REPORT FROM THE 63rd ANNUAL MEETING OF THE AMERICAN ACADEMY OF NEUROLOGY (AAN), HONOLULU, HAWAII, APRIL 9-16, 2011- Three new studies presented at the AAN annual meeting have failed to provide supportive evidence of chronic cerebrospinal venous insufficiency (CCSVI) in MS.

A Canadian study investigated venous anomalies in 67 subjects with clinically definite MS, possible MS, clinically isolated syndrome (CIS), or not-MS (Alikhani et al. AAN 2011; abstract S01.006). Nineteen of 34 CDMS patients had relapsing-remitting MS, 9 had secondary-progressive MS and 6 had primary progressive MS. All subjects underwent contrast-enhanced magnetic resonance venography (MRV).

MRV abnormalities were found in 7 of 34 (20.5%) of CDMS, 4 of 20 (20%) of not-MS, 0 of 7 (0%) possible MS and 1 of 6 (16.7%) of CIS subjects. Venous anomalies were one internal jugular vein (IJV) stenosis (4 CDMS, 1 not-MS), two IJV stenoses (2 MS, 1 CIS, 2 not-MS), occlusion in one IJV (1 MS), and occlusion in two IJV (1 not-MS). The mean ages of MS patients with normal versus abnormal MRV were 45.58 and 52.28 years, respectively. The mean EDSS of MS patients with abnormal MRV was 6.17, and 3.57 with normal MRV. The mean duration of MS was 18 years in those with abnormal MRV versus 11.14 years in those with normal MRV. The researchers concluded that neck vein abnormalities are uncommon and occur independently of an MS diagnosis.

A separate group in Europe performed extracranial and transcranial Doppler studies on 94 MS patients and 20 controls (Connolly et al. AAN 2011; abstract S01.001). None of the subjects fulfilled more than one of the Zamboni CCSVI criteria. No cases of internal jugular vein (IJV) stenosis were detected in any subject. Blood flow direction in IJV and vertebral veins was normal in all healthy controls and in 93 of 94 MS patients. The decrease in blood volume flow in an upright position was less pronounced in MS patients and resulted in higher blood volume flow in the upright position versus controls (250 mL vs. 218 mL).

A duplex sonographic study in Germany assessed blood flow volume and direction in 20 MS patients and 20 healthy controls (Mayer et al. AAN 2011; abstract S01.002).  There was no evidence of retrograde blood flow. Venous stenosis, defined as venous cross-sectional area < 0.3 cm², was found in 13 MS patients and 16 controls (p=0.48). One of 20 healthy controls and no MS patient fulfilled >2 CCSVI criteria. There was a significant correlation between venous stenosis and the age of the subject (p=0.005).

Zivadinov and colleagues also reported the results of a study comparing MRV with Doppler sonography in 150 MS patients and 63 healthy controls (Dolic et al. AAN 2011; abstract P05.071). A total of 98 MS patients (65.3%) and 18 controls (28.6%) met >2 criteria for CCSVI. At least one abnormal Doppler sonographic finding in at least one IJV was shown in 75.3% of MS patients and 52.3% of controls. MRV showed abnormal IJV flow in 30% of MS patients and 25.4% of controls. There were no vertebral vein (VV) blood flow differences between MS patients and controls either with Doppler sonography or MRV.

For more coverage of the topic on Neurosens see CCSVI 2010: The Year in Review (January 18, 2011), CCSVI: interventions not justified (October 14, 2010), CCSVI: an update (June 2, 2010), andChronic cerebrospinal venous insufficiency (CCSVI) (February 16, 2010).

http://neuro-sens.com/congress-news/3-general/209265