Affiliated to teaching/tutoring
Associate Professor in Neurology at Karolinska Institutet, Sweden.
Senior Consultant in Neurology, Karolinska University Hospital (Solna), Acute Stroke Unit (Sektionsöverläkare R15).
An established interest in acute stroke but also of the consequences of the disease. Responsible for the acute stroke unit at the Karolinska University Hospital (Solna) since December 2012 and has extensive clinical experience of all phases of the clinical pathway for stroke survivors.
My research is focused on stroke recovery. Although we have effective treatment for acute ischemic stroke, there is un urgent need for additional treatment.
Each year, stroke affects 16 million people for the first time. About 50% of survivors will have long-term residual disability. One promising intervention is fluoxetine, a selective serotonin reuptake inhibitor (SSRI). SSRIs have been used in clinical practice since 1988 to treat mood disorders Animal studies have shown that fluoxetine may improve post-ischaemic brain injury in many ways that augment neuroplasticity.
The FLAME trial result ignited worldwide interest in the role of fluoxetine. In this double-blind, placebo-controlled, multicentre trial 118 patients with ischaemic stroke were randomised to fluoxetine 20 mg daily or placebo for 3 months. At day 90 the frequency of independent patients [with a modified Rankin scale (mRS) of 0–2] was significantly higher in the fluoxetine group (26 % vs. 9 %, p = 0.015).
I am the Chief investigator for EFFECTS (Efficacy oF Fluoxetine – a randomisEd Controlled Trial in Stroke), an investigated led multicentre, parallel group, randomised, placebo-controlled trial
If we give Fluoxetine 20 mg once daily for 6 months then we will improves independent measured by (mRS) at 6 months post stroke.
Secondary hypothesis If we give Fluoxetine 20 mg once daily for 6 months, then we will:
- Increases survival
- Increases health status
- Decreases depression
- Decreases fatigue
- Improve cognition
- Results in better quality of life
- Is cost effective
EFFECTS started 20/10/2014 and we have included 699 subjects at 35 centers in total (07/05/2017). The goal is 1 500 patients and currently we are including 30 subjects/month. We hope that the inclusion is completed in October 2018, with the last follow-up one year later.
EFFECTS collaborate with two other studies – FOCUS (Great Britain), and AFFINITY (Australia and New Zealand). The three trial investigator teams have collaboratively developed a core protocol. Minor variations have been tailored to the national. Each trial is run and funded independently and will report its own results. A prospectively planned individual patient data meta-analysis of all three trials are planned.
Importance If fluoxetine is safe and effective in promoting functional recovery, it could be rapidly, widely and affordably implemented in routine clinical practice and reduce the burden of disability due to stroke. Furthermore, the cost of 6 months of treatment is low (30 Euro).
Approval and publication for EFFECTS
- EudraCT number 2011-006130-16.
- Ethical approval, Stockholm (Dnr: 2013/1265-31/2. Date 30/09/2013).
- Approval from Medical Product Agency (Läkemedelsverket), Uppsala. 08/08/2014 (Dnr 5.1-2014-43006).
- Registred at Clinicatrials.gov, number NCT02683213.
- Protocol published, together with our sister studies, FOCUS and AFFINITY, in Trials.
Co-supervisor of a PhD student, Svante Wallmark, at Uppsala University, Department of Neuroscience, section of Neurosurgery) that focus on the effects of subarachnoid haemorrhage, including cognitive impairment. Dr Wallmark defended his thesis Life after subarachnoid haemorrhage 17/01/2017.
Main supervisor of PhD student, Ann-Sofie Rudberg, at Karolinska Institutet, Dep of Clinical Neuroscience, section of Neurology. Accepted as a PhD-student in the fall of 2017. Dr Rudbergs projects will investigate long-term survival, health-related quality of life and cost aspects associated with stroke treatment, and will be based on two clinical stroke studies: IST-3 and EFFECTS.
Co-supervisor of PhD-student Melinda Berg Roaldsen at UiT, the Arctic University of Norway. Her research focuses on thrombolytic treatment of acute ischaemic stroke with a special emphasis on wake-up stroke. She is currently the international Trial Manager of the randomised-controlled trial TWIST (Tenecteplase in Wake-up Ischaemic Stroke Trial).
Extensive teaching at Uppsala University in Neurology for medical students, nurses, physio therapist and occupational therapists. Some teaching for medical student at Karolinska Institutet, Sweden.
- MD, Uppsala University, Sweden: 1993.
- Specialist in Neurology, (vascular neurology), Akademiska sjukhuset (Uppsala University Hospital), 2005.
- PhD: 2009 Department of Neuroscience, Neurology and Rehabilitation medicine, Uppsala University, Sweden. Name of the Thesis: Spasticity after first-ever stroke.
Academic honours, awards and prizes
Principal Investigator at Uppsala University Hospital and awarded Top recruiting center för IST-3 (The third international stroke trial: a randomised controlled tria). IST-3 is the largest study of thrombolysis for acute ischaemic stroke (N=3,035), and Uppsala University hospital was the third largest recruiter for the study in the world (n=100).