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  • Public defence: 2017-09-08 13:00 Örebro universitet, Campus USÖ, Hörsal C3, Örebro
    Sundelin, Heléne E.K.
    Örebro University, School of Medical Sciences.
    Comorbidity and complications in neurological diseases2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Neurological diseases are complex and many share etiology as well as comorbidities. Epilepsy, a brain disorder characterized by an enduring predisposition to generate epileptic seizures and autism spectrum disorder (ASD), are considered to be associated, but the connection is still not fully uncovered. Cerebral palsy (CP), a lifelong, nonspecific, non-progressive disorder of posture and movement control, and Ehlers-Danlos Syndrome (EDS), a connective tissue disorder, both have many consequences for health and wellbeing throughout life.

    Aims: The aim of this thesis was to explore the impact of comorbidity and complications in neurological diseases and EDS. The objective was to gain information on the nature of the connection between epilepsy and ASD, if EDS, ASD and CP have consequences for pregnancy outcome, and the risk of traffic accidents in individuals with epilepsy.

    Materials and methods: The studies are all historical observational population- based cohort studies with prospectively collected data from national registers. The risk of ASD was analysed in 85,201 individuals with epilepsy and compared with 425,760 controls as well as for their firstdegree relatives. In a cohort of 1,248,178 singleton births, 314 births to women with EDS, 2,072 births to women with ASD, and 770 births to women with CP, pregnancy outcome was explored. The risk of traffic accidents was estimated in 29,220 individuals with epilepsy and 267,637 matched controls.

    Results: There is an increased risk of; ASD in individuals with epilepsy and their relatives, moderately preterm birth and pre-eclampsia in maternal ASD, of preterm birth in maternal CP and transport accidents in individuals with epilepsy. There is no increased risk of adverse pregnancy outcome in women with EDS.

    Conclusions: This thesis found proofs of a bidirectional association between epilepsy and ASD, that ASD and CP have consequences for pregnancy outcome and epilepsy is a risk factor for traffic accidents.

    List of papers
    1. Autism and epilepsy: A population-based nationwide cohort study
    Open this publication in new window or tab >>Autism and epilepsy: A population-based nationwide cohort study
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    2016 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 87, no 2, 192-197 p.Article in journal (Refereed) Published
    Abstract [en]

    Objective: To investigate the risk of autism spectrum disorder (ASD) in individuals with epilepsy and in their first-degree relatives to determine shared etiology.

    Methods: Through the Swedish Patient Register, we identified 85,201 individuals with epilepsy, as well as all their siblings (n = 80,511) and offspring (n = 98,534). Each individual with epilepsy was compared with 5 controls, matched for age, sex, calendar period, and county, while siblings and offspring were compared with siblings and offspring of controls. We excluded siblings and offspring with epilepsy. Using Cox regression, we calculated hazard ratios (HRs) for future diagnosis of ASD. Logistic regression was applied to calculate odds ratios (ORs) for prior diagnosis of ASD.

    Results: During follow-up, 1,381 (1.6%) individuals with epilepsy and 700 (0.2%) controls were diagnosed with ASD. Individuals with epilepsy were therefore at increased risk of future ASD (HR 10.49, 95% confidence interval [CI] 9.55-11.53), with the highest risk seen in individuals diagnosed with epilepsy in childhood. Both siblings (HR 1.62, 95% CI 1.43-1.83) and offspring (HR 1.64, 95% CI 1.46-1.84) of epilepsy patients were at increased risk of ASD. The risk in the offspring was particularly high in mothers with epilepsy (HR 1.91; 95% CI 1.63-2.23). Epilepsy was also associated with a prior diagnosis of ASD (OR 4.56, 95% CI 4.02-5.18).

    Conclusions: Individuals with epilepsy are at increased risk of ASD, especially if epilepsy appears in childhood. Further, ASD is more common in the siblings and offspring of individuals with epilepsy, suggesting shared etiology.

    Place, publisher, year, edition, pages
    Philadelphia, USA: Lippincott Williams & Wilkins, 2016
    National Category
    Medical and Health Sciences Neurosciences
    Identifiers
    urn:nbn:se:oru:diva-54630 (URN)10.1212/WNL.0000000000002836 (DOI)000381470700039 ()27306624 (PubMedID)2-s2.0-84979000396 (Scopus ID)
    Funder
    Swedish Research Council
    Note

    Funding Agencies:

    Swedish Initiative for research on Microdata in the Social and Medical Sciences (SIMSAM) 

    Swedish Research Council for Health, Working Life and Welfare 

    Available from: 2017-01-12 Created: 2017-01-12 Last updated: 2017-08-15Bibliographically approved
    2. Pregnancy outcome in joint hypermobility syndrome and Ehlers-Danlos syndrome
    Open this publication in new window or tab >>Pregnancy outcome in joint hypermobility syndrome and Ehlers-Danlos syndrome
    2017 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 1, 114-119 p.Article in journal (Refereed) Published
    Abstract [en]

    INTRODUCTION: An increased risk of preterm birth in women with joint hypermobility syndrome or Ehlers-Danlos syndrome is suspected.

    MATERIAL AND METHODS: In this nationwide cohort study from 1997 through 2011, women with either joint hypermobility syndrome or Ehlers-Danlos syndrome or both disorders were identified through the Swedish Patient Register, and linked to the Medical Birth Register. Thereby, 314 singleton births to women with joint hypermobility syndrome/Ehlers-Danlos syndrome before delivery were identified. These births were compared with 1 247 864 singleton births to women without a diagnosis of joint hypermobility syndrome/Ehlers-Danlos syndrome. We used logistic regression, adjusted for maternal age, smoking, parity, and year of birth, to calculate adjusted odds ratios for adverse pregnancy outcomes.

