1
|
Gandhi S, Marr K, Mancini M, Caprio MG, Jakimovski D, Chandra A, Hagemeier J, Hojnacki D, Kolb C, Weinstock-Guttman B, Zivadinov R. No association between variations in extracranial venous anatomy and clinical outcomes in multiple sclerosis patients over 5 years. BMC Neurol 2019; 19:121. [PMID: 31185944 PMCID: PMC6560860 DOI: 10.1186/s12883-019-1350-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/31/2019] [Indexed: 01/08/2023] Open
Abstract
Background No longitudinal, long-term, follow-up studies have explored the association between presence and severity of variations in extracranial venous anatomy, and clinical outcomes in patients with multiple sclerosis (MS). Objective This prospective 5-year follow-up study assessed the relationship of variations in extracranial venous anatomy, indicative of chronic cerebrospinal venous insufficiency (CCSVI) on Doppler sonography, according to the International Society for Neurovascular Disease (ISNVD) proposed consensus criteria, with clinical outcomes and disease progression in MS patients. Methods 90 MS patients (52 relapsing-remitting, RRMS and 38 secondary-progressive, SPMS) and 38 age- and sex-matched HIs were prospectively followed for 5.5 years. Extracranial and transcranial Doppler-based venous hemodynamic assessment was conducted at baseline and follow-up to determine the extent of variations in extracranial venous anatomy. Change in Expanded Disability Status Scale (∆EDSS), development of disability progression (DP) and annualized relapse rate (ARR) were assessed. Results No significant differences were observed in MS patients, based on their presence of variations in extracranial venous anatomy at baseline or at the follow-up, in ∆EDSS, development of DP or ARR. While more MS patients had ISNVD CCSVI criteria fulfilled at baseline compared to HIs (58% vs. 37%, p = 0.03), no differences were found at the 5-year follow-up (61% vs. 56%, p = 0.486). Discussion This is the longest follow-up study assessing the longitudinal relationship between the presence of variations in extracranial venous anatomy and clinical outcomes in MS patients. Conclusion: The presence of variations in extracranial venous anatomy does not influence clinical outcomes over the 5-year follow-up in MS patients. Electronic supplementary material The online version of this article (10.1186/s12883-019-1350-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sirin Gandhi
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Karen Marr
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Marcello Mancini
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Rome, Italy
| | - Maria Grazia Caprio
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Rome, Italy
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Avinash Chandra
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - David Hojnacki
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Channa Kolb
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. .,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
| |
Collapse
|
2
|
Hynes SM, Ghahari S, Forwell SJ. "Waiting for Science to Catch up with Practice": an examination of 10-year YouTube trends in discussions of chronic cerebral spinal venous insufficiency treatment for multiple sclerosis. Inform Health Soc Care 2019; 44:327-337. [PMID: 30913949 DOI: 10.1080/17538157.2019.1582052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objective of this longitudinal study examined, first, whether people with multiple sclerosis who previously advocated for angioplasty to treat chronic cerebral spinal venous insufficiency (CCSVI) through YouTube continued reporting benefits. Second, it examined a new cohort reporting on CCSVI treatment, and third, whether perspectives have changed.Method: YouTube videos from August 2011 to January 2019 related to CCSVI were retrieved. Once retrieved, all videos were compiled, classified and analyzed. Categorical data were reported and a pre-determined code-book was used to code videos. Data from the videos were extracted and analyzed using discourse analysis.Results: 1293 videos related to CCSVI were uploaded by 54 people with multiple sclerosis who met the inclusion criteria. YouTube videos uploaded by people with multiple sclerosis have shifted in volume and message. The initial surge in interest in CCSVI treatment has diminished, but there still exists strong advocates for its use. There appears to be an inconsistency between positive results, actual improvements in symptoms, and the overall messages reported. Very little long-term data was available as the procedure is relatively new.Conclusion: Practitioners may be faced with pressure to provide unproven treatments in the future and should be understanding but evidence-driven when supporting multiple sclerosis therapies.
