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Vågberg, Mattias
Alternative names
Publications (10 of 19) Show all publications
Salzer, J., Granåsen, G., Sundström, P., Vågberg, M. & Svenningsson, A. (2020). Prevention of post-dural puncture headache: a randomized controlled trial. European Journal of Neurology
Open this publication in new window or tab >>Prevention of post-dural puncture headache: a randomized controlled trial
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2020 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background and purpose: We investigated 952 subjects undergoing diagnostic lumbar puncture (LP) to study the effects of needle size, needle design and stylet reinsertion on the risk of post‐dural puncture headache (PDPH).

Methods: This randomized double‐blind study was performed at Umeå University Hospital in Sweden during 2013–2018. Subjects were randomly assigned one of three needles [22 gauge (G) atraumatic, 25G atraumatic and 25G cutting] and stylet reinsertion before needle withdrawal or not. The main outcome measure was PDPH assessed by standardized telephone interview(s) 5 days after the LP, repeated until headache cessation. We used logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CI) for PDPH.

Results: The mean (SD) age was 51.1 (16.7) years and 53.6% were females. The smaller bore (25G) atraumatic needle incurred a lower risk of headache compared with the larger bore (22G) atraumatic needle [22.0% (69/314) vs. 30.2% (98/324); OR, 0.65; 95% CI, 0.45–0.93] and compared with the cutting needle [32.8% (103/314); OR, 0.58; 95% CI, 0.40–0.82]. Reinserting the stylet before needle withdrawal did not reduce the risk of headache.

Conclusions: These data suggest that a 25G atraumatic needle is superior to a larger atraumatic needle, and to a same‐sized cutting needle, in preventing PDPH after diagnostic LP. In contrast to one earlier report, this study did not find that stylet reinsertion was effective in preventing PDPH. This study provides class I evidence that a small atraumatic needle decreases the risk of PDPH and that stylet reinsertion does not influence PDPH risk.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2020
Keywords
headache, lumbar puncture, post-dural puncture headache, randomized controlled trial
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-168838 (URN)10.1111/ene.14158 (DOI)000514599100001 ()31997481 (PubMedID)
Available from: 2020-03-19 Created: 2020-03-19 Last updated: 2020-03-19
Vågberg, M., Granåsen, G. & Svenningsson, A. (2017). Brain parenchymal fraction in healthy adults: a systematic review of the literature. PLoS ONE, 12(1), Article ID e0170018.
Open this publication in new window or tab >>Brain parenchymal fraction in healthy adults: a systematic review of the literature
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 1, article id e0170018Article in journal (Refereed) Published
Abstract [en]

Brain atrophy is an important feature of many neurodegenerative disorders. It can be described in terms of change in the brain parenchymal fraction (BPF). In order to interpret the BPF in disease, knowledge on the BPF in healthy individuals is required. The aim of this study was to determine data on the BPF of healthy individuals via a systematic review of the literature. The databases PubMed and Scopus were searched and 95 articles, including a total of 9269 individuals, were identified including the required data. We present values of BPF from healthy individuals stratified by age and post-processing method. The BPF correlated with age and there were significant differences in age-adjusted BPF between methods. This study contributes to increased knowledge on BPF in healthy individuals, which may assist in the interpretation of BPF in the setting of disease. We highlight the differences between post-processing methods and the need for a consensus gold standard. 

National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-128695 (URN)10.1371/journal.pone.0170018 (DOI)000392372300051 ()28095463 (PubMedID)
Available from: 2016-12-12 Created: 2016-12-12 Last updated: 2018-06-09Bibliographically approved
Vågberg, M., Axelsson, M., Birgander, R., Burman, J., Cananau, C., Forslin, Y., . . . Wikström, J. (2017). Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society. Acta Neurologica Scandinavica, 135(1), 17-24
Open this publication in new window or tab >>Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society
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2017 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 135, no 1, p. 17-24Article, review/survey (Refereed) Published
Abstract [en]

