Jesper Gyllenborg - Academia.edu (original) (raw)
Papers by Jesper Gyllenborg
Ugeskrift for laeger, Jan 8, 2010
Epilepsy is a common neurological disorder, and between one fourth and one third of the patients ... more Epilepsy is a common neurological disorder, and between one fourth and one third of the patients do not obtain seizure freedom after treatment with antiepileptic drugs. If the epileptic seizures in such patients have severe consequences, the patients should be assessed for epilepsy surgery. In case epilepsy surgery is not feasible, vagus nerve stimulation (VNS) should be offered. VNS seems to have an effect in all epilepsy syndromes and seizure types. VNS is generally well-tolerated, and may even improve mood and quality of life. Many more epilepsy patients in Denmark should be offered VNS.
Emergency Medicine Journal, 2014
Helicopters are widely used for interhospital transfers of stroke patients, but the benefit is sp... more Helicopters are widely used for interhospital transfers of stroke patients, but the benefit is sparsely documented. We hypothesised that helicopter transport would reduce system delay to thrombolytic treatment at the regional stroke centre. In this prospective controlled observational study, we included patients referred to a stroke centre if their ground transport time exceeded 30 min, or they were transported by a secondarily dispatched, physician-staffed helicopter. The primary endpoint was time from telephone contact to triaging neurologist to arrival in the stroke centre. Secondary endpoints included modified Rankin Scale at 3 months, 30-day and 1-year mortality. A total of 330 patients were included; 265 with ground transport and 65 with helicopter, of which 87 (33%) and 22 (34%), received thrombolysis, respectively (p=0.88). Time from contact to triaging neurologist to arrival in the regional stroke centre was significantly shorter in the ground group (55 (34-85) vs 68 (40-85) min, p<0.01). The distance from scene to stroke centre was shorter in the ground group (67 (42-136) km) than in the helicopter group (83 (46-143) km) (p<0.01). We did not detect significant differences in modified Rankin Scale at 3 months, in 30-day (9.4% vs 0%; p=0.20) nor 1-year (18.8% vs 13.6%; p=0.76) mortality between ground and helicopter transport. We found significantly shorter time from contact to triaging neurologist to arrival in the regional stroke centre if stroke patients were transported by primarily dispatched ground ambulance compared with a secondarily dispatched helicopter.
Journal of Neurology Research, 2012
The Objective was to briefly review the rare condition Posterior Cortical Atrophy (PCA) and demon... more The Objective was to briefly review the rare condition Posterior Cortical Atrophy (PCA) and demonstrate a difficult case suffering from both visual disturbances due to glaucoma and visual agnosia due to PCA. The short review was made by Pub Med search including "Posterior Cortical Atrophy" and the reference lists from the obtained articles were scrutinized for relevant literature not retrieved from PubMed. PCA is a slowly progressing neurodegenerative disorder that is very disabling due to disturbances of higher visual functions, although memory might be relatively preserved until late in the course. Some previous authors have underscored, that to diagnose a patient with PCA one must rule out that the patient is suffering from an eye disease. We demonstrate a difficult case suffering from both glaucoma and PCA. The diagnostic characteristics for PCA are described, and neuroimaging including positron emission tomography (PET) with the amyloid binding ligand (11C) Pittsburgh compound B (PiB), and results from treatment of PCA are presented. Caution should be advised when patients with impaired visual acuity develop signs of cognitive dysfunction, and a full neuropsychological examination should be performed whenever there is doubt of the significance of visual impairment and impaired visuospatial functions.
Danish medical journal, 2013
The purpose of the study was to analyse caregiver burden and consumption of psychosocial services... more The purpose of the study was to analyse caregiver burden and consumption of psychosocial services in a consecutive group of patients with early onset Alzheimer's disease (EOAD) compared with a matching group with late onset Alzheimer's disease (LOAD). This was a case-control study with 42 patients who were matched according to disease severity at the time of diagnosis. Caregivers in both groups were interviewed using the Neuro Psychiatric Inventory (NPI), the Activities of Daily Living (ADL) scale and the Resource Utilization in Dementia scale. The quantitative outcomes were compared statistically. The EOAD group had a significantly higher ADL score than the LOAD group. There was a trend towards caregivers in the LOAD group spending more time helping the patients, and they needed more social services than the EOAD group. NPI scores were not significantly different, but a tendency towards a higher caregiver burden in the EOAD group was observed. The higher caregiver burden in...