Collapse
Affiliation(s)
- Sinéad M Hynes
- Discipline of Occupational Therapy, College of Medicine, Nursing and Health Sciences, Áras Moyola, National University of Ireland, Galway, Ireland
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.,Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Susan J Forwell
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| |
Collapse
|
3
|
Ulivelli M, Monti L, Ballerini M, Bartalini S, Cerase A, Cecconi F, Pizzirusso G, Bezzini D, Rossi A, Rossi S. Prospective study of clinical, neurophysiological and urodynamic findings in multiple sclerosis patients undergoing percutaneous transluminal venous angioplasty. Clin Neurophysiol 2018; 130:138-144. [PMID: 30537671 DOI: 10.1016/j.clinph.2018.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 10/06/2018] [Accepted: 10/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Verify whether Percutaneous Transluminal Angioplasty (PTA) may affect neural conduction properties in Multiple Sclerosis (MS) patients, thereby modifying patients' disability, with prospective neurophysiological, urodynamic, clinical and subjective well-being evaluations. METHODS In 55 out of 72 consecutively screened MS patients, the following procedures were carried out before (T0), at 2-6 months (T1) and at 6-15 months (T2) after a diagnostic phlebography, eventually followed by the PTA intervention if chronic cerebrospinal venous insufficiency (CCSVI) was diagnosed: clinical/objective evaluation (Expanded Disability Status Scale, EDSS), ratings of subjective well-being, evaluation of urodynamic functions and multimodal EPs (visual, acoustic, upper and lower limbs somatosensory and motor evoked potentials). RESULTS The number of dropouts was relatively high, and a complete set of neurophysiological and clinical data remained available for 37 patients (19 for urological investigations). The subjective well-being score significantly increased at T1 and returned close to basal values at T2, but their degree of objective disability did not change. Nevertheless, global EP-scores (indexing the impairment in conductivity of central pathways in multiple functional domains) significantly increased from T0 (7.9 ± 6.0) to T1 (9.2 ± 6.3) and from T0 to T2 (9.8 ± 6.3), but not from T1 and T2 (p > 0.05). Neurogenic urological lower tract dysfunctions slightly increased throughout the study. CONCLUSIONS The PTA intervention did not induce significant changes in disability in the present cohort of MS patients, in line with recent evidence of clinical inefficacy of this procedure. SIGNIFICANCE Absence of multimodal neurophysiological and functional testing changes in the first 15 months following PTA suggests that conduction properties of neural pathways are unaffected by PTA. Current findings suggest that the short-lived (2-6 months), post-PTA, beneficial effect on subjective well-being measures experienced by MS patients is likely related to a placebo effect.
Collapse
Affiliation(s)
- Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, University of Siena, Italy.
| | - Lucia Monti
- Department of Medicine, Surgery and Neuroscience, NINT Section, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Michele Ballerini
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, University of Siena, Italy
| | - Sabina Bartalini
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, University of Siena, Italy
| | - Alfonso Cerase
- Department of Medicine, Surgery and Neuroscience, NINT Section, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Filippo Cecconi
- Urologia, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | | | - Alessandro Rossi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, University of Siena, Italy; Department of Medicine, Surgery and Neuroscience, NINT Section, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, University of Siena, Italy.
| |
Collapse
|
4
|
Abstract
Background The objective of this review is to describe the diagnosis of neck vein obstruction and the possible role of chronic persistent Chlamydophila pneumoniae infection in producing the syndrome of chronic cerebrospinal venous obstruction. Method The normal patterns of flow in the neck veins are described and guidelines for interpretation of the quantitative duplex ultrasound examination of the extracranial neck veins are developed. Result An infective cause of neck vein obstruction is proposed and from a literature search of the role of the obligate intracellular bacterium Chlamydophila pneumoniae in vascular and chronic diseases, a diagnostic protocol for confirming chronic persistent Chlamydophila pneumoniae infection, which includes the quantitative duplex ultrasound examination and specific blood tests are suggested. Conclusion Further research to validate this diagnostic protocol is required.
