To Örebro University

BACKGROUND: Cadaver dissection is a well-established method to teach neuroanatomy in medical school. However, the outcome on functional anatomical understanding and student experience has not been studied. The aim of this study was to compare traditional topographically based brain cadaver dissections with dissections based on functional white matter dissections with regard to functional-anatomical knowledge and student experience.

METHODS: Pre-clinical medical students were randomly assigned to a control group with traditional two dimensional topographical cadaver dissections and to study groups with functionally based white matter dissections. The control dissections were performed as formerly planned by non-clinical anatomy tutors and the study dissections were planned and overseen by an experienced neurosurgeon. After the dissections, the students underwent a web-based questionnaire including four questions on topographical and functional neuroanatomy, and three questions on experience and self-evaluation of neuroanatomical knowledge.

RESULTS: A total of 130 students were included, (n=33 in the control group and n=97 in the study group). Students in the study group scored higher on knowledge-based multiple-choice questions regarding speech and language, motor functions and the ventricular system; however, statistical significance was observed only for speech and language. They also scored higher in self-perceived knowledge after the dissections, although not statistically significant.

DISCUSSION: Including functional and clinical aspects in brain cadaver improves anatomy teaching in pre-clinical medical students. The authors argue that it is of importance to integrate clinicians in the pre-clinical anatomy teaching.

This paper illustrates a method to map cognitive subcortical white matter pathways in brain tumour surgery, in patients not eligible for awake intraoperative mapping. The latter being the gold standard, it is not feasible in all patients. Illustrated by three cases, the presented method includes a preoperative mapping of both motor and subcortical eloquent structures - such as arcuate fasciculus and basal ganglia - subsequentially using subcortical motor mapping as a landmark to indirectly identify the cognitive structures.

PURPOSE: Patient involvement and shared decision-making (SDM) are central to patient-centered care and have been linked to improved patient satisfaction and outcomes. However, their implementation in spinal surgery remains limited, and the effect of patient involvement on postoperative outcomes is not well described.

METHODS: This observational cohort study used data from the Swedish Spine Registry (Swespine) to examine the association between perceived patient involvement in decision-making and postoperative outcomes among adults undergoing cervical spinal surgery between 2006 and 2020. Propensity score-matching was performed at a ratio of 2:1 to minimize baseline differences between groups. Uni- and multivariable analyses were conducted to identify factors associated with patient's perception of involvement in decision-making.

RESULTS: A total of 3,249 patients were included, with 81% (n = 2,640) reporting perceived involvement in decision-making and 19% (n = 609) not. Following matching, patients who were involved in decision-making had significantly greater improvements at one year follow-up regarding neck and arm pain (p < 0.001), disability (p < 0.001), health-related quality of life (p < 0.001), and subjective satisfaction (p < 0.001). Patients with poorer preoperative health status are more likely to feel involved in decision making, while those undergoing minor procedures feel significantly less involved. Positive predictors of perceived patient involvement included number of operated levels (OR 1.13, p = 0.041), unemployment (OR 1.89, p < 0.001), walking less than 100 m at a normal pace (OR 1.45, p = 0.044), and higher preoperative NDI (OR 1.01, p = 0.039). Negative predictors included higher preoperative EQ-5D index (OR 0.64, p = 0.022) and higher preoperative myelopathy score (OR 0.96, p = 0.042).

CONCLUSION: Patients with a higher degree of perceived involvement report better postoperative patient-reported outcomes following cervical spinal surgery. Patients undergoing larger surgeries and with poorer preoperative health status were more likely to perceive involvement than those undergoing minor procedures. Identifying and supporting patients that are susceptible to feel less involved in treatment-related decisions through individualized information or counseling may help optimize outcomes and satisfaction.

Introduction: Traumatic Brain Injury (TBI) is a global health concern and a leading cause of trauma-related death worldwide. Computed tomography (CT) scan is the gold standard for screening for intracranial bleeding following TBI. Most cases of TBI are mild, with negative CT scans. Different instruments and guidelines are employed to better predict which patients need a CT scan and to minimise unnecessary radiation exposure and save resources. One such instrument is the Scandinavian Neurotrauma Committee guidelines.

Research question: To validate and examine adherence to the Scandinavian Neurotrauma Committee guidelines in Region Örebro County.

Material and methods: We executed a retrospective study with review of patient records and data analysis. Descriptive and comparative statistics were used, along with binary logistic regression analysis to account for confounding factors.

Results: A total of 505 cases were reviewed. Sensitivity of the guidelines was measured at 95% with specificity at 29%. The positive and negative predictive values were 0.77 and 0.69, respectively. A total of 17 false negative cases were found. One case required surgery, during which a chronic subdural hematoma was identified. Adherence to guidelines was 56%, with the lack of analysis of S100B primarily accounting for non-adherence. A total of 54 CT scans were performed outside of guideline indications.

