Objectives:

Venous vesssel pathology in patients with multiple sclerosis (MS) has increased a great interest in the scientific community. The new vascular entity named chronic cerebrospinal venous insufficiency (CCSVI) is characterised by multiple stenoses of the extracranial veins – jugular and azygous veins. A four patterns of venous stenosis was decribed.

Pathohistological studies desribed perivenous distribution of demyelinating lesions, and by high resolution MR venography a cenral vein in the long axis of MS lesions was highlighted. The role of an iron accumulation in the brain tissue is discussed.The aim of our study was to elucidate the occurence of the venous vessel pathology in patients with an advanced progressive course of MS. 

Methods:

The MS patients who fulfilled 2 or more of the 5 proposed criteria obtained by Doppler sonography required for the CCSVI, underwent selective venography. Disability status was assessed by the Expanded Disability Status Scale (EDSS). Fatigue was evaluated using Fatigue Severity Scale (FSS). Selective venography by placing a coronary catheter in the right femoral vein was peroformed. Informed consent by participating subjects and agreement of the National ethical committee was obtained. 

Results:

In this study we enrolled 30 consecutive MS patients (aged 27-73 years) with progressive course of disease – 17 patients with secondary progressive and 13 with primary progressive MS with mean EDSS 5.53 (range 2.0-7.5). The mean narrowing of the jugular and azygous veins was 75% (range 50-95%). After 95 transluminal dilatations the improvement of the venous outflow was achived. Endovascular treatment did not produced any serious side effects. The significant improvement of EDSS score (less than 1.0 point) was not noticed, but significant amelioration of the fatigue assessed by FSS (p < 0.001). 

Conclusion:

In all MS patients with the progressive course of disease venous vessel pathology was dicovered. Selective venography is a very important and sensitive method in detecting stenosis of the extracranial venous pathway. By advanced pyramidal involvement an improvement of disability score is not expected. The amelioration of fatigue plays an important role in defeating daily obstacles in MS patients. Even in advanced disability, quality of life could be well preserved. It seems that the endovascular treatment in more disabled MS patients is promising.

ENS 2011: Lisbon, Portugal · 28 – 31 May 2011

Multiple sclerosis: clinical aspects

Sunday May 29 2011

Extracranial venous vessel pathology in multiple sclerosis

M. Denislic, Z. Milosevic, M. Zorc, O. Mendiz, M. Leskosek, D. Ravnik (Ljubljana, SI; Buenos Aires, AR; Vrhnika, SI)

http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=130557&XNSPRACHE_ID=2&XNKONGRESS_ID=140&XNMASKEN_ID=900