Publications by authors named "Helle H Nielsen"

Background: Alemtuzumab is approved in the European Union for treating highly active relapsing-remitting multiple sclerosis (RRMS). Patient-reported outcomes measure the treatment impact on quality of life (QoL), including fatigue, a common symptom in multiple sclerosis (MS). Chronic diseases like MS also affect the patient's caregiver.

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Aim: This qualitative study explored the experiences of patients, caregivers and healthcare professionals after replacing hospital consultations with a home service solution for patients treated for severe spasticity with intrathecal baclofen.

Method: Semi-structured interviews were conducted with six patients, six caregivers and six healthcare professionals. The data were analysed using interpretative phenomenological analysis.

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This article describes how a home visit solution was developed in a co-design process between patients in treatment for severe spasticity, their caregivers and hospital nurses. The solution was developed using a participatory design approach and was based on the identified needs of the participants. We developed a home visit solution through an iterative process and a collective 'reflection-in-action' approach with patients, caregivers and healthcare professionals.

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Background: Body weight unloaded treadmill training has shown limited efficacy in further improving functional capacity after subacute rehabilitation of ischemic stroke patients. Dynamic robot assisted bodyweight unloading is a novel technology that may provide superior training stimuli and continued functional improvements in individuals with residual impairments in the chronic phase after the ischemic insult. The aim of the present study is to investigate the effect of dynamic robot-assisted versus standard training, initiated 6 months post-stroke, on motor function, physical function, fatigue, and quality of life in stroke-affected individuals still suffering from moderate-to-severe disabilities after subacute rehabilitation.

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  • Peripheral cytokine levels could be useful biomarkers for tracking how well patients with multiple sclerosis respond to treatment and monitor their condition over time.
  • The study involved 27 patients with MS who underwent performance tests before and after 14 days of fampridine treatment, revealing improvements in gait and hand function.
  • Significant correlations were found between various performance measures and changes in specific plasma cytokine levels, suggesting that increased inflammation might enhance the effectiveness of fampridine rather than being a direct result of the treatment itself.
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Background: Chronic pain is a major health problem worldwide but the limited knowledge of its underlying pathophysiology impairs the opportunities for diagnostics and treatment. Biomarkers of chronic pain are greatly needed to understand the disease and develop new targets for interventions and drug treatments, and potentially introduce more precise diagnostic procedures. Much evidence points to a neuroimmune pathology for many chronic pain conditions and that important neuroimmune biomarkers exist in the cerebrospinal fluid (CSF) of patients with chronic pain.

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  • The study investigated the effect of cannabis-based medicine (CBM) on neuropathic pain (NP) and spasticity in patients with multiple sclerosis (MS) and spinal cord injury (SCI) through a randomized, placebo-controlled trial in Denmark.
  • A total of 134 patients were assigned to either THC, CBD, a combination of both, or a placebo for six weeks, but the results showed no significant differences in pain or spasticity levels between the active treatments and placebo.
  • Recruitment challenges due to COVID-19 led to fewer participants than planned, and ultimately, the findings indicated that CBM had no evident impact on NP or spasticity in the studied patient groups.
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  • Ocrelizumab, a targeted monoclonal antibody for treating relapsing-remitting MS, significantly reduces relapse rates and disability compared to interferon beta 1a, while rituximab is often used off-label as an alternative.
  • This study aimed to determine if rituximab's effectiveness is comparable (noninferior) to that of ocrelizumab in treating relapsing-remitting MS.
  • The observational study included over 1600 patients from MS registries with matched baseline characteristics, focusing on annual relapse rates as the primary outcome measure.
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Background: Despite the wide range of existing performance measures to evaluate functional status of patients with multiple sclerosis, the heterogeneous nature of the disease hinders clinical characterization and monitoring of disease severity. Speckle tracking ultrasonography is a non-invasive technique to assess isolated muscle function by evaluating the contractile properties of muscle tissue, i.e.

