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Astradsson A, Sørensen NT, Graversen AS, Nemeiko I, Bilgin-Freiert A, Stephansen LV, Einarsson HB, Schougaard LMV, Juhler M, Hansen TS. Hydroflex: Use of Patient Reported Outcomes in a Clinical Setting Among Patients with Hydrocephalus. World Neurosurg 2023; 169:e67-e72. [PMID: 36270591 DOI: 10.1016/j.wneu.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/BACKGROUND A patient-reported outcome (PRO) measure is defined as "any report of the status of a patient's health condition that comes directly from the patient without interpretation of the patient's response by a clinician or anyone else". PRO data are increasingly being used in health care to facilitate monitoring of symptoms, facilitate communication between patients and clinicians, facilitate early identification of problems, and reduce unnecessary outpatient appointments for stable patients. METHODS We have designed a PRO system specifically for hydrocephalus, a program named Hydroflex. The aim of Hydroflex is to use PRO measures to decide the need for clinical attention and let the patients report their need regarding a physical consultation. Patients receive questionnaires at home instead of having prescheduled appointments at the outpatient clinic. Based on an automated algorithm, the patients' PRO measures are ranked to help clinical decision-making. RESULTS In this paper, we describe the implementation and early experience of Hydroflex at our institution. CONCLUSIONS It is our belief that Hydroflex provides more continuity in the treatment of patients with hydrocephalus. Also, it provides for a more standardized follow-up scheme, and we postulate this will lead to improved patient satisfaction and involvement and fewer outpatient appointments. Also, Hydroflex is useful for quality control and prospective research.
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Affiliation(s)
- Arnar Astradsson
- Department of neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
| | - Nanna Toxvig Sørensen
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | | | - Ivona Nemeiko
- Department of neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Liv Marit Valen Schougaard
- AmbuFlex - Center for Patient-reported Outcomes, Central Denmark Region, Gødstrup Hospital, Herning, Denmark
| | - Marianne Juhler
- Department of neurosurgery, Aarhus University Hospital, Aarhus, Denmark
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Boysen AK, Ording AG, Astradsson A, Høyer M, Spindler KL. Metastasis directed treatment of brain metastases from colorectal cancer - a Danish population-based cohort study. Acta Oncol 2020; 59:1118-1122. [PMID: 32441550 DOI: 10.1080/0284186x.2020.1769861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Brain metastases (BMs) are an uncommon presentation of metastatic colorectal cancer (mCRC) with reported incidence of about 2-4%. Today, there is an increased awareness towards a metastasis directed treatment approach with either surgical resection, stereotactic radiotherapy (SRT) or both. We examined patient characteristics and survival for patients treated with a localized modality for BM from CRC in a nationwide population-based study.Methods: A registry-based cohort study of all patients with a resected primary colorectal cancer and localized treatment of BM during 2000-2013. We computed descriptive statistics and analysed overall survival by the Kaplan-Meier method and Cox regression.Results: A total of 38131 patients had surgery for a primary CRC and 235 patients were recorded with a metastasis directed treatment for BM, comprising resection alone (n = 158), SRT alone (n = 51) and combined resection and SRT (n = 26). Rectal primary tumor (48.9% vs. 36.2%, p < .001) and lung metastasectomy (11.9 vs 2.8%, p < .001) were more frequent in the BM group. The median survival of patients receiving localized treatment for BM was 9.6 months (95% confidence interval (CI) 7.2-10.8). The 1- and 5-year overall survival were 41.7% (95% CI 35-48%) and 11.2% (95% CI 6.9-16.3%). In multivariate analysis, nodal stage was associated with increased mortality with a hazard ratio of 1.63 (95% CI 1.07-2.60, p = .03) for N2 stage with reference to N0.Conclusion: We report a median overall survival of 9.6 months for patients receiving localized treatment for BM from CRC. Lung metastases and rectal primary tumor are more common in the population treated for BM.
