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Lilja-Lund, O., Nyberg, L., Maripuu, M. & Laurell, K. (2022). Dual-Task Performance in Older Adults With and Without Idiopathic Normal Pressure Hydrocephalus. Frontiers in Aging Neuroscience, 14, Article ID 904194.
Open this publication in new window or tab >>Dual-Task Performance in Older Adults With and Without Idiopathic Normal Pressure Hydrocephalus
2022 (English)In: Frontiers in Aging Neuroscience, ISSN 1663-4365, E-ISSN 1663-4365, Vol. 14, article id 904194Article in journal (Refereed) Published
Abstract [en]

Two of the main features of idiopathic normal pressure hydrocephalus (iNPH) are disturbed gait and cognition. These features are typically investigated separately, but here we combined walking with a cognitive task to investigate if older adults with iNPH were more susceptible to dual-task interference on walking than those without iNPH. In total, 95 individuals from the general population participated in our study. Of these, 20 were classified as Possible iNPH (median [interquartile range, IQR] 80 years [75–82.5]) and 75 as Unlikely iNPH (74 years [72–78]). Conversation, 10-m walking, semantic and phonemic verbal fluency were performed either combined or independently. “Stopping walking while talking” was noted. Pairwise comparisons and multiple logistic regression analyses were used. We found that the Possible iNPH group was older, stopped walking more frequently during the conversation, and had a slower single-task pace. The dual-task pace was slower for both groups. Only single-task walking pace could predict Possible iNPH when adjusted for age. We could establish a dual-task cost on gait performance in this sample of older adults from the general population, but the cost was not exclusive for individuals with Possible iNPH. To further assess the value of dual-task testing in iNPH, including observations of stopping walking while talking, a study of a clinical iNPH material with more severe symptoms would be valuable.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
idiopathic normal pressure hydrocephalus, cognition, dual-task, ageing
National Category
Neurology
Research subject
Neurology; Clinical Psychology
Identifiers
urn:nbn:se:umu:diva-201140 (URN)10.3389/fnagi.2022.904194 (DOI)000810184900001 ()35707704 (PubMedID)2-s2.0-85132248019 (Scopus ID)
Funder
Knut and Alice Wallenberg FoundationUmeå UniversityUppsala UniversityRegion Jämtland Härjedalen
Available from: 2022-11-21 Created: 2022-11-21 Last updated: 2022-11-25Bibliographically approved
Andrén, K., Wikkelsø, C., Sundström, N., Israelsson, H., Agerskov, S., Laurell, K., . . . Tullberg, M. (2020). Survival in treated idiopathic normal pressure hydrocephalus. Journal of Neurology, 267(3), 640-648
Open this publication in new window or tab >>Survival in treated idiopathic normal pressure hydrocephalus
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2020 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 267, no 3, p. 640-648Article in journal (Refereed) Published
Abstract [en]

Objective: To describe survival and causes of death in 979 treated iNPH patients from the Swedish Hydrocephalus Quality Registry (SHQR), and to examine the influence of comorbidities, symptom severity and postoperative outcome.

Methods: All 979 patients operated for iNPH 2004–2011 and registered in the SHQR were included. A matched control group of 4890 persons from the general population was selected by Statistics Sweden. Data from the Swedish Cause of Death Registry was obtained for patients and controls.

Results: At a median 5.9 (IQR 4.2–8.1) year follow-up, 37% of the iNPH patients and 23% of the controls had died. Mortality was increased in iNPH patients by a hazard ratio of 1.81, 95% CI 1.61–2.04, p < 0.001. More pronounced symptoms in the preoperative ordinal gait scale and the Mini-mental State Examination were the most important independent predictors of mortality along with the prevalence of heart disease. Patients who improved in both the gait scale and in the modified Rankin Scale postoperatively (n = 144) had a similar survival as the general population (p = 0.391). Deaths due to cerebrovascular disease or dementia were more common in iNPH patients, while more controls died because of neoplasms or disorders of the circulatory system.

