Via Sandro Rasman – Multiple Sclerosis: three recent confirmations for Zamboni's theory

Acta Phlebologica 2012 December;13(3):141-8
Results from 823 consecutive Duplex exams for CCSVI in a Vascular Centre
Bavera P. M., Agus G. B., Alpini D., Cecconi P., Guazzoni A., Tori A., Costantini E., Lupattelli T.

Aim. Ultrasound (US) diagnosis of chronic cerebrospinal venous insufficiency (CCSVI) and its association with MS is highly controversial, perhaps for lack of both training and awareness of what is normal in cervical veins mainly because they are not segments usually investigated in Vascular Labs.

Methods. The work is based upon the results of 823 consecutive Duplex (DU) exams carried out in one year on Multiple Sclerosis (MS) patients. The purpose was to eventually detect and quantify the presence of CCSVI and possible benefits on PTA-treated patients, according to the Zamboni criteria protocol. The authors scanned first a consecutive group of 60 controls, not affected by MS, aged 28-62 years old, in order to improve the personal learning curve in investigating the cervical veins. Therefore they investigated 696 MS patients and 127 MS patients post-PTA treatment for diagnosed CCSVI.

Results. Within the 60 controls, only 3 (5%) showed one flow abnormality according to the Zamboni criteria, considered insufficient for CCSVI diagnosis, while in the remaining 57 (95%) they were totally absent. In the 823 patients affected by MS, 627 (90%) matched with sufficient Zamboni criteria scores. The frequency of CCSVI among MS patients and non-MS controls revealed a higher CCSVI prevalence in the MS group (odds ratio 576.7; 95% confidence interval 286.2-1161.9; ?2=310 and P-value<0.0001). Finally, 88 patients (69%) of the post procedural Duplex examination were negative for CCSVI Zamboni criteria and this result was associated to symptoms improvements. Other previous, but smaller studies, were previously carried out with the aim to investigate CCSVI in MS and the lack of detection in this particular population of patients may be subsequent to insufficient training and completion of an adequate learning curve.

Conclusion. The present study demonstrates in a large survey, the strong association between the two conditions. In addition, PTA may revert abnormal duplex haemodynamics in a large proportion of patients.
Source: http://www.minervamedica.it/en/journals/acta-phlebologica/article.php?cod=R43Y2012N03A0141

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Current Health Sciences Journal Vol. 39, No. 1, 2013 January March
The value of Doppler cerebral parameters to assess a group of patients with multiple sclerosis
AURA COTEANU, SIMONA GUSTI, CATALINA COTEANU

ABSTRACT: Background: The current definition of multiple sclerosis is an inflammatory/degenerative disease of central nervous system with focal demyelination around cerebral veins. In 2007 a theory was proposed that demonstrates an alteration of cerebral venous flow in patients with multiple sclerosis. Our study wants to see if there is a statistically significant differences between cerebral venous hemodynamics in multiple sclerosis patients and healthy people. Methods: We admitted in the study twenty-seven patients with multiple sclerois possible or defined, and thirty clinically healthy persons. All subjects underwent neurological assessment and extra-cranial Doppler examination. We calculated for each internal jugular vein a parameter called ?CSA. The sum of all the venous flows was then calculated in clinostatism and in seated position and the difference between the two parameters has been named ?CVF. We assess the eventual presence of reflux in the internal jugular vein after a short period of apnea. Results: Between results of ?CSA parameter were differences with very high statistical significance. Similarly a negative ?CVF is significantly associated with multiple sclerosis. The persisting presence of reflux in internal jugular vein was observed in 60% multiple sclerosis patients. Conclusions: Studied parameters have revealed that there is a hemodynamic significance in the pathology of multiple sclerosis. Thus data obtained led us to the conclusion that the presence of reflux in the internal jugular vein correlated with a negative ?CVF is statistically significant in patients with multiple sclerosis.
Source: http://www.chsjournal.org/current-issue/original-papers/the-value-of-doppler-cerebral-parameters-to-assess-a-group-of-patients-with-multiple-sclerosis