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Affiliation(s)
- A. K. Boysen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A. G. Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - A. Astradsson
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - M. Høyer
- Danish Center for Particle Therapy, Aarhus, Denmark
| | - K.-L. Spindler
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Astradsson A, Munck Af Rosenschöld P, Poulsgaard L, Ohlhues L, Engelholm SA, Feldt-Rasmussen U, Marsh R, Roed H, Juhler M. Cerebral infarction after fractionated stereotactic radiation therapy of benign anterior skull base tumors. Clin Transl Radiat Oncol 2019; 15:93-98. [PMID: 30815592 PMCID: PMC6378839 DOI: 10.1016/j.ctro.2019.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 01/15/2023] Open
Abstract
Background The purpose of this study was to examine the occurrence of cerebral infarction (ischemic stroke), in a large combined cohort of patients with anterior skull base meningiomas, pituitary adenomas and craniopharyngiomas, after fractionated stereotactic radiation therapy (FSRT). Material and Methods All patients, 18 years and older, with anterior skull base meningiomas, pituitary adenomas and craniopharyngiomas, treated with fractionated stereotactic radiation, in our center, from January 1999 to December 2015 were identified. In total 169 patients were included. The prescription dose to the tumor was 54 Gy for 164 patients (97%) and 46.0-52.2 Gy for 5 patients (3%). Cases of cerebral infarctions subsequent to FSRT were identified from the Danish National Patient Registry and verified with review of case notes. The rate of cerebral infarction after FSRT was compared to the rate in the general population with a one sample t-test after standardization for age and year. We explored if age, sex, disease type, radiation dose and dose per fraction was associated with increased risk of cerebral infarction using univariate Cox models. Results At a median follow-up of 9.3 years (range 0.1-16.5), 7 of the 169 patients (4.1%) developed a cerebral infarction, at a median 5.7 years (range 1.2-11.5) after FSRT. The mean cerebral infarction rate for the general population was 0.0035 and 0.0048 for the FSRT cohort (p = 0.423). Univariate cox models analysis showed that increasing age correlated significantly with the cerebral infarction risk, with a hazard ratio of 1.090 (p = 0.013). Conclusion Increased risk of cerebral infarction after FSRT of anterior skull base tumors was associated with age, similar to the general population. Our study revealed that FSRT did not introduce an excess risk of cerebral infarction.
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Affiliation(s)
- Arnar Astradsson
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Traumatic Brain Injury and Neurorehabilitation, Rigshospitalet, Hvidovre, Denmark
| | - Per Munck Af Rosenschöld
- Radiation Physics, Skåne University Hospital, Lund, Sweden.,Niels Bohr Institute, Copenhagen University, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Lars Ohlhues
- Department of Radiation Oncology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Reginald Marsh
- Gillies McIndoe Research Institute, Newtown, Wellington, New Zealand
| | - Henrik Roed
- Department of Radiation Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
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Harley B, Shivapathasundram G, Astradsson A, Muthurajah V, Wickremesekera A. An unusual presentation of cerebellar lymphoma. J Clin Neurosci 2018; 57:177-180. [PMID: 30146400 DOI: 10.1016/j.jocn.2018.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/30/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
We report a case of a 40 year old female who presented with a three month history of headaches with a background of Myasthenia Gravis (MG), treated with azathioprine. MRI brain demonstrated a rim-enhancing lesion in the left posterior fossa. CT scan of the chest abdomen and pelvis revealed no other lesion. The patient was taken for resection of the lesion via left retrosigmoid approach. Histologically the neoplasm was a large B-cell lymphoma, Epstein-Barr virus (EBV) positive, with clonality confirmed by IGH gene rearrangement studies. To the best of our knowledge this is the first case of primary central nervous system (CNS) EBV-positive diffuse large B-cell lymphoma of the posterior fossa in a patient with MG treated with azathioprine.
