Study: CCSVI can be
result of the progression
of multiple sclerosis
A recently published study on the relationship between multiple sclerosis (MS) and chronic cerebral venous insufficiency (CCIVS), a narrowing of the extracranial veins that restricts the normal flow of blood brain found that CCSVI may be the result of MS, not a cause.
The study, conducted by researchers at the University at Buffalo, appears in the latest issue of Neurology , the Journal of the American Academy of Neurology.
Zivadinov Robert, MD, PhD, associate professor of neurology School of Medicine and Biomedical Sciences UB and the president of the International Society for neurovascular disease, is first author on the paper.
Zivadinov says of the findings: "Given the great interest in the hypothesis that CCSVI is a possible cause of multiple sclerosis, an independent evaluation of CCSVI was identified as an urgent necessity.
"Our results indicate that only 56.1 percent of patients with MS and 38.1 percent of patients with a condition known as clinically isolated syndrome (CIS), an individual first neurological episode Instead, there CCSVI.
"While this may suggest an association between the Member States and CCSVI, the association does not imply causation. In fact, 42.3 percent of participants classified as other neurological diseases (OND) and as 22.7 percent of healthy controls participating in the study, also presented CCSVI.
"These results indicate that CCSVI not have a major role in causing MS," says Zivadinov. "Our findings are consistent with a higher prevalence of CCSVI in MS, but substantially lower rates of sensitivity and specificity reported in MS originally by Italian investigators. "
CCSVI is a complex vascular disease discovered and described by Paolo Zamboni, MD, University of Ferrara, Italy. It is characterized by narrowing of vessels that drain blood from the skull. Zamboni hypothesized that this reduction restricts normal blood flow to the brain, leading to alterations in blood flow patterns within the brain that eventually cause brain tissue damage and degeneration of neurons, leading to MS .
Zamboni original research on a group of 65 patients and 235 controls showed that seemed CCSVI be strongly associated with MS, increasing the risk of MS by 43 times.
The results of the UB is based on 499 participants in the combined and extracranial venous transcranial Doppler Assessment (CTEVD) study, which began at the university in April 2009.
The study group consisted of 289 people with MS and 163 healthy controls, 26 with OND and 21 with the CIS.
MS patients were also defined by type of disease: relapsing-remitting (RR), secondary progressive (SP), primary-progressive (PP), progressive-relapsing (PR) and MS with neuromyelitis optica (NMO) - a type of MS that affects the optic nerves and spinal cord exclusively.
All patients underwent transcranial and extracranial Doppler ultrasound scans of the head and neck. People who were considered "positive CCSVI" meeting two or more of five venous hemodynamics (VH) criteria.
prevalence rates were calculated in three groups: subjects with positive and negative CCSVI diagnoses, and only borderline cases included in the negative group, and subjects who meet any of the five criteria.
CCSVI When only positive and negative cases were considered, the results showed a prevalence of 62.5 percent CCSVI in MS patients, 45.8 percent in those with OND, 42.1 percent in the CIS and 25.5 percent in healthy controls.
When questionable cases were included as negative CCSVI prevalence rates were 56.1 percent in patients with MS, 42.3 percent in those with OND, 38.1 percent with the CIS and 22.7 percent in healthy controls.
When all cases that meet at least one of the five criteria of VH were included in the analysis, prevalence CCIVS of 81.3 percent in MS cases, 76.2 percent in CIS patients, 65.4 percent in the OND cases and 55.2 percent in healthy controls.
The highest prevalence was observed in relapsing-primary progressive MS (89.4 percent), followed by non-relapsing secondary progressive MS (67.2 percent), NMO (66.6 percent) , primary-progressive MS (54.5 percent) and relapsing-remitting MS (49.2 percent). CCSVI Prevalence was significantly higher in progressive MS patients with non-progressive MS. In addition, patients with a subtype of the disease with progressive MS had higher prevalence CCSVI than non-progressive MS.
"CCSVI The higher prevalence in patients with progressive MS CCSVI suggests that there may be a consequence rather than a cause of MS," says Bianca Weinstock-Guttman, MD, co-principal investigator of the study and Professor of Neurology at UB. Therefore, the possibility that CCSVI may be a consequence of the progression of MS can not be excluded and should be investigated further.
"Several studies have reported that patients with progressive MS show decreased blood flow through the brain's neural tissue, CCSVI indicating that it may be secondary to reduced perfusion, "said Weinstock-Guttman." Moreover, recently showed an association between the severity of CCSVI and reduction of cerebral blood flow in the brain parenchyma of MS patients in a pilot study published. "
E. Ann Yeh, MD, assistant professor of neurology at UB and major contributor to the study, said that of the 10 pediatric patients with MS who participated in the study, five had CCSVI (50 percent), giving a prevalence similar to that of adult patients with multiple sclerosis.
"Although the sample size was too small to draw definitive conclusions, these results suggest that CCSVI is also present in children and is not the result of aging," she says.
Zivadinov concludes:. "The differences between our study, the original Italian CCSVI and other recent studies also emphasize the need for a multimodal approach for the evaluation of CCSVI addition of Doppler ultrasound, the use of selective venography, magnetic resonance venography and intraluminal Doppler methods can provide more evidence of the true prevalence of CCSVI in MS. "
Source: University of Buffalo
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