Multiple sclerosis (MS) is associated with inflammatory lesions in the brain and spinal cord. The detection of such inflammatory lesions using magnetic resonance imaging (MRI) is important in the consideration of the diagnosis and differential diagnoses of MS, as well as in the monitoring of disease activity and predicting treatment efficacy. Although there is strong evidence supporting the use of MRI for both the diagnosis and monitoring of disease activity, there is a lack of evidence regarding which MRI protocols to use, the frequency of examinations, and in what clinical situations to consider MRI examination. A national workshop to discuss these issues was held in Stockholm, Sweden, in August 2015, which resulted in a Swedish consensus statement regarding the use of MRI in the care of individuals with MS. The aim of this consensus statement is to provide practical advice for the use of MRI in this setting. The recommendations are based on a review of relevant literature and the clinical experience of workshop attendees. It is our hope that these recommendations will benefit individuals with MS and guide healthcare professionals responsible for their care.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2017
Keywords
guidelines, magnetic resonance imaging, multiple sclerosis, recommendations
National Category
Radiology, Nuclear Medicine and Medical Imaging Neurology
Identifiers
urn:nbn:se:umu:diva-129699 (URN)10.1111/ane.12667 (DOI)000389421400002 ()27558404 (PubMedID)
Available from: 2017-01-10 Created: 2017-01-09 Last updated: 2018-06-09Bibliographically approved
Vågberg, M., Ambarki, K., Lindqvist, T., Birgander, R. & Svenningsson, A. (2016). Brain parenchymal fraction in an age-stratified healthy population: determined by MRI using manual segmentation and three automated segmentation methods. Journal of neuroradiology, 43(6), 384-391
Open this publication in new window or tab >>Brain parenchymal fraction in an age-stratified healthy population: determined by MRI using manual segmentation and three automated segmentation methods
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2016 (English)In: Journal of neuroradiology, ISSN 0150-9861, E-ISSN 1773-0406, Vol. 43, no 6, p. 384-391Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: Brain atrophy is a prominent feature in many neurodegenerative diseases, such as multiple sclerosis, but age-related decrease of brain volume occurs regardless of pathological neurodegeneration. Changes in brain volume can be described by use of the brain parenchymal fraction (BPF), most often defined as the ratio of total brain parenchyma to total intracranial space. The BPF is of interest both in research and in clinical practice. To be able to properly interpret this variable, the normal range of BPF must be known. The objective of this study is to present normal values for BPF, stratified by age, and compare manual BPF measurement to three automated methods. MATERIALS AND METHODS: The BPFs of 106 healthy individuals aged 21 to 85 years were determined by the automated segmentation methods SyMap, VBM8 and SPM12. In a subgroup of 54 randomly selected individuals, the BPF was also determined by manual segmentation. RESULTS: The median (IQR) BPFs of the whole study population were 0.857 (0.064), 0.819 (0.028) and 0.784 (0.073) determined by SyMap, VBM8 and SPM12, respectively. The BPF decreased with increasing age. The correlation coefficients between manual segmentation and SyMap, VBM8 and SPM12 were 0.93 (P<0.001), 0.77 (P<0.001) and 0.56 (P<0.001), respectively. CONCLUSIONS: There was a clear relationship between increasing age and decreasing BPF. Knowledge of the range of normal BPF in relation to age group will help in the interpretation of BPF data. The automated segmentation methods displayed varying degrees of similarity to the manual reference, with SyMap being the most similar.