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Affiliation(s)
- Benjamin Harley
- Department of Neurosurgery, Wellington Hospital, Wellington, New Zealand.
| | | | - Arnar Astradsson
- Department of Neurosurgery, Wellington Hospital, Wellington, New Zealand; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Vanaja Muthurajah
- Department of Pathology, Wellington Hospital, Wellington, New Zealand
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Boysen A, Ording A, Astradsson A, Høyer M, Spindler K. Survival following curative indented treatment of brain metastases from colorectal cancer: A Danish population-based cohort study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy150.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Astradsson A, Munck af Rosenschöld P, Feldt-Rasmussen U, Poulsgaard L, Wiencke AK, Ohlhues L, Engelholm SA, Broholm H, Hansen Møller E, Klose M, Roed H, Juhler M. Visual outcome, endocrine function and tumor control after fractionated stereotactic radiation therapy of craniopharyngiomas in adults: findings in a prospective cohort. Acta Oncol 2017; 56:415-421. [PMID: 28084862 DOI: 10.1080/0284186x.2016.1270466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to examine visual outcome, endocrine function and tumor control in a prospective cohort of craniopharyngioma patients, treated with fractionated stereotactic radiation therapy (FSRT). MATERIAL AND METHODS Sixteen adult patients with craniopharyngiomas were eligible for analysis. They were treated with linear accelerator-based FSRT during 1999-2015. In all cases, diagnosis was confirmed by histological analysis. The prescription dose to the tumor was 54 Gy (median, range 48-54) in 1.8 or 2.0 Gy per fraction, and the maximum radiation dose to the optic nerves and chiasm was 54.2 Gy (median, range 48.6-60.0) for the cohort. Serial ophthalmological and endocrine evaluations and magnetic resonance imaging (MRI) scans were performed at regular intervals. Median follow-up was 3.3 years (range 1.1-14.1), 3.7 years (range 0.8-15.2), and 3.6 years (range 0.7-13.1) for visual outcome, endocrine function, and tumor control, respectively. RESULTS Visual acuity impairment was present in 10 patients (62.5%) and visual field defects were present in 12 patients (75%) before FSRT. One patient developed radiation-induced optic neuropathy at seven years after FSRT. Thirteen of 16 patients (81.3%) had pituitary deficiency before FSRT, and did not develop further pituitary deficiency after FSRT. Mean tumor volume pre-FSRT was 2.72 cm3 (range 0.20-9.90) and post-FSRT 1.2 cm3 (range 0.00-13.10). Tumor control rate was 81.3% at two, five, and 10 years after FSRT. CONCLUSIONS FSRT was relatively safe in this prospective cohort of craniopharyngiomas, with only one case of radiation-induced optic neuropathy and no case of new endocrinopathy. Tumor control rate was acceptable.
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Affiliation(s)
- Arnar Astradsson
- Department of Neurorehabilitation, Traumatic Brain Injury Unit, Rigshospitalet, Hvidovre, Denmark
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Lars Poulsgaard
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Lars Ohlhues
- Department of Radiation Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Svend Aage Engelholm
- Department of Radiation Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Helle Broholm
- Department of Neuropathology, Rigshospitalet, Copenhagen, Denmark
| | - Emil Hansen Møller
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Klose
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Roed
- Department of Radiation Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
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Affiliation(s)
- Arnar Astradsson
- Department of Neurorehabilitation, Traumatic Brain Injury Unit, Copenhagen University Hospital of Glostrup, Denmark
| | - Tipu Aziz
- Division of Clinical Neurology, Nuffield Department of Surgical Sciences, University of Oxford, UK
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Astradsson A, Aziz TZ. Parkinson's disease: fetal cell or stem cell-derived treatments. BMJ Clin Evid 2015; 2015:1203. [PMID: 25898159 PMCID: PMC4404982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The mean age of onset of Parkinson's disease is about 65 years, with a median time of 9 years between diagnosis and death. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical question: What are the effects of fetal cell or stem cell-derived therapy in people with Parkinson's disease? We searched: Medline, Embase, The Cochrane Library and other important databases up to September 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found two studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: fetal cell therapy versus deep brain stimulation; fetal cell therapy versus sham surgery; stem cell-derived therapy versus deep brain stimulation; stem cell-derived therapy versus sham surgery.
