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August 17, 2011

Progressive multiple sclerosis is not associated with chronic cerebrospinal venous insufficiency

August 30, 2011 issue
77 (9) 844-850

Abstract

Objective:

Chronic cerebrospinal venous insufficiency (CCSVI) had been suggested to play a major pathogenetic role in multiple sclerosis (MS), but recent data on early stages of MS have not confirmed this theory. Nonetheless, CCSVI could represent a late phenomenon of MS or be associated with progression of disability. Thus, we studied CCSVI prevalence in primary progressive (PP) and secondary progressive (SP) MS, to clarify whether CCSVI characterizes the progressive forms of this disease.

Methods:

A total of 35 patients with SPMS, 25 patients with PPMS, and 60 age- and gender-matched normal controls (NC) were enrolled into a cross-sectional study. Extracranial and transcranial high-resolution venous echo color Doppler sonography (ECDS-TCDS) was performed in all patients and NC. Those patients having any abnormal ultrasound finding were asked to undergo selective venography (VGF).

Results:

Patients with PPMS (11 women, 14 men; mean age 47 ± 11 years) had a disease duration of 11 ± 7 years and Expanded Disability Status Scale (EDSS) score of 6.0 ± 0.5. Patients with SPMS (22 women, 13 men; mean age 45 ± 14.5 years) had a disease duration of 18 ± 14 years and EDSS score of 6.0 ± 0.8. TCDS was normal in all patients. ECDS showed one or more abnormal findings in 9/60 (15.0%) patients (7/35 [20.0%] SPMS, 2/25 [8.0%] PPMS) and in 14/60 (23.3%) NC (p not significant for all comparisons). CCSVI criteria were fulfilled in 0 NC and 4 (6.7%) patients with MS: 3 SPMS and 1 PPMS. VGF, performed in 6/9 patients, was abnormal only in one case who had bilateral internal jugular vein stenosis.

Conclusion:

Our findings indicate that CCSVI is not a late secondary phenomenon of MS and is not associated with disability.

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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 77Number 9August 30, 2011
Pages: 844-850
PubMed: 21849656

Publication History

Received: January 14, 2011
Accepted: May 13, 2011
Published online: August 17, 2011
Published in print: August 30, 2011

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Disclosure

Dr. Baracchini serves on the executive committee of the European Society of Neurosonology and Cerebral Hemodynamics; has received funding for travel and speaker honoraria from Pfizer Inc, sanofi-aventis, Laboratori Guidotti S.P.A., and Novartis; serves as an Associate Editor for BMC Neurology; and has given expert testimony in a medico-legal case. Dr. Perini has received funding for travel and speaker honoraria from Biogen-Dompé AG, sanofi-aventis, and Merck Serono. Dr. Causin reports no disclosures. Dr. Calabrese serves on scientific advisory boards and speakers' bureaus for and has received funding for travel from Merck Serono, Biogen Idec, sanofi-aventis, and Bayer Schering Pharma; and serves as a consultant for Merck Serono and sanofi-aventis. Dr. Rinaldi reports no disclosures. Prof. Gallo serves on scientific advisory boards, as a consultant, and on speakers' bureaus for and has received funding for travel and speaker honoraria from Novartis, Biogen Idec/Elan Corporation, Merck Serono, sanofi-aventis, and Bayer Schering Pharma; and receives research support from Novartis, Biogen Idec/Elan Corporation, Merck Serono, sanofi-aventis, and Bayer Schering Pharma, the Veneto Region of Italy, the University of Padova, and the Ministry of Public Health of Italy.

Authors

Affiliations & Disclosures

C. Baracchini, MD*
From the First Neurology Clinic (C.B., P.P., M.C., F.R., P.G.), Multiple Sclerosis Centre of The Veneto Region (P.P., M.C., F.R., P.G.), and Neuroradiology Unit (F.C.), Department of Neurosciences, University Hospital, Padova, Italy.
P. Perini, MD*
From the First Neurology Clinic (C.B., P.P., M.C., F.R., P.G.), Multiple Sclerosis Centre of The Veneto Region (P.P., M.C., F.R., P.G.), and Neuroradiology Unit (F.C.), Department of Neurosciences, University Hospital, Padova, Italy.
F. Causin, MD
From the First Neurology Clinic (C.B., P.P., M.C., F.R., P.G.), Multiple Sclerosis Centre of The Veneto Region (P.P., M.C., F.R., P.G.), and Neuroradiology Unit (F.C.), Department of Neurosciences, University Hospital, Padova, Italy.
M. Calabrese, MD
From the First Neurology Clinic (C.B., P.P., M.C., F.R., P.G.), Multiple Sclerosis Centre of The Veneto Region (P.P., M.C., F.R., P.G.), and Neuroradiology Unit (F.C.), Department of Neurosciences, University Hospital, Padova, Italy.
F. Rinaldi, MD
From the First Neurology Clinic (C.B., P.P., M.C., F.R., P.G.), Multiple Sclerosis Centre of The Veneto Region (P.P., M.C., F.R., P.G.), and Neuroradiology Unit (F.C.), Department of Neurosciences, University Hospital, Padova, Italy.
P. Gallo, MD
From the First Neurology Clinic (C.B., P.P., M.C., F.R., P.G.), Multiple Sclerosis Centre of The Veneto Region (P.P., M.C., F.R., P.G.), and Neuroradiology Unit (F.C.), Department of Neurosciences, University Hospital, Padova, Italy.

Notes

Address correspondence and reprint requests to Dr. Claudio Baracchini, First Neurology Clinic, Department of Neuroscience, University of Padua, Via Giustiniani, 5, 35128 Padova, Italy [email protected]
*
These authors contributed equally to this work.

Author Contributions

Dr. Claudio Baracchini: study design, ECDS-TCDS, manuscript preparation. Dr. Paola Perini: patient clinical management, EDSS and CSF data analysis. Dr. Francesco Causin: phlebography. Dr. Massimiliano Calabrese: MRI data analysis, statistical analysis. Dr. Francesca Rinaldi: patient clinical management. Prof. Paolo Gallo: study design, statistical analysis, manuscript preparation.

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