    RESULTS: Maternal joint hypermobility syndrome/Ehlers-Danlos syndrome was not associated with any of our outcomes: preterm birth (adjusted odds ratio = 0.6, 95% confidence interval 0.3-1.2), preterm premature rupture of membranes (adjusted odds ratio = 0.8; 95% confidence interval 0.3-2.2), cesarean section (adjusted odds ratio = 0.9, 95% confidence interval 0.7-1.2), stillbirth (adjusted odds ratio = 1.1, 95% confidence interval 0.2-7.9), low Apgar score (adjusted odds ratio = 1.6, 95% confidence interval 0.7-3.6), small for gestational age (adjusted odds ratio = 0.9, 95% confidence interval 0.4-1.8) or large for gestational age (adjusted odds ratio = 1.2, 95% confidence interval 0.6-2.1). Examining only women with Ehlers-Danlos syndrome (n = 62), we found a higher risk of induction of labor (adjusted odds ratio = 2.6; 95% confidence interval 1.4-4.6) and amniotomy (adjusted odds ratio = 3.8; 95% confidence interval 2.0-7.1). No excess risks for adverse pregnancy outcome were seen in joint hypermobility syndrome.

    CONCLUSION: Women with joint hypermobility syndrome/Ehlers-Danlos syndrome do not seem to be at increased risk of adverse pregnancy outcome.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2017
    Keyword
    Ehlers-Danlos syndrome, Joint hypermobility syndrome, child, obstetric - cohort study, pregnancy
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:oru:diva-59089 (URN)10.1111/aogs.13043 (DOI)000391980100014 ()27743500 (PubMedID)2-s2.0-85006078185 (Scopus ID)
    Funder
    Swedish Research Council, 2013-2429Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-01369Stockholm County Council, 20130156
    Available from: 2017-08-15 Created: 2017-08-15 Last updated: 2017-08-15Bibliographically approved
    3. Pregnancy outcomes in women with autism: A Nationwide populationbased cohort study
    Open this publication in new window or tab >>Pregnancy outcomes in women with autism: A Nationwide populationbased cohort study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:oru:diva-59093 (URN)
    Available from: 2017-08-15 Created: 2017-08-15 Last updated: 2017-08-15Bibliographically approved
    4. Pregnancy outcome in women with cerebral palsy: A nationwide population-based cohort study
    Open this publication in new window or tab >>Pregnancy outcome in women with cerebral palsy: A nationwide population-based cohort study
    (English)Manuscript (preprint) (Other academic)
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:oru:diva-59096 (URN)
    Available from: 2017-08-15 Created: 2017-08-15 Last updated: 2017-08-15Bibliographically approved
    5. Epilepsy, anti-epileptic drugs, and serious transport accidents: A nationwide cohort study
    Open this publication in new window or tab >>Epilepsy, anti-epileptic drugs, and serious transport accidents: A nationwide cohort study
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Family Medicine
    Identifiers
    urn:nbn:se:oru:diva-59097 (URN)
    Available from: 2017-08-15 Created: 2017-08-15 Last updated: 2017-08-15Bibliographically approved
  • Public defence: 2017-09-11 09:15 Örebro universitet, Långhuset, Hörsal 2, Örebro
    Bauducco, Serena
    Örebro University, School of Law, Psychology and Social Work, Örebro University, Sweden.
    Adolescents' sleep in a 24/7 society: Epidemiology and prevention2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-09-15 09:00 Örebro universitet, Prismahuset, Hörsal 1, Örebro
    Boström, Marianne
    Örebro University, School of Health Sciences.
    Vardagslivets aktiviteter: Handlingen som terapeutiskt redskap för personer med svårare psykiska funktionshinder - analys av arbetsterapeuters berättelser med hjälp av G. H. Meads teori om social handling2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-09-20 10:00 Örebro universitet, Prismahuset, Hörsal 1, Örebro
    Pavli, Antonia
    Örebro University, School of Health Sciences.
    Creative Disability Classification Systems: The case of Greece, 1990-20152017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-09-22 09:00 Campus USÖ, hörsal C2, Örebro
    Wijk, Lena
    Örebro University, School of Medical Sciences.
    Enhanced Recovery After Hysterectomy2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-09-22 10:00 Södertörns högskola, sal MB503, Huddinge
    Mai Thi Van, Anh
    Örebro University, Örebro University School of Business.
    Organizing for Efficiency: Essays on merger policies, independence of authorities, and technology diffusion2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-10-06 09:00 Campus USÖ, hörsal C1, Örebro
    Wanjura, Viktor
    Örebro University, School of Medical Sciences.
    Register-based studies on cholecystectomy: Quality of life after cholecystectomy, and cholecystectomy incidence and complications after gastric bypass2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-10-06 13:15 Örebro universitet, Hörsalen, Musikhögskolan, Örebro
    Bornhäll, Anders
    Örebro University, Örebro University School of Business.
    Unseen job creators and firm growth barriers: the role of capital constraints and seniority rules2017Doctoral thesis, comprehensive summary (Other academic)
  • Public defence: 2017-10-06 13:15 Örebro universitet, Prismahuset, Hörsal 1, Örebro
    Yassin Falk, Daroon
    Örebro University, School of Humanities, Education and Social Sciences.
    Skrivundervisning i grundskolans årskurs 32017Doctoral thesis, monograph (Other academic)
  • Public defence: 2017-10-27 09:00 Campus USÖ, hörsal C3, Örebro
    Kuchalik, Jan
    Örebro University, School of Medical Sciences.
    Postoperative pain, inflammation and functional recovery after total hip arthroplasty: Prospective, randomized, clinical studies2017Doctoral thesis, comprehensive summary (Other academic)