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Affiliation(s)
- Arnar Astradsson
- Department of Neurorehabilitation, Traumatic Brain Injury Unit, Copenhagen University Hospital of Glostrup, Copenhagen, Denmark
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Hallett PJ, Deleidi M, Astradsson A, Smith GA, Cooper O, Osborn TM, Sundberg M, Moore MA, Perez-Torres E, Brownell AL, Schumacher JM, Spealman RD, Isacson O. Successful function of autologous iPSC-derived dopamine neurons following transplantation in a non-human primate model of Parkinson's disease. Cell Stem Cell 2015; 16:269-74. [PMID: 25732245 DOI: 10.1016/j.stem.2015.01.018] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/17/2014] [Accepted: 01/30/2015] [Indexed: 12/12/2022]
Abstract
Autologous transplantation of patient-specific induced pluripotent stem cell (iPSC)-derived neurons is a potential clinical approach for treatment of neurological disease. Preclinical demonstration of long-term efficacy, feasibility, and safety of iPSC-derived dopamine neurons in non-human primate models will be an important step in clinical development of cell therapy. Here, we analyzed cynomolgus monkey (CM) iPSC-derived midbrain dopamine neurons for up to 2 years following autologous transplantation in a Parkinson's disease (PD) model. In one animal, with the most successful protocol, we found that unilateral engraftment of CM-iPSCs could provide a gradual onset of functional motor improvement contralateral to the side of dopamine neuron transplantation, and increased motor activity, without a need for immunosuppression. Postmortem analyses demonstrated robust survival of midbrain-like dopaminergic neurons and extensive outgrowth into the transplanted putamen. Our proof of concept findings support further development of autologous iPSC-derived cell transplantation for treatment of PD.
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Affiliation(s)
- Penelope J Hallett
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA
| | - Michela Deleidi
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA
| | - Arnar Astradsson
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA
| | - Gaynor A Smith
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA
| | - Oliver Cooper
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA
| | - Teresia M Osborn
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA
| | - Maria Sundberg
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA
| | - Michele A Moore
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA; New England Primate Research Center, Harvard Medical School, Southborough, MA 01772, USA
| | - Eduardo Perez-Torres
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA
| | - Anna-Liisa Brownell
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA; MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - James M Schumacher
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA
| | - Roger D Spealman
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA; New England Primate Research Center, Harvard Medical School, Southborough, MA 01772, USA
| | - Ole Isacson
- Neuroregeneration Research Institute, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA; Harvard Stem Cell Institute, Cambridge, MA 02138, USA.
