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Latini, F., Fahlström, M., Berntsson, S. G., Larsson, E.-M., Smits, A. & Ryttlefors, M. (2019). A novel radiological classification system for cerebral gliomas: The Brain-Grid. PLoS ONE, 14(1), Article ID e0211243.
Open this publication in new window or tab >>A novel radiological classification system for cerebral gliomas: The Brain-Grid
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 1, article id e0211243Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Standard radiological/topographical classifications of gliomas often do not reflect the real extension of the tumor within the lobar-cortical anatomy. Furthermore, these systems do not provide information on the relationship between tumor growth and the subcortical white matter architecture. We propose the use of an anatomically standardized grid system (the Brain-Grid) to merge serial morphological magnetic resonance imaging (MRI) scans with a representative tractographic atlas. Two illustrative cases are presented to show the potential advantages of this classification system.

METHODS: MRI scans of 39 patients (WHO grade II and III gliomas) were analyzed with a standardized grid created by intersecting longitudinal lines on the axial, sagittal, and coronal planes. The anatomical landmarks were chosen from an average brain, spatially normalized to the Montreal Neurological Institute (MNI) space and the Talairach space. Major white matter pathways were reconstructed with a deterministic tracking algorithm on a reference atlas and analyzed using the Brain-Grid system.

RESULTS: In all, 48 brain grid voxels (areas defined by 3 coordinates, axial (A), coronal (C), sagittal (S) and numbers from 1 to 4) were delineated in each MRI sequence and on the tractographic atlas. The number of grid voxels infiltrated was consistent, also in the MNI space. The sub-cortical insula/basal ganglia (A3-C2-S2) and the fronto-insular region (A3-C2-S1) were most frequently involved. The inferior fronto-occipital fasciculus, anterior thalamic radiation, uncinate fasciculus, and external capsule were the most frequently associated pathways in both hemispheres.

CONCLUSIONS: The Brain-Grid based classification system provides an accurate observational tool in all patients with suspected gliomas, based on the comparison of grid voxels on a morphological MRI and segmented white matter atlas. Important biological information on tumor kinetics including extension, speed, and preferential direction of progression can be observed and even predicted with this system. This novel classification can easily be applied to both prospective and retrospective cohorts of patients and increase our comprehension of glioma behavior.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-375437 (URN)10.1371/journal.pone.0211243 (DOI)000456700400066 ()30677090 (PubMedID)
Note

De 2 sista författarna delar sistaförfattarskapet.

Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2019-03-07Bibliographically approved
Gunnarsson, S., Alehagen, S., Lemming, D., Ertzgaard, P., Berntsson, S. G. & Samuelsson, K. (2019). Experiences from intrathecal baclofen treatment based on medical records and patient- and proxy-reported outcome: a multicentre study. Disability and Rehabilitation, 41(9), 1037-1043
Open this publication in new window or tab >>Experiences from intrathecal baclofen treatment based on medical records and patient- and proxy-reported outcome: a multicentre study
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2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 9, p. 1037-1043Article in journal (Refereed) Published
Abstract [en]

Purpose:

To investigate patient satisfaction with intrathecal baclofen treatment, complications from the treatment, and the impact of general expectations on treatment outcome in relation to satisfaction.

Methods:

A multicentre study with cross-sectional design. Data were collected through questionnaires and patient records. Patients were recruited from six outpatient intrathecal baclofen clinics in Sweden. Eighty-three patients who had been treated with intrathecal baclofen for 1-4 years were included. For patients unable to communicate, data were collected through a proxy. The Patient Global Impression of Change was used to measure patients' general satisfaction with change from intrathecal baclofen treatment. The Life Orientation Test - revised, was used to measure general expectations/optimism.

Results:

General satisfaction with intrathecal baclofen treatment was high; 51/77 patients reported "much improved" or "very much improved." There was no relationship between the two main outcomes (general satisfaction and general expectations/optimism) (r(s) = 0.12, p = 0.382). The two groups; those who could and those who could not communicate, did differ regarding personal characteristics and should be evaluated as such.

Conclusions:

Most patients/proxies reported a high level of satisfaction with intrathecal baclofen treatment. The reported satisfaction with intrathecal baclofen treatment was not dependent on general expectations.