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BMC Neurology 2013 Feb 13;13(1):20. [Epub ahead of print]
Chronic cerebrospinal venous insufficiency in multiple sclerosis: a highly prevalent age-dependent phenomenon

Roberta Lanzillo, Marcello Mancini, Raffaele Liuzzi, Orlando Di Donato, Elena Salvatore, Valentina Maglio, Giovanni Vacca, Luca Amato, Gennaro D¿Anna, Arturo Brunetti and Vincenzo Brescia Morra

Abstract (provisional)

Background
This study aimed to investigate the prevalence and clinical relevance of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) patients and healthy controls using extra- and intracranial colour Doppler sonography.

Methods
We examined 146 MS patients, presenting with a clinically isolated syndrome, relapsing-remitting, secondary progressive, or primary progressive MS, and 38 healthy controls. Sonographic examination was performed according to Zamboni's protocol and was performed by three independent sonographers. The results of sonographic examination were compared with clinical and demographic characteristics of the patients.

Results
CCSVI, defined as the presence of at least two positive Zamboni's criteria, was found in 76% of MS patients and 16% of control subjects. B-mode anomalies of internal jugular veins, such as stenosis, malformed valves, annuli, and septa were the most common lesions detected in MS patients (80.8%) and controls (47.4%). We observed a positive correlation between sonographic diagnosis of CCSVI and the patients' age (p=0.003). However, such a correlation was not found in controls (p=0.635). Notably, no significant correlations were found between sonographic signs of CCSVI and clinical characteristics of MS, except for absent flow in the jugular veins, which was found more often in primary (p<0.005) and secondary (p<0.05) progressive patients compared with non-progressive patients. Absent flow in jugular veins was significantly correlated with patients' age (p<0.0001).

Conclusions
Sonographically defined CCSVI is common in MS patients. However, CCSVI appears to be primarily associated with the patient's age, and poorly correlated with the clinical course of the disease.
Source: http://www.biomedcentral.com/1471-2377/13/20/abstract



Multiple Sclerosis: three recent confirmations for Zamboni's theory

Acta Phlebologica 2012 December;13(3):141-8
Results from 823 consecutive Duplex exams for CCSVI in a Vascular Centre
Bavera P. M., Agus G. B., Alpini D., Cecconi P., Guazzoni A., Tori A., Costantini E., Lupattelli T.
Aim. Ultrasound (US) diagnosis of chronic cerebrospinal venous insufficiency (CCSVI) and its association with MS is highly controversial, perhaps for lack of both training and awareness of what is normal in cervical veins mainly because they are not segments usually investigated in Vascular Labs.
Methods. The work is based upon the results of 823 consecutive Duplex (DU) exams carried out in one year on Multiple Sclerosis (MS) patients. The purpose was to eventually detect and quantify the presence of CCSVI and possible benefits on PTA-treated patients, according to the Zamboni criteria protocol. The authors scanned first a consecutive group of 60 controls, not affected by MS, aged 28-62 years old, in order to improve the personal learning curve in investigating the cervical veins. Therefore they investigated 696 MS patients and 127 MS patients post-PTA treatment for diagnosed CCSVI.
Results. Within the 60 controls, only 3 (5%) showed one flow abnormality according to the Zamboni criteria, considered insufficient for CCSVI diagnosis, while in the remaining 57 (95%) they were totally absent. In the 823 patients affected by MS, 627 (90%) matched with sufficient Zamboni criteria scores. The frequency of CCSVI among MS patients and non-MS controls revealed a higher CCSVI prevalence in the MS group (odds ratio 576.7; 95% confidence interval 286.2-1161.9; χ2=310 and P-value<0.0001). Finally, 88 patients (69%) of the post procedural Duplex examination were negative for CCSVI Zamboni criteria and this result was associated to symptoms improvements. Other previous, but smaller studies, were previously carried out with the aim to investigate CCSVI in MS and the lack of detection in this particular population of patients may be subsequent to insufficient training and completion of an adequate learning curve.
Conclusion. The present study demonstrates in a large survey, the strong association between the two conditions. In addition, PTA may revert abnormal duplex haemodynamics in a large proportion of patients.
Source: http://www.minervamedica.it/en/journals/acta-phlebologica/article.php?cod=R43Y2012N03A0141