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Sundberg M, Bogetofte H, Lawson T, Jansson J, Smith G, Astradsson A, Moore M, Osborn T, Cooper O, Spealman R, Hallett P, Isacson O. Improved cell therapy protocols for Parkinson's disease based on differentiation efficiency and safety of hESC-, hiPSC-, and non-human primate iPSC-derived dopaminergic neurons. Stem Cells 2014; 31:1548-62. [PMID: 23666606 DOI: 10.1002/stem.1415] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 04/01/2013] [Indexed: 12/22/2022]
Abstract
The main motor symptoms of Parkinson's disease are due to the loss of dopaminergic (DA) neurons in the ventral midbrain (VM). For the future treatment of Parkinson's disease with cell transplantation it is important to develop efficient differentiation methods for production of human iPSCs and hESCs-derived midbrain-type DA neurons. Here we describe an efficient differentiation and sorting strategy for DA neurons from both human ES/iPS cells and non-human primate iPSCs. The use of non-human primate iPSCs for neuronal differentiation and autologous transplantation is important for preclinical evaluation of safety and efficacy of stem cell-derived DA neurons. The aim of this study was to improve the safety of human- and non-human primate iPSC (PiPSC)-derived DA neurons. According to our results, NCAM(+) /CD29(low) sorting enriched VM DA neurons from pluripotent stem cell-derived neural cell populations. NCAM(+) /CD29(low) DA neurons were positive for FOXA2/TH and EN1/TH and this cell population had increased expression levels of FOXA2, LMX1A, TH, GIRK2, PITX3, EN1, NURR1 mRNA compared to unsorted neural cell populations. PiPSC-derived NCAM(+) /CD29(low) DA neurons were able to restore motor function of 6-hydroxydopamine (6-OHDA) lesioned rats 16 weeks after transplantation. The transplanted sorted cells also integrated in the rodent brain tissue, with robust TH+/hNCAM+ neuritic innervation of the host striatum. One year after autologous transplantation, the primate iPSC-derived neural cells survived in the striatum of one primate without any immunosuppression. These neural cell grafts contained FOXA2/TH-positive neurons in the graft site. This is an important proof of concept for the feasibility and safety of iPSC-derived cell transplantation therapies in the future.
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Affiliation(s)
- Maria Sundberg
- Neuroregeneration Laboratories, Harvard Medical School/McLean Hospital, Belmont, Massachusetts, USA
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Astradsson A, Wiencke AK, Munck af Rosenschold P, Engelholm SA, Ohlhues L, Roed H, Juhler M. Visual outcome after fractionated stereotactic radiation therapy of benign anterior skull base tumors. J Neurooncol 2014; 118:101-8. [PMID: 24532196 PMCID: PMC4023078 DOI: 10.1007/s11060-014-1399-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 01/31/2014] [Indexed: 12/25/2022]
Abstract
To determine visual outcome including the occurrence of radiation induced optic neuropathy (RION) as well as tumor control after fractionated stereotactic radiation therapy (FSRT) of benign anterior skull base meningiomas or pituitary adenomas. Thirty-nine patients treated with FSRT for anterior skull base meningiomas and 55 patients treated with FSRT for pituitary adenomas between January 1999 and December 2009 with at least 2 years follow-up were included. Patients were followed up prospectively with magnetic resonance imaging scans, visual acuity and visual field examinations. RION was found in four (10 %) patients with anterior skull base meningiomas and seven patients (13 %) with pituitary adenomas. The five-year actuarial freedom from 25 % RION visual field loss was 94 % following FSRT. Actuarial 2-, 5- and 10-year tumor control rates were 100, 88.4 and 64.5 % for anterior skull base meningiomas and 100, 98.2 and 94.9 % for pituitary adenomas, respectively. Patients with an impaired visual field function pre-FSRT were more likely to experience worsened function (p = 0.016). We found that RION, was a relatively uncommon event, in a large prospective cohort of patients that were systematically monitored following FSRT of benign anterior skull base tumors. Long term tumor control was favorable, especially for pituitary adenomas.
