Effectiveness of Natalizumab in Achieving No Evidence of Disease Activity (NEDA-3)—Data From a Local Norwegian Cohort

Objective: We aimed to determine the effectiveness of natalizumab (NTZ) by assessing overall No Evidence of Disease Activity 3 (NEDA-3) in a local Norwegian cohort. Background: NTZ is an immunomodulating drug used in the treatment of multiple sclerosis (MS). It has typically been used as a second-line treatment, but certain patients with high disease activity have started directly with NTZ. Methods: This retrospective cohort study includes all patients who received NTZ for relapsing–remitting MS at Nordland Hospital in the period 2008–2018. In June 2019, status for every patient was assessed, and a survival curve was used to show the cumulative probability of achieving NEDA-3 over time. Results: The cohort consisted of 66 patients, 49 women and 17 men with a mean age of 40.0 ± 10.8 years. Each patient received on average 45.8 ± 36.4 NTZ infusions. Mean age and Expanded Disability Status Scale (EDSS) at first infusion was 34.8 ± 10.5 and 3.2 ± 1.9, respectively. Prior to NTZ treatment, 83% had used other disease modulating drugs and 65% were anti-JC virus (JCV) seronegative. During the study period, seven patients converted to seropositive. In 2019, 40 patients had switched or stopped treatment: 19 due to positive JCV serostatus, 9 due to disease activity, 7 due to adverse effects or complications (1 progressive multifocal leukoencephalopathy), 2 due to pregnancy, and 3 due to autologous hematopoietic cell transplantation abroad. Three patients experienced rebound in the wake of discontinuation (7.5%). Of the patients receiving NTZ for more than 3 years (n = 33), 50% had achieved NEDA-3 after 3 years. Compared to those with evidence of disease activity (EDA), these NEDA-3 patients had significant lower EDSS score before first NTZ treatment (p = 0.04). They were also slightly, but not significantly, younger at debut of their MS, at the diagnosis and at first NTZ treatment. Of all the patients who ever started on NTZ, 23% had achieved NEDA-3 5 years later. The mean EDSS in 2019 was 3.6 ± 2.5. Conclusion: Despite the high rate of treatment switch, mainly due to the risk of PML, almost one in four who started on NTZ achieved NEDA-3 after 5 years, and the overall disease progression was low in the total cohort. Treating less advanced disease seems to predict better long-term stability

Comorbidity in multiple sclerosis patients from Nordland County, Norway - validated data from the Norwegian Patient Registry

Postponed access: the file will be available after 2021-12-21Background: Knowledge of comorbid disorders is important to optimize therapy for multiple sclerosis (MS), but data are limited. The aim of this study was to assess comorbidity in persons with MS living in Nordland County on January 1, 2017. Methods: Data were retrieved from the Norwegian Patient Registry (2008-2017) and validated through review of electronic hospital charts (1970-2017). Comorbidity was defined as any distinct disorder, classified in the International Classification of Diseases (ICD-10), that had existed or occurred after the diagnosis of MS was established. Results: Data from 637 subjects were reviewed, and 97.5% were registered with at least one comorbid condition. Malignant melanoma was found in 0.5%, and non-melanoma skin cancers in 1.9%. In female subjects, breast cancer was found in 3.3%. Hypothyroidism was confirmed in 3.1%, type-1 diabetes in 0.3%, type-2 diabetes in 3.9%, psychosis in 0.6%, epilepsy in 2.8%, myocardial infarction in 1.7%, subarachnoid hemorrhage in 0.2%, cerebral infarction in 0.6%, pulmonary embolism in 0.9%, inflammatory bowel disease in 1.3%, and rheumatoid arthritis in 0.6%. Conclusion: Compared to reports from other Norwegian epidemiological studies, a higher proportion of inflammatory bowel disease and epilepsy was found. This is in accordance with findings from other studies. The prevalence of non-melanoma skin cancers was significantly higher than in the general Norwegian population as they were reported by The Cancer Registry of Norway.acceptedVersio

Behandling av motoriske symptomer ved Parkinsons sykdom

Gjennom de siste årene har nye terapimuligheter og økt kunnskap om gamle metoder ført til endringer i vår behandling av Parkinsons sykdom. Likevel åpner alle tilgjengelige norske og utenlandske terapianbefalinger for ulike og ofte sidestilte alternativer. Basert på de evidensbaserte terapianbefalingene og på våre egne personlige erfaringer og oppfatninger presenterer vi i denne kliniske oversikten et forslag til fremgangsmåte for medisinsk behandling av motoriske symptomer ved Parkinsons sykdom

