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Publications (10 of 22) Show all publications
Steensland, I., Koskinen, L.-O. D. & Lindvall, P. (2019). Treatment of Restless legs with a pump; efficacy and complications. Acta Neurologica Scandinavica
Open this publication in new window or tab >>Treatment of Restless legs with a pump; efficacy and complications
2019 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: Restless legs (RLS) has a prevalence of 2.5-15 % in the general population.. For those who suffer from a medically refractory RLS, intrathecal morphine treatment has been shown to be effective. The aim of this retrospective study was to investigate efficacy, complications and side effects in patients treated over several years with an implantable pump. A comparison was done to a group of patients treated with a similar pump system due to spasticity.

MATERIALS AND METHODS: The charts of ten patients with severe or very severe RLS have been reviewed. These patients have received an intrathecal drug delivery system during 2000 -2016. To compare the rate of complications, a control group of 20 patients treated with intrathecal baclofen due to spasticity was included in the study. Their time of treatment corresponded to the RLS patients'.

RESULTS: The severity of symptoms related to RLS decreased significantly after treatment. Doses required ranged from 68 to 140 µg/day. Two cases of side effects were detected; one case with nausea and dizziness and one case with headache and fatigue. The rate of mechanical-, infectious- and other complications were similar between the two groups.

CONCLUSIONS: In light of the decrease in symptom severity and the low rate of side effects, intrathecal morphine can be considered an adequate treatment for those suffering from medically refractory RLS. The occurrence of complications did not differ between subjects with RLS and spasticity.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Intrathecal Morphine, Restless legs, complications
National Category
Neurology
Research subject
Neurosurgery
Identifiers
urn:nbn:se:umu:diva-167469 (URN)10.1111/ane.13213 (DOI)31883387 (PubMedID)
Available from: 2020-01-22 Created: 2020-01-22 Last updated: 2020-01-24
Magaard, G., Wester, P., Levi, R., Lindvall, P., Gustafsson, E., Nazemroaya Sedeh, A., . . . Hu, X.-L. (2018). Identifying unmet rehabilitation needs in patients after stroke with a graphic rehab-compassTM. Journal of Stroke & Cerebrovascular Diseases, 27(11), 3224-3235
Open this publication in new window or tab >>Identifying unmet rehabilitation needs in patients after stroke with a graphic rehab-compassTM
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2018 (English)In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 27, no 11, p. 3224-3235Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic "Rehab-Compass," a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients' rehabilitation needs in clinical practice.

METHODS: A new graphic overview of broad unmet rehabilitation needs covers deficits in functioning, daily activity, participation, and quality of life. It was constructed by using 5 patient-oriented, well-validated, and reliable existing instruments with converted data into a 0 (worst outcome) to 100 (best outcome) scale but unchanged in terms of variable properties. Satisfaction of the Rehab-CompassTM was studied by a qualitative interview of 9 patients with stroke and 3 clinicians. Practical feasibility and capacity of the instrument were evaluated in a cross-sectionalstudy with 48 patients at 5-month follow-ups after subarachnoid hemorrhage.

RESULTS: The Rehab-CompassTM identified and graphically visualized a panoramic view of the multidimensional needs over time which was completed before clinical consultation. The Rehab-CompassTM appeared to be feasible and time-efficientin clinical use. The interviews of both patients and clinicians showed high satisfaction when using the Rehab-CompassTM graph. In the studied stroke patients, the Rehab-CompassTM identified memory and processing information, fatigue, mood, and pain after subarachnoid hemorrhage as the most common problems.