Ugeskrift for laeger
Epilepsy is a common neurological disorder, and between one fourth and one third of the patients ... more Epilepsy is a common neurological disorder, and between one fourth and one third of the patients do not obtain seizure freedom after treatment with antiepileptic drugs. If the epileptic seizures in such patients have severe consequences, the patients should be assessed for epilepsy surgery. In case epilepsy surgery is not feasible, vagus nerve stimulation (VNS) should be offered. VNS seems to have an effect in all epilepsy syndromes and seizure types. VNS is generally well-tolerated, and may even improve mood and quality of life. Many more epilepsy patients in Denmark should be offered VNS.
Neurology, 2009
A 33-year-old man with a history of tick bites presented with bursts of involuntary horizontal co... more A 33-year-old man with a history of tick bites presented with bursts of involuntary horizontal conjugate saccades, myoclonic head jerks, and truncal ataxia. A cerebral MRI was normal, and no antineuronal antibodies were found (anti-Hu, anti-Yo, anti-Ri). Despite negative serum antibodies for Borrelia burgdorferi, acute neuroborreliosis was suspected because of lymphocytic mild meningitis (19 white cells/mm 3 , protein 0.79 g/L) and apparent intrathecal synthesis of B burgdorferi IgM antibodies (ELISA titers 6.17, normal Ͻ0.3), although false-positive IgM serologies can occur in this setting. Intravenous ceftriaxone treatment resulted in dramatic clinical improvement within a few weeks.
Metabolism, 2001
Males have higher risk of cardiovascular disease (CVD) than premenopausal females. Gonadal steroi... more Males have higher risk of cardiovascular disease (CVD) than premenopausal females. Gonadal steroids are probably involved in the gender difference in CVD, but previous results have been conflicting. We investigated the associations between CVD risk factors and sex hormones in a cross-sectional designed study of 508 healthy males, aged 41 to 72 years. We determined total testosterone (T), sex hormone-binding globulin (SHBG), free androgen index (FAI), and estradiol (E2) and studied their relationship to body fat mass (BF), blood pressure (BP), aortic compliance, left ventricular mass (LVM), and plasma lipids (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], very--low-density lipoprotein [VLDL], and triglycerides). In quartile analyses after adjustment for confounders (age, body mass index [BMI], alcohol consumption, and smoking), SHBG and E2 were positively associated with HDL, while FAI was negatively associated with HDL. T and SHBG were negatively associated with VLDL and triglycerides, while FAI was positively associated with VLDL and triglycerides. T and SHBG were negatively associated with BMI and BF, while FAI and E2 were positively associated with BMI and BF. E2 was negatively associated with LVM. No hormone varied with total cholesterol, LDL, BP, and aortic compliance in the adjusted analyses. In multiple regression analyses, SHBG was the main predictive variable of HDL, VLDL, and triglycerides explaining 12%, 17%, and 17% of the variation, respectively. No other hormones were selected as predictive variables for VLDL and triglycerides, but E2, T, and FAI were selected in the HDL regression, explaining 3%, 2%, and less than 1%, respectively. Our regression analyses illustrate the diverging results when investigating associations between gonadal steroids and lipids with and without SHBG adjustment. Atherogenic lipid profile in males is associated with low SHBG, low T levels, and a high FAI. Males with high E2 levels may have a less atherogenic lipid profile and lower LVM. SHBG is a key hormone in the association between sex hormones and plasma lipids. We suggest that conflicting results of cross-sectional and intervention studies of sex hormones and lipids, in part, may be explained by interindividual differences or changes in SHBG. Thus, further studies on the potential role of SHBG in the development of ischemic heart disease (IHD) should be performed.