Keywords
General expectations, optimism, ITB, satisfaction, proxy
National Category
Neurology Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:uu:diva-383515 (URN)10.1080/09638288.2017.1419291 (DOI)000465207500004 ()29307239 (PubMedID)
Available from: 2019-05-16 Created: 2019-05-16 Last updated: 2019-05-16Bibliographically approved
Berntsson, S. G., Gauffin, H., Melberg, A., Holtz, A. & Landtblom, A.-M. (2019). Inherited Ataxia and Intrathecal Baclofen for the Treatment of Spasticity and Painful Spasms. Stereotactic and Functional Neurosurgery, 97(1), 18-23
Open this publication in new window or tab >>Inherited Ataxia and Intrathecal Baclofen for the Treatment of Spasticity and Painful Spasms
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2019 (English)In: Stereotactic and Functional Neurosurgery, ISSN 1011-6125, E-ISSN 1423-0372, Vol. 97, no 1, p. 18-23Article in journal (Refereed) Published
Abstract [en]

Background: Intrathecal baclofen (ITB) treatment is considered a powerful tool in the management of severe spasticity in neurological conditions such as multiple sclerosis, cerebral palsy, and traumatic spinal cord and brain injury.

Objectives: The objective of this study was to assess the effectiveness of the ITB in patients with inherited ataxia suffering from severe painful spasms and/or spasticity.

Method: A total of 5 patients with spinocerebellar ataxia 3 or 7 or Friedreich's ataxia were included in this observational multicenter study. The patients were interviewed and completed outcome measures assessing pain (The Brief Pain Inventory), fatigue (Fatigue Severity Scale), and life satisfaction (LiSAT-9) before and 1 year after the treatment. Spasticity (Modified Ashworth Scale) and spasm frequency (SPFS) were measured objectively for each patient.

Results: The mean treatment time was 1.9 years. Evaluation of established standard forms revealed symptomatic relief from spasticity, spasms, pain, and fatigue in addition to improved body posture, sleep, and life satisfaction after ITB treatment.

Conclusions: We report the potential beneficial effects of ITB treatment in patients with inherited ataxia who also suffer from spasticity/spasms. ITB treatment indication in neurological disorders allows for extension to the treatment of spasticity/spasms in patients with hereditary ataxia.

Place, publisher, year, edition, pages
KARGER, 2019
Keywords
Intrathecal baclofen treatment, Inherited ataxia, Spasms, Spasticity, Pain
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-384476 (URN)10.1159/000497165 (DOI)000467683300003 ()31050312 (PubMedID)
Available from: 2019-06-05 Created: 2019-06-05 Last updated: 2019-06-05Bibliographically approved
Roodakker, K. R., Alhuseinalkhudhur, A., Al-Jaff, M., Georganaki, M., Zetterling, M., Berntsson, S. G., . . . Smits, A. (2019). Region-by-region analysis of PET, MRI, and histology in en bloc-resected oligodendrogliomas reveals intra-tumoral heterogeneity. European Journal of Nuclear Medicine and Molecular Imaging, 46(3), 569-579
Open this publication in new window or tab >>Region-by-region analysis of PET, MRI, and histology in en bloc-resected oligodendrogliomas reveals intra-tumoral heterogeneity
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2019 (English)In: European Journal of Nuclear Medicine and Molecular Imaging, ISSN 1619-7070, E-ISSN 1619-7089, Vol. 46, no 3, p. 569-579Article in journal (Refereed) Published
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Computerized Image Processing
Identifiers
urn:nbn:se:uu:diva-356591 (URN)10.1007/s00259-018-4107-z (DOI)000457151600005 ()30109401 (PubMedID)
Funder
Erik, Karin och Gösta Selanders Foundation
Available from: 2018-08-14 Created: 2018-08-08 Last updated: 2019-04-06Bibliographically approved
Landtblom, A.-M. -., Katsarogiannis, E., Kristoffersson, A., Berntsson, S. G., Semnic, R. & Boström, I. (2018). Challenges in diagnosing OCB-negative MS - the importance of imaging. Paper presented at 34th Congress of the European-Committee-for-Treatment-and-Research-in-Multiple-Sclerosis (ECTRIMS), OCT 10-12, 2018, Berlin, GERMANY. Multiple Sclerosis, 24, 743-743
Open this publication in new window or tab >>Challenges in diagnosing OCB-negative MS - the importance of imaging
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2018 (English)In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 24, p. 743-743Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Sage Publications, 2018
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-369959 (URN)000446861402011 ()
Conference
34th Congress of the European-Committee-for-Treatment-and-Research-in-Multiple-Sclerosis (ECTRIMS), OCT 10-12, 2018, Berlin, GERMANY
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2018-12-17Bibliographically approved
Berntsson, S. G., Merrell, R. T., Amirian, E. S., Armstrong, G. N., Lachance, D., Smits, A., . . . Melin, B. S. (2018). Glioma-related seizures in relation to histopathological subtypes: a report from the glioma international case-control study. Journal of Neurology, 265(6), 1432-1442
Open this publication in new window or tab >>Glioma-related seizures in relation to histopathological subtypes: a report from the glioma international case-control study
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2018 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 265, no 6, p. 1432-1442Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The purpose of this study was to evaluate the distribution of glioma-related seizures and seizure control at the time of tumor diagnosis with respect to tumor histologic subtypes, tumor treatment and patient characteristics, and to compare seizure history preceding tumor diagnosis (or study enrollment) between glioma patients and healthy controls.

