Syvertsen M.,Drammen Hospital |
Nakken K.O.,University of Oslo |
Edland A.,Drammen Hospital |
Hansen G.,Drammen Hospital |
And 2 more authors.
Epilepsia | Year: 2015
Objective Epilepsy represents a substantial personal and social burden worldwide. When addressing the multifaceted issues of epilepsy care, updated epidemiologic studies using recent guidelines are essential. The aim of this study was to find the prevalence and causes of epilepsy in a representative Norwegian county, implementing the new guidelines and terminology suggested by the International League Against Epilepsy (ILAE). Methods Included in the study were all patients from Buskerud County in Norway with a diagnosis of epilepsy at Drammen Hospital and the National Center for Epilepsy at Oslo University Hospital. The study period was 1999-2014. Patients with active epilepsy were identified through a systematic review of medical records, containing information about case history, electroencephalography (EEG), cerebral magnetic resonance imaging (MRI), genetic tests, blood samples, treatment, and other investigations. Epilepsies were classified according to the revised terminology suggested by the ILAE in 2010. Results In a population of 272,228 inhabitants, 1,771 persons had active epilepsy. Point prevalence on January 1, 2014 was 0.65%. Of the subjects registered with a diagnostic code of epilepsy, 20% did not fulfill the ILAE criteria of the diagnosis. Epilepsy etiology was structural-metabolic in 43%, genetic/presumed genetic in 20%, and unknown in 32%. Due to lack of information, etiology could not be determined in 4%. Significance Epilepsy is a common disorder, affecting 0.65% of the subjects in this cohort. Every fifth subject registered with a diagnosis of epilepsy was misdiagnosed. In those with a reliable epilepsy diagnosis, every third patient had an unknown etiology. Future advances in genetic research will probably lead to an increased identification of genetic and hopefully treatable causes of epilepsy. © Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.
Qvigstad E.,University of Oslo |
Kramer-Johansen J.,University of Oslo |
Tomte T.,Drammen Hospital |
Skalhegg T.,University of Oslo |
And 3 more authors.
Resuscitation | Year: 2013
Purpose of the study: Optimal hand position for chest compressions during cardiopulmonary resuscitation is unknown. Recent imaging studies indicate significant inter-individual anatomical variations, which might cause varying haemodynamic responses with standard chest compressions. This prospective clinical pilot study intended to assess the feasibility of utilizing capnography to optimize chest compressions and identify the optimal hand position. Materials and methods: Intubated cardiac arrest patients treated by the physician manned ambulance between February and December 2011 monitored with continuous end-tidal CO2 (EtCO2) measurements were included. One minute of chest compressions at the inter-nipple line (INL) optimized using EtCO2 feedback, was followed by four 30-s intervals with compressions at four different sites; INL, 2cm below the INL, 2cm below and to the left of INL and 2cm below and to the right of INL. Results: Thirty patients were included. At the end of each 30-s interval median (range) EtCO2 was 3.1kPa (0.7-8.7kPa) at INL, 3.5kPa (0.5-10.7) 2cm below INL, 3.5kPa (0.5-10.3kPa) 2cm below and to the left of INL, and 3.8kPa (0.4-8.8kPa) 2cm below and to the right of INL (p=0.4). The EtCO2 difference within each subject between hand positions with maximum and minimum values varied between individuals from 0.2 to 3.4kPa (median 0.9kPa). Conclusion: Monitoring and optimizing chest compressions using capnography was feasible. We could not demonstrate one superior hand position, but inter-individual differences suggest optimal hand position might vary significantly among patients. © 2013 Elsevier Ireland Ltd.
Bjornara K.A.,Drammen Hospital |
Dietrichs E.,University of Oslo |
Toft M.,University of Oslo
European Journal of Neurology | Year: 2015
Background and purpose: Rapid eye movement (REM) sleep behaviour disorder (RBD) is frequently present in patients with Parkinson's disease (PD) and may have prognostic implications. There are few longitudinal studies of RBD in patients with PD. Our aim was to investigate whether RBD was a persistent feature in a follow-up study of 107 patients with PD. Methods: After a mean follow-up time of 3 years, 96 patients were available for reassessment. Probable RBD (pRBD) was diagnosed by the REM sleep behaviour disorder screening questionnaire. Results: At follow-up, pRBD was found in 49% of the patients, versus 38% at baseline. The pRBD status remained unchanged in three-quarters of the patients, whilst 17% had new pRBD symptoms. Disease duration was longer in the pRBD group, 9.4 vs. 7.6 years (P = 0.02). Conclusions: Probable RBD is a persistent feature in PD and probably increases over time. © 2015 EAN.
