scores indicate poor performance.

Results: After the clinical post-ictal phase, performances of SE patients were poor on all domains (n = 46). Mean z-scores with 95% confidence intervals were below zero for tests of psychomotor speed, executive thinking times and memory. Both SE patients at follow-up (n = 39) and patients with multiple GTC seizures (n = 24) performed poorer than controls (n = 20) on tests of memory. These group differences remained significant after covariate adjustments. SE patients at follow-up scored below patients with multiple GTC seizures on tests of psychomotor speed (mean difference -0.59, P = 0.020), but after adjusting for covariates this difference was no longer significant.

Conclusions: Our data do not allow a firm conclusion as to whether SE is a more pronounced risk factor for cognitive dysfunction than repeated generalized tonic clonic seizures. In both patient groups, memory and learning dysfunction remained significant after adjusting for estimated premorbid IQ and structural brain lesions.
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http://dx.doi.org/10.1016/j.eplepsyres.2017.11.014DOI Listing
February 2018

Eculizumab: a treatment option for myasthenia gravis?

Authors:
Nils Erik Gilhus

Lancet Neurol 2017 12 20;16(12):947-948. Epub 2017 Oct 20.

Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway. Electronic address:

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http://dx.doi.org/10.1016/S1474-4422(17)30363-0DOI Listing
December 2017

Pathophysiology and immunological profile of myasthenia gravis and its subgroups.

Curr Opin Immunol 2017 Dec 4;49:9-13. Epub 2017 Aug 4.

Department of Neurology, Haukeland University Hospital, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Myasthenia gravis (MG) is an autoimmune antibody-mediated disease characterized by muscle weakness and fatigability. It is believed that the initial steps triggering humoral immunity in MG take place inside thymic tissue and thymoma. The immune response against one or several epitopes expressed on thymic tissue cells spills over to neuromuscular junction components sharing the same epitope causing humoral autoimmunity and antibody production. The main cause of MG is acetylcholine receptor antibodies. However, many other neuromuscular junction membrane protein targets, intracellular and extracellular proteins are suggested to participate in MG pathophysiology. MG should be divided into subgroups based on clinical presentation and immunology. This includes onset age, clinical characteristics, thymic pathology and antibody profile. The immunological profile of these subgroups is determined by the antibodies present.
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http://dx.doi.org/10.1016/j.coi.2017.07.006DOI Listing
December 2017

Juvenile-onset myasthenia gravis: autoantibody status, clinical characteristics and genetic polymorphisms.

J Neurol 2017 May 31;264(5):955-962. Epub 2017 Mar 31.

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Myasthenia gravis (MG) is an autoimmune disorder mediated by antibodies against proteins at the neuromuscular junction. Juvenile-onset MG (JMG) has been reported to have special characteristics. It is still unclear whether there are any pathogenic and genetic differences between juvenile and adult MG. In this study, we evaluated the clinical characteristics, autoantibody status (antibodies against AChR, MuSK, LRP4, titin and RyR) and genetic susceptibility (CHRNA1, CTLA4 and AIRE) in 114 Chinese JMG patients, and compared with 207 young adult MG patients (onset age 18-40 years). JMG patients were classified into two subgroups: the very early onset group (<8 years) and puberty onset group (8-18 years). The very early onset MG patients had a higher proportion of ocular MG and thymus hyperplasia, compared with puberty onset MG and young adult MG (P < 0.05). AChR antibodies were found in majority of JMG patients and were associated with more severe disease (P < 0.05), while other antibodies were rare in JMG. Moreover, the very early onset MG had a more prominent genetic predisposition than puberty and adult MG, affecting the susceptible genes CHRNA1 and CTLA4. JMG has the same pathogenic background as adult MG, but has typical clinical features and a prominent genetic predisposition in very early onset patients (<8 years). Specific therapeutic considerations are needed.
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http://dx.doi.org/10.1007/s00415-017-8478-zDOI Listing
May 2017

Overweight in epilepsy as a risk factor for pregnancy and delivery complications.

Epilepsia 2016 11 13;57(11):1849-1857. Epub 2016 Oct 13.

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Objective: To investigate whether prepregnancy overweight in women with epilepsy increases their risk for complications during pregnancy and delivery.

Methods: This study is based on The Norwegian Mother and Child Cohort Study (MoBa) linked to the Medical Birth Registry of Norway. A diagnosis of epilepsy was reported in 706 pregnancies. Overweight was defined as body mass index ≥ 25 prepregnancy. Overweight women with epilepsy (n = 259) were compared to normal-weight women with epilepsy (n = 416), and to women without epilepsy with and without overweight (n = 30,516 and n = 67,977, respectively). The risks of pregnancy and delivery complications were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for adverse socioeconomic factors, age, parity, and smoking.

Results: Women with epilepsy were more often overweight than women without epilepsy (38.4% vs. 31.3%, p < 0.001). The majority of pregnancy and delivery complications were more frequent in overweight women with epilepsy. Compared to overweight women without epilepsy, the risk was increased for cesarean section (OR 1.6, CI 1.2-2.2, p < 0.001), excessive bleeding (OR 1.4, CI 1.0-1.8, p = 0.04), peripartum anxiety and depressive symptoms (OR 1.9, CI 1.3-2.8, p < 0.001), small for gestational age children (OR 2.4, CI 1.2-4.8, p = 0.02), and transfer of the infant to a neonatal ward (OR 1.5, CI 1.1-2.2, p = 0.02). Compared to normal-weight women with epilepsy, the risk of cesarean section (OR 1.6, CI 1.1-2.3, p < 0.05), gestational hypertension (OR 2.0, CI 1.1-3.5, p < 0.05), preeclampsia (OR 2.3, CI 1.2-4.5, p < 0.05), and transfer of the infant to a neonatal ward (OR 2.2, CI 1.3-3.6, p < 0.01) was increased.

Significance: Prepregnancy overweight in combination with epilepsy entails a strong negative effect on risk of complications during pregnancy and delivery. In women with epilepsy and overweight referral to a nutritionist should be considered when an antiepileptic drug is started as well as when pregnancy is planned. These women should be regarded as a high-risk group.
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http://dx.doi.org/10.1111/epi.13573DOI Listing
November 2016
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