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Bergenheim, A. Tommy
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Publications (10 of 77) Show all publications
Gunnarsson, S., Lemming, D., Alehagen, S., Bergenheim, T., Gerdle, B. & Samuelsson, K. (2023). Patients' expectations before initiation of intrathecal baclofen treatment: a longitudinal study with 1-year follow-up. Journal of Rehabilitation Medicine, 55, Article ID jrm00371.
Open this publication in new window or tab >>Patients' expectations before initiation of intrathecal baclofen treatment: a longitudinal study with 1-year follow-up
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2023 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 55, article id jrm00371Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate patients' expectations, met/unmet expectations and satisfaction with intrathecal baclofen treatment in relation to effect on spasticity, pain intensity, sleep quality, occupational performance, well-being and self-efficacy.

Design: A prospective longitudinal study with follow-up at 1 year.

Patients: Consecutive patients, age ≥ 18 years with a disabling spasticity of cerebral or spinal origin selected for intrathecal baclofen treatment at 2 university hospitals in Sweden were included. From August 2016 to June 2019, 35 patients began intrathecal baclofen treatment; 29 patients were included and completed the study.

Methods: Baseline and 1-year follow-up included assessment of spasticity by physiotherapists, a semi-structured interview regarding occupational performance using the Canadian Occupational Performance Measure and a questionnaire.

Results: Overall satisfaction with treatment and satisfaction with occupational performance were reported as moderate. Important variables that explained satisfaction with occupational performance were improvements in performance, expectations and performance before treatment. Patients had higher expectations compared with the 1-year outcomes regarding occupational performance, spasticity, pain intensity and sleep quality, although improvements were reported.

Conclusion: A thorough discussion of goal setting with intrathecal baclofen treatment before implantation is necessary to give patients individual and realistic expectations.

Place, publisher, year, edition, pages
Medical journals Sweden, 2023
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-204668 (URN)10.2340/jrm.v55.3424 (DOI)000927466400001 ()36718657 (PubMedID)2-s2.0-85147157965 (Scopus ID)
Available from: 2023-02-10 Created: 2023-02-10 Last updated: 2023-09-05Bibliographically approved
Björkblom, B., Wibom, C., Eriksson, M., Bergenheim, A. T., Sjöberg, R. L., Jonsson, P., . . . Melin, B. S. (2022). Distinct metabolic hallmarks of WHO classified adult glioma subtypes. Neuro-Oncology, 24(9), 1454-1468, Article ID noac042.
Open this publication in new window or tab >>Distinct metabolic hallmarks of WHO classified adult glioma subtypes
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2022 (English)In: Neuro-Oncology, ISSN 1522-8517, E-ISSN 1523-5866, Vol. 24, no 9, p. 1454-1468, article id noac042Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Gliomas are complex tumors with several genetic aberrations and diverse metabolic programs contributing to their aggressive phenotypes and poor prognoses. This study defines key metabolic features that can be used to differentiate between glioma subtypes, with potential for improved diagnostics and subtype targeted therapy.

METHODS: Cross-platform global metabolomic profiling coupled with clinical, genetic, and pathological analysis of glioma tissue from 224 tumors - oligodendroglioma (n=31), astrocytoma (n=31) and glioblastoma (n=162) - were performed. Identified metabolic phenotypes were evaluated in accordance with the WHO classification, IDH-mutation, 1p/19q-codeletion, WHO-grading 2-4, and MGMT promoter methylation.

RESULTS: Distinct metabolic phenotypes separate all six analyzed glioma subtypes. IDH-mutated subtypes, expressing 2-hydroxyglutaric acid, were clearly distinguished from IDH-wildtype subtypes. Considerable metabolic heterogeneity outside of the mutated IDH pathway were also evident, with key metabolites being high expression of glycerophosphates, inositols, monosaccharides and sugar alcohols and low levels of sphingosine and lysoglycerophospholipids in IDH-mutants. Among the IDH-mutated subtypes, we observed high levels of amino acids, especially glycine and 2-aminoadipic acid, in grade 4 glioma, and N-acetyl aspartic acid in low-grade astrocytoma and oligodendroglioma. Both IDH-wildtype and mutated oligodendroglioma and glioblastoma were characterized by high levels of acylcarnitines, likely driven by rapid cell growth and hypoxic features. We found elevated levels of 5-HIAA in gliosarcoma and a subtype of oligodendroglioma not yet defined as a specific entity, indicating a previously not described role for the serotonin pathway linked to glioma with bimorphic tissue.