Place, publisher, year, edition, pages
Masson Editeur, 2016
Keywords
BPF, Brain atrophy, SPM, SyMap, VBM
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-128693 (URN)10.1016/j.neurad.2016.08.002 (DOI)000391158900004 ()27720265 (PubMedID)2-s2.0-84995584817 (Scopus ID)
Available from: 2016-12-12 Created: 2016-12-12 Last updated: 2018-06-09Bibliographically approved
Vågberg, M. (2016). Brain parenchymal fraction in healthy individuals and in clinical follow-up of multiple sclerosis. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Brain parenchymal fraction in healthy individuals and in clinical follow-up of multiple sclerosis
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Multiple sclerosis (MS) is an autoimmune disease characterised by inflammatory damage to the central nervous system (CNS). Accumulated CNS injury can be quantified as brain atrophy, definable as a reduction in brain parenchymal fraction (BPF). BPF correlate with disability in MS and is used routinely as an endpoint in clinical trials. In 2009/2010, a new MS clinical care program, that includes follow-up of BPF, was introduced at Umeå University Hospital (NUS). Levels of neurofilament light polypetide (NFL) and glial fibrillary acidic protein (GFAP) in cerebrospinal fluid (CSF) are markers of axonal and astrocytic injury, respectively, and also potential surrogate biomarkers for BPF decline. The goals of this thesis were to establish age-adjusted values of BPF in healthy individuals and to relate these to the BPF values from individuals with MS as well as to the levels of NFL and GFAP in CSF. Another goal was to investigate if expanded disability status scale (EDSS)-worsening could be predicted in a clinical MS cohort and if BPF measurements could contribute to such predictions. Methods A group of 111 healthy individuals volunteered to participate in the studies. A total of 106 of these underwent MRI with BPF measurements, 53 underwent lumbar puncture (LP) with measurement of NFL and GFAP and 48 underwent both MRI and LP. Three different automatic and one manual method were utilised to determine BPF. A literature search on BPF in healthy individuals was performed for the purpose of a systematic review. For studying disability progression in MS, all individuals with MS followed at NUS and included in the Swedish MS registry were included if they had matched data on BPF, EDSS and lesion load as part of clinical follow-up (n=278). Results BPF as well as NFL and GFAP levels in CSF were all associated with age. NFL was associated with BPF and GFAP, but only the association with GFAP was retained when adjusting for age. Significant differences were found between different methods for BPF determination. In the MS population, BPF was associated with EDSS. Only progressive disease course could predict EDSS worsening. Conclusion The data on BPF and levels of NFL and GFAP in CSF of healthy individuals can aid in the interpretation of these variables in the setting of MS. Knowledge on differences in BPF data from different methods for BPF determination can be useful in comparing data across studies, but also highlights the need for a commonly accepted gold standard. The correlation between GFAP and NFL levels in CSF may indicate an association between glial and axonal turnover that is independent of the aging effect on the brain. However, the low number of volunteers for LP precluded clear conclusions. An association between BPF and EDSS was seen in the MS group. The ability to predict EDSS worsening in the clinical MS cohort was limited.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. p. 80
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1867
Keywords
Brain parenchymal fraction, Neurofilament light, Glial fibrillary acidic protein, Brain atrophy, Multiple Sclerosis, Clinical follow-up
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-128697 (URN)978-91-7601-621-3 (ISBN)
Public defence
2017-01-20, Sal A, Tandläkarhögskolan 9 trappor, byggnad 1D, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-12-16 Created: 2016-12-12 Last updated: 2018-06-09Bibliographically approved
Salzer, J., Rajda, C., Sundström, P., Vågberg, M., Vecsei, L. & Svenningsson, A. (2016). How to minimize the risk for headache?: a lumbar puncture practice questionnaire study. IDEGGYOGYASZATI SZEMLE-CLINICAL NEUROSCIENCE, 69(11-12), 397-402
Open this publication in new window or tab >>How to minimize the risk for headache?: a lumbar puncture practice questionnaire study
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2016 (English)In: IDEGGYOGYASZATI SZEMLE-CLINICAL NEUROSCIENCE, ISSN 0019-1442, Vol. 69, no 11-12, p. 397-402Article in journal (Refereed) Published
Abstract [en]

Background - To lower the risk for post lumbar puncture (LP) headache the American Academy of Neurology (AAN) recommended using small bore atraumatic needles together with stylet reinsertion in a report from 2005. It is unclear whether these recommendations are followed or not. Objectives To investigate the diagnostic LP preferences with respect to the AAN guidelines among neurologists by use of a short online questionnaire, and to review previously published literature on the subject. Results - A total of 284 respondents who performed diagnostic LPs completed the questionnaire. Almost half (41%) answered that they always use atraumatic needles. The most common reason (73%) for not using atraumatic needles was that these were not available. Less than half of the respondents who performed LPs had knowledge about the MN guidelines for diagnostic LPs, and 48-76% agreed with the different recommendations therein. Five previously (1998-2015) published studies investigating LP practice among neurologists were identified. The reported frequency of atraumatic needle use (always/routinely) varied between 2 and 16%. Discussion - Atraumatic needle use was more common in this study compared with previous publications. There is still skepticism regarding some of the MN recommendations, and needle availability appears to be the most important factor preventing atraumatic needle use. To increase the use of atraumatic needles we may perform additional studies investigating their potential benefits, and arrange training sessions for neurologists to increase their awareness and level of comfort with the atraumatic LP technique.

