Erik Lundström
Adjunct Professor at Department of Medical Sciences; Neurology
- E-mail:
- erik.lundstrom@neuro.uu.se
- Visiting address:
- Akademiska sjukhuset
- Postal address:
- Akademiska sjukhuset, ing 85 plan 2
751 85 UPPSALA
Download contact information for Erik Lundström at Department of Medical Sciences; Neurology
- ORCID:
- 0000-0002-5313-9052
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Short presentation
Vision for science
Stroke research that matters.
Vision as a leader
Inject people with passion.
I was the Chief Investigator of the EFFECTS (Efficacy of Fluoxetine – a randomised controlled trial in stroke) trial, published in The Lancet Neurology. You're welcome to connect with me on TWITTER and Facebook.
Keywords
- akut neurologi
- fluoxetine
- neurology
- plasticity
- randomised controlled trial
- rct
- stroke
Biography
Current position
- Consultant in Neurology at Uppsala University Hospital and clinical lead for the stroke unit. Ongoing (since April 2018).
- Senior lecturer of Neurology at Department of Neuroscience, Uppsala University. Ongoing (since July 2018).
- Chief Investigator of EFFECTS, the largest randomised controlled stroke study in Sweden. Although we reported the main results in Lancet Neurology Aug 2020, we continue to publish important results.
EFFECTS was an academic-initiated, investigated led multicentre, parallel-group, randomised, placebo-controlled trial of fluoxetine for stroke recovery.
We investigated whether routine administration of fluoxetine 20mg once daily in the 6 months after an acute stroke improves the patient’s functional outcome.
EFFECTS was supported by the Swedish Research Council (Vetenskapsrådet), the Swedish Brain Foundation,(Hjärnfonden), the Swedish Heart-Lung Foundation (Hjärt- Lungfonden), the Swedish Society of Medicine (Svenska Läkaresällskapet), the Swedish Stroke Association (Stroke Riksförbundet), King Gustav V and Queen Victorias Foundation of Freemasons, Karolinska Institutet, and Uppsala University. All funders are non-commercial. None of the funders have any influence on the planning, conduct or interpretation of the study.
Medical degrees
- Associate Professor of Neurology, Uppsala University. 2022.
- Associate Professor of Neurology at Karolinska Institutet. 2017.
- Dissertation at Uppsala University, Sweden, Inst f Neuroscience, Neurology and rehabilitation medicine. Spasticity after first-ever stroke. 2009.
- Medical Degree at Uppsala University. 1993.
Supervision for PhD students
- Co-supervisor of Svante Wallmark, at Uppsala University, Department of Neuroscience, Neurosurgery. Dr Wallmarks thesis studied the effects of subarachnoid haemorrhage, including cognitive impairment, and defended his thesis Life after subarachnoid haemorrhage 17/01/2017.
- Supervisor of Ann-Sofie Rudberg and Eva Isaksson, both at Karolinska Institutet.
Dr Rudberg's 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. Ongoing.
Eva Isaksson's thesis aims to describe factors that contribute to successful recruitment in a randomised controlled trial. Ongoing. - Co-supervision for Melinda Berg Roaldsen, PhD student at UiT The Arctic University of Norway (ongoing). Roaldsen's 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). Ongoing,
Supervision of students
- 14 students at Uppsala University, Medicine Programme, student thesis, 9 x 30 credits, 5 x 7,5 credits
- 1 student at Karolinska Institutet, Medicine Programme, 30 credits
- 1 student at Gothenburg University, Pharmacy Programme, 30 credits
Teaching
- Extensive teaching (> 400 h) for medical students, physiotherapists and nurses at Uppsala University. Also taught at the physiotherapist-, speech therapy- and at biomedical analysts-programme, Uppsala University.
Some teaching at the medical programme, Karolinska Institutet.
Clinical experience since 2005
- Consultant Neurology and Medically responsible doctor for the stroke unit at Karolinska University Hospital, Solna. Between December 2012 and Mars mars 2018.
- Consultant Neurology, Uppsala University Hospital. 2012.
- Specialist in neurology Uppsala University Hospital and specialist examination in Neurology 2005.
Research
CURRENT PROJECT
TICH-3 Cog
Every year, 1.7 million, experience a spontaneous brain haemorrhage, and out of those who manage to survive, one-third of them develop cognitive issues. In the case of Sweden, there is a prevalence of 2,700 cases of brain haemorrhage annually. Presently, there is no emergency medical intervention available except for the reduction of blood pressure. Despite the patients' emphasis on cognition as the most crucial research area and the European Stroke Organization's identification of significant gaps in knowledge, there is a paucity of randomized controlled studies investigating the possibility of mitigating cognitive impairment.
TICH-3 Cog in an acronym for Tranexamic acid for Hyperacute Spontaneous Intracerebral Haemorrhage Cognition.
The goal TICH-3 Cog trial is to investigate whether tranexamic acid could reduce cognitive impairment when given within 4.5 hours after intracerebral haemorrhage? The hypothesis is that tranexamic acid reduces the size of the haemorrhage and thereby reduces secondary brain damage. The primary outcome measure is cognition at 1 year as measured by the Montreal Cognitive Assessment scale.