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Affiliation(s)
- Arnar Astradsson
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark,
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Abstract
Background Brain abscess is a potentially fatal disease. This study assesses clinical aspects of brain abscess in a large hospital cohort. Methods Retrospective review of adult patients with pyogenic brain abscess at Rigshospitalet University Hospital, Denmark between 1994 and 2009. Prognostic factors associated with Glasgow Outcome Score (GOS) (death, severe disability or vegetative state) were assessed by logistic regression. Results 102 patients were included. On admission, only 20% of patients had a triad of fever, headache and nausea, 39% had no fever, 26% had normal CRP and 49% had no leucocytosis. Median delay from symptom onset to antibiotic treatment was 7 days (range 0–97 days). Source of infection was contiguous in 36%, haematogenous in 28%, surgical or traumatic in 9% and unknown in 27% of cases. Abscess location did not accurately predict the portal of entry. 67% were treated by burr hole aspiration, 20% by craniotomy and 13% by antibiotics alone. Median duration of antibiotic treatment was 62 days. No cases of recurrent abscess were observed. At discharge 23% had GOS ≤3. The 1-, 3- and 12-month mortality was 11%, 17% and 19%. Adverse outcome was associated with a low GCS at admission, presence of comorbidities and intraventricular rupture of abscess. Conclusions The clinical signs of brain abscess are unspecific, many patients presented without clear signs of infection and diagnosis and treatment were often delayed. Decreased GCS, presence of comorbidities and intraventricular rupture of brain abscess were associated with poor outcome. Brain abscess remains associated with considerable morbidity and mortality.
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Affiliation(s)
- Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Yoon WS, Kim JT, Han YM, Chung DS, Park YS, Lizarraga KJ, Allen-Auerbach M, De Salles AA, Yong WH, Chen W, Ruge MI, Kickingereder P, Simon T, Treuer H, Sturm V, D'Alessandro PR, Jarrett J, Walling SA, Fleetwood IG, Kim TG, Lim DH, McGovern SL, Grosshans D, McAleer MF, Chintagumpala M, Khatua S, Vats T, Mahajan A, Beauchesne PD, Faure G, Noel G, Schmitt T, Martin L, Jadaud E, Carnin C, Astradsson A, Rosenschold PMA, Lund AKW, Feldt-Rasmussen U, Roed H, Juhler M, Kumar N, Kumar R, Sharma SC, Mukherjee KK, Khandelwal N, Kumar R, Gupta PK, Bansal A, Kapoor R, Ghosal S, Barney CL, Brown AP, Lowe MC, McAleer MF, Grosshans DR, de Groot JF, Puduvalli V, Gilbert MR, Vats TS, Brown PD, Mahajan A, Pollock BE, Stafford SL, Link MJ, Brown PD, Garces YI, Foote RL, Ryu S, Kim EY, Yechieli R, Kim JK, Mikkelsen T, Kalkanis S, Rock J, Prithviraj GK, Oppelt P, Arfons L, Cuneo KC, Vredenburgh J, Desjardins A, Peters K, Sampson J, Chang Z, Kirkpatrick J, Nath SK, Sheridan AD, Rauch PJ, Contessa JN, Yu JB, Knisely JP, Minja FJ, Vortmeyer AO, Chiang VL, Koto M, Hasegawa A, Takagi R, Sasahara G, Ikawa H, Kamada T, Iwadate Y, Matsutani M, Kanner AA, Sela G, Gez E, Matceyevsky D, Strauss N, Corn BW, Brachman DG, Smith KA, Nakaji P, Sorensen S, Redmond KJ, Mahone EM, Kleinberg L, Terezakis S, McNutt T, Agbahiwe H, Cohen K, Lim M, Wharam M, Horska A, Amendola B, Wolf A, Coy S, Blach L, Mesfin F, Suki D, Mahajan A, Rao G, Palkonda VAR, More N, Ganesan P, Kesavan R, Shunmugavel M, Kasirajan T, Maram VR, Kakkar S, Upadhyay P, Das S, Nigudgi S, Katz JS, Knisely JP, Ghaly M, Schulder M, Palkonda VAR, More N, Shunmugavel M, Kasirajan T, Ganesan P, Kakkar S, Maram VR, Nigudgi