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 - 21.10.2011 - Late Breaking News

Late Breaking News

Friday, October 21, 2011, 15:30 - 17:00

Prospective, case-control study of CCSVI with imaging-blinded assessment: progress report focused on neurosonography

A.D. Barreto, S.A. Brod, T. Bui, J. Jamelka, L.A. Kramer, K. Ton, A.M. Cohen, J.W. Lindsey, F. Nelson, P.A. Narayana, J.S. Wolinsky (Houston, US)

Background: Chronic cerebrospinal venous insufficiency (CCSVI) is proposed to have a role in multiple sclerosis (MS) pathogenesis.
Objective: To determine if CCSVI exists, if it is associated with MS, and determine what tools might establish its presence. Overlapped steps include: determine if neurosonography (NS) provides reliable information on cerebral venous outflow patterns suitable as a first screen, learn if NS findings are supported by 3T magnetic resonance venography (MRV) of the head and neck, chest, abdomen and pelvis, and evaluate if NS and/or MRV accurately reflect 'true' venous anatomy seen by transluminal venography (TV). This report details NS findings on the first 162 participants of a targeted 305 subject study.
Methods: Informed consent was obtained from all participants. High resolution B-mode imaging with color and spectral flow Doppler was used to investigate extracranial and intracranial venous drainage. Studies were performed and recorded by TB, blind to the subject's diagnosis. Results were evaluated by ADB who had no patient contact or access to subject information. The only members of the study team with access to the complete database were KT and JSW.
Results: Subjects distributed by clinical groupings as 10 healthy controls, 12 cerebrovascular diseases, 19 other neurological diseases, 121 MS (6 clinically isolated syndrome, 71 relapsing remitting, 28 secondary progressive, 15 primary progressive, 1 progressive relapsing). MS patients were slightly older than non-MS subjects (49.610.2 v 46.810.3 years), had durations from first symptoms and diagnosis of 13.89.6 and 10.27.8 years, and EDSS 2.92.0. NS identified 48/162 subjects fulfilling at least one of five criteria for anomalous venous outflow proposed by Zamboni; 10/48 fulfilled two criteria consistent with CCSVI; none fulfilled >2 criteria. The distribution of subjects with 0, 1 or 2 criteria did not differ significantly across all diagnostic groupings, between MS and non-MS subjects, or within the MS subgroups. No significant differences emerged between MS and non-MS subjects for measures of cross-sectional areas of the internal jugular veins at fixed anatomic sites or for extracranial or intracranial venous flow rates.
Conclusion: At this stage, our studies suggest that NS findings described as CCSVI are much less prevalent than previously reported and do not distinguish MS from other subjects. We will now focus on whether NS can be complemented or supplanted by MRV and/or TV.

Study supported by National Multiple Sclerosis Society RC 1019-A-5 ADB: Research support from the National Institutes of Health, and National MS Society. SAB: Consulting agreements or speaker for Bayer HealthCare, EMD Serono , Genzyme, Pfizer, Questcor, Teva Neurosciences and research or contractual support from the Clayton Foundation for Research, EMD Serono, Pfizer and Questcor. TB: Nothing to declare. JJ: Research support from the National MS Society. LAK: Research or contractual support from the National Institute of Drug Abuse and National MS Society. KT: Nothing to declare. AMC: Consulting agreement for Medcomp. JWL: Consulting agreements or speaking for Biogen, EMD Serono, Pfizer, Teva, and research or contractual support from the Clayton Foundation for Research, Teva, National MS Society, National Institutes of Health FN: Consulting or speaker for Bayer HealthCare, Biogen Idec, EMD Serono, National MS Society, MS Association of America, Novartis, sanofi-aventis, Teva Neurosciences, and the University of Massachusetts Medical School and research or contractual support from the National Institutes of Health, Novartis and sanofi-aventis. PAN: Consulting agreement with Acorda and research or contractual support from the Department of Defense, National Institutes of Health, and sanofi-aventis. JSW: Consulting agreements or speaking for Astellas, Bayer HealthCare, Celgene, Consortium of MS Clinics, Eli Lilly, Hoffman LaRoche, Medscape CME, Novartis, sanofi-aventis, Serono Symposia International Foundation, Texas Neurological Society, Teva and Teva Neurosciences, royalties from Millipore [Chemicon International] Corporation, and research or contractual support from the Clayton Foundation for Research, National Institutes of Health, National MS Society and sanofi-aventis.