Sakari Simula

Etelä-Savo Hospital District · Department of Neurology

Background Brain atrophy appears during the progression of multiple sclerosis (MS) and is associated with the disability caused by the disease. Methods We investigated global and regional grey matter (GM) and white matter (WM) volumes, WM lesion load, and corpus callosum index (CCI), in benign relapsing‐remitting MS (BRRMS, n = 35) with and withou...

Background Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. Objectives To evaluate the safety of alemtuzumab in a nationwide cohort of Finnish MS patients. Methods In this retrospective case series study, we analyzed the data of all...

Objective We aimed to investigate serum glial fibrillary acidic protein (GFAP) and serum neurofilament light chain (NfL) levels as potential discriminative biomarkers between benign relapsing-remitting multiple sclerosis (BRRMS) and aggressive relapsing-remitting MS (ARRMS). Methods Serum GFAP and NfL levels were analyzed in patients with BRRMS (n...

Background: Natalizumab (NTZ) is widely used for highly active relapsing-remitting multiple sclerosis (MS). Inflammatory disease activity often returns after NTZ treatment discontinuation. We aimed to identify predictive factors for such reactivation in a real-life setting. Methods: We conducted a retrospective survey in four Finnish hospitals....

Background: Cardiac repolarization is modulated by the autonomic nervous system. Even though multiple sclerosis associates with prolonged cardiac repolarization the physiology responsible for the phenomenon remains unknown. Objective: To study in longitudinal setting whether the patients with confirmed benign and disabling outcome of relapsing-r...

Background Fingolimod is a sphingosine‐1‐phosphate receptor modulator for the treatment of relapsing–remitting multiple sclerosis (RRMS). Despite an established effect on heart rate, the effect of fingolimod on cardiac repolarization is not completely known. Methods Twenty‐seven patients with RRMS underwent 24‐hr ambulatory ECG before fingolimod (...

Introduction Multiple sclerosis is associated with prolonged cardiac repolarization but the underlying physiology has remained unknown. In this study, we compared cardiac repolarization during the relapsing‐remitting multiple sclerosis (RRMS) disease course in patients with motor and sensory onset symptom. Methods Twenty‐five RRMS patients with mo...

Background: Homeostasis between heart rate and blood pressure is based on several interacting regulatory reflexes, which become influenced by fingolimod initiation. The aim of this study was to determine the sequence of changes in cardiovascular autonomic regulation after fingolimod initiation. Methods: Twenty-seven patients with relapsing-remit...

Background: Fingolimod is an immunomodulator with a disease modifying effect on relapsing-remitting multiple sclerosis (RRMS). A heart rate (HR) decrease shortly after fingolimod initiation, however, requires a clinical vigilance. The aim of this study was to prospectively investigate whether cardiac autonomic regulation can predict the magnitude...

Table S1. Heart rate variability during night and day before fingolimod initiation (B), at the day of fingolimod initiation (1D) and after 3 months of fingolimod treatment (3M). Absolute P‐values are presented in green.

Table S2. Night to day ratio for different heart rate variability measures before (B), at the day of fingolimod initiation (1D) and after 3 months of fingolimod treatment (3M). Absolute P‐values are presented in this supplementary Table.

Fingolimod is an oral sphingosine-1-phospate (S1P) receptor modulator for the treatment of relapsing-remitting multiple sclerosis (RRMS). In addition to therapeutic effects on lymphoid and neural tissue, fingolimod influences cardiovascular system by specific S1P-receptor modulation. The effects of S1P-receptor modulation on the endogenous circadia...

Background: Fingolimod modulates sphingosine-1-phosphate receptors that are also found in cardiovascular tissue. Objective: To investigate the effects of fingolimod on cardiac autonomic regulation prospectively. Methods: Twenty-seven relapsing-remitting multiple sclerosis patients underwent 24-hour electrocardiogram recording before, at the fi...

Fingolimod is a novel disease-modifying drug for relapsing-remitting multiple sclerosis (RRMS). Fingolimod initiation associates with a decrease in heart rate (HR). However, the long-term effects of fingolimod on HR are not known. The aim of this study was prospectively investigate the effect of 3-month fingolimod therapy on HR. Twenty-seven RRMS p...

Clostridium tetani, the bacterium causing tetanus, can be found both in the soil and intestinal normal flora. While the majority of the Finnish population has adequate vaccination protection, part of the population exhibits weakened protection. We describe a case in which a patient developed tetanus as a consequence of pressure ulcer. The symptoms...