CONCLUSIONS: The graphic Rehab-CompassTM seems to be a feasible, useful, and time-saving tool for identification of unmet rehabilitation needs among stroke survivors in clinical practice. Further research is needed to make the Rehab-CompassTM more concise and evaluate the instrument among different stroke subgroups.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
stroke, needs assessment, outcome and process assessment, quality improvement, referral and consultation, rehabilitation
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-153269 (URN)10.1016/j.jstrokecerebrovasdis.2018.07.013 (DOI)000450569700044 ()30097401 (PubMedID)
Funder
Västerbotten County CouncilSwedish Heart Lung Foundation
Available from: 2018-11-13 Created: 2018-11-13 Last updated: 2019-11-19Bibliographically approved
Sjöberg, R. L., Bergenheim, T., Mörén, L., Antti, H., Lindgren, C., Naredi, S. & Lindvall, P. (2015). Blood Metabolomic Predictors of 1-Year Outcome in Subarachnoid Hemorrhage. Neurocritical Care, 23(2), 225-232
Open this publication in new window or tab >>Blood Metabolomic Predictors of 1-Year Outcome in Subarachnoid Hemorrhage
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2015 (English)In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 23, no 2, p. 225-232Article in journal (Refereed) Published
Abstract [en]

Delayed neurological deficit (DND) is the most important cause of morbidity and mortality in patients with subarachnoid hemorrhage (SAH) whose aneurysms have been secured. However, the methods currently used to predict the development of DND, such as trans-cranial Doppler or levels biochemical markers in blood and cerebrospinal fluid are not very accurate. Venous blood was drawn from 50 patients with SAH, admitted to the neurosurgical department UmeAyen University Hospital, at day 1-3 and day 7 after the bleed. The clinical status of the patients was followed up approximately 1 year after this episode and classified according to the Glasgow Outcome Score (GOS). Results showed considerable differences in blood metabolomic patterns between day 1-3 and 7 after the hemorrhage. Fifty-six out of 98 metabolites could be identified from our in-house library and 17 of these metabolites changed significantly from day 1-3 to 7 after the bleed. One of these, myo-inositol, was predictive of clinical outcome even after correction for multiple testing. An estimation of the diagnostic accuracy of high levels of this substance in predicting good outcome (GOS 4-5) yielded a sensitivity of .763 and a specificity of .5 at the optimal cut off point. SAH is an event with a profound effect on blood metabolomics profiles. Myo-inositol might be an interesting compound for future study to focus on in the search for metabolic markers in venous blood of delayed neurological deterioration in SAH patients.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
Delayed neurological deficit, Myo-inositol, Metabolomics, Subarachnoid hemorrhage, Vasospasm, nous blood
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-109362 (URN)10.1007/s12028-014-0089-2 (DOI)000360700700012 ()25667130 (PubMedID)
Available from: 2015-09-30 Created: 2015-09-25 Last updated: 2018-06-07Bibliographically approved
Lindvall, P., Grayson, D., Bergström, P. & Bergenheim, A. T. (2015). Hypofractionated stereotactic radiotherapy in medium-sized to large arteriovenous malformations. Journal of clinical neuroscience, 22(6), 955-958
Open this publication in new window or tab >>Hypofractionated stereotactic radiotherapy in medium-sized to large arteriovenous malformations
2015 (English)In: Journal of clinical neuroscience, ISSN 0967-5868, E-ISSN 1532-2653, Vol. 22, no 6, p. 955-958Article in journal (Refereed) Published
Abstract [en]

We have reviewed treatment results in terms of obliteration and complications in 24 patients with medium to large sized cerebral arteriovenous malformations (AVMs) (mean volume 18.5 +/- 8.9 cm(3); range: 10-42) treated with hypofractionated stereotactic radiotherapy (HSRT). AVMs are congenital lesions associated with a high morbidity and mortality. Radiosurgery is one option for treatment. However, in larger AVMs with volumes exceeding 10 cm(3) obliteration rates are less favourable and radiation induced complications more frequent. For larger AVMs, volume-staged radiosurgery is one option while another option may be the use of HSRT. Patients were treated with 6-7 Gy in five fractions to a total dose of 30-35 Gy (mean total dose 32.9 +/- 1.6 Gy [standard error of the mean]). Sixteen patients (69.6%) showed obliteration after a mean time of 35.2 +/- 14.8 months (range: 24-60). Only one patient (4.2%) experienced symptomatic radionecrosis. Our treatment with HSRT seems safe and efficient for treatment of medium to large sized AVMs. Treatment results seem to be in line with volume-staged radiosurgery and may be an alternative for AVMs not suitable for single fraction radiosurgery.

