title: Is chronic fatigue the symptom of venous insufficiency associated with multiple sclerosis? A longitudinal pilot study.
abstract: OBJECTIVE
  Chronic fatigue (CF) severely affects patients with multiple sclerosis (MS), but its pathogenesis remains elusive and the effectiveness of available treatments is modest. We aimed to evaluate the effect on CF of the balloon dilatation of stenosing lesions affecting the main extracranial veins configuring the chronic cerebrospinal venous insufficiency (CCSVI), a condition strongly associated with MS.
  
  
  METHODS
  Thirty-one MS consecutive patients (16 males, age 46.2+/-9.4 years) with associated CCSVI and CF underwent the endovascular procedure. Fatigue was assessed using the Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS) at baseline (T0) and one (T1), six (T6) and twelve (T12) months after the procedure. In ambulatory patients (N.=28), mobility was evaluated using the 6-min walking test at T0 and T1.
  
  
  RESULTS
  and MFIS scores significantly improved from preoperative values, and the positive trend was maintained at one year (FSS: T0=5.1+/-1.0 to T12=3.5+/-1.8, P<0.001; MFIS-total score: T0=34.9+/-14.8 to T12=22.5+/-13.7, P<0.001; MFIS-Physical subscale: T0=21.2+/-8.0 to T12=13.5+/-9.7 P<0.001; MFIS-Cognitive subscale: T0=9.2+/-9.5 to T12=6.0+/-6.3, P=0.03; MFIS-Psychosocial subscale: T0=4.5+/-2.1 to T12=2.5+/-2.1, P<0.001). Six-min walking distance (6MWD) at T1 improved significantly (332+/-190m to 378+/-200m, P=0.0002). In addition, an inverted correlation between 6MWD and MFIS-physical subscale variations was found in the subgroup of patients (N.=8) with no lower limb motor impairment (r=-0.74, P=0.035).
  
  
  CONCLUSIONS
  The reestablishment of cerebral venous return dramatically reduced CF perception in a group of MS patients with associated CCSVI, suggesting that CF is likely the symptom of CCSVI.
authors.affiliation: Vascular Diseases Center, University of Ferrara, Ferrara, Italy. mlgnmr@unife.it
authors.forename: A M
authors.initials: AM
authors.lastname: Malagoni
authors.forename: R
authors.initials: R
authors.lastname: Galeotti
authors.forename: E
authors.initials: E
authors.lastname: Menegatti
authors.forename: F
authors.initials: F
authors.lastname: Manfredini
authors.forename: N
authors.initials: N
authors.lastname: Basaglia
authors.forename: F
authors.initials: F
authors.lastname: Salvi
authors.forename: P
authors.initials: P
authors.lastname: Zamboni
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon; D001401:Azygos Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D002908:Chronic Disease; D003251:Constriction, Pathologic; D004185:Disability Evaluation; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D010690:Phlebography; D010865:Pilot Projects; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000098:blood supply*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency; D014689:Venous Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*