CONCLUSION: Key metabolic differences exist across adult glioma subtypes.

Place, publisher, year, edition, pages
Oxford University Press, 2022
Keywords
Astrocytoma, Glioblastoma, Metabolic reprogramming, Oligodendroglioma, WHO classification
National Category
Cancer and Oncology
Research subject
Molecular Biology; Pathology; Oncology
Identifiers
urn:nbn:se:umu:diva-192529 (URN)10.1093/neuonc/noac042 (DOI)000785708300001 ()35157758 (PubMedID)2-s2.0-85137137374 (Scopus ID)
Funder
Swedish Cancer Society, 2018/390Swedish Cancer Society, 2013/0291Swedish Cancer Society, 19 0370Swedish Research Council, 2019-01566Cancerforskningsfonden i Norrland, AMP17-899Cancerforskningsfonden i Norrland, AMP17- 882Sjöberg Foundation, 2020-01-07-08
Available from: 2022-05-17 Created: 2022-05-17 Last updated: 2023-05-23Bibliographically approved
Bergenheim, A. T. & Bergenheim, Å. (2021). Hjärnor och hjärtan: Lars Leksell : neurokirurgen, innovatören, humanisten. Stockholm: Carlsson Bokförlag
Open this publication in new window or tab >>Hjärnor och hjärtan: Lars Leksell : neurokirurgen, innovatören, humanisten
2021 (Swedish)Book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Carlsson Bokförlag, 2021. p. 342
National Category
Humanities and the Arts Medical and Health Sciences
Research subject
History Of Sciences and Ideas; History; Medical Humanities; Neurosurgery
Identifiers
urn:nbn:se:umu:diva-192358 (URN)9789189063501 (ISBN)
Available from: 2022-02-10 Created: 2022-02-10 Last updated: 2022-02-11Bibliographically approved
Bergman, J., Burman, J., Bergenheim, A. T. & Svenningsson, A. (2021). Intrathecal treatment trial of rituximab in progressive MS: results after a 2-year extension. Journal of Neurology, 268(2), 651-657
Open this publication in new window or tab >>Intrathecal treatment trial of rituximab in progressive MS: results after a 2-year extension
2021 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 268, no 2, p. 651-657Article in journal (Refereed) Published
Abstract [en]

Objectives: To evaluate the effect of intrathecally (IT) delivered rituximab as a therapeutic intervention for progressive multiple sclerosis (PMS) during a 3-year follow-up period.

Methods: Participants of a 1-year open-label phase 1b study of IT delivered rituximab to patients with PMS were offered extended treatment with follow-up for an additional 2 years. During the extension phase, treatment with 25 mg rituximab was administered every 6 months via a subcutaneous Ommaya reservoir connected to the right frontal horn with a ventricular catheter.

Results: Mild to moderate vertigo and nausea occurred in 4 out of 14 participants as temporary adverse events associated with IT rituximab infusion. During the entire 3-year period, two cases of low-virulent bacterial meningitis occurred, which were successfully treated. Walking speed deteriorated significantly during the study.

Conclusions: IT administration of rituximab via a ventricular catheter was well tolerated. Considering the meningitis cases, the risk of infection was not negligible. The continued loss of walking speed indicates that IT rituximab was not able to stop disease progression.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2021
Keywords
Multiple sclerosis, Rituximab, Intrathecal, Progressive MS, Treatment, Clinical trial
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-175373 (URN)10.1007/s00415-020-10210-0 (DOI)000567784200002 ()32901316 (PubMedID)2-s2.0-85090434104 (Scopus ID)
Funder
Region Västerbotten
Available from: 2020-09-29 Created: 2020-09-29 Last updated: 2022-05-03Bibliographically approved
Stålnacke, M., Bergenheim, A. T. & Sjöberg, R. L. (2021). Neuropsychological function and quality of life after resection of suspected lower-grade glioma in the face primary motor area. Journal of Clinical Medicine, 10(4), Article ID 580.
Open this publication in new window or tab >>Neuropsychological function and quality of life after resection of suspected lower-grade glioma in the face primary motor area
2021 (English)In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 4, article id 580Article in journal (Refereed) Published
Abstract [en]

The negative side effects of neurosurgical resection of the lower third of the primary motorcortex (M1) are often described as relatively mild. However, detailed descriptions of how theseresections affect neurocognitive function, speech, mental health and quality of life (QoL) are sparse. Inthe present study, seven patients with suspected lower-grade glioma (WHO II-III) in the inferior M1were assessed for facial motor function, cognitive function, anxiety and QoL before and after awakesurgical resections. The main finding was that after surgery, six of the seven patients experienced amild facial motor dysfunction, mainly affecting the mouth, tongue and throat. At the group level,we were also able to observe a significant postoperative decline in maximum verbal speed, whereasno negative effects on measures of word production (i.e., verbal fluency) were seen. Self-reportedQoL data suggest that some patients experienced increased social isolation postoperatively but donot lend support to the interpretation that this was caused by direct neurological side effects of thesurgery. The results appear to support the general notion that awake surgery in the lower M1 canbe performed safely and with postoperative deficits that are most often perceived by the patient astolerable.