METHODS: The Glioma International Case Control study (GICC) risk factor questionnaire collected information on demographics, past medical/medication history, and occupational history. Cases from eight centers were also asked detailed questions on seizures in relation to glioma diagnosis; cases (n = 4533) and controls (n = 4171) were also asked about seizures less than 2 years from diagnosis and previous seizure history more than 2 years prior to tumor diagnosis, including childhood seizures.

RESULTS: Low-grade gliomas (LGGs), particularly oligodendrogliomas/oligoastrocytomas, had the highest proportion of glioma-related seizures. Patients with low-grade astrocytoma demonstrated the most medically refractory seizures. A total of 83% of patients were using only one antiepileptic drug (AED), which was levetiracetam in 71% of cases. Gross total resection was strongly associated with reduced seizure frequency (p < 0.009). No significant difference was found between glioma cases and controls in terms of seizure occurring more than 2 years before diagnosis or during childhood.

CONCLUSIONS: Our study showed that glioma-related seizures were most common in low-grade gliomas. Gross total resection was associated with lower seizure frequency. Additionally, having a history of childhood seizures is not a risk factor ***for developing glioma-related seizures or glioma.

Keywords
Epileptic seizures, Glioma-related seizures, Observational study (cohort, case–control), Primary brain tumor
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-349379 (URN)10.1007/s00415-018-8857-0 (DOI)000434462300023 ()29687214 (PubMedID)
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-08-30Bibliographically approved
Berntsson, S. G., Kristoffersson, A., Boström, I., Feresiadou, A., Burman, J. & Landtblom, A.-M. (2018). Rapidly increasing off-label use of rituximab in multiple sclerosis in Sweden: Outlier or predecessor?. Acta Neurologica Scandinavica, 138(4), 327-331
Open this publication in new window or tab >>Rapidly increasing off-label use of rituximab in multiple sclerosis in Sweden: Outlier or predecessor?
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2018 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 138, no 4, p. 327-331Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Off-label use of rituximab to treat MS patients in Sweden is high, and the need for long-term safety data may not be met. Our objectives were to assess the rate of rituximab prescription in patients with multiple sclerosis in Sweden and, in addition, to evaluate the safety of rituximab in a single centre for patients with multiple sclerosis.

MATERIAL AND METHODS: Review of the Swedish MS register was performed to study the number of MS patients treated with rituximab during the last 6 years. Investigation also included a retrospective review of medical files in search for possible side effects/adverse events in all adult patients with MS treated with rituximab at Uppsala University Hospital.

RESULTS: Presently, in Sweden the rate of rituximab prescriptions in relation to other annually started of disease- modifying drugs in MS is 53.5%.

CONCLUSIONS: The share of MS patients in Sweden who are treated with rituximab is very high, and also rapidly increasing. Taken into account the off-label use, cases with adverse medical conditions that could possibly be related to rituximab use should be reported thoroughly.

Keywords
adverse events, immunomodulatory drugs, multiple sclerosis, off-label prescription, pharmacotherapy, rituximab side effects
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-352681 (URN)10.1111/ane.12963 (DOI)000443931400009 ()29797711 (PubMedID)
Available from: 2018-06-07 Created: 2018-06-07 Last updated: 2018-11-06Bibliographically approved
Berntsson, S. G., Landtblom, A.-M. & Flensner, G. (2017). Cerebellar ataxia and intrathecal baclofen therapy: Focus on patients' experiences. PLoS ONE, 12(6), Article ID e0180054.
Open this publication in new window or tab >>Cerebellar ataxia and intrathecal baclofen therapy: Focus on patients' experiences
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 6, article id e0180054Article in journal (Refereed) Published
Abstract [en]

Elucidating patients' experiences of living with chronic progressive hereditary ataxia and the symptomatic treatment with intrathecal baclofen (ITB) is the objective of the current study. A multicenter qualitative study with four patients included due to the rare combination of hereditary ataxia and ITB therapy was designed to elucidate participants' experiences through semi-structured interviews. The transcribed text was analyzed according to content analysis guidelines. Overall we identified living in the present/ taking one day at a time as the main theme covering the following categories: 1) Uncertainty about the future as a consequence of living with a hereditary disease; The disease; 2) Impact on life as a whole, 3) Influence on personal life in terms of feeling forced to terminate employment, 4) Limiting daily activities, and 5) ITB therapy, advantages, and disadvantages. Uncertainty about the future was the category that affected participants' personal life, employment, and daily activities. The participants' experience of receiving ITB therapy was expressed in terms of improved quality of life due to better body position and movement as well as better sleep and pain relief.