Keywords
Arteriovenous malformations, Linear accelerator, Radiosurgery, Treatment results
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-106122 (URN)10.1016/j.jocn.2014.12.015 (DOI)000355050300006 ()25827867 (PubMedID)
Available from: 2015-07-14 Created: 2015-07-09 Last updated: 2018-06-07Bibliographically approved
Lindgren, C., Hultin, M., Koskinen, L.-O. D., Lindvall, P., Borota, L. & Naredi, S. (2014). ADMA levels and arginine/ADMA ratios reflect severity of disease and extent of inflammation after subarachnoid hemorraghe. Neurocritical Care, 21(1), 91-101
Open this publication in new window or tab >>ADMA levels and arginine/ADMA ratios reflect severity of disease and extent of inflammation after subarachnoid hemorraghe
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2014 (English)In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 21, no 1, p. 91-101Article in journal (Refereed) Published
Abstract [en]

Background: Subarachnoid hemorrhage (SAH) is characterized by an inflammatory response that might induce endothelial dysfunction. The aim of this study was to evaluate if ADMA and arginine/ADMA ratios after SAH (indicators of endothelial dysfunction) are related to clinical parameters, inflammatory response, and outcome.

Methods: Prospective observational study. ADMA, arginine, C-reactive protein (CRP), and cytokines were obtained 0–240 h (h) after SAH. Definition of severe clinical condition was Hunt&Hess (H&H) 3–5 and less severe clinical condition H&H 1–2. Impaired cerebral circulation was assessed by clinical examination, transcranial doppler, CT-scan, and angiography. Glasgow outcome scale (GOS) evaluated the outcome.

Results: Compared to admission, 0–48 h after SAH, the following was observed 49–240 h after SAH; (a) ADMA was significantly increased at 97–240 h (highest 217–240 h), (b) CRP was significantly increased at 49–240 h (highest 73–96 h), (c) interleukin-6 (IL-6) was significantly lower at 97–240 h (highest 49–96 h), p < 0.05. ADMA, CRP, and IL-6 were significantly lower and peak arginine/ADMA ratio was significantly higher in patients with H&H 1–2 compared to patients with H&H 3–5, p < 0.05. The peak ADMA or the nadir arginine/ADMA ratio did not differ significantly between patients with (55 %) or without (45 %) signs of impaired cerebral circulation. The peak ADMA or the nadir arginine/ADMA ratio did not differ significantly between patients with GOS 1–3 and patients with GOS 4–5.

Conclusions: ADMA increased significantly after SAH, and the increase in ADMA started after the pro-inflammatory markers (CRP and IL-6) had peaked. This might indicate that endothelial dysfunction, with ADMA as a marker, is induced by a systemic inflammation.

Place, publisher, year, edition, pages
Humana Press, 2014
Keywords
ADMA, subarachnoid hemorrage, inflammation, interleukin
National Category
Anesthesiology and Intensive Care Neurosciences Neurology
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:umu:diva-87531 (URN)10.1007/s12028-013-9945-8 (DOI)000339350500014 ()24408146 (PubMedID)
Funder
Swedish Society for Medical Research (SSMF)
Available from: 2014-04-02 Created: 2014-04-02 Last updated: 2018-06-08Bibliographically approved
Bobinski, L., Koskinen, L.-O. D. & Lindvall, P. (2013). Complications following cranioplasty using autologous bone or polymethylmethacrylate-Retrospective experience from a single center. Clinical neurology and neurosurgery (Dutch-Flemish ed. Print), 115(9), 1788-1791
Open this publication in new window or tab >>Complications following cranioplasty using autologous bone or polymethylmethacrylate-Retrospective experience from a single center
2013 (English)In: Clinical neurology and neurosurgery (Dutch-Flemish ed. Print), ISSN 0303-8467, E-ISSN 1872-6968, Vol. 115, no 9, p. 1788-1791Article in journal (Refereed) Published
Abstract [en]

