5th Joint triennial congress of the European and Americas Committees
for Treatment and Research in Multiple Sclerosis
Amsterdam, The Netherlands

19.10.2011 - 22.10.2011
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Home - 20.10.2011 - Chronic cerebro-spinal venous insufficiency (CCSVI) 1


Chronic cerebro-spinal venous insufficiency (CCSVI) 1

Thursday, October 20, 2011, 15:30 - 17:00

CCSVI prevalence in a northern Italian population of MS patients and controls

P. Cavalla, M. Vercellino, M. Matta, A. Romagnolo, A. Mattioda, S. Masera, F. Dematteis, L. Di Maggio, D. Rossato, G. Gandini, L. Lopiano, L. Pinessi (Turin, IT)

Introduction: Recent studies assessing chronic cerebrospinal venous insufficiency (CCSVI) prevalence by means of venous ecocolordoppler (ECD) in MS patients and controls have led to widely variable and conflicting results (1, 2, 3). In this study, we wished to assess CCSVI prevalence in a population of MS patients and controls from Northern Italy, with a blinded ECD study design.
Materials and method: This study was performed on 45 healthy subjects (HS) and 133 MS patients (relapsing –remitting MS 79.7%, secondary progressive MS 18.0%, primary progressive MS 1.5%, CIS 0.8%). Median age was 38 years in HS (range 21-64), 40 years in MS patient (range 23-70). An informed consent was obtained for all MS patients and HS. ECD was performed by experienced and trained sonologists, blinded to patient/control status, using an Esaote Vinco Lab scanner. CCSVI Zamboni’s criteria (1) were used; a sonologic pattern of CCSVI was considered present when two out of five criteria were fulfilled. Venous hemodynamic insufficiency severity score (VHISS) was also evaluated.
Results: CCSVI was present in 33,4% of HS and 53.4% of MS patients (p = 0.02). No significant differences were noted between CCSVI and non- CCSVI MS patients regarding gender, disease duration, age, age of onset, EDSS, disease course. Mean VHISS was higher in secondary progressive MS (3.12 vs 2.29; p = 0.015) than in relapsing-remitting MS; a weak correlation between VHISS and EDSS was also observed.
Discussion and conclusion: In our population, CCSVI assessed by ECD appears to be more frequent in MS patients than in controls; however, CCSVI is found in more than one third of normal controls. These data are similar to those obtained with a similar protocol in a larger North American population (3). The issue of anomalous venous drainage in MS needs to be further clarified, also evaluating patients affected by other neurological diseases. The high frequency of CCSVI also in healthy controls suggests poor specificity of the current CCSVI criteria. 1 Zamboni P et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009 Apr;80(4):392-9. 2 Baracchini C et al. No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset. Ann Neurol. 2011 Jan;69(1):90-9. 3 Zivadinov R et al. Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS. Neurology. 2011 Apr 13. [Epub ahead of print]

The Authors have nothing to disclose