Conclusions: Mortality in operated iNPH patients is 1.8 times increased compared to the general population, a lower figure than previously reported. The survival of iNPH patients who improve in gait and functional independence is similar to that of the general population, indicating that shunt surgery for iNPH, besides improving symptoms and signs, can normalize survival.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2020
Keywords
Hydrocephalus, Gait disorders, Cognitive disorders, Prognosis, Cohort studies
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-165753 (URN)10.1007/s00415-019-09598-1 (DOI)000495682300002 ()31713102 (PubMedID)2-s2.0-85075162415 (Scopus ID)
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2021-04-28Bibliographically approved
Shanks, J., Bloch, K. M., Laurell, K., Cesarini, K. G., Fahlstroem, M., Larsson, E.-M. & Virhammar, J. (2019). Aqueductal CSF Stroke Volume Is Increased in Patients with Idiopathic Normal Pressure Hydrocephalus and Decreases after Shunt Surgery. American Journal of Neuroradiology, 40(3), 453-459
Open this publication in new window or tab >>Aqueductal CSF Stroke Volume Is Increased in Patients with Idiopathic Normal Pressure Hydrocephalus and Decreases after Shunt Surgery
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2019 (English)In: American Journal of Neuroradiology, ISSN 0195-6108, E-ISSN 1936-959X, Vol. 40, no 3, p. 453-459Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: Increased CSF stroke volume through the cerebral aqueduct has been proposed as a possible indicator of positive surgical outcome in patients with idiopathic normal pressure hydrocephalus; however, consensus is lacking. In this prospective study, we aimed to compare CSF flow parameters in patients with idiopathic normal pressure hydrocephalus with those in healthy controls and change after shunt surgery and to investigate whether any parameter could predict surgical outcome.

MATERIALS AND METHODS: Twenty-one patients with idiopathic normal pressure hydrocephalus and 21 age- and sex-matched healthy controls were prospectively included and examined clinically and with MR imaging of the brain. Eighteen patients were treated with shunt implantation and were re-examined clinically and with MR imaging the day before the operation and 3 months postoperatively. All MR imaging scans included a phase-contrast sequence.

RESULTS: The median aqueductal CSF stroke volume was significantly larger in patients compared with healthy controls (103.5 μL; interquartile range, 69.8–142.8 μL) compared with 62.5 μL (interquartile range, 58.3–73.8 μL; P < .01) and was significantly reduced 3 months after shunt surgery from 94.8 μL (interquartile range, 81–241 μL) to 88 μL (interquartile range, 51.8–173.3 μL; P < .05). Net flow in the caudocranial direction (retrograde) was present in 11/21 patients and in 10/21 controls. Peak flow and net flow did not differ between patients and controls. There were no correlations between any CSF flow parameters and surgical outcomes.

CONCLUSIONS: Aqueductal CSF stroke volume was increased in patients with idiopathic normal pressure hydrocephalus and decreased after shunt surgery, whereas retrograde aqueductal net flow did not seem to be specific for patients with idiopathic normal pressure hydrocephalus. On the basis of the results, the usefulness of CSF flow parameters to predict outcome after shunt surgery seem to be limited.

Place, publisher, year, edition, pages
American Society of Neuroradiology, 2019
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-157768 (URN)10.3174/ajnr.A5972 (DOI)000461201600016 ()30792248 (PubMedID)2-s2.0-85062962080 (Scopus ID)
Available from: 2019-04-04 Created: 2019-04-04 Last updated: 2023-03-24Bibliographically approved
de Flon, P., Laurell, K., Sundström, P., Blennow, K., Söderström, L., Zetterberg, H., . . . Svenningsson, A. (2019). Comparison of plasma and cerebrospinal fluid neurofilament light in a multiple sclerosis trial. Acta Neurologica Scandinavica, 139(5), 462-468
Open this publication in new window or tab >>Comparison of plasma and cerebrospinal fluid neurofilament light in a multiple sclerosis trial
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2019 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 139, no 5, p. 462-468Article in journal (Refereed) Published
Abstract [en]

Objective: The main objective of this study was to evaluate the axonal component neurofilament light protein (NFL) in plasma and cerebrospinal fluid (CSF) as an outcome measure in a clinical trial on disease-modifying treatments in multiple sclerosis.