Objective: A decompressive hemicraniectomy is a potentially life-saving intervention following head trauma. Once performed patients are obliged to undergo a second procedure with cranioplasty. Two of the most commonly used materials are autologous bone and polymethylmethacrylate (PMMA). We have now evaluated complications following a cranioplasty using these materials. Materials and methods: During a 7-year period (2002-2008) 49 patients were operated with a decompressive craniectomy following head trauma. Patients received a cranioplasty consisting of autologous bone (30 patients, 61.2%) or PMMA (19 patients, 38.8%) and were followed at least 24 months. Patient data were collected retrospectively. Results: Twenty patients (20/49, 40.8%) experienced a complication that prompted a re-operation. There was a significantly higher rate of complications leading to a re-operation (53.3% vs. 21.1%, p = 0.03) and a shorter survival time of the cranioplasty (mean 48.1 +/- 7.8 vs. 79.5 +/- 9.0 months, p = 0.035) in patients with autologous bone compared to PMMA. Bone resorption and the presence of postoperative hematomas were significantly more common in patients with autologous bone. The material used for cranioplasty was the only variable that significantly correlated to the rate of complications. Conclusions: In our series we had a high percentage of patients needing re-operation due to complications following a cranioplasty. Though generally considered a straightforward procedure, complications and associated morbidity in patients undergoing cranioplasty should not be underestimated. 

Keywords
Decompressive hemicraniectomy, Cranioplasty, Autologous bone, Polymethylmethacrylate, Complications
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-82299 (URN)10.1016/j.clineuro.2013.04.013 (DOI)000324787900039 ()
Available from: 2013-12-02 Created: 2013-10-29 Last updated: 2018-06-08Bibliographically approved
Lindgren, C., Dahlqvist, P., Lindvall, P., Nilsson, L., Koskinen, L.-O. & Naredi, S. (2013). Cortisol levels are influenced by sedation in the acute phase after subarachnoid haemorrhage. Acta Anaesthesiologica Scandinavica, 57(4), 452-460
Open this publication in new window or tab >>Cortisol levels are influenced by sedation in the acute phase after subarachnoid haemorrhage
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2013 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 4, p. 452-460Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Subarachnoid haemorrhage (SAH) is a life-threatening condition that may be aggravated by acute pituitary damage and cortisol insufficiency. Robust diagnostic criteria for critical illness-related corticosteroid insufficiency (CIRCI) are lacking. The aim of this study was to assess the frequency of CIRCI in the acute phase (0-240 h) after SAH and to evaluate associations between cortisol levels and clinical parameters (sedation, circulatory failure, gender, age, severity of disease, treatment). CIRCI was defined as a single morning serum cortisol (mSC) < 200 nmol/L. The lower limit for calculated free cortisol (cFC) was set at < 22 nmol/L, and for saliva cortisol at < 7.7 nmol/L.

METHODS: Fifty patients were included. Serum/saliva cortisol and corticosteroid-binding globulin were obtained every second morning. A logistic regression model was used for multivariate analysis comparing cortisol levels with clinical parameters.

RESULTS: Of the patients, 21/50 (42%) had an mSC < 200 nmol/L and 30/50 (60%) had a cFC < 22 nmol/L. In patients with continuous intravenous sedation, the odds ratio for a mSC to be < 200 nmol/L was 18 times higher (95% confidence interval 4.2-85.0, P < 0.001), and the odds ratio for a cFC to be < 22 nmol/L was 2.4 times higher (95% confidence interval 1.2-4.7, P < 0.05) compared with patients with no continuous intravenous sedation.

