Chronic cerebrospinal venous insufficiency in multiple sclerosis: clinical correlates from a multicentre study.
BACKGROUND
Chronic cerebrospinal venous insufficiency (CCSVI) has recently been reported to be associated with multiple sclerosis (MS). However, its actual prevalence, possible association with specific MS phenotypes, and potential pathophysiological role are debated.


METHODS
We analysed the clinical data of 710 MS patients attending six centres (five Italian and one Canadian). All were submitted to venous Doppler sonography and diagnosed as having or not having CCSVI according to the criteria of Zamboni et al.


RESULTS
Overall, CCSVI was diagnosed in 86% of the patients, but the frequency varied greatly between the centres. Even greater differences were found when considering singly the five diagnostic criteria proposed by Zamboni et al. Despite these differences, significant associations with clinical data were found, the most striking being age at disease onset (about five years greater in CCSVI-positive patients) and clinical severity (mean EDSS score about one point higher in CCSVI-positive patients). Patients with progressive MS were more likely to have CCSVI than those with relapsing-remitting MS.


CONCLUSIONS
The methods for diagnosing CCSVI need to be refined, as the between-centre differences, particularly in single criteria, were excessively high. Despite these discrepancies, the strong associations between CCSVI and MS phenotype suggest that the presence of CCSVI may favour a later development of MS in patients with a lower susceptibility to autoimmune diseases and may increase its severity.
Department of Public Health and Neurosciences, IRCCS C, Mondino National Institute of Neurology Foundation, University of Pavia, Italy. stefano.bastianello@yahoo.it
Stefano
S
Bastianello
Alfredo
A
Romani
Gisela
G
Viselner
Enrico Colli
EC
Tibaldi
Elisabetta
E
Giugni
Marta
M
Altieri
Pietro
P
Cecconi
Laura
L
Mendozzi
Massimiliano
M
Farina
Donatella
D
Mariani
Antonio
A
Galassi
Claudio
C
Quattrini
Marcello
M
Mancini
Vincenzo
V
Bresciamorra
Angela
A
Lagace
Sandy
S
McDonald
Giorgio
G
Bono
Roberto
R
Bergamaschi
D000328:Adult; D001921:Brain / Q000098:blood supply* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000000981:diagnostic imaging; D015995:Prevalence; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging; D017585:Ultrasonography, Doppler, Transcranial; D014689:Venous Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*