Half of the patients will receive an intravenous infusion of tranexamic acid and the other half a placebo. Treatment begins within 4.5 hours of becoming ill.
TICH-3 Cog is a Swedish sub-study embedded in the international TICH-3 trial
TICH-3 Cog is embedded in the Tranexamic acid for Intracerebral Haemorrhage (TICH-3) trial, a pragmatic phase III prospective randomized placebo-controlled study that aims to include 5,500 individuals from around the world.
The research plan for TICH-3 Cog is written in collaboration with the principal investigator for TICH-3, Prof Nikola Sprigg, Nottingham, UK. The primary outcome measure for TICH-3 is death within 7 days.
Details of the TICH-3 trial can be found here.
PREVIOUS AND ONGOING WORK
The EFFECTS study
The purpose of EFFECTS was to find a new treatment for stroke recovery. We tested whether an established drug against depression (Fluoxetine) could improve recovery and quality of life after stroke.
The primary outcome was neutral. You can read about the results in the Lancet Neurology here.
The project’s originality and novelty
- We were studying a new mechanism for stroke, selective serotonin re-uptake inhibitors (SSRI), for stroke recovery. We wanted to test whether routine administration of Fluoxetine (20 mg once daily) in the 6 months after an acute stroke improves the patient’s functional outcome.
- An academic-initiated, investigator-led, randomised controlled study (RCT).
- We included 1,500 patients in Sweden, making EFFECTS the largest RCT study of stroke in Sweden.
- A collaboration with FOCUS (published in Lancet) and AFFINITY (published in the Lancet Neurology) two other international, investigator-led studies, with the same inclusion and exclusion criteria. A meta-analysis of individual patient data is planned.
- It has a pragmatic design, that is we investigate if the interventions work in normal practice, with fewer selected patients and a flexible intervention applied as it would be in normal practice, and finally, outcomes that are relevant to patients and society.
- The study includes both ischemic and haemorrhagic stroke.
Publications
Recent publications
- Development of a Swedish short version of the Montreal Cognitive Assessment for cognitive screening in patients with stroke (2023)
- Physical Activity Trajectories and Functional Recovery After Acute Stroke Among Adults in Sweden (2023)
- Study protocol for a randomized, controlled, multicentre, pragmatic trial with Rehabkompassen®-a digital structured follow-up tool for facilitating patient-tailored rehabilitation in persons after stroke (2023)
- The impact of stroke on the ability to live an independent life at old age (2023)
- Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST) (2023)
All publications
Articles
- Development of a Swedish short version of the Montreal Cognitive Assessment for cognitive screening in patients with stroke (2023)
- Physical Activity Trajectories and Functional Recovery After Acute Stroke Among Adults in Sweden (2023)
- Study protocol for a randomized, controlled, multicentre, pragmatic trial with Rehabkompassen®-a digital structured follow-up tool for facilitating patient-tailored rehabilitation in persons after stroke (2023)
- The impact of stroke on the ability to live an independent life at old age (2023)
- Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST) (2023)
- Does fluoxetine reduce apathetic and depressive symptoms after stroke? An analysis of the EFFECTS trial dataset. (2023)
- Predicting post-stroke cognitive impairment using acute CT neuroimaging (2022)
- Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging (2022)
- Complete functional recovery in a child after endovascular treatment of basilar artery occlusion caused by spontaneous dissection (2022)
- Repeated Measures of Modified Rankin Scale Scores to Assess Functional Recovery From Stroke (2022)
- Statistical analysis plan for the randomized controlled trial Tenecteplase in Wake-up Ischaemic Stroke Trial (TWIST) (2022)
- Digital Graphic Follow-up Tool (Rehabkompassen) for Identifying Rehabilitation Needs Among People After Stroke (2022)
- Selective Serotonin Reuptake Inhibitors for Stroke Recovery (2022)
- Development of a short-form Swedish version of the Montreal Cognitive Assessment (s-MoCA-SWE) (2021)
- Twelve-Month Outcomes of the AFFINITY Trial of Fluoxetine for Functional Recovery After Acute Stroke AFFINITY Trial Steering Committee on Behalf of the AFFINITY Trial Collaboration (2021)
- Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery (2021)
- Effects of Fluoxetine on Outcomes at 12 Months After Acute Stroke Results From EFFECTS, a Randomized Controlled Trial (2021)
- Stroke survivors' priorities for research related to life after stroke (2021)
- Effects on walking performance and lower body strength by short message service guided training after stroke or transient ischemic attack (The STROKEWALK Study) (2021)
- Potential effects on cardiometabolic risk factors and body composition by short message service (SMS)-guided training after recent minor stroke or transient ischaemic attack (2021)
- Levels of physical activity before and after stroke in relation to early cognitive function (2021)
- Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY) (2020)