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Ceruloplasmin (Cp) is a multicopper oxidase with ferroxidase properties being of importance to the mobilisation and export of iron from cells and its ability to bind copper. In ageing humans, Cp deficiency is known to result in aceruloplasminemia, which among other is characterised by neurological symptoms. To obtain novel information about the functions of Cp in the central nervous system (CNS) we compared the brain proteome in forebrains from asymptomatic 4-6-month-old Cp-deficient (B6N(Cg)-Cp /J) and wild-type mice.

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  • Fampridine was tested for its effects on gait quality and function in multiple sclerosis patients, focusing on changes after two weeks of treatment using three-dimensional gait analysis and performance-based tests.
  • A study involving 14 participants found no improvement in gait quality (measured through Gait Profile Scores), but demonstrated significant improvements in various performance-based tests and self-reported walking abilities.
  • The results indicate that while fampridine enhances gait function, it does not lead to noticeable changes in the overall kinematic quality of walking.
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Objective: The purpose of this interventional study on participants with multiple sclerosis (MS) with walking disability was to evaluate changes in functional hand and walking measurements after fampridine treatment, after stratifying by the Expanded Disability Status Scale (EDSS). We furthermore wanted to investigate different functional measurements to evaluate their ability to detect responders to fampridine with a clinically relevant improvement.

Methods: Patients were recruited from the MS Clinic at Odense University Hospital and were classified into two disability groups based on their EDSS score (moderate EDSS (EDSS) 4.

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Methods: Twenty patients with newly diagnosed neurosarcoidosis were examined for multiple outcomes in an observational cohort study with 12-month follow-up.

Results: The patients' contrast-enhancing lesions on MRI scans reduced during treatment (p < 0.0001).

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  • Teriflunomide (Aubagio®) is a once-daily oral medication for treating relapsing multiple sclerosis (MS), and a study called Teri-LIFE evaluated its impact on patients' quality of life in real-world settings.
  • The study involved 200 patients from Nordic countries, measuring changes in quality of life using the SF-36 questionnaire over 24 months, along with various secondary outcomes like treatment satisfaction and adherence.
  • Results showed stable quality of life scores, reduced relapse activity, and high treatment adherence; patients generally found teriflunomide acceptable, with some differences observed between treatment-naïve and previously treated patients.
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Methods: Cerebrospinal fluid (CSF) and plasma levels of 38 biomarkers from 20 neurosarcoidosis (NS) patients were compared to healthy controls (HC).

Results: In CSF, 25 biomarkers were significantly elevated compared to HC: IFNγ, TNFα, TNFβ, IL-2, IL-6, IL-10, IL-12B, IL-15, IL-16, CCL2, CCL3, CCL4, CCL11, CCL13, CCL17, CCL22, CCL26, CXCL8, CXCL10, TNFR2, VEGF-A, PIGF, SAA, VCAM1, and ICAM1. In plasma, 12 biomarkers were significantly elevated compared to HC: IFNγ, TNFα, CCL2, CCL3, CCL4, CCL17, CXCL10, VEGFR1, PIGF, SAA, VCAM1, and ICAM1.

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Background: Potential supplemental disease-modifying and neuroprotective treatment strategies are warranted in multiple sclerosis (MS). Exercise is a promising non-pharmacological approach, and an uninvestigated 'window of opportunity' exists early in the disease course.

Objective: To investigate the effect of early exercise on relapse rate, global brain atrophy and secondary magnetic resonance imaging (MRI) outcomes.

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Hyperammonaemic encephalopathy in adults is a rare condition in the absence of liver disease and is associated with a high mortality and risk of permanent neurological deficits. Seldomly, the condition is caused by an inborn error of metabolism in the urea cycle, triggered by an exogenic factor such as gastrointestinal haemorrhage, gastric bypass surgery, starvation, seizures, vigorous exercise, burn injuries, or drugs hampering the elimination of ammonia. Here, we present a fatal case of an unrecognized genetic ornithine transcarbamylase deficiency (OTCD) presenting with a subacute progressive encephalopathy.