Materials and methods: Seventy-five patients with clinically stable relapsing-remitting multiple sclerosis (RRMS) participating in the clinical trial "Switch-To RItuXimab in MS" (STRIX-MS) were switched to rituximab from first-line injectable therapy and then followed up for 2 years. Thirty patients from the extension trial (STRIX-MS extension), accepting repeated lumbar punctures, were followed up for an additional 3 years. Plasma and CSF samples were collected yearly during the follow-up. NFL concentration in plasma was measured by an in-house NF-light assay on the Simoa platform with a Homebrew kit. NFL concentration in CSF was measured by sandwich ELISA.

Results: The mean levels of NFL, in both CSF and plasma, were low. The reduction of CSF-NFL was 25% during the first year of follow-up (from a mean of 471 [SD 393] to 354 [SD 174] pg/mL; P = 0.006) and was statistically significant. The corresponding reduction in plasma NFL was 18% (from 9.73 [SD 7.04] to 7.94 [SD 3.10] pg/mL; P = 0.055) and did not reach statistical significance.

Conclusion: This study indicates that NFL in plasma is less sensitive as an endpoint in group comparisons than NFL in CSF. Given that plasma NFL is far easier to access, it is a promising and awaited method but further studies are needed to optimize the use in clinical trials.

Keywords
cerebrospinal fluid, clinical trial, multiple sclerosis, neurofilament light, plasma, rituximab, treatment
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-158568 (URN)10.1111/ane.13078 (DOI)000464338600008 ()30740668 (PubMedID)2-s2.0-85062548724 (Scopus ID)
Available from: 2019-05-27 Created: 2019-05-27 Last updated: 2023-03-24Bibliographically approved
Virhammar, J., Laurell, K., Cesarini, K. G. & Larsson, E.-M. (2019). Increase in callosal angle and decrease in ventricular volume after shunt surgery in patients with idiopathic normal pressure hydrocephalus. Journal of Neurosurgery, 130(1), 130-135
Open this publication in new window or tab >>Increase in callosal angle and decrease in ventricular volume after shunt surgery in patients with idiopathic normal pressure hydrocephalus
2019 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 130, no 1, p. 130-135Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Postoperative decrease in ventricle size is usually not detectable either by visual assessment or by measuring the Evans index in patients with idiopathic normal pressure hydrocephalus (iNPH). The aim of the present study was to investigate whether the angle between the lateral ventricles (the callosal angle [CA]) increases and ventricular volume decreases after shunt surgery in patients with iNPH.

METHODS: Magnetic resonance imaging of the brain was performed before and 3 months after shunt surgery in 18 patients with iNPH. The CA and Evans index were measured on T1-weighted 3D MR images, and ventricular volume contralateral to the shunt valve was measured with quantitative MRI.

RESULTS: The CA was larger postoperatively (mean 78°, 95% CI 69°–87°) than preoperatively (mean 67°, 95% CI 60°–73°; p < 0.001). The volume of the lateral ventricle contralateral to the shunt valve decreased from 73 ml (95% CI 66–80 ml) preoperatively to 63 ml (95% CI 54–72 ml) postoperatively (p < 0.001). The Evans index was 0.365 (95% CI 0.35–0.38) preoperatively and 0.358 (95% CI 0.34–0.38) postoperatively (p < 0.05). Postoperative change of CA showed a negative correlation with change of ventricular volume (r = −0.76, p < 0.01).