Collapse
|
5
|
Caprio MG, Marr K, Gandhi S, Jakimovski D, Hagemeier J, Weinstock-Guttman B, Zivadinov R, Mancini M. Centralized and Local Color Doppler Ultrasound Reading Agreement for Diagnosis of the Chronic Cerebrospinal Venous Insufficiency in Patients with Multiple Sclerosis. Curr Neurovasc Res 2018; 14:266-273. [PMID: 28721810 PMCID: PMC5684782 DOI: 10.2174/1567202614666170718095203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 06/28/2017] [Accepted: 07/08/2017] [Indexed: 11/25/2022]
Abstract
Background: An impaired cerebrospinal venous drainage was postulated to be a cofactor in the multifactorial path-ogenesis of multiple sclerosis (MS). Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by abnormalities of the main extracranial cerebrospinal venous outflow routes, which can be detected by color Doppler Ultrasound (CDUS) using 5 venous hemodynamic (VH) criteria. Discrepant results between different investigators were reported in the past, therefore the usefulness and applicability of the CCSVI CDUS-based diagnosis in clinical research and practice has been questioned. The reproducibility of proposed criteria for CCSVI detection depends on the blinding, training level, skills of the operator and interpretation of VH criteria. Objectives: To assess agreement between centralized and local reading of CDUS examination for diagnosis of CCSVI in trained Doppler sonologists. Methods: This study was performed in 78 MS patients and 28 age- and sex-matched healthy controls (HCs). Extracranial and transcranial CDUS venous hemodynamic assessment was conducted, according to International Society of Neurovascu-lar Disease (ISNVD) recommended criteria, by a single CCSVI-trained expert sonologist blinded to the subject disease sta-tus. After the local Doppler sonologist performed the investigation, all images and video clips of the CDUS examination were sent to the centralized reading center, where a second blinded reading was performed by two CCSVI-trained expert sonologists. Statistical analyses were performed comparing accuracy of CCSVI diagnosis (≥2 VH criteria) and each of the 5 individual VH criteria using Cohen kappa statistic, along with positive/negative agreement and Odds ratio (OR) with 95% confidence intervals (95% CI). Results: Diagnosis of CCSVI was obtained in 59.7% of local and 64.3% centralized readers (Kappa, 0.67, p<0.001). Simi-lar Kappa values were obtained for CCSVI diagnosis and individual CCSVI criteria in both MS patients and HCs. The high-est Kappa between local and centralized readers was observed for VH criteria 5 (0.93) followed by VH criteria 4 (0.70), VH criteria 1 (0.66), VH criteria 2 (0.64) and VH criteria 3 (0.58). The positive predictive value (PPV) and negative predictive value (NPV) for CCSVI diagnosis were 82.7% and 86,7%, respectively with an OR of 31.1 (95% CI 11.1-87.5, p<0.001). The highest agreement between local and centralized readers was observed for VH criteria 4 (OR 98.7, 95% CI 17.1-569.9, p<0.001) with 72.7% PPV and 97.3% NPV followed by VH criteria 5 (53, 95% CI 13.4-209.2, p<0.001) with 98.1% PPV and 100% NPV value. Conclusion: Centralized reading of the CDUS examination for the diagnosis of CCSVI is feasible with high accuracy in CCSVI-trained Doppler sonologists. The most reproducible VH criteria between local and centralized readers were VH cri-teria 4 and 5.