Place, publisher, year, edition, pages
MDPI, 2021
Keywords
glioma resections, quality of life, onco-functional balance, anxietym, awake craniotomy
National Category
Neurology Surgery Cancer and Oncology Psychology
Research subject
Neurosurgery
Identifiers
urn:nbn:se:umu:diva-179636 (URN)10.3390/jcm10040580 (DOI)000624012700001 ()33557128 (PubMedID)2-s2.0-85114075701 (Scopus ID)
Funder
Region VästerbottenSjöberg FoundationSwedish Cancer Society
Available from: 2021-02-05 Created: 2021-02-05 Last updated: 2023-04-19Bibliographically approved
Tabatabaei, P., Asklund, T., Bergström, P., Björn, E., Johansson, M. & Bergenheim, A. T. (2020). Intratumoral retrograde microdialysis treatment of high-grade glioma with cisplatin. Acta Neurochirurgica, 162(12), 3043-3053
Open this publication in new window or tab >>Intratumoral retrograde microdialysis treatment of high-grade glioma with cisplatin
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2020 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 162, no 12, p. 3043-3053Article in journal (Refereed) Published
Abstract [en]

Purpose: This study evaluates the application of a microdialysis technique for interstitial chemotherapy using cisplatin in high-grade glioma.

Method: An in vitro study demonstrated that cisplatin can be administered through retrograde microdialysis and defined the recovery for cisplatin. In a subsequent phase I study, 1–4 microdialysis catheters were implanted in tumor tissue, brain adjacent to tumor (BAT) tissue, and subcutaneous tissue in 10 patients with recurrent high-grade glioma. Cisplatin was administered continuously in daily doses between 0.3 and 3.9 mg for 4 to12 days. Microdialysis samples were continuously collected and analyzed for glucose metabolites, glutamate, glycerol, and cisplatin concentrations. Treatment tolerability was evaluated through clinical monitoring. Quality of life was assessed using the EORTC-QLQ-C30 questionnaire for up to 3 months after treatment.

Results: This in vitro study showed that cisplatin could be administrated with a recovery of 41–97%, depending on flowrate, type of catheter, and cisplatin concentration. During the treatment, patients were exposed to a total dose of 1.2–36.8 mg cisplatin. The concentration of cisplatin in BAT, serum, and subcutaneous tissue was close to detection level in all but two patients. A transient neurologic deterioration due to edema was commonly observed, but no systemic side effects were recorded. After onset of treatment, concentrations of glutamate and glycerol were significantly increased in tumor tissue but not in BAT, with a peak after 3 days, and consistent for the rest of the treatment. Five of the patients survived between 153 and 492 days after treatment.

Conclusion: This phase I study demonstrates that retrograde microdialysis can be used to administer cisplatin interstitially into high-grade glioma tissue. A high cytotoxicity was detected in tumor tissue, but not in the surrounding brain. Retrograde microdialysis appears to be a clinically useful method for intratumoral drug administration in high-grade glioma.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
Retrograde microdialysis, Malignant glioma, Cisplatin, Brain microdialysis, Interstitial, Chemotherapy
National Category
Cancer and Oncology Surgery
Identifiers
urn:nbn:se:umu:diva-173750 (URN)10.1007/s00701-020-04488-2 (DOI)000548470200001 ()32666378 (PubMedID)2-s2.0-85087876038 (Scopus ID)
Funder
Swedish Cancer SocietySwedish Research CouncilCancerforskningsfonden i NorrlandRegion Västerbotten
Available from: 2020-07-31 Created: 2020-07-31 Last updated: 2023-03-24Bibliographically approved
Bergman, J., Svenningsson, A., Liv, P., Bergenheim, A. T. & Burman, J. (2020). Location matters: highly divergent protein levels in samples from diferent CNS compartments in a clinical trial of rituximab for progressive MS. Fluids and Barriers of the CNS (1), Article ID 49.
Open this publication in new window or tab >>Location matters: highly divergent protein levels in samples from diferent CNS compartments in a clinical trial of rituximab for progressive MS
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2020 (English)In: Fluids and Barriers of the CNS, E-ISSN 2045-8118, no 1, article id 49Article in journal (Refereed) Published
Abstract [en]

Background: The relationship between proteins in different CNS extracellular compartments is unknown. In this study the levels of selected proteins in three compartments in people with progressive multiple sclerosis (PMS) were compared.