S, Upadhyay P, Das S, Kesavan R, Taylor RB, Schaner PE, Dragovic AF, Markert JM, Guthrie BL, Dobelbower MC, Spencer SA, Fiveash JB, Katz JS, Knisely JP, Ghaly M, Schulder M, Chen L, Guerrero-Cazares H, Ford E, McNutt T, Kleinberg L, Lim M, Quinones-Hinojosa A, Redmond K, Wernicke AG, Chao KC, Nori D, Parashar B, Yondorf M, Boockvar JA, Pannullo S, Stieg P, Schwartz TH, Leeman JE, Clump DA, Flickinger JC, Burton SA, Mintz AH, Heron DE, O'Neil SH, Wong K, Buranahirun C, Gonzalez-Morkos B, Brown RJ, Hamilton A, Malvar J, Sposto R, Dhall G, Finlay J, Olch A, Reddy K, Damek D, Gaspar L, Ney D, Kavanagh B, Waziri A, Lillehei K, Stuhr K, Chen C, Kalakota K, Offor O, Patel R, Dess R, Schumacher A, Helenowski I, Marymont M, Sperduto P, Chmura SJ, Mehta M, Zadeh G, Shi W, Liu H, Studenski M, Fu L, Peng C, Gunn V, Rudoler S, Farrell C, Andrews D, Chu J, Turian J, Rooney JW, Ramiscal JAB, Laack NN, Shah K, Surucu M, Melian E, Anderson D, Prabhu V, Origitano T, Sethi A, Emami B. CLIN-RADIATION THERAPY. Neuro Oncol 2012; 14:vi133-vi141. [PMCID: PMC3488792 DOI: 10.1093/neuonc/nos238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
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Astradsson A, Schweder P, Joint C, Forrow B, Thevathasan W, Pereira EA, Green AL, Aziz TZ. THALAMOTOMY FOR POSTAPOPLECTIC HEMIBALLISTIC CHOREA IN OLDER ADULTS. J Am Geriatr Soc 2010; 58:2240-1. [DOI: 10.1111/j.1532-5415.2010.03111.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cooper O, Astradsson A, Hallett P, Robertson H, Mendez I, Isacson O. Lack of functional relevance of isolated cell damage in transplants of Parkinson's disease patients. J Neurol 2009; 256 Suppl 3:310-6. [PMID: 19711122 DOI: 10.1007/s00415-009-5242-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Postmortem analyses from clinical neural transplantation trials of several subjects with Parkinson's disease revealed surviving grafted dopaminergic neurons after more than a decade. A subset of these subjects displayed isolated dopaminergic neurons within the grafts that contained Lewy body-like structures. In this review, we discuss why this isolated cell damage is unlikely to affect the overall graft function and how we can use these observations to help us to understand age-related neurodegeneration and refine our future cell replacement therapies.
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Affiliation(s)
- Oliver Cooper
- Center for Neuroregeneration Research, NINDS Udall Parkinson's Disease Research Center of Excellence, McLean Hospital, Harvard Medical School, Harvard University, MRC 130, 115 Mill Street, Belmont, MA 02478, USA
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Isacson O, Hallett P, Astradsson A, Cooper O, Robertson H, Mendez I. O.106 Post-mortem analyses of fetal transplants of dopamine neurons in Parkinson's disease patients reveal no or minimal pathology. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Only seven pairs of identical twins with intracranial aneurysms have been reported in the literature. In six of these, both twins had aneurysms, but in one pair only one twin had an aneurysm. We present another such pair of identical twins 21 years of age of whom only one twin had an aneurysm. She presented with a subarachnoid haemorrhage. Four-vessel angiography showed one aneurysm on the internal carotid artery; the aneurysm was clipped. Four-vessel angiography in her identical twin sister revealed no aneurysms. We have reviewed the seven previous reports of identical twins with intracranial aneurysms. We conclude that in case of an aneurysm in one identical twin, the other twin should be examined.