CONCLUSIONS: In this sample of patients with iNPH, the CA increased and ventricular volume decreased after shunt surgery. The relative difference was most pronounced for the CA, indicating that this accessible, noninvasive radiological marker should be evaluated further as an indirect method to determine shunt function in patients with iNPH.

Place, publisher, year, edition, pages
American Association of Neurological Surgeons, 2019
Keywords
normal pressure hydrocephalus, callosal angle, Evans index, postoperative radiology, quantitative MRI, NPH, shunt dysfunction
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-155641 (URN)10.3171/2017.8.JNS17547 (DOI)000454604000015 ()29393749 (PubMedID)2-s2.0-85064119774 (Scopus ID)
Funder
Erik, Karin och Gösta Selanders Foundation
Available from: 2019-01-25 Created: 2019-01-25 Last updated: 2023-03-24Bibliographically approved
Libard, S., Laurell, K., Cesarini, K. G. & Alafuzoff, I. (2019). Neuronal loss and progression of Alzheimer's disease related pathology observed in a Swedish patient with clinical diagnosis of idiopathic normal pressure hydrocephalus. Paper presented at 19th International Congress of Neuropathology, SEP 23-27, 2018, Tokyo, JAPAN. Brain Pathology, 29, 69-69
Open this publication in new window or tab >>Neuronal loss and progression of Alzheimer's disease related pathology observed in a Swedish patient with clinical diagnosis of idiopathic normal pressure hydrocephalus
2019 (English)In: Brain Pathology, ISSN 1015-6305, E-ISSN 1750-3639, Vol. 29, p. 69-69Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Neurology Neurosciences
Identifiers
urn:nbn:se:umu:diva-157591 (URN)000459814800214 ()
Conference
19th International Congress of Neuropathology, SEP 23-27, 2018, Tokyo, JAPAN
Note

Supplement: 1

Special Issue: SI

Meeting Abstract: P2-1

Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2019-11-25Bibliographically approved
Irewall, A.-L., Ögren, J., Bergström, L., Laurell, K., Söderström, L. & Mooe, T. (2019). Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a randomized controlled trial sub-study. Trials, 20, Article ID 52.
Open this publication in new window or tab >>Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a randomized controlled trial sub-study
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2019 (Swedish)In: Trials, E-ISSN 1745-6215, Vol. 20, article id 52Article in journal (Refereed) Published
Abstract [en]

Background: The objective of this study was to analyze the impact of two forms of secondary preventive followup on the association between education level and levels of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) after stroke/transient ischemic attack (TIA).

Methods: We included a population-based cohort of 771 stroke and TIA patients randomly assigned (1:1) to secondary preventive follow-up within primary health care (control) or nurse-led, telephone-based follow-up (intervention) between January 1, 2010, and December 31, 2013, as part of the NAILED (nurse-based ageindependent intervention to limit evolution of disease) stroke risk factor trial. We compared BP and LDL-C levels 12 months after hospital discharge in relation to education level (low, ≤10 years; high, >10 years) separately for the intervention and control groups.

Results: Among controls, systolic BP (SBP) decreased only among the highly educated (−2.5 mm Hg, 95% confidence interval (CI) −0.2 to −4.8), whereas LDL-C increased in the low-education group (0.2 mmol/L, 95% CI 0.1 to 0.3). At 12 months, controls with low education not more than 70 years of age had higher SBP than controls of the same age with high education (5.8 mm Hg, 95% CI 1.0 to 10.6). In contrast, SBP in the intervention group decreased similarly regardless of education level, LDL-C decreased among those with low education (−0.3 mmol/L, 95% CI −0.2 to −0.4) and, in the subgroup not more than 70 years old, low-educated participants had lower LDL-C at 12 months than those with high education (0.3 mmol/L, 95% CI 0.1 to 0.5).

