Erik Lundström

Vision for science
Stroke research that matters.

Vision as a leader
Inject people with passion.

I was the Chief Investigator of the EFFECTS (Efficacy of Fluoxetine – a randomised controlled trial in stroke) trial, published in The Lancet Neurology. You're welcome to connect with me on TWITTER and Facebook.

Current position

• Consultant in Neurology at Uppsala University Hospital and clinical lead for the stroke unit. Ongoing (since April 2018).
• Senior lecturer of Neurology at Department of Neuroscience, Uppsala University. Ongoing (since July 2018).
• Chief Investigator of EFFECTS, the largest randomised controlled stroke study in Sweden. Although we reported the main results in Lancet Neurology Aug 2020, we continue to publish important results.
  
  EFFECTS was an academic-initiated, investigated led multicentre, parallel-group, randomised, placebo-controlled trial of fluoxetine for stroke recovery.
  We investigated whether routine administration of fluoxetine 20mg once daily in the 6 months after an acute stroke improves the patient’s functional outcome.
  
  EFFECTS was supported by the Swedish Research Council (Vetenskapsrådet), the Swedish Brain Foundation,(Hjärnfonden), the Swedish Heart-Lung Foundation (Hjärt- Lungfonden), the Swedish Society of Medicine (Svenska Läkaresällskapet), the Swedish Stroke Association (Stroke Riksförbundet), King Gustav V and Queen Victorias Foundation of Freemasons, Karolinska Institutet, and Uppsala University. All funders are non-commercial. None of the funders have any influence on the planning, conduct or interpretation of the study.

Medical degrees

• Associate Professor of Neurology, Uppsala University. 2022.
• Associate Professor of Neurology at Karolinska Institutet. 2017.
• Dissertation at Uppsala University, Sweden, Inst f Neuroscience, Neurology and rehabilitation medicine. Spasticity after first-ever stroke. 2009.
• Medical Degree at Uppsala University. 1993.

Supervision for PhD students

• Co-supervisor of Svante Wallmark, at Uppsala University, Department of Neuroscience, Neurosurgery. Dr Wallmarks thesis studied the effects of subarachnoid haemorrhage, including cognitive impairment, and defended his thesis Life after subarachnoid haemorrhage 17/01/2017.
• Supervisor of Ann-Sofie Rudberg and Eva Isaksson, both at Karolinska Institutet.
  Dr Rudberg's projects will investigate long-term survival, health-related quality of life and cost aspects associated with stroke treatment, and will be based on two clinical stroke studies: IST-3 and EFFECTS. Ongoing.
  Eva Isaksson's thesis aims to describe factors that contribute to successful recruitment in a randomised controlled trial. Ongoing.
• Co-supervision for Melinda Berg Roaldsen, PhD student at UiT The Arctic University of Norway (ongoing). Roaldsen's research focuses on thrombolytic treatment of acute ischaemic stroke with a special emphasis on wake-up stroke. She is currently the international Trial Manager of the randomised-controlled trial TWIST (Tenecteplase in Wake-up Ischaemic Stroke Trial). Ongoing,

Supervision of students

• 14 students at Uppsala University, Medicine Programme, student thesis, 9 x 30 credits, 5 x 7,5 credits
• 1 student at Karolinska Institutet, Medicine Programme, 30 credits
• 1 student at Gothenburg University, Pharmacy Programme, 30 credits

Teaching

• Extensive teaching (> 400 h) for medical students, physiotherapists and nurses at Uppsala University. Also taught at the physiotherapist-, speech therapy- and at biomedical analysts-programme, Uppsala University.
  Some teaching at the medical programme, Karolinska Institutet.

Clinical experience since 2005

• Consultant Neurology and Medically responsible doctor for the stroke unit at Karolinska University Hospital, Solna. Between December 2012 and Mars mars 2018.
• Consultant Neurology, Uppsala University Hospital. 2012.
• Specialist in neurology Uppsala University Hospital and specialist examination in Neurology 2005.

CURRENT PROJECT

TICH-3 Cog

Every year, 1.7 million, experience a spontaneous brain haemorrhage, and out of those who manage to survive, one-third of them develop cognitive issues. In the case of Sweden, there is a prevalence of 2,700 cases of brain haemorrhage annually. Presently, there is no emergency medical intervention available except for the reduction of blood pressure. Despite the patients' emphasis on cognition as the most crucial research area and the European Stroke Organization's identification of significant gaps in knowledge, there is a paucity of randomized controlled studies investigating the possibility of mitigating cognitive impairment.

TICH-3 Cog in an acronym for Tranexamic acid for Hyperacute Spontaneous Intracerebral Haemorrhage Cognition.

The goal TICH-3 Cog trial is to investigate whether tranexamic acid could reduce cognitive impairment when given within 4.5 hours after intracerebral haemorrhage? The hypothesis is that tranexamic acid reduces the size of the haemorrhage and thereby reduces secondary brain damage. The primary outcome measure is cognition at 1 year as measured by the Montreal Cognitive Assessment scale.

Half of the patients will receive an intravenous infusion of tranexamic acid and the other half a placebo. Treatment begins within 4.5 hours of becoming ill.

TICH-3 Cog is a Swedish sub-study embedded in the international TICH-3 trial

TICH-3 Cog is embedded in the Tranexamic acid for Intracerebral Haemorrhage (TICH-3) trial, a pragmatic phase III prospective randomized placebo-controlled study that aims to include 5,500 individuals from around the world.
The research plan for TICH-3 Cog is written in collaboration with the principal investigator for TICH-3, Prof Nikola Sprigg, Nottingham, UK. The primary outcome measure for TICH-3 is death within 7 days.

Details of the TICH-3 trial can be found here.

PREVIOUS AND ONGOING WORK
The EFFECTS study

The purpose of EFFECTS was to find a new treatment for stroke recovery. We tested whether an established drug against depression (Fluoxetine) could improve recovery and quality of life after stroke.

The primary outcome was neutral. You can read about the results in the Lancet Neurology here.

The project’s originality and novelty

1. We were studying a new mechanism for stroke, selective serotonin re-uptake inhibitors (SSRI), for stroke recovery. We wanted to test whether routine administration of Fluoxetine (20 mg once daily) in the 6 months after an acute stroke improves the patient’s functional outcome.
2. An academic-initiated, investigator-led, randomised controlled study (RCT).
3. We included 1,500 patients in Sweden, making EFFECTS the largest RCT study of stroke in Sweden.
4. A collaboration with FOCUS (published in Lancet) and AFFINITY (published in the Lancet Neurology) two other international, investigator-led studies, with the same inclusion and exclusion criteria. A meta-analysis of individual patient data is planned.
5. It has a pragmatic design, that is we investigate if the interventions work in normal practice, with fewer selected patients and a flexible intervention applied as it would be in normal practice, and finally, outcomes that are relevant to patients and society.
6. The study includes both ischemic and haemorrhagic stroke.