Bjornara K.A.,Drammen Hospital |
Dietrichs E.,University of Oslo |
Toft M.,University of Oslo
Clinical Neurology and Neurosurgery | Year: 2014
Objective Sleep disturbances, such as REM sleep behavior disorder (RBD) and excessive daytime sleepiness, are more common in patients with Parkinson's disease (PD) than in the general population. Apart from that, their relation to PD seems to diverge considerably. Our aim was to explore the frequency and associated motor- and non-motor features of sleep related symptoms in PD. Methods One hundred and seven patients with PD, 65 men and 42 women, were included in a cross-sectional study. Excessive daytime sleepiness was examined by the Epworth sleepiness scale. Probable RBD (pRBD) was diagnosed by the validated REM sleep behavior disorder screening questionnaire. Further sleep symptoms were explored by the Parkinson's disease sleep scale. Motor- and non-motor symptoms were assessed and compared in patients with and without pRBD and excessive daytime sleepiness, respectively. Results pRBD was present in 38% and excessive daytime sleepiness was present in 29% of the patients. As opposed to excessive daytime sleepiness, pRBD showed no association to disease duration or severity. PD patients with pRBD reported more cognitive problems. There was a trend towards more autonomic dysfunction in patients with pRBD. Nocturia and sleep fragmentation were the most frequent general sleep problems reported by the patients. Conclusions Our results suggest that excessive daytime sleepiness is related to disease duration, and possibly caused by progressive neurodegeneration. pRBD seems to be a distinct feature present in only a proportion of PD patients. © 2014 Elsevier B.V.
Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): An open-label randomised controlled trial
Tegn N.,University of Oslo |
Abdelnoor M.,University of Oslo |
Aaberge L.,University of Oslo |
Endresen K.,University of Oslo |
And 8 more authors.
The Lancet | Year: 2016
Background Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris are frequent causes of hospital admission in the elderly. However, clinical trials targeting this population are scarce, and these patients are less likely to receive treatment according to guidelines. We aimed to investigate whether this population would benefit from an early invasive strategy versus a conservative strategy. Methods In this open-label randomised controlled multicentre trial, patients aged 80 years or older with NSTEMI or unstable angina admitted to 16 hospitals in the South-East Health Region of Norway were randomly assigned to an invasive strategy (including early coronary angiography with immediate assessment for percutaneous coronary intervention, coronary artery bypass graft, and optimum medical treatment) or to a conservative strategy (optimum medical treatment alone). A permuted block randomisation was generated by the Centre for Biostatistics and Epidemiology with stratification on the inclusion hospitals in opaque concealed envelopes, and sealed envelopes with consecutive inclusion numbers were made. The primary outcome was a composite of myocardial infarction, need for urgent revascularisation, stroke, and death and was assessed between Dec 10, 2010, and Nov 18, 2014. An intention-to-treat analysis was used. This study is registered with ClinicalTrials.gov, number NCT01255540. Findings During a median follow-up of 1·53 years of participants recruited between Dec 10, 2010, and Feb 21, 2014, the primary outcome occurred in 93 (40·6%) of 229 patients assigned to the invasive group and 140 (61·4%) of 228 patients assigned to the conservative group (hazard ratio [HR] 0·53 [95% CI 0·41-0·69], p=0·0001). Five patients dropped out of the invasive group and one from the conservative group. HRs for the four components of the primary composite endpoint were 0·52 (0·35-0·76; p=0·0010) for myocardial infarction, 0·19 (0·07-0·52; p=0·0010) for the need for urgent revascularisation, 0·60 (0·25-1·46; p=0·2650) for stroke, and 0·89 (0·62-1·28; p=0·5340) for death from any cause. The invasive group had four (1·7%) major and 23 (10·0%) minor bleeding complications whereas the conservative group had four (1·8%) major and 16 (7·0%) minor bleeding complications. Interpretation In patients aged 80 years or more with NSTEMI or unstable angina, an invasive strategy is superior to a conservative strategy in the reduction of composite events. Efficacy of the invasive strategy was diluted with increasing age (after adjustment for creatinine and effect modification). The two strategies did not differ in terms of bleeding complications. Funding Norwegian Health Association (ExtraStiftelsen) and Inger and John Fredriksen Heart Foundation. © 2016 Elsevier Ltd.