Month of birth and risk of multiple sclerosis: confounding and adjustments

A month of birth effect on multiple sclerosis (MS) risk has been reported from different countries. Recent critics have suggested that this finding is caused by confounding and that adequately adjusting for year and place of birth would markedly reduce this effect. All inhabitants in Norway are registered in the Norwegian Population Registry (Statistics Norway), making this an ideal area for performing adjusted analyses. Using the entire Norwegian population born between 1930 and 1979 (n = 2,899,260), we calculated the excess between observed and expected number of births for each month for 6649 Norwegian MS patients, 5711 mothers, 5247 fathers, and 8956 unaffected siblings. The analyses were adjusted for year of birth and place of birth according to the 19 counties in Norway. An unadjusted analysis revealed 13% fewer MS births than expected in February (P = 0.0015; Bonferroni corrected P = 0.018), 10% more in April (P = 0.0083; Bonferroni corrected P = 0.0996) and 15% more in December (P = 0.00058; Bonferroni corrected P = 0.007). Adjustments for both year and place of birth significantly altered our results for February and December, but even after these adjustments there were still 10% more MS births than expected in April (P = 0.00796; Bonferroni corrected P = 0.096). MS patients had a higher incidence of April births than their siblings (Fisher-exact test; P = 0.011), mothers (Fisher-exact test; P = 0.004), and fathers (Fisher-exact test; P = 0.011) without MS. Adjustments for confounding significantly affected our results. However, even after adjustments, there appears to be a persistent higher than expected frequency of April births in the MS population. © 2014 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals, Inc on behalf of American Neurological Association

Synesthesia and Migraine: Case Report

<p>Abstract</p> <p>Background</p> <p>Synesthesia is, as visual migraine aura, a common and fascinating perceptual phenomenon. Here we present a unique case with synesthesias exclusively during visual migraine auras.</p> <p>Case presentation</p> <p>A 40-year-old woman with a cyclic mood disorder had suffered from migraine with visual aura for several years. On several occasions she had experienced "mixing of senses" during the aura phase. Staring at strong bright light she could experience intense taste of lemon with flow from the salivary glands.</p> <p>Conclusion</p> <p>Acquired synesthesia, exclusively coincident with migraine aura, gives support to the idea of an anomalous cortical processing underlying the phenomenon.</p

Multiple sclerosis in Northern Norway, epidemiology and comorbidity

Background: Multiple sclerosis (MS) is a severe chronic inflammatory disease in the central nervous system, mainly affecting young adults. The prevalence varies between different parts of the world, but the general rule is that it increases with increasing latitude. Studies on comorbid conditions in MS are limited, but this topic have gained increasing interest. Aims: To describe the occurrence of MS in Nordland County, and explore the extent to which the number of registered cases of MS in the Norwegian Patient Registry (NPR) corresponds to the actual number of MS patients in the county. To study the occurrence of comorbid conditions in the same MS population. Methods: Cross-sectional and longitudinal studies with the use of the electronic medical record system at the Nordland Hospital Trust in Bodø combined with data from the NPR. Results: The average yearly incidence per 100 000 was 0.7 during the period 1970 – 1974 and 10.1 in the period 2005 – 2009. The prevalence was 270.5 per 100 000 as of January 1, 2017. For an individual with MS to be correctly registered in the NPR, the sensitivity was 0.97, and for an individual in the NPR to have MS the positive predictive value was 0.92. The Cohen’s kappa was 0.94. The prevalence of active epilepsy was 3.2 % in those with MS living in the county as of January 1, 2010. In the MS patients correctly registered in the NPR as of January 1, 2017, epilepsy was found in 2.8 %, inflammatory bowel disease in 1.3 % and non-melanoma skin cancer in 1.7 %. Conclusion: The occurrence of MS has been increased during the whole period from 1970 to 2017, and the prevalence in Nordland is now as high as in southern regions of Norway. The number of MS patients in Nordland registered in the NPR corresponds well with the actual number of MS patients in the county. The prevalence of epilepsy, inflammatory bowel disease and non-melanoma skin cancer is increased compared to what is found in the general Norwegian population