Methods: During an open label, phase 1b study on intraventricular administration of rituximab for PMS, samples were collected from the interstitial space (ISS) of the brain through microdialysis. Samples were also obtained from ventricular and lumbar cerebrospinal fluid (CSF). These samples were analyzed with a multiplexed proximity extension assay, measuring the levels of 180 proteins split equally between two panels, detecting proteins associated with immunology and neurology, respectively.

Results: Considerable differences in concentrations were observed between the three analyzed compartments. Compared to ventricular CSF, ISS fluid contained statistically significant higher levels of 25 proteins (84% immunology panel and 16% neurology panel). Ventricular CSF contained significantly higher levels of 54 proteins (31% immunology panel and 69% neurology panel) compared to ISS fluid, and 17 proteins (76% immunology panel and 24% neurology panel) compared to lumbar CSF. Lumbar CSF showed significantly higher levels of 115 proteins (32% immunology panel and 68% neurology panel) compared to ventricular CSF. The three compartments displayed poor correlation with a median Spearman’s rho of -0.1 (IQR 0.4) between ISS and ventricular CSF and 0.3 (IQR 0.4) between ventricular and lumbar CSF.

Conclusion: A substantial heterogeneity in the protein levels of samples obtained from different CNS compartments was seen. Therefore, data obtained from analysis of lumbar CSF should be interpreted with caution when making conclusions about pathophysiological processes in brain tissue.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Cerebrospinal fuid, Microdialysis, Ventricular CSF, Lumbar CSF, Interstitial fuid, CSF compartments, CSF proteins, Progressive MS
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-169319 (URN)10.1186/s12987-020-00205-4 (DOI)000557471600001 ()32727487 (PubMedID)2-s2.0-85088850911 (Scopus ID)
Funder
Region Västerbotten
Note

Originally included in thesis in manuscript form, with title: "Location matters: highly divergent protein levels in samples from different CNS compartments"

Available from: 2020-03-31 Created: 2020-03-31 Last updated: 2024-01-17Bibliographically approved
Björkblom, B., Jonsson, P., Tabatabaei, P., Bergström, P., Johansson, M., Asklund, T., . . . Antti, H. (2020). Metabolic response patterns in brain microdialysis fluids and serum during interstitial cisplatin treatment of high-grade glioma. British Journal of Cancer, 122(2), 221-232
Open this publication in new window or tab >>Metabolic response patterns in brain microdialysis fluids and serum during interstitial cisplatin treatment of high-grade glioma
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2020 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 122, no 2, p. 221-232Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: High-grade gliomas are associated with poor prognosis. Tumour heterogeneity and invasiveness create challenges for effective treatment and use of systemically administrated drugs. Furthermore, lack of functional predictive response-assays based on drug efficacy complicates evaluation of early treatment responses.

METHODS: We used microdialysis to deliver cisplatin into the tumour and to monitor levels of metabolic compounds present in the tumour and non-malignant brain tissue adjacent to tumour, before and during treatment. In parallel, we collected serum samples and used multivariate statistics to analyse the metabolic effects.

RESULTS: We found distinct metabolic patterns in the extracellular fluids from tumour compared to non-malignant brain tissue, including high concentrations of a wide range of amino acids, amino acid derivatives and reduced levels of monosaccharides and purine nucleosides. We found that locoregional cisplatin delivery had a strong metabolic effect at the tumour site, resulting in substantial release of glutamic acid, phosphate, and spermidine and a reduction of cysteine levels. In addition, patients with long-time survival displayed different treatment response patterns in both tumour and serum. Longer survival was associated with low tumour levels of lactic acid, glyceric acid, ketoses, creatinine and cysteine. Patients with longer survival displayed lower serum levels of ketohexoses, fatty acid methyl esters, glycerol-3-phosphate and alpha-tocopherol, while elevated phosphate levels were seen in both tumour and serum during treatment.

CONCLUSION: We highlight distinct metabolic patterns associated with high-grade tumour metabolism, and responses to cytotoxic cisplatin treatment.