Keywords
lumbar puncture, LP, questionnaire, AAN guidelines, post lumbar puncture headache
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-131002 (URN)10.18071/isz.69.0397 (DOI)000391162900005 ()
Available from: 2017-02-08 Created: 2017-02-02 Last updated: 2018-06-09Bibliographically approved
Salzer, J., Svenningsson, R., Alping, P., Novakova, L., Björck, A., Fink, K., . . . Svenningsson, A. (2016). Rituximab in multiple sclerosis: a retrospective observational study on safety and efficacy. Neurology, 87(20), 2074-2081
Open this publication in new window or tab >>Rituximab in multiple sclerosis: a retrospective observational study on safety and efficacy
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2016 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 87, no 20, p. 2074-2081Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the safety and efficacy of rituximab in multiple sclerosis (MS). Methods: In this retrospective uncontrolled observational multicenter study, off-label rituximab-treated patients with MS were identified through the Swedish MS register. Outcome data were collected from the MS register and medical charts. Adverse events (AEs) grades 2-5 according to the Common Terminology Criteria for Adverse Events were recorded. Results: A total of 822 rituximab-treated patients with MS were identified: 557 relapsing-remitting MS (RRMS), 198 secondary progressive MS (SPMS), and 67 primary progressive MS (PPMS). At baseline, 26.2% had contrast-enhancing lesions (CELs). Patients were treated with 500 or 1,000 mg rituximab IV every 6-12 months, during a mean 21.8 (SD 14.3) months. During treatment, the annualized relapse rates were 0.044 (RRMS), 0.038 (SPMS), and 0.015 (PPMS), and 4.6% of patients displayed CELs. Median Expanded Disability Status Scale remained unchanged in RRMS (p = 0.42) and increased by 0.5 and 1.0 in SPMS and PPMS, respectively (p = 0.10 and 0.25). Infusion-related AEs occurred during 7.8% of infusions and most were mild. A total of 89 AEs grades >= 2 (of which 76 infections) were recorded in 72 patients. No case of progressive multifocal leukoencephalopathy was detected. Conclusions: This is the largest cohort of patients with MS treated with rituximab reported so far. The safety, clinical, and MRI findings in this heterogeneous real-world cohort treated with different doses of rituximab were similar to those reported in previous randomized controlled trials on B-cell depletion therapy in MS. Classification of evidence: This study provides Class IV evidence that for patients with MS, rituximab is safe and effective.

National Category
Neurosciences Neurology
Identifiers
urn:nbn:se:umu:diva-132168 (URN)10.1212/WNL.0000000000003331 (DOI)000392236100007 ()27760868 (PubMedID)
Available from: 2017-03-06 Created: 2017-03-06 Last updated: 2018-06-09Bibliographically approved
Sandberg, L., Bistrom, M., Salzer, J., Vagberg, M., Svenningsson, A. & Sundstrom, P. (2016). Vitamin D and axonal injury in multiple sclerosis. Multiple Sclerosis, 22(8), 1027-1031
Open this publication in new window or tab >>Vitamin D and axonal injury in multiple sclerosis
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2016 (English)In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 22, no 8, p. 1027-1031Article in journal (Refereed) Published
Abstract [en]