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  • The study investigates the relationship between the Multiple Sclerosis Impairment Scale (MSIS) and other measures like the Expanded Disability Status Scale (EDSS) and MRI outcomes in patients with secondary progressive MS (SPMS).
  • A total of 68 SPMS patients were assessed, revealing significant correlations between MSIS and functional mobility tests, suggesting that MSIS is a relevant tool for evaluating impairment.
  • Findings indicate that MSIS may be more sensitive in detecting cerebellar and sensory function impairments compared to EDSS, as it showed stronger correlations with MRI markers of brain atrophy.
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  • The study aimed to assess the impact of progressive aerobic exercise (PAE) on fatigue, walking ability, cardiorespiratory fitness, and quality of life in individuals with multiple sclerosis (MS).
  • It involved a 24-week randomized controlled trial with two groups: one participating in PAE and the other on a waitlist, measuring various outcomes using established scales and tests.
  • The results indicated that PAE significantly reduced fatigue impact and improved cardiorespiratory fitness, while showing only minor improvements in walking ability and no change in quality of life, suggesting the need for further research to confirm these findings.
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Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system (CNS), characterized by pathogenic, complement-activating autoantibodies against the main water channel in the CNS, aquaporin 4 (AQP4). NMOSD is frequently associated with additional autoantibodies and antibody-mediated diseases. Because the alternative pathway amplifies complement activation, our aim was to evaluate the presence of autoantibodies against the alternative pathway C3 convertase, its components C3b and factor B, and the complement regulator factor H (FH) in NMOSD.

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Tumor necrosis factor receptor 1 and 2 (TNFR1 and TNFR2) have been found in brain parenchyma of stroke patients, and plasma levels are increased in the acute phase of stroke. We evaluated associations between TNFR1 and TNFR2 plasma levels and stroke severity, infarct size, and functional outcome. Furthermore, we examined cellular expression of TNFR1 and TNFR2 on leukocyte subpopulations to explore the origin of the increased receptor levels.

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  • A population-based study was conducted to characterize and compare clinical features of aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (AQP4-Ab+ NMOSD) between Danish and Hungarian patients.
  • Results showed Danes presented more with transverse myelitis and long-term spinal cord damage, while Hungarians more often exhibited optic neuritis with similar visual outcomes.
  • The study highlighted significant differences in disease prevalence and incidence rates between the two populations, indicating a need for further genetic and environmental research in NMOSD.
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  • Neurofilament light chain (NFL) levels are significantly elevated in the cerebrospinal fluid and plasma of neurosarcoidosis patients compared to those with extra-neurologic sarcoidosis and healthy controls.
  • The study found a median NFL level of 2304 pg/mL in cerebrospinal fluid for neurosarcoidosis patients, highlighting NFL's potential as a biomarker for disease activity.
  • Higher NFL levels correlated with the severity of inflammation seen in MRI, indicating that they could be effective in distinguishing neurosarcoidosis patients from other groups.
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To identify markers in the CSF of multiple sclerosis (MS) subtypes, we used a two-step proteomic approach: (i) Discovery proteomics compared 169 pooled CSF from MS subtypes and inflammatory/degenerative CNS diseases (NMO spectrum and Alzheimer disease) and healthy controls. (ii) Next, 299 proteins selected by comprehensive statistics were quantified in 170 individual CSF samples. (iii) Genes of the identified proteins were also screened among transcripts in 73 MS brain lesions compared to 25 control brains.

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The use of non-selective tumor necrosis factor (TNF) inhibitors is well known in the treatment of inflammatory diseases such as rheumatoid arthritis, Crohn's disease, and psoriasis. Its use in neurological disorders is limited however, due to rare adverse events of demyelination, even in patients without preceding demyelinating disease. We review here the molecular and cellular aspects of this neuroinflammatory process in light of a case of severe monophasic demyelination caused by treatment with infliximab.

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