Current Health Sciences Journal Vol. 39, No. 1, 2013 January March
The value of Doppler cerebral parameters to assess a group of patients with multiple sclerosis
AURA COTEANU, SIMONA GUSTI, CATALINA COTEANU
ABSTRACT: Background: The current definition of multiple sclerosis is an inflammatory/degenerative disease of central nervous system with focal demyelination around cerebral veins. In 2007 a theory was proposed that demonstrates an alteration of cerebral venous flow in patients with multiple sclerosis. Our study wants to see if there is a statistically significant differences between cerebral venous hemodynamics in multiple sclerosis patients and healthy people. Methods: We admitted in the study twenty-seven patients with multiple sclerois possible or defined, and thirty clinically healthy persons. All subjects underwent neurological assessment and extra-cranial Doppler examination. We calculated for each internal jugular vein a parameter called ΔCSA. The sum of all the venous flows was then calculated in clinostatism and in seated position and the difference between the two parameters has been named ΔCVF. We assess the eventual presence of reflux in the internal jugular vein after a short period of apnea. Results: Between results of ΔCSA parameter were differences with very high statistical significance. Similarly a negative ΔCVF is significantly associated with multiple sclerosis. The persisting presence of reflux in internal jugular vein was observed in 60% multiple sclerosis patients. Conclusions: Studied parameters have revealed that there is a hemodynamic significance in the pathology of multiple sclerosis. Thus data obtained led us to the conclusion that the presence of reflux in the internal jugular vein correlated with a negative ΔCVF is statistically significant in patients with multiple sclerosis.
Source: http://www.chsjournal.org/current-issue/original-papers/the-value-of-doppler-cerebral-parameters-to-assess-a-group-of-patients-with-multiple-sclerosis

BMC Neurology 2013 Feb 13;13(1):20. [Epub ahead of print]
Chronic cerebrospinal venous insufficiency in multiple sclerosis: a highly prevalent age-dependent phenomenon
Roberta Lanzillo, Marcello Mancini, Raffaele Liuzzi, Orlando Di Donato, Elena Salvatore, Valentina Maglio, Giovanni Vacca, Luca Amato, Gennaro D¿Anna, Arturo Brunetti and Vincenzo Brescia Morra
Abstract (provisional)
Background
This study aimed to investigate the prevalence and clinical relevance of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) patients and healthy controls using extra- and intracranial colour Doppler sonography.
Methods
We examined 146 MS patients, presenting with a clinically isolated syndrome, relapsing-remitting, secondary progressive, or primary progressive MS, and 38 healthy controls. Sonographic examination was performed according to Zamboni's protocol and was performed by three independent sonographers. The results of sonographic examination were compared with clinical and demographic characteristics of the patients.
Results
CCSVI, defined as the presence of at least two positive Zamboni's criteria, was found in 76% of MS patients and 16% of control subjects. B-mode anomalies of internal jugular veins, such as stenosis, malformed valves, annuli, and septa were the most common lesions detected in MS patients (80.8%) and controls (47.4%). We observed a positive correlation between sonographic diagnosis of CCSVI and the patients' age (p=0.003). However, such a correlation was not found in controls (p=0.635). Notably, no significant correlations were found between sonographic signs of CCSVI and clinical characteristics of MS, except for absent flow in the jugular veins, which was found more often in primary (p<0.005) and secondary (p<0.05) progressive patients compared with non-progressive patients. Absent flow in jugular veins was significantly correlated with patients' age (p<0.0001).
Conclusions
Sonographically defined CCSVI is common in MS patients. However, CCSVI appears to be primarily associated with the patient's age, and poorly correlated with the clinical course of the disease.
Source: http://www.biomedcentral.com/1471-2377/13/20/abstract