CONCLUSIONS: Continuous intravenous sedation was significantly associated with cortisol values under defined limits (mSC < 200, cFC < 22 nmol/L). The possibility that sedating drugs per se may influence cortisol levels should be taken into consideration before CIRCI is diagnosed.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-64100 (URN)10.1111/aas.12014 (DOI)000316138800006 ()23167448 (PubMedID)
Available from: 2013-01-15 Created: 2013-01-15 Last updated: 2018-06-08Bibliographically approved
Lindvall, P. & Koskinen, L.-O. D. (2013). Intracranial Hypertension due to Cerebral Venous Sinus Thrombosis following Head Trauma: A Report of Two Cases.. Case Reports in Neurology, 5(3), 168-174
Open this publication in new window or tab >>Intracranial Hypertension due to Cerebral Venous Sinus Thrombosis following Head Trauma: A Report of Two Cases.
2013 (English)In: Case Reports in Neurology, ISSN 1662-680X, E-ISSN 1662-680X, Vol. 5, no 3, p. 168-174Article in journal (Refereed) Published
Abstract [en]

Cerebral venous sinus thrombosis (CVST) may occur following head trauma and contribute to intracranial hypertension that mandates immediate action. Anticoagulant therapy is the first line of treatment in CVST but may not be applicable in patients with head trauma. Here, we report on the treatment of 2 patients with CVST. In 1 patient, there was an attempt to perform thrombectomy and thrombolysis, and eventually a decompressive craniectomy was performed. In this patient, there was an excellent outcome. In the other patient, an immediate decompressive craniectomy was performed that did not improve the outcome.

Keywords
Cerebral venous sinus thrombosis, Decompressive craniectomy, Head trauma, Intracranial hypertension, Thrombectomy
National Category
Neurology
Research subject
Neurosurgery
Identifiers
urn:nbn:se:umu:diva-167873 (URN)10.1159/000355394 (DOI)24163673 (PubMedID)
Available from: 2020-02-05 Created: 2020-02-05 Last updated: 2020-02-06Bibliographically approved
Lindvall, P., Hariz, G.-M. & Blomstedt, P. (2013). Overall self-perceived health in Restless legs treated with intrathecal morphine. Acta Neurologica Scandinavica, 127(4), 268-273
Open this publication in new window or tab >>Overall self-perceived health in Restless legs treated with intrathecal morphine
2013 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 127, no 4, p. 268-273Article in journal (Refereed) Published
Abstract [en]

Objectives Restless legs syndrome (RLS) has a high prevalence in the general population. Treatment with intrathecal morphine has been shown to be successful in a small number of patients. Our aim was to quantify the effect on RLS-related symptoms, health and quality of life in three patients treated with intrathecal morphine. Materials and Methods Three patients with medically refractory RLS received an implanted pump for delivery of intrathecal morphine. Severity of RLS and self-assessed health were rated using the International Restless Legs Syndrome Study Group (IRLSSG) rating scale and the Short Form health survey (SF-36). Assessments were made preoperatively and after 6months of follow-up. Results Preoperatively two patients had very severe RLS, scoring 35 and 36 on the IRLSSG rating scale, and one patient had severe RLS (score, 26). All three patients were free of symptoms of RLS post-operatively and also at the 6-month follow-up. The daily doses of intrathecal morphine ranged from 73 to 199 mu g. Results from the SF-36 health survey showed that all three patients had a better physical health compared to before surgery. Conclusion Intrathecal morphine may be efficient in the treatment for medically refractory RLS. All three patients became completely free of symptoms, and there was also improvement in self-perceived overall health.

National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-68251 (URN)10.1111/j.1600-0404.2012.01707.x (DOI)000316215900008 ()
Available from: 2013-04-18 Created: 2013-04-15 Last updated: 2018-06-08Bibliographically approved
Lindvall, P. & Blomstedt, P. (2012). Cerebral oedema as a complication following treatment of a giant arachnoid cyst [Letter to the editor]. Acta Neurochirurgica, 154(8), 1417-1418
Open this publication in new window or tab >>Cerebral oedema as a complication following treatment of a giant arachnoid cyst
2012 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 154, no 8, p. 1417-1418Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Wien, Austria: Springer, 2012
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-60334 (URN)10.1007/s00701-012-1401-6 (DOI)000307242500013 ()
Available from: 2012-11-06 Created: 2012-10-09 Last updated: 2018-06-08Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-9552-2957

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