Immaterielle eiendelers rolle for skattemotivert overskuddsflytting : en case-studie av Coca-Cola

Denne masterutredningen setter fokus på skattemotivert overskuddsflytting gjennom manipulasjon av internpriser i konserninterne transaksjoner. Tidligere forskning har gitt klare indikasjoner på at flernasjonale selskaper benytter seg av den usikkerheten som kan oppstå ved håndhevelsen av armlengdeprinsippet, for å redusere sin skattebyrde i høyskatteland. Slik skatteplanlegging vil gjerne bli godt hjulpet i de tilfeller man skal verdsette immaterielle eiendeler, da usikkerheten rundt verdien av slike eiendeler kan være stor på grunn av blant annet de immaterielle eiendelenes unike natur, noe som kan gi lav sammenlignbarhet med andre transaksjoner i markedet. Vårt fokus er på nettopp slike eiendeler, og vi ser da særlig på forretningshemmeligheter fra et teoretisk perspektiv, samt i case-studien av Coca-Cola. Forretningshemmeligheter er en type intellektuell eiendom som kan være et alternativ til patenter i ulike situasjoner. Ofte vil patenter være det naturlige valget for beskyttelse av et selskaps intellektuelle eiendom, da de gir bedre beskyttelse fra et juridisk standpunkt. Til tross for dette finnes det ulike grunner til at det kan være hensiktmessig for et selskap å benytte seg av forretningshemmeligheter. Vi tar utgangspunkt i rammeverket til Schwartz (2013) som peker på at valget av type intellektuell eiendom avhenger av både kompleksiteten og størrelsen til oppfinnelsen, samt ressursbasen i selskapet der særlig større flernasjonale aksjeselskaper med spesifikk og kompleks intellektuell eiendom vil tenkes å velge forretningshemmeligheter. Dette følger av at de vil ha gode forutsetninger for å utnytte informasjonen best ved å holde den hemmelig, framfor å gjøre den offentlig tilgjengelig gjennom opprettelsen av et patent. Skattemessig gir mangelen på offentlig informasjon rundt forretningshemmeligheter et fortrinn i internprisingssammenhet. Vi illustrerer dette gjennom vår case-studie av CocaCola, inkludert en gjennomgang av argumentene i to forskjellige rettsprosedyrer mellom selskapet og amerikanske skattemyndigheter. Her ser vi at ulike, sentrale metoder for å avdekke internprismanipulasjon får særlige utfordringer når immaterielle eiendeler er involvert, og at forretningshemmeligheter kan bidra til å øke usikkerheten gjennom redusert offentlig tilgjengelig informasjon. Denne og lignende saker har betydelig konsekvenser for skatteproveny og investorers inntekt, hvilket understreker viktigheten av et godt fungerende lovverk. Det ligger på den annen side betydelige utfordringer i å utforme et lovverk som både fungerer etter hensikten, og som ikke produserer utilsiktede negative konsekvenser for aktørene i markedet.nhhma

Climate variability, food production shocks, and violent conflict in Sub-Saharan Africa

Earlier research that reports a correlational pattern between climate anomalies and violent conflict routinely refers to drought-induced agricultural shocks and adverse economic spillover effects as a key causal mechanism linking the two phenomena. Comparing half a century of statistics on climate variability, food production, and political violence across Sub-Saharan Africa, this study offers the most precise and theoretically consistent empirical assessment to date of the purported indirect relationship. The analysis reveals a robust link between weather patterns and food production where more rainfall generally is associated with higher yields. However, the second step in the causal model is not supported; agricultural output and violent conflict are only weakly and inconsistently connected, even in the specific contexts where production shocks are believed to have particularly devastating social consequences. Although this null result could, in theory, be fully compatible with recent reports of food price-related riots, it suggests that the wider socioeconomic and political context is much more important than drought and crop failures in explaining violent conflict in contemporary Africa

Posterior reversible encephalopathy syndrome, a clinically diverse and challenging disorder

The characterizing features of Posterior reversible encephalopathy syndrome (PRES) are broad and diverse, making early recognition and diagnosis challenging tasks. To illustrate the heterogeneous nature of PRES, we present three cases and discuss their clinical and radiological presentation