Place, publisher, year, edition, pages
Nature Publishing Group, 2020
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-167291 (URN)10.1038/s41416-019-0652-x (DOI)000510823600009 ()31819184 (PubMedID)2-s2.0-85076541777 (Scopus ID)
Funder
Swedish Cancer SocietySwedish Research Council
Available from: 2020-01-15 Created: 2020-01-15 Last updated: 2023-03-23Bibliographically approved
Stålnacke, M., Solowska, K., Bergenheim, T. & Sjöberg, R. L. (2020). Phenomenology of glioma resection in the dorsal medial frontal cortex. Acta Neurologica Scandinavica, 142(3), 216-220
Open this publication in new window or tab >>Phenomenology of glioma resection in the dorsal medial frontal cortex
2020 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 142, no 3, p. 216-220Article in journal, Editorial material (Refereed) Published
Abstract [en]

BACKGROUND: During the latest decades the hypothesis that the subjective experience of free will is determined by preconscious activity in the dominant dorsal medial frontal cortex (dMFC) has repeatedly challenged our commonly held concepts of moral responsibility.

AIMS OF THE STUDY: To investigate whether dMFC activity determines the sense of free will and to investigate effects of resections in this area on Quality of life (QoL).

METHODS: A cohort of nine patients affected by transient declines in speech and movement skills after surgery involving the left dMFC answered questions about their postoperative, subjective experiences of volition in relation to symptoms. In eight cases resections were performed as part of glioma surgery and in the ninth case a meningioma adjacent to the dMFC was resected. In addition, a QoL questionnaire was administrated before and after surgery.

RESULTS: None of the patients perceived the transient disabilities related to surgery as associated with a loss or absence of volition. No declines in QoL were detected after surgery. Two QoL domains showed improved function (motor dysfunction and future uncertainty).

CONCLUSIONS:The subjective sense of volition is not contingent on dMFC activity. Surgical resections of this area are not typically associated with declines in QoL.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
higher cortical functions, neurooncology, quality of life
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-169262 (URN)10.1111/ane.13245 (DOI)000554574100004 ()32198926 (PubMedID)2-s2.0-85082967562 (Scopus ID)
Available from: 2020-03-27 Created: 2020-03-27 Last updated: 2023-04-19Bibliographically approved
Eriksson, M., Kahari, J., Vestman, A., Hallmans, M., Johansson, M., Bergenheim, A. T. & Sandström, M. (2019). Improved treatment of glioblastoma: changes in survival over two decades at a single regional Centre. Acta Oncologica, 58(3), 334-341
Open this publication in new window or tab >>Improved treatment of glioblastoma: changes in survival over two decades at a single regional Centre
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2019 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 58, no 3, p. 334-341Article in journal (Refereed) Published
Abstract [en]

Background: Glioblastoma (GBM) is an aggressive brain tumor with a short overall survival (OS) in general. The treatment of GBM has evolved over the last decades and is today multimodal including surgical resection followed by radiochemotherapy and adjuvant chemotherapy for patients in good performance status. The aim of this study was to evaluate the development of treatment and the outcome for GBM patients at a single regional center.

Patients and methods: Survival was studied for 571 patients in our region diagnosed with GBM between 1995 and 2015. Samples from 244 patients out of those treated 2005-2015 have been included in a tissue/blood bank and a clinical database has been set up with basic patient characteristics and details on surgery and non-surgical treatment.

Results: The median OS for all patients from 1995 to 2015 was 9.3 months. There was a stepwise improvement from 6.9 to 10.3 months for patients diagnosed 1995-1996 and 2010-2015, respectively (p<.05). The 2-year survival for the same time periods improved from 7% to 18% (p<.01). After introduction of postoperative radiochemotherapy for patients in good performance status in 2005 an increased OS was noted and following implementation of intraoperative 5-aminolevulinic acid the number of tumor resection 95% did increase from 33% to 54% (p<.001). Positive prognostic factors for survival were young age, good performance status, absence of inflammatory disease, absence of diabetes or metabolic disease, tumor resection 95%, and completion of postoperative radiochemotherapy.

Discussion: The results of this study are consistent with earlier results regarding survival and prognostic factors and confirm results from randomized controlled trials in a clinical setting. Despite the improvements made, the prognosis is still dismal and the need for further research on GBM treatment is great.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-158751 (URN)10.1080/0284186X.2019.1571278 (DOI)000462947900011 ()30732527 (PubMedID)2-s2.0-85061246023 (Scopus ID)
Available from: 2019-05-15 Created: 2019-05-15 Last updated: 2023-03-24Bibliographically approved
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