Dementia and Geriatric Cognitive Disorders, 2012
Early-onset Alzheimer's disease (EOAD) is generally thought to have a more rapid course c... more Early-onset Alzheimer's disease (EOAD) is generally thought to have a more rapid course compared to late-onset Alzheimer's disease (LOAD). The faster progression of EOAD observed in some studies has also been thought to correlate with cerebrospinal fluid (CSF) biomarkers. Our clinical experience has not been suggestive of any difference in disease progression; therefore, we decided to investigate whether differences in clinical progression and CSF biomarkers between EOAD and LOAD could be demonstrated. Case-control study with 42 patients, 21 EOAD and 21 matched LOAD patients. Rates of progression were calculated and these, as well as CSF biomarker levels, were statistically compared. There were no statistically significant differences in clinical progression between the EOAD group and the LOAD group. There was no significant difference in the absolute values of CSF biomarkers, but a tendency towards lower levels of β-amyloid in patients with EOAD was observed. Our findings did not converge with results from the majority of previous studies, which have been suggestive of a faster clinical progression in EOAD. Possibly, the very strict algorithm by which our patients were matched explains our findings. However, the findings should be repeated in a larger study population.
Clinical Neurophysiology, 2013
To examine if periodic EEG discharges (PDs) predict poor outcome and development of epilepsy in p... more To examine if periodic EEG discharges (PDs) predict poor outcome and development of epilepsy in patients with acute brain illnesses irrespective of underlying cerebral pathology. In case-control study we retrospectively analyzed outcome of 102 patients with PDs and 102 age-, gender- and etiology matched controls without PDs. Of cases, 46.1% had lateralized PDs (LPDs), 3.9% bilateral PDs (BIPDs), 15.7% generalized PDs (GPDs) and 34.3% had combinations thereof. Stroke was most common cause of LPDs (53%), cardiac arrest of GPDs (10.5%), previous stroke, CNS infection, anoxia and metabolic encephalopathy all caused 1 case of BIPDs. Mortality rate and acquired disability was significantly higher in patients with PDs than in controls, odds ratio (OR) 2.5, 95% CI 1.43-4.40 (p = 0.001). Patients with PDs without superimposed EEG activity had worse outcome than patients with superimposed EEG activity. Tardive epilepsy: Patients with LPDs associated with fast superimposed EEG activity (LPDs-plus) had higher risk for tardive epilepsy than patients with LPDs alone (p = 0.034). PDs predicted poor functional outcome and patients with LPDs-plus had higher risk for later development of epilepsy. Detailed evaluation of PDs provided valuable prognostic information in neurological patients with disturbed consciousness.
Circulation, 2002
Background-Insulin-like growth factor I (IGF-I) has been suggested to be involved in the pathogen... more Background-Insulin-like growth factor I (IGF-I) has been suggested to be involved in the pathogenesis of atherosclerosis.
Journal of the Neurological Sciences, 2009
Hereditary spastic paraplegia (HSP) is a group of clinically and genetically heterogeneous neurod... more Hereditary spastic paraplegia (HSP) is a group of clinically and genetically heterogeneous neurodegenerative disorders characterized by progressive spasticity and weakness in the lower limbs. The most common forms of autosomal dominant HSP, SPG4 and SPG3, are caused by sequence variants in the SPAST and SPG3A genes, respectively. The pathogenic variants are scattered all over these genes and many variants are unique to a specific family. The phenotype in SPG4 patients can be modified by a variant in SPAST (p.Ser44Leu) and recently, a variant in HSPD1, the gene underlying SPG13, was reported as a second genetic modifier in SPG4 patients. In this study HSP patients were screened for variants in SPG3A, SPAST and HSPD1 in order to identify disease causing variations. SPAST was sequenced in all patients whereas subsets were sequenced in HSPD1 and in selected exons of SPG3A. SPG4 patients and their HSP relatives were genotyped for the modifying variant in HSPD1. We report six new sequence variants in SPAST including a fourth non synonymous sequence variant in exon 1 and two synonymous changes of which one has been found in a HSP patient previously, but never in controls. Of the novel variants in SPAST four were interpreted as disease causing. In addition one new disease causing sequence variant and one non pathogenic non synonymous variant were found in SPG3A. In HSPD1 we identified a sporadic patient homozygote for the potential modifying variation. The effect of the modifying HSPD1 variation was not supported by identification in one SPG4 family.