Conclusions: Nurse-led, telephone-based secondary preventive follow-up led to comparable improvements in BP across education groups, while routine follow-up disfavored those with low education.

Trial registration: ISRCTN Registry ISRCTN23868518, June 19, 2012 - Retrospectively registered

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Secondary prevention, Stroke, Transient ischemic attack, Socioeconomic position
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-130496 (URN)10.1186/s13063-018-3131-4 (DOI)000455819200001 ()30646948 (PubMedID)2-s2.0-85059986556 (Scopus ID)
Note

Originally included in thesis in manuscript form with title: Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a prospective cohort study

Available from: 2017-01-20 Created: 2017-01-20 Last updated: 2024-03-18Bibliographically approved
Andersson, J., Rosell, M., Kockum, K., Lilja-Lund, O., Soderstrom, L. & Laurell, K. (2019). Prevalence of idiopathic normal pressure hydrocephalus: A prospective, population-based study. PLOS ONE, 14(5), Article ID e0217705.
Open this publication in new window or tab >>Prevalence of idiopathic normal pressure hydrocephalus: A prospective, population-based study
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2019 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 5, article id e0217705Article in journal (Refereed) Published
Abstract [en]

Background: Idiopathic normal pressure hydrocephalus (iNPH) causing gait impairment, dementia and urinary incontinence among the elderly, is probably under-diagnosed and under-treated. Despite being known since the 1960s, there is still a lack of prospective, population-based studies on the prevalence of iNPH. Such studies are warranted to minimize selection bias and estimate the true prevalence of the disease.

Methods: The prevalence of iNPH was determined in a randomly selected sample of residents, aged 65 years and older, in the Swedish county of Jämtland. Out of 1,000 individuals invited to participate, 673 (67.3%) completed a questionnaire with seven questions on iNPH symptoms. A subgroup, with and without self-reported symptoms, participated in clinical and radiological evaluations and were diagnosed according to international guidelines. Measurement of cerebrospinal fluid opening pressure was not performed as it was considered too invasive.

Results: Those who reported at least two symptoms in the questionnaire (n = 117) and 51 randomly selected individuals with 0–1 symptom participated in further examinations. Out of them, 25 individuals received the diagnosis probable iNPH according to American-European guidelines (except for the criterion of CSF opening pressure) corresponding to a prevalence of 3.7%. The prevalence of iNPH was four times higher among those aged 80 years and older (8.9%) than among those aged 65–79 years (2.1%) (p <0.001). The difference in prevalence between men (4.6%) and women (2.9%) was not significant (p = 0.24). When iNPH was diagnosed according to the Japanese guidelines the prevalence was 1.5%

Conclusions: In this prospective, population-based study the prevalence of iNPH was 3.7% among individuals 65 years and older, and more common in the higher age group, 80 years and above. INPH should be increasingly recognized since it is a fairly common condition and an important cause of gait impairment and dementia among the elderly that can be effectively treated by shunt surgery.

Place, publisher, year, edition, pages
Public Library Science, 2019
National Category
Geriatrics Neurology
Identifiers
urn:nbn:se:umu:diva-160294 (URN)10.1371/journal.pone.0217705 (DOI)000469323000074 ()31141553 (PubMedID)2-s2.0-85067114888 (Scopus ID)
Available from: 2019-06-17 Created: 2019-06-17 Last updated: 2023-03-24Bibliographically approved
Kockum, K., Virhammar, J., Riklund, K., Söderström, L., Larsson, E.-M. & Laurell, K. (2019). Standardized image evaluation in patients with idiopathic normal pressure hydrocephalus: consistency and reproducibility. Neuroradiology, 61(12), 1397-1406
Open this publication in new window or tab >>Standardized image evaluation in patients with idiopathic normal pressure hydrocephalus: consistency and reproducibility
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2019 (English)In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 61, no 12, p. 1397-1406Article in journal (Refereed) Published
Abstract [en]

Purpose: Assess the agreement for two investigators between computed tomography (CT) and magnetic resonance imaging (MRI) for seven imaging features included in the iNPH Radscale, a radiological screening tool.

