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About me

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.


  • 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.

Research description

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

Primary hypothesis

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.

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


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).

Teaching portfolio

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 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).


Enhancing Recruitment Using Teleconference and Commitment Contract (ERUTECC): study protocol for a randomised, stepped-wedge cluster trial within the EFFECTS trial
Lundström E, Isaksson E, Wester P, Laska Ac, Näsman P
Trials 2018;19(1):14-

Trends in diagnosis-specific work disability before and after ischaemic heart disease: a nationwide population-based cohort study in Sweden
Ervasti J, Virtanen M, Lallukka T, Friberg E, Mittendorfer-rutz E, Lundström E, et al
BMJ open 2018;8(4):e019749-

Trends in Diagnosis-Specific Work Disability Before and After Stroke: A Longitudinal Population-Based Study in Sweden
Lallukka T, Ervasti J, Lundström E, Mittendorfer-rutz E, Friberg E, Virtanen M, et al
Journal of the American Heart Association 2018;7(1):-

Nongated Cardiac Computed Tomographic Angiograms for Detection of Embolic Sources in Acute Ischemic Stroke
Yeo Lll, Holmin S, Andersson T, Lundström E, Gopinathan A, Lim El, et al
Stroke 2017;48(5):1256-1261

Permanent work disability before and after ischaemic heart disease or stroke event: a nationwide population-based cohort study in Sweden
Ervasti J, Virtanen M, Lallukka T, Friberg E, Mittendorfer-rutz E, Lundström E, et al
BMJ open 2017;7(9):e017910-

Synchronous cardiocerebral infarction in the era of endovascular therapy: which to treat first?
Yeo Lll, Andersson T, Yee Kw, Tan Byq, Paliwal P, Gopinathan A, et al
Journal of thrombosis and thrombolysis 2017;44(1):104-111

The FOCUS, AFFINITY and EFFECTS trials studying the effect(s) of fluoxetine in patients with a recent stroke: statistical and health economic analysis plan for the trials and for the individual patient data meta-analysis
Graham C, Lewis S, Forbes J, Mead G, Hackett Ml, Hankey Gj, et al
Trials 2017;18(1):627-

Validation of Serial Alberta Stroke Program Early CT Score as an Outcome Predictor in Thrombolyzed Stroke Patients
Kong Wy, Tan Byq, Ngiam Njh, Tan Dyc, Yuan Ch, Holmin S, et al
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 2017;26(10):2264-2271

Work disability before and after a major cardiovascular event: a ten-year study using nationwide medical and insurance registers
Virtanen M, Ervasti J, Mittendorfer-rutz E, Lallukka T, Kjeldgård L, Friberg E, et al
Scientific reports 2017;7(1):1142-

Effects of alteplase on survival after ischaemic stroke (IST-3): 3 year follow-up of a randomised, controlled, open-label trial
Ist-3 Collaborative Group, Berge E, Cohen G, Roaldsen Mb, Lundström E, Isaksson E, et al
The Lancet. Neurology 2016;15(10):1028-34

Predicting return to work after subarachnoid hemorrhage using the Montreal Cognitive Assessment (MoCA)
Wallmark S, Ronne-engstrom E, Lundstrom E
ACTA NEUROCHIRURGICA 2016;158(2):233-9

Attention deficits after aneurysmal subarachnoid hemorrhage measured using the test of variables of attention
Wallmark S, Lundström E, Wikström J, Ronne-engström E
Stroke 2015;46(5):1374-6

How common is isolated dysphasia among patients with stroke treated with intravenous thrombolysis, and what is their outcome? Results from the SITS-ISTR
Lundström E, Zini A, Wahlgren N, Ahmed N
BMJ open 2015;5(11):e009109-

The FOCUS, AFFINITY and EFFECTS trials studying the effect(s) of fluoxetine in patients with a recent stroke: a study protocol for three multicentre randomised controlled trials
Mead G, Hackett Ml, Lundström E, Murray V, Hankey Gj, Dennis M
Trials 2015;16():369-

Agreement between ambulance nurses and physicians in assessing stroke patients
Blomberg H, Lundstrom E, Toss H, Gedeborg R, Johansson J

Wallmark S, Ronne-engstrom E, Lundstrom E

Health-related quality of life at median 12 months after aneurysmal subarachnoid hemorrhage, measured with EuroQoL-5D
Ronne-engstrom E, Enblad P, Lundstrom E
ACTA NEUROCHIRURGICA 2013;155(4):587-93

Letter by Mead et al Regarding Article, "Selective Serotonin Reuptake Inhibitors for Stroke: More Trials are Needed"
Focus Efects Affinity Trialists, Mead Ge, Dennis M, Lundstrom E, Murray V, Hackett M, et al
STROKE 2013;44(4):e40-1

Migrainous Infarction: Aspects on Risk Factors and Therapy
Laurell K, Lundstrom E

Outcome After Spontaneous Subarachnoid Hemorrhage Measured With the EQ-5D
Ronne-engstrom E, Enblad P, Lundstrom E
STROKE 2011;42(11):3284-6

Update on the third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited
Ist-3 Collaborative Grp, Sandercock P, Lindley R, Wardlaw J, Dennis M, Innes K, et al
TRIALS 2011;:252-

Four-fold increase in direct costs of stroke survivors with spasticity compared with stroke survivors without spasticity: the first year after the event
Lundström E, Smits A, Borg J, Terént A
Stroke 2010;41(2):319-24

International Comparisons of Stroke Costs Are Always Limited
Lundstrom E
STROKE 2010;41(7):e472-

Response to Letter by Dobkin
Lundstrom E
STROKE 2010;41(7):E471-E471

Time-course and determinants of spasticity during the first six months following first-ever stroke
Lundström E, Smits A, Terént A, Borg J
Journal of rehabilitation medicine 2010;42(4):296-301

Risk factors for stroke-related pain 1 year after first-ever stroke
Lundström E, Smits A, Terént A, Borg J
European journal of neurology 2009;16(2):188-93

Prevalence of disabling spasticity 1 year after first-ever stroke
Lundström E, Terént A, Borg J
European journal of neurology 2008;15(6):533-9

Objective assessment of cervical dystonia: a pilot study
Zetterberg L, Halvorsen K, Farnstrand C, Lundstrom E, Lindmark B, Aquilonius Sm

["Save the brain"-network in the county of Uppsala for thrombolytic therapy in stroke]
Lundström E, Andersson P, Gustavsson L, Terént A
Lakartidningen 2004;101(8):678-82

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