Background: Previous studies in patients with multiple sclerosis (MS) have shown an association between high serum 25-hydroxyvitamin D (25[OH]D) levels and decreased inflammatory activity. Objective: The purpose of this study was to examine the association between 25(OH)D levels and axonal injury in MS. Cerebrospinal fluid neurofilament light (CSF-NFL) was used as a marker for axonal injury. Methods: Patients were identified through clinical practice at the Department of Neurology in Umea University Hospital, Sweden. Blood draw, magnetic resonance imaging, scoring of disability and lumbar puncture were performed at inclusion in 153 patients, and also at median 12 months follow-up in 87 patients. For analyses of serum 25(OH)D levels and CSF-NFL, enzyme-linked immunosorbent assays were used. Results: There was an inverse association between serum 25(OH)D and CSF-NFL levels in categorical (dichotomized at 75 or 100 nmol/l) analyses. A dose-response effect for 25(OH)D levels on CSF-NFL levels (p for trend=0.034) was also present. Serum 25(OH)D levels above 100 nmol/l were associated with lower CSF-NFL levels independently of ongoing MS treatment. Conclusion: High 25(OH)D levels are associated with decreased axonal injury in MS.

Keywords
Vitamin D, axonal injury, multiple sclerosis, neurofilament light
National Category
Neurosciences
Identifiers
urn:nbn:se:umu:diva-124684 (URN)10.1177/1352458515606986 (DOI)000380117000010 ()26462862 (PubMedID)
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2018-06-07Bibliographically approved
Salzer, J., Rajda, C., Sundström, P., Vågberg, M., Vecsei, L. & Svenningsson, A. (2015). Are we minimizing the patients' risk for headache?: a lumbar puncture practice questionnaire study among European neurologists. Paper presented at 31st Congress of the European-Committee-for-Treatment-and-Research-in-Multiple-Sclerosis (ECTRIMS), OCT 07-10, 2015, Barcelona, SPAIN. Multiple Sclerosis, 21, 733-734
Open this publication in new window or tab >>Are we minimizing the patients' risk for headache?: a lumbar puncture practice questionnaire study among European neurologists
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2015 (English)In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 21, p. 733-734Article in journal, Meeting abstract (Other academic) Published
National Category
Neurosciences Neurology
Identifiers
urn:nbn:se:umu:diva-113879 (URN)000365729402267 ()
Conference
31st Congress of the European-Committee-for-Treatment-and-Research-in-Multiple-Sclerosis (ECTRIMS), OCT 07-10, 2015, Barcelona, SPAIN
Note

Supplement: 11, Meeting Abstract: EP1403

Available from: 2016-03-14 Created: 2016-01-04 Last updated: 2018-06-07Bibliographically approved
Svenningsson, A., Salzer, J., Vågberg, M. & Sundström, P. (2015). Increasing prevalence of multiple sclerosis in Vasterbotten County of Sweden. Acta Neurologica Scandinavica, 132(6), 389-394
Open this publication in new window or tab >>Increasing prevalence of multiple sclerosis in Vasterbotten County of Sweden
2015 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 132, no 6, p. 389-394Article in journal (Refereed) Published
Abstract [en]

Objectives To update the incidence and prevalence of multiple sclerosis (MS) in Vasterbotten County, Sweden, and to compare this to previous investigations in the same area. Background Northern Sweden is a high-risk area for developing MS. Vasterbotten County has previously been surveyed in detail regarding the occurrence of MS. In several countries, increases in MS prevalence and incidence as well as a change in the sex ratio have been reported. Materials and methods Multiple sources were used to identify MS cases in Vasterbotten that either had their onset of the disease from 1998 to 2010 and/or lived in Vasterbotten, the two dates chosen for prevalence calculation: the 31st of December 2005 and 2010. Results The mean yearly incidence of MS in Vasterbotten during the entire period 1998-2010 was 6.0/100,000. The female to male ratio was 2.1. The prevalence of MS in Vasterbotten was 188/100,000 on 31st of December 2005 and 215/100,000 on 31st of December 2010. The MS prevalence increased over time from 1990 to 2010. Conclusions The prevalence of MS in Vasterbotten County has increased between 1990 and 2010, while no statistically significant increase in incidence was seen.

Keywords
epidemiology, incidence, multiple sclerosis, prevalence
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-110974 (URN)10.1111/ane.12408 (DOI)000362751600003 ()25857351 (PubMedID)
Available from: 2015-11-19 Created: 2015-11-02 Last updated: 2018-06-07Bibliographically approved
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