Ugeskrift for laeger, Jan 8, 2010
Epilepsy is a common neurological disorder, and between one fourth and one third of the patients ... more Epilepsy is a common neurological disorder, and between one fourth and one third of the patients do not obtain seizure freedom after treatment with antiepileptic drugs. If the epileptic seizures in such patients have severe consequences, the patients should be assessed for epilepsy surgery. In case epilepsy surgery is not feasible, vagus nerve stimulation (VNS) should be offered. VNS seems to have an effect in all epilepsy syndromes and seizure types. VNS is generally well-tolerated, and may even improve mood and quality of life. Many more epilepsy patients in Denmark should be offered VNS.
Emergency Medicine Journal, 2014
Helicopters are widely used for interhospital transfers of stroke patients, but the benefit is sp... more Helicopters are widely used for interhospital transfers of stroke patients, but the benefit is sparsely documented. We hypothesised that helicopter transport would reduce system delay to thrombolytic treatment at the regional stroke centre. In this prospective controlled observational study, we included patients referred to a stroke centre if their ground transport time exceeded 30 min, or they were transported by a secondarily dispatched, physician-staffed helicopter. The primary endpoint was time from telephone contact to triaging neurologist to arrival in the stroke centre. Secondary endpoints included modified Rankin Scale at 3 months, 30-day and 1-year mortality. A total of 330 patients were included; 265 with ground transport and 65 with helicopter, of which 87 (33%) and 22 (34%), received thrombolysis, respectively (p=0.88). Time from contact to triaging neurologist to arrival in the regional stroke centre was significantly shorter in the ground group (55 (34-85) vs 68 (40-85) min, p<0.01). The distance from scene to stroke centre was shorter in the ground group (67 (42-136) km) than in the helicopter group (83 (46-143) km) (p<0.01). We did not detect significant differences in modified Rankin Scale at 3 months, in 30-day (9.4% vs 0%; p=0.20) nor 1-year (18.8% vs 13.6%; p=0.76) mortality between ground and helicopter transport. We found significantly shorter time from contact to triaging neurologist to arrival in the regional stroke centre if stroke patients were transported by primarily dispatched ground ambulance compared with a secondarily dispatched helicopter.
Journal of Neurology Research, 2012
The Objective was to briefly review the rare condition Posterior Cortical Atrophy (PCA) and demon... more The Objective was to briefly review the rare condition Posterior Cortical Atrophy (PCA) and demonstrate a difficult case suffering from both visual disturbances due to glaucoma and visual agnosia due to PCA. The short review was made by Pub Med search including "Posterior Cortical Atrophy" and the reference lists from the obtained articles were scrutinized for relevant literature not retrieved from PubMed. PCA is a slowly progressing neurodegenerative disorder that is very disabling due to disturbances of higher visual functions, although memory might be relatively preserved until late in the course. Some previous authors have underscored, that to diagnose a patient with PCA one must rule out that the patient is suffering from an eye disease. We demonstrate a difficult case suffering from both glaucoma and PCA. The diagnostic characteristics for PCA are described, and neuroimaging including positron emission tomography (PET) with the amyloid binding ligand (11C) Pittsburgh compound B (PiB), and results from treatment of PCA are presented. Caution should be advised when patients with impaired visual acuity develop signs of cognitive dysfunction, and a full neuropsychological examination should be performed whenever there is doubt of the significance of visual impairment and impaired visuospatial functions.
Danish medical journal, 2013
The purpose of the study was to analyse caregiver burden and consumption of psychosocial services... more The purpose of the study was to analyse caregiver burden and consumption of psychosocial services in a consecutive group of patients with early onset Alzheimer's disease (EOAD) compared with a matching group with late onset Alzheimer's disease (LOAD). This was a case-control study with 42 patients who were matched according to disease severity at the time of diagnosis. Caregivers in both groups were interviewed using the Neuro Psychiatric Inventory (NPI), the Activities of Daily Living (ADL) scale and the Resource Utilization in Dementia scale. The quantitative outcomes were compared statistically. The EOAD group had a significantly higher ADL score than the LOAD group. There was a trend towards caregivers in the LOAD group spending more time helping the patients, and they needed more social services than the EOAD group. NPI scores were not significantly different, but a tendency towards a higher caregiver burden in the EOAD group was observed. The higher caregiver burden in...