Collapse
Affiliation(s)
- Maria Grazia Caprio
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Naples. Italy
| | - Karen Marr
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY. United States
| | - Sirin Gandhi
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY. United States
| | - Dejan Jakimovski
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY. United States
| | - Jesper Hagemeier
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY. United States
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Multiple Sclerosis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY. United States
| | - Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY. United States
| | - Marcello Mancini
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Via Tommaso De Amicis, 95, 80145 Naples. Italy
| |
Collapse
|
6
|
Sadovnick AD, Yee IM, Attwell-Pope K, Keyes G, Kipp L, Traboulsee AL. Patient-Reported Benefits of Extracranial Venous Therapy: British Columbia CCSVI Registry. Can J Neurol Sci 2017; 44:246-54. [PMID: 28270250 DOI: 10.1017/cjn.2017.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective Chronic cerebrospinal venous insufficiency (CCSVI) has been hypothesized to be a risk factor for multiple sclerosis (MS). Venoplasty has been proposed as a treatment for CCSVI. The aim of our study was to gain a better understanding of the "real-world" safety and longitudinal effectiveness of venoplasty Methods: British Columbia residents who self-reported having had venoplasty and consented to participate in the study were interviewed and followed for up to 24 months post-therapy using standardized structured questionnaires Results: Participants reported procedure-related complications (11.5%) and complications within the first month after the procedure (17.3%). Initially, more than 40% of participants perceived that the venoplasty had had positive effects on their health conditions, such as fatigue, numbness, balance, concentration/memory and mobility. However, this improvement was not maintained over time Conclusions: Follow-up patient-reported outcomes indicated that the initial perception of the positive impact of venoplasty on the health conditions of MS patients was not sustained over time. In addition, venoplasty was not without associated morbidity.
Collapse
|
7
|
Metz LM, Greenfield J, Marrie RA, Jette N, Blevins G, Svenson LW, Alikhani K, Wall W, Dhaliwal R, Suchowersky O. Medical Tourism for CCSVI Procedures in People with Multiple Sclerosis: An Observational Study. Can J Neurol Sci 2016; 43:360-7. [PMID: 26891024 DOI: 10.1017/cjn.2015.350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Many Canadians with multiple sclerosis (MS) have recently travelled internationally to have procedures for a putative condition called chronic cerebrospinal venous insufficiency (CCSVI). Here, we describe where and when they went and describe the baseline characteristics of persons with MS who participated in this non-evidence-based medical tourism for CCSVI procedures. METHODS We conducted a longitudinal observational study that used online questionnaires to collect patient-reported information about the safety, experiences, and outcomes following procedures for CCSVI. A convenience sample of all Albertans with MS was recruited between July 2011 and March 2013. RESULTS In total, 868 individuals enrolled; 704 were included in this cross-sectional, baseline analysis. Of these, 128 (18.2%) participants retrospectively reported having procedures for CCSVI between April 2010 and September 2012. The proportion of participants reporting CCSVI procedures declined from 80 (62.5%) in 2010, to 40 (31.1%) in 2011, and 8 (6.3%) in 2012. In multivariable logistic regression analysis, CCSVI procedures were independently associated with longer disease duration, secondary progressive clinical course, and greater disability status. CONCLUSIONS Although all types of people with MS pursued procedures for CCSVI, a major driver of participation was greater disability. This highlights that those with the greatest disability are the most vulnerable to unproven experimental procedures. Participation in CCSVI procedures waned over time possibly reflecting unmet expectations of treated patients, decreased media attention, or that individuals who wanted procedures had them soon after the CCSVI hypothesis was widely publicized.
Collapse
|
8
|
Abstract
OBJECTIVES To study the ultrastructure of intraluminal defects found in the internal jugular vein by using a scanning electron microscopy. METHODS Using a scanning electron microscopy, intraluminal septa and/or defective valves blocking the flow in the distal internal jugular vein of seven patients were studied together with the adjacent wall and compared with control specimen. RESULTS The internal jugular veins' wall showed a significant derangement of the endothelial layer as compared to controls. Surprisingly, no endothelial cells were found in the defective cusps, and the surface of the structure is covered by a fibro-reticular lamina. CONCLUSIONS Although the lack of endothelial cells in the internal jugular vein intraluminal obstacles is a further abnormality found in course of chronic cerebrospinal venous insufficiency, our investigation cannot clarify whether this finding is primary or caused by progressive loss of endothelium in relation to altered haemodynamic forces and/or to a past post-thrombotic/inflammatory remodelling.