Methods: The study included 35 patients with idiopathic normal pressure hydrocephalus (iNPH) who were treated surgically from 2011 to 2015 at Uppsala University Hospital with preoperative CT and MRI performed with maximum 3 months between scans. Seven features were assessed: Evans’ index, temporal horn size, callosal angle, periventricular white matter changes, narrow high convexity sulci, focally enlarged sulci, and enlarged Sylvian fissures. All scans were assessed by two investigators who were blinded to each other’s results and to clinical data.

Results: The agreement between CT and MRI was almost perfect for Evans’ index, temporal horns, narrow sulci, and Sylvian fissures (kappa and intraclass correlation, 0.84–0.91, p ≤ 0.001). There was substantial to almost perfect agreement for callosal angle and focally enlarged sulci. The concordance between modalities was fair for changes in periventricular white matter.

Conclusion: CT and MRI are equally good for assessing radiological signs associated with iNPH except for periventricular white matter changes, as MRI has superior soft tissue contrast. The other imaging features can be evaluated consistently, and assessments are reproducible independent of modality. Therefore, the iNPH Radscale is applicable to both CT and MRI and may become an important tool for standardized evaluation in the workup in patients with suspected iNPH.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Hydrocephalus, normal pressure, Magnetic resonance imaging, Tomography, x-ray computed, Observer variation
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-165745 (URN)10.1007/s00234-019-02273-2 (DOI)000495810200006 ()31399851 (PubMedID)2-s2.0-85070272714 (Scopus ID)
Available from: 2019-12-10 Created: 2019-12-10 Last updated: 2023-03-23Bibliographically approved
de Flon, P., Söderström, L., Laurell, K., Dring, A., Sundström, P., Gunnarsson, M. & Svenningsson, A. (2018). Immunological profile in cerebrospinal fluid of patients with multiple sclerosis after treatment switch to rituximab and compared with healthy controls. PLOS ONE, 13(2), Article ID e0192516.
Open this publication in new window or tab >>Immunological profile in cerebrospinal fluid of patients with multiple sclerosis after treatment switch to rituximab and compared with healthy controls
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2018 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 13, no 2, article id e0192516Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate changes in the cerebrospinal fluid (CSF) immunological profile after treatment switch from first-line injectables to rituximab in patients with relapsing-remitting MS (RRMS), and to compare the profile in MS patients with healthy controls (HC).

METHOD: Cerebrospinal fluid from 70 patients with clinically stable RRMS and 55 HC was analysed by a multiplex electrochemiluminescence method for a broad panel of cytokines and immunoactive substances before, and over a two-year period after, treatment switch to rituximab. After quality assessment of data, using a predefined algorithm, 14 analytes were included in the final analysis.

RESULTS: Ten of the 14 analytes differed significantly in MS patients compared with HC at baseline. Levels of IP-10 (CXCL10), IL-12/23p40, IL-6, sVCAM1, IL-15, sICAM1 and IL-8 (CXCL8) decreased significantly after treatment switch to rituximab. The cytokines IP-10 and IL-12/IL-23p40 displayed the largest difference versus HC at baseline and also the largest relative reduction after therapy switch to rituximab.

CONCLUSION: We found significant changes in the immunological profile after therapy switch to rituximab in RRMS in the direction towards the values of HC. IP-10 and IL12/IL-23p40 deserve further studies as part of the immunopathogenesis of MS as well as for the mode of action of rituximab in MS.

National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-145871 (URN)10.1371/journal.pone.0192516 (DOI)000424517900086 ()29420590 (PubMedID)2-s2.0-85041734965 (Scopus ID)
Available from: 2018-03-20 Created: 2018-03-20 Last updated: 2023-03-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-7504-8354

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