Ugeskrift for laeger
Epilepsy is a common neurological disorder, and between one fourth and one third of the patients ... more Epilepsy is a common neurological disorder, and between one fourth and one third of the patients do not obtain seizure freedom after treatment with antiepileptic drugs. If the epileptic seizures in such patients have severe consequences, the patients should be assessed for epilepsy surgery. In case epilepsy surgery is not feasible, vagus nerve stimulation (VNS) should be offered. VNS seems to have an effect in all epilepsy syndromes and seizure types. VNS is generally well-tolerated, and may even improve mood and quality of life. Many more epilepsy patients in Denmark should be offered VNS.
Neurology, 2009
A 33-year-old man with a history of tick bites presented with bursts of involuntary horizontal co... more A 33-year-old man with a history of tick bites presented with bursts of involuntary horizontal conjugate saccades, myoclonic head jerks, and truncal ataxia. A cerebral MRI was normal, and no antineuronal antibodies were found (anti-Hu, anti-Yo, anti-Ri). Despite negative serum antibodies for Borrelia burgdorferi, acute neuroborreliosis was suspected because of lymphocytic mild meningitis (19 white cells/mm 3 , protein 0.79 g/L) and apparent intrathecal synthesis of B burgdorferi IgM antibodies (ELISA titers 6.17, normal Ͻ0.3), although false-positive IgM serologies can occur in this setting. Intravenous ceftriaxone treatment resulted in dramatic clinical improvement within a few weeks.
Metabolism, 2001
Males have higher risk of cardiovascular disease (CVD) than premenopausal females. Gonadal steroi... more Males have higher risk of cardiovascular disease (CVD) than premenopausal females. Gonadal steroids are probably involved in the gender difference in CVD, but previous results have been conflicting. We investigated the associations between CVD risk factors and sex hormones in a cross-sectional designed study of 508 healthy males, aged 41 to 72 years. We determined total testosterone (T), sex hormone-binding globulin (SHBG), free androgen index (FAI), and estradiol (E2) and studied their relationship to body fat mass (BF), blood pressure (BP), aortic compliance, left ventricular mass (LVM), and plasma lipids (total cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], very--low-density lipoprotein [VLDL], and triglycerides). In quartile analyses after adjustment for confounders (age, body mass index [BMI], alcohol consumption, and smoking), SHBG and E2 were positively associated with HDL, while FAI was negatively associated with HDL. T and SHBG were negatively associated with VLDL and triglycerides, while FAI was positively associated with VLDL and triglycerides. T and SHBG were negatively associated with BMI and BF, while FAI and E2 were positively associated with BMI and BF. E2 was negatively associated with LVM. No hormone varied with total cholesterol, LDL, BP, and aortic compliance in the adjusted analyses. In multiple regression analyses, SHBG was the main predictive variable of HDL, VLDL, and triglycerides explaining 12%, 17%, and 17% of the variation, respectively. No other hormones were selected as predictive variables for VLDL and triglycerides, but E2, T, and FAI were selected in the HDL regression, explaining 3%, 2%, and less than 1%, respectively. Our regression analyses illustrate the diverging results when investigating associations between gonadal steroids and lipids with and without SHBG adjustment. Atherogenic lipid profile in males is associated with low SHBG, low T levels, and a high FAI. Males with high E2 levels may have a less atherogenic lipid profile and lower LVM. SHBG is a key hormone in the association between sex hormones and plasma lipids. We suggest that conflicting results of cross-sectional and intervention studies of sex hormones and lipids, in part, may be explained by interindividual differences or changes in SHBG. Thus, further studies on the potential role of SHBG in the development of ischemic heart disease (IHD) should be performed.