Discussion and conclusions: The guidelines can effectively predict which patients need a CT scan. Increased adherence could potentially decrease the number of CT scans, while inclusion of older age limit as an independent rule-in law for CT scans would increase patient safety.

OBJECTIVE: The objective of this study was to evaluate the diagnostic yield and clinical utility of an automated AI video-based seizure detection device, Nelli®, (SDD) in pharmacoresistant epilepsy patients. The SDD captures and automatically classifies nocturnal motor behavior suggestive of epileptic seizures or non-epileptic motor behavior of potential clinical value.

METHODS: Patients with focal epilepsy and pharmacoresistance referred for inpatient long-term video-EEG monitoring were prospectively recruited. Participants were monitored in their home at night with the SDD for a median of 15.5 nights. Captured video recordings were analyzed by clinical experts and each SDD-registration session was classified as diagnostic or not. Clinical utility for each participant was assessed from pre-specified utility measures. The outcome measures were compared between major focal motor and subtle focal motor seizures.

RESULTS: One SDD-registration session in each of the 20 participants was performed and analyzed. Video recordings were captured in 18 sessions. Diagnostic yield was found in 11 registration sessions (55.0 %) and clinical utility in 8 registration sessions (40.0 %). No significant difference was found between the AI-algorithm classification and clinical experts' consensus assessment of captured video recordings as epileptic or not. Positive predictive value was 81.8 % for registration sessions containing video recordings classified as epileptic seizures. The diagnostic yield and clinical utility were significantly higher among major focal motor seizures (81.8 % and 63.6 %) compared to subtle focal motor seizures.

SIGNIFICANCE: The SDD is useful to evaluate patients with pharmacoresistant epilepsy and major focal motor seizures (hyperkinetic, tonic, clonic, focal to bilateral tonic-clonic seizures); it may facilitate the diagnostic process in patients referred for long-term inpatient video-EEG evaluation and beneficially change anti-seizure treatments. The SDD provided accurate classification of major focal motor seizures as epileptic, or non-epileptic, and may serve as a useful diagnostic tool to distinguish epileptic and non-epileptic episodic events with a prominent motor component.

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Kleine-Levins syndrom är en sömnsjukdom som beskrevs av Willi Kleine 1925 och därefter utvecklades i fallbeskrivningar av Max Levin och McDonald Chritchley. De symptom som beskrevs var återkommande sömnperioder (periodisk hypersomnia), en tendens att äta mycket i samband med dessa perioder (hyperfagi) och ökad sexdrift i samband med perioderna (hypersexualitet) och, i senare beskrivningar, kognitiva och beteendemässiga störningar. Enligt tidigare beskrivningar var patienterna återställda mellan sömnperioderna. Dessa varade i dagar-veckor och återkom flera gånger årligen. Sjukdomen debuterade vanligtvis i tonåren och beskrevs gå över efter åtta år.

d avhandling beskriver diagnosens utveckling över tid och sätter forskningen i sitt teoretiska sammanhang. Med det senare menas att det diskuteras hur forskningen förhåller sig till en diagnos som förändras över tid och där olika läkare kan ha olika kunskap kring och förhållningssätt till diagnosen.

De studier som ingår i avhandlingen har undersökt flera olika aspekter av Kleine-Levins syndrom. Den första studien undersökte arbetsminnet hos patienterna och kunde påvisa att det var nedsatt jämfört med friska försökspersoner, även mellan sömnperioderna, något som inte var visat systematiskt tidigare. Dessutom sågsandra aktiveringsmönster i hjärnan när patienterna försökte klara arbetsminnesuppgiften, jämfört med aktiveringsmönstren hos friska försökspersoner. Hos hälften av patienterna sågs dessutom avvikande blodflöde i delar av hjärnan även när ingen särskild arbetsuppgift utfördes. Detta sågs även hos patienter som tillfrisknat.

Då det funnits hypoteser i annan forsking att sjukdomen kan ha ett genetiskt/ärftligt inslag undersöktes huruvida patienterna hade en gen som tidigare har kopplats till sjukdomen. I den grupp av patienter som undersöktes i avhandlingens sista artikel kunde dock ingen sådan koppling ses.

Slutsatsen av forskningsresultaten är att (1) patienter med Kleine-Levins syndrom har en störning av arbetsminnet som verkar konstant. (2) De uppvisar andra hjärnaktiveringsmönster än friska personer som gör samma arbetsminnesuppgift. (3) Hälften av patienterna har ett avvikande blodflödesmönster även i vila och efter tillfrisknande. (4) En eventuell ärftlig komponent kan inte påvisas avseende de undersökta generna.