- Trends in stroke reperfusion treatment and outcomes in New Zealand (2020)
- Validation of the Simplified Modified Rankin Scale Questionnaire (2020)
- Selective Serotonin Reuptake Inhibitors for Stroke Recovery (2020)
- Safety and efficacy of fluoxetine on functional recovery after acute stroke (EFFECTS) (2020)
- Update on the EFFECTS study of fluoxetine for stroke recovery (2020)
- Fluoxetine for stroke recovery (2020)
- Update to the FOCUS, AFFINITY and EFFECTS trials studying the effect(s) of fluoxetine in patients with a recent stroke (2020)
- Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11-13 November 2018. (2019)
- Effects of fluoxetine on functional outcomes after acute stroke (FOCUS) (2019)
- Fluoxetine and Fractures After Stroke (2019)
- Identifying important barriers to recruitment of patients in randomised clinical studies using a questionnaire for study personnel (2019)
- Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery (2019)
- Hur ska alla i Sverige få tillgång till trombektomi vid stroke? (2019)
- Update On The Effects Trial Of Fluoxetine For Stroke Recovery (2019)
- Återinsättning av trombocythämmare RESTART ger oss (nästan) hela svaret (2019)
- TWIST tenecteplase in wake-up ischaemic stroke trial (2019)
- Trends in Diagnosis-Specific Work Disability Before and After Stroke (2018)
- Trombektomi är möjlig upp till 24 timmar efter stroke (2018)
- Enhancing Recruitment Using Teleconference and Commitment Contract (ERUTECC) (2018)
- Effect of IV alteplase on the ischemic brain lesion at 24-48 hours after ischemic stroke. (2018)
- Long-term health-related quality of life, survival and costs by different levels of functional outcome six months after stroke (2018)
- Recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 13–15 November 2016 (2017)
- Permanent work disability before and after ischaemic heart disease or stroke event (2017)
- The FOCUS, AFFINITY and EFFECTS trials studying the effect(s) of fluoxetine in patients with a recent stroke (2017)
- Validation of Serial Alberta Stroke Program Early CT Score as an Outcome Predictor in Thrombolyzed Stroke Patients. (2017)
- Medicinsk behandling av cervical dissektion (2017)
- Arterial Obstruction on Computed Tomographic or Magnetic Resonance Angiography and Response to Intravenous Thrombolytics in Ischemic Stroke (2017)
- Work disability before and after a major cardiovascular event (2017)
- Synchronous cardiocerebral infarction in the era of endovascular therapy (2017)
- Nongated Cardiac Computed Tomographic Angiograms for Detection of Embolic Sources in Acute Ischemic Stroke (2017)
- Effects of alteplase on survival after ischaemic stroke (IST-3) (2016)
- EFFECTS (2016)
- Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke. (2016)
- Predicting return to work after subarachnoid hemorrhage using the Montreal Cognitive Assessment (MoCA) (2016)
- Trombektomi vid ischemisk stroke (2015)
- How common is isolated dysphasia among patients with stroke treated with intravenous thrombolysis, and what is their outcome? Results from the SITS-ISTR. (2015)
- The FOCUS, AFFINITY and EFFECTS trials studying the effect(s) of fluoxetine in patients with a recent stroke (2015)
- Attention Deficits After Aneurysmal Subarachnoid Hemorrhage Measured Using the Test of Variables of Attention (2015)
- Association between brain imaging signs, early and late outcomes, and response to intravenous alteplase after acute ischaemic stroke in the third International Stroke Trial (IST-3) (2015)
- Prevalence of spasticity after aneurysmal subarachnoid haemorrhage (2014)
- Agreement between ambulance nurses and physicians in assessing stroke patients (2013)
- Letter by Mead et al Regarding Article, "Selective Serotonin Reuptake Inhibitors for Stroke: More Trials are Needed" (2013)
- Health-related quality of life at median 12 months after aneurysmal subarachnoid hemorrhage, measured with EuroQoL-5D (2013)
- Effect of thrombolysis with alteplase within 6 h of acute ischaemic stroke on long-term outcomes (the third International Stroke Trial [IST-3]) (2013)
- Migrainous Infarction (2012)
- Outcome After Spontaneous Subarachnoid Hemorrhage Measured With the EQ-5D (2011)
- Update on the third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited (2011)
- International Comparisons of Stroke Costs Are Always Limited (2010)
- Response to Letter by Dobkin (2010)
- Response to Letter by Dobkin (2010)
- International comparisons of stroke costs are always limited (2010)
- Four-fold increase in direct costs of stroke-survivors with spas-ticity compared to stroke-survivors without spasticity (2010)
- Time-course and determinants of spasticity during the first six months following first-ever stroke (2010)
- Risk factors for stroke-related pain 1 year after first-ever stroke (2009)
- Prevalence of disabling spasticity 1 year after first-ever stroke (2008)
- Objective assessment of cervical dystonia (2005)
- "Rädda hjärnan" - nätverk i Uppsala län för trombolys vid slaganfall=[Save the brain-network in the county of Uppsala for throbolytic therapy in stroke] (2004)
Books
Conferences
- The Effects Of Fluoxetine On Fracture Risk After Stroke (2019)
- Objective assessment in cervical dystonia (2004)