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Affiliation(s)
- A Astradsson
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
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Astradsson A, Jenkins BG, Choi JK, Hallett PJ, Levesque MA, McDowell JS, Brownell AL, Spealman RD, Isacson O. The blood-brain barrier is intact after levodopa-induced dyskinesias in parkinsonian primates--evidence from in vivo neuroimaging studies. Neurobiol Dis 2009; 35:348-51. [PMID: 19501164 DOI: 10.1016/j.nbd.2009.05.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 05/06/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022] Open
Abstract
It has been suggested, based on rodent studies, that levodopa (L-dopa) induced dyskinesia is associated with a disrupted blood-brain barrier (BBB). We have investigated BBB integrity with in vivo neuroimaging techniques in six 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) lesioned primates exhibiting L-dopa-induced dyskinesia. Magnetic resonance imaging (MRI) performed before and after injection of Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) revealed an intact BBB in the basal ganglia showing that l-dopa-induced dyskinesia is not associated with a disrupted BBB in this model.
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Affiliation(s)
- Arnar Astradsson
- Harvard University and McLean Hospital, NINDS Udall Parkinson's Disease Research Center of Excellence, Belmont, MA 02478, USA
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Abstract
In this review, the authors discuss recent advances in the field of cell therapy for Parkinson disease (PD). They compare and contrast recent clinical trials using fetal dopaminergic neurons. They attribute differences in cell preparation techniques, cell type specification, and immunosuppression as reasons for variable outcome and for some of the side effects observed in these clinical trials. To address ethical, practical, and technical issues related to the use of fetal cell sources, alternative sources of therapeutic dopaminergic neurons are being developed. The authors describe the progress in enrichment and purification strategies of stem cell-derived dopaminergic midbrain neurons. They conclude that recent advances in cell therapy for PD will create a viable long-term treatment option for synaptic repair for this debilitating disease.
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Affiliation(s)
- Arnar Astradsson
- NINDS Udall Parkinson's Disease Research Center of Excellence, Harvard University and McLean Hospital, Belmont, Massachusetts 02478, USA
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Mendez I, Viñuela A, Astradsson A, Mukhida K, Hallett P, Robertson H, Tierney T, Holness R, Dagher A, Trojanowski JQ, Isacson O. Dopamine neurons implanted into people with Parkinson's disease survive without pathology for 14 years. Nat Med 2008; 14:507-9. [PMID: 18391961 DOI: 10.1038/nm1752] [Citation(s) in RCA: 316] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 03/11/2008] [Indexed: 02/02/2023]
Abstract
Postmortem analysis of five subjects with Parkinson's disease 9-14 years after transplantation of fetal midbrain cell suspensions revealed surviving grafts that included dopamine and serotonin neurons without pathology. These findings are important for the understanding of the etiopathogenesis of midbrain dopamine neuron degeneration and future use of cell replacement therapies.
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Affiliation(s)
- Ivar Mendez
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Division of Neurosurgery and Department of Anatomy & Neurobiology, 1976 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
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Astradsson A, Dons K, Gjerris F, Hauerberg J, Jørgensen L, Juhler M, Kosteljanetz M, Møller CM, Bøg-Rasmussen T. [Lumbar puncture 2]. Ugeskr Laeger 2006; 168:595-6. [PMID: 16476228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Abstract
PURPOSE We wished to determine incidence, clinical features, and prognosis of benign rolandic seizures (BRS) and benign rolandic epilepsy (BRE) in a total population. METHODS Cases were ascertained through review of all EEG records, and diagnosis was verified by review of medical records. Follow-up information regarding seizures and treatment was obtained from parents and treating physicians. RESULTS In the Icelandic population aged 3-15 years, the incidence of BRS is 6.2 and BRE 4.7 in 100,000. Five years after onset 95% were seizure-free. At last follow-up, all were seizure free and had not been treated with antiepileptic drugs (AEDs) for at least 1 year. CONCLUSIONS Our study demonstrates that BRS is a common entity in children. The prognosis is excellent and treatment is not necessary in all cases. It is important to identify BRE/BRS correctly and distinguish it from other types of epilepsy.
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Affiliation(s)
- A Astradsson
- Department of Neurology, National University Hospital (Landspitalinn), Reykjavik, Iceland
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