National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-328061 (URN)10.1371/journal.pone.0180054 (DOI)000404541500051 ()28654671 (PubMedID)
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2017-11-29Bibliographically approved
Moraes-Fontes, M. F. & Berntsson, S. G. (2017). Comment on: PML in patients with systemic lupus erythematosus: a systematic literature review [Letter to the editor]. Lupus, 26(1), 106-106
Open this publication in new window or tab >>Comment on: PML in patients with systemic lupus erythematosus: a systematic literature review
2017 (English)In: Lupus, ISSN 0961-2033, E-ISSN 1477-0962, Vol. 26, no 1, p. 106-106Article in journal, Letter (Refereed) Published
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:uu:diva-315128 (URN)10.1177/0961203316655216 (DOI)000390847600015 ()
Available from: 2017-02-09 Created: 2017-02-09 Last updated: 2017-11-29Bibliographically approved
Falk Delgado, A., Fahlström, M., Nilsson, M., Berntsson, S. G., Zetterling, M., Libard, S., . . . Larsson, E.-M. (2017). Diffusion kurtosis imaging of gliomas grades II and III: a study of perilesional tumor infiltration, tumor grades and subtypes at clinical presentation. Radiology and Oncology, 51(2), 121-129
Open this publication in new window or tab >>Diffusion kurtosis imaging of gliomas grades II and III: a study of perilesional tumor infiltration, tumor grades and subtypes at clinical presentation
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2017 (English)In: Radiology and Oncology, ISSN 1318-2099, E-ISSN 1581-3207, Vol. 51, no 2, p. 121-129Article in journal (Refereed) Published
Abstract [en]

Background. Diffusion kurtosis imaging (DKI) allows for assessment of diffusion influenced by microcellular structures. We analyzed DKI in suspected low-grade gliomas prior to histopathological diagnosis. The aim was to investigate if diffusion parameters in the perilesional normal-appearing white matter (NAWM) differed from contralesional white matter, and to investigate differences between glioma malignancy grades II and III and glioma subtypes (astrocytomas and oligodendrogliomas).

Patients and methods. Forty-eight patients with suspected low-grade glioma were prospectively recruited to this institutional review board-approved study and investigated with preoperative DKI at 3T after written informed consent. Patients with histologically proven glioma grades II or III were further analyzed (n=35). Regions of interest (ROIs) were delineated on T2FLAIR images and co-registered to diffusion MRI parameter maps. Mean DKI data were compared between perilesional and contralesional NAWM (student's t-test for dependent samples, Wilcoxon matched pairs test). Histogram DKI data were compared between glioma types and glioma grades (multiple comparisons of mean ranks for all groups). The discriminating potential for DKI in assessing glioma type and grade was assessed with receiver operating characteristics (ROC) curves.

Results. There were significant differences in all mean DKI variables between perilesional and contralesional NAWM (p=< 0.000), except for axial kurtosis (p=0.099). Forty-four histogram variables differed significantly between glioma grades II (n=23) and III (n=12) (p=0.003-0.048) and 10 variables differed significantly between ACs (n=18) and ODs (n=17) (p=0.011-0.050). ROC curves of the best discriminating variables had an area under the curve (AUC) of 0.657-0.815.

Conclusions. Mean DKI variables in perilesional NAWM differ significantly from contralesional NAWM, suggesting altered microstructure by tumor infiltration not depicted on morphological MRI. Histogram analysis of DKI data identifies differences between glioma grades and subtypes.

Keywords
diffusion kurtosis imaging (DKI), glioma, perilesional, tumor infiltration, grade, subtype
National Category
Radiology, Nuclear Medicine and Medical Imaging Cancer and Oncology Clinical Laboratory Medicine
Research subject
Pathology
Identifiers
urn:nbn:se:uu:diva-323762 (URN)10.1515/raon-2017-0010 (DOI)000401697000001 ()
Funder
Swedish Cancer Society
Available from: 2017-06-09 Created: 2017-06-09 Last updated: 2019-03-29Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2251-5879

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