Abstract
BackgroundChronic cerebrospinal venous insufficiency (CCSVI) has been associated to multiple sclerosis (MS).ObjectiveTo evaluate the possible association between CCSVI and MS, using a population-based control design.MethodsA random cohort of 148 incident MS patients were enrolled in the study. We have also studied 20 patients with clinically isolated syndrome (CIS), 40 patients with other neurological diseases (OND), and 172 healthy controls. Transcranial (TCC) and Echo Color Doppler (ECD) were carried out in 380 subjects. A subject was considered CCSVI positive if ≥2 venous hemodynamic criteria were fulfilled.ResultsCCSVI was present in 28 (18.9%) of the MS patients, in 2 (10%) of CIS patients, in 11 (6.4%) of the controls, and in 2 (5%) of the OND patients. A significant association between MS and CCSVI was found with an odds ratio of 3.41 (95% confidence interval 1.63–7.13; p = 0.001). CCSVI was significantly more frequent among MS subjects with a disease duration longer than 144 months (26.1% versus 12.6% of patients with duration shorter than 144 months; p = 0.03) and among patients with secondary progressive (SP) and primary progressive (PP) forms (30.2% and 29.4, respectively) than in patients with relapsing remitting (RR) MS (14.3%). A stronger association was found considering SP and PP forms (age adjusted OR = 4.7; 95% CI 1.83–12.0, p = 0.001); the association was weaker with the RR patients (age adjusted OR = 2.58; 95%CI 1.12–5.92; p = 0.02) or not significant in CIS group (age adjusted OR = 2.04; 95%CI 0.40–10.3; p = 0.4).ConclusionsA higher frequency of CCSVI has been found in MS patients; it was more evident in patients with advanced MS, suggesting that CCSVI could be related to MS disability.
Highlights
Multiple sclerosis (MS) was firstly described by Charcot in 1868; since that it was known that plaques in multiple sclerosis (MS) are venocentric [1]
A higher frequency of Chronic cerebrospinal venous insufficiency (CCSVI) has been found in MS patients; it was more evident in patients with advanced MS, suggesting that CCSVI could be related to MS disability
A meta-analysis performed on studies that reported the frequency of CCSVI among patients with and those without MS showed a positive association between CCSVI and MS [16], but it was outlined that poor reporting of the success of blinding and marked heterogeneity among the studies precluded definitive conclusions [16]
Summary
Multiple sclerosis (MS) was firstly described by Charcot in 1868; since that it was known that plaques in MS are venocentric [1]. It was described that Echo Color Doppler (ECD), Transcranial (TCC) sonography and other techniques were capable of showing abnormalities of cerebral and spine venous return [8,9,10,11,12]. These abnormalities and the existence of possible venous outflow abnormalities at extracranial level could be responsible for the high frequency of inversion of the physiological flow direction [10]. Chronic cerebrospinal venous insufficiency (CCSVI) has been associated to multiple sclerosis (MS)
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