Heart rate variability (HRV) becomes impaired in symptomatic coronary artery disease (CAD), particularly, after myocardial infarction. The mechanism how CAD results in impairment of cardiac autonomic regulation is not known. Whether it results rather from coronary atherosclerosis itself than myocardial ischemia and myocardial injury has remained el...

Prolonged QT interval associates with increased risk for sudden cardiac death after acute ischemic stroke. However, pathophysiology of prolonged QT interval after stroke is poorly elucidated. In this study, we investigated whether QT interval dynamics is different in patients with right and left middle cerebral artery (MCA) territory stroke. Electr...

Baroreflex sensitivity (BRS) reflects the effectiveness of cardiac parasympathetic regulation. BRS becomes impaired in stable coronary artery disease (CAD) and after myocardial infarction and carries prognostic information in these patients. Whether impaired BRS is found already in asymptomatic subjects, with subclinical coronary atherosclerosis, h...

Dysfunction of the hypoglossal nerve (nervus hypoglossus) occurs usually as part of a larger symptom complex, only rarely being the sole symptom of a neurologic disorder. Peripheral etiology must also be kept in mind, especially in patients with malignant primary disease. We describe a patient who developed an isolated right hypoglossal nerve palsy...

Myocardial (123) I-metaiodobenzylguanidine (MIBG) kinetics reflect the integrity and function of cardiac presynaptic sympathetic nerve terminals. Heart rate variability (HRV) is an indicator of cardiac sympatho-vagal balance. However, the function of cardiac sympathetic nerve terminals as a modulator of HRV in asymptomatic subjects has remained elu...

Malignant cerebral infarction has 80% mortality rate that could be decreased by hemicraniectomy. We retrospectively evaluated medical records of all 12 consecutive patients who underwent hemicraniectomy due to malignant cerebral infarction in Kuopio university hospital between 2003 and 2/2009. Infarction affected left hemisphere in 4/12 patients an...

Catheter-based intracoronary vascular endothelial growth factor (VEGF) gene transfer is a potential treatment for coronary heart disease. However, only limited data are available about local VEGF gene transfer given during angioplasty (PTCA) and stenting. Patients with coronary heart disease (n=103; Canadian Cardiovascular Society class II to III;...

Hypertrophic cardiomyopathy (HCM) is a genetic disease caused by mutations in genes encoding sarcomeric proteins. However, other genetic and possibly also environmental factors modify the phenotypic expression of left ventricular (LV) hypertrophy. The present study investigated whether cardiac adrenergic activity affects the severity of LV hypertro...

The aim of this study was to investigate whether, in subjects with a very early stage of coronary artery disease without hemodynamically significant coronary artery stenoses, cardiac adrenergic innervation is already affected. Quantitative coronary angiography and dual-isotope SPECT with 123I-metaiodobenzylguanidine (MIBG) and 99mTc-sestamibi (MIBI...

It is widely accepted that myocardial infarction results in adrenergic denervation of the infarcted and peri-infarcted myocardium. On the contrary, the concept of re-innervation of adrenergic nerve fibres is less well established. Although there is evidence of partial re-innervation occuring several months after myocardial infarction, the extent an...

In spite of smaller infarct size and better preserved left ventricular function the long-term prognosis after a non-Q-wave infarction is not better than after a Q-wave infarction. In fact, the risk of sudden cardiac death is higher in patients with a non-Q-wave infarction than in patients with a Q-wave infarction. One possible reason for postinfarc...

In spite of smaller infarct size and better preserved left ventricular function the long-term prognosis after a non-Q-wave infarction is not better than after a Q-wave infarction. In fact, the risk of sudden cardiac death is higher in patients with a non-Q-wave infarction than in patients with a Q-wave infarction. One possible reason for postinfarc...

We compared analogue and digital 24-h electrocardiogram (ECG) recordings in the assessment of heart rate variability (HRV) in 41 patients with suspected coronary artery disease. The patients underwent ambulatory ECG recordings simultaneously with analogue (A) (Marquette 8500) and digital (D) (Oxford Medilog FD-3) recorders. Digital ECG recordings w...

We compared analog and digital 24-h ECG recordings in the assessment of heart rate variability (HRV) in 30 patients with stable coronary artery disease. The patients underwent ambullatory ECG recording simultaneously with analog (Marquette 8500) and digital (Oxford Medilog FD-3) recorders. Digital ECG recordings were analysed with Excel Medilog II...