Dementia and Geriatric Cognitive Disorders, 2012
Early-onset Alzheimer's disease (EOAD) is generally thought to have a more rapid course c... more Early-onset Alzheimer's disease (EOAD) is generally thought to have a more rapid course compared to late-onset Alzheimer's disease (LOAD). The faster progression of EOAD observed in some studies has also been thought to correlate with cerebrospinal fluid (CSF) biomarkers. Our clinical experience has not been suggestive of any difference in disease progression; therefore, we decided to investigate whether differences in clinical progression and CSF biomarkers between EOAD and LOAD could be demonstrated. Case-control study with 42 patients, 21 EOAD and 21 matched LOAD patients. Rates of progression were calculated and these, as well as CSF biomarker levels, were statistically compared. There were no statistically significant differences in clinical progression between the EOAD group and the LOAD group. There was no significant difference in the absolute values of CSF biomarkers, but a tendency towards lower levels of β-amyloid in patients with EOAD was observed. Our findings did not converge with results from the majority of previous studies, which have been suggestive of a faster clinical progression in EOAD. Possibly, the very strict algorithm by which our patients were matched explains our findings. However, the findings should be repeated in a larger study population.
Clinical Neurophysiology, 2013
To examine if periodic EEG discharges (PDs) predict poor outcome and development of epilepsy in p... more To examine if periodic EEG discharges (PDs) predict poor outcome and development of epilepsy in patients with acute brain illnesses irrespective of underlying cerebral pathology. In case-control study we retrospectively analyzed outcome of 102 patients with PDs and 102 age-, gender- and etiology matched controls without PDs. Of cases, 46.1% had lateralized PDs (LPDs), 3.9% bilateral PDs (BIPDs), 15.7% generalized PDs (GPDs) and 34.3% had combinations thereof. Stroke was most common cause of LPDs (53%), cardiac arrest of GPDs (10.5%), previous stroke, CNS infection, anoxia and metabolic encephalopathy all caused 1 case of BIPDs. Mortality rate and acquired disability was significantly higher in patients with PDs than in controls, odds ratio (OR) 2.5, 95% CI 1.43-4.40 (p = 0.001). Patients with PDs without superimposed EEG activity had worse outcome than patients with superimposed EEG activity. Tardive epilepsy: Patients with LPDs associated with fast superimposed EEG activity (LPDs-plus) had higher risk for tardive epilepsy than patients with LPDs alone (p = 0.034). PDs predicted poor functional outcome and patients with LPDs-plus had higher risk for later development of epilepsy. Detailed evaluation of PDs provided valuable prognostic information in neurological patients with disturbed consciousness.
Circulation, 2002
Background-Insulin-like growth factor I (IGF-I) has been suggested to be involved in the pathogen... more Background-Insulin-like growth factor I (IGF-I) has been suggested to be involved in the pathogenesis of atherosclerosis.
Journal of the Neurological Sciences, 2009
Hereditary spastic paraplegia (HSP) is a group of clinically and genetically heterogeneous neurod... more Hereditary spastic paraplegia (HSP) is a group of clinically and genetically heterogeneous neurodegenerative disorders characterized by progressive spasticity and weakness in the lower limbs. The most common forms of autosomal dominant HSP, SPG4 and SPG3, are caused by sequence variants in the SPAST and SPG3A genes, respectively. The pathogenic variants are scattered all over these genes and many variants are unique to a specific family. The phenotype in SPG4 patients can be modified by a variant in SPAST (p.Ser44Leu) and recently, a variant in HSPD1, the gene underlying SPG13, was reported as a second genetic modifier in SPG4 patients. In this study HSP patients were screened for variants in SPG3A, SPAST and HSPD1 in order to identify disease causing variations. SPAST was sequenced in all patients whereas subsets were sequenced in HSPD1 and in selected exons of SPG3A. SPG4 patients and their HSP relatives were genotyped for the modifying variant in HSPD1. We report six new sequence variants in SPAST including a fourth non synonymous sequence variant in exon 1 and two synonymous changes of which one has been found in a HSP patient previously, but never in controls. Of the novel variants in SPAST four were interpreted as disease causing. In addition one new disease causing sequence variant and one non pathogenic non synonymous variant were found in SPG3A. In HSPD1 we identified a sporadic patient homozygote for the potential modifying variation. The effect of the modifying HSPD1 variation was not supported by identification in one SPG4 family.