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.
- 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.
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.
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 410 subjects at 29 centers in total (01/07/2016). The goal is 1 500 patients at 35 centers. According to plan, we have been able to include 20-51 subjects/month. We estimate 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.
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. Planned disputation Jan 2017.
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.
Academic honors, 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).