Collapse
Affiliation(s)
- P Zamboni
- Vascular Disease Center, University of Ferrara, Italy Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy
| | - V Tisato
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy
| | - E Menegatti
- Vascular Disease Center, University of Ferrara, Italy Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy
| | - F Mascoli
- Vascular Disease Center, University of Ferrara, Italy Vascular and Endovascular Unit, S. Anna University Hospital, Ferrara, Italy
| | - S Gianesini
- Vascular Disease Center, University of Ferrara, Italy Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy
| | - F Salvi
- IRCCS Neurosciences, Bologna, Italy
| | - P Secchiero
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy
| |
Collapse
|
9
|
Leone MA, Raymkulova O, Lochner P, Bolamperti L, Rivadossi G, Stecco A, Zaccala G, Maggio M, Liboni W, Guido M, Coppo L, Imperiale D. Chronic cerebrospinal venous insufficiency is not associated with chronic venous disorders: A case-control study. Phlebology 2014; 30:736-8. [PMID: 25081746 DOI: 10.1177/0268355514544782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the relationship between chronic cerebrospinal venous insufficiency (CCSVI) and the presence of a Chronic Venous Disorder (CVD). METHOD We included 55 subjects with CCSVI aged >18 years, and 186 controls without CCSVI. Each subject was evaluated with color Doppler sonography in accordance with Zamboni's five criteria, examined by two neurologists and interviewed with an ad-hoc designed form. The neurologists and the sonographers were mutually blinded. CVD were classified according to CEAP. RESULTS Mean age was 42 years (SD = 9) in cases and 43 years (10) in controls (p = ns). The odds ratios in subjects CCSVI were 0.6 (0.2-2.2) for CEAP 1, 0.9 (0.2-4.5) for CEAP 2, and 1.0 (0.6-1.9) for family history of varicose veins. The prevalence of CVD and, family history of varicose veins, was similar between cases and controls for each Zamboni criterion. CONCLUSIONS We found no association of CCSVI with the presence of CVD or family history of varicose veins.
Collapse
Affiliation(s)
- Maurizio A Leone
- SCDU Neurologia, Head and Neck Department, AOU "Maggiore della Carità", Novara, Italy Interdisciplinary Research Center of Autoimmune Diseases, IRCAD, Novara, Italy
| | - Olga Raymkulova
- SCDU Neurologia, Head and Neck Department, AOU "Maggiore della Carità", Novara, Italy
| | | | - Laura Bolamperti
- SCDU Neurologia, Head and Neck Department, AOU "Maggiore della Carità", Novara, Italy
| | | | - Alessandro Stecco
- Istituto di Radiologia Diagnostica e Interventistica, AOU "Maggiore della Carità", Novara, Italy
| | - Giuseppe Zaccala
- Department of Medicine, AOU "Maggiore della Carità", Novara, Italy
| | | | | | | | - Lorenzo Coppo
- SCDU Neurologia, Head and Neck Department, AOU "Maggiore della Carità", Novara, Italy
| | | |
Collapse
|
10
|
Jedynak W, Cieszanowski A. Is there any relation between chronic cerebrospinal venous insufficiency and multiple sclerosis? - a critical review. Pol J Radiol 2014; 79:131-6. [PMID: 24917892 PMCID: PMC4049975 DOI: 10.12659/pjr.890379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/03/2014] [Indexed: 11/17/2022] Open
Abstract
Summary Though the etiology of multiple sclerosis remains unknown, the widely accepted explanation is that it has an autoimmune inflammatory background. In 2006 Paolo Zamboni renewed the somewhat forgotten vascular theory of the pathogenesis of multiple sclerosis, proposing the new entity of 'chronic cerebrospinal venous insufficiency'. As a result of this hypothesis, Zamboni suggested an endovascular treatment for multiple sclerosis involving venoplasty of the internal jugular vein and the azygos vein. Unfortunately, several teams have tried to replicate Zamboni's results without success. In this review, we present a chronological description of the results of the studies conducted by Zamboni and the later attempts to replicate his work. The main conclusion is that, taking into account results that are currently available, we should remain cautious and routine use of this treatment in patients should not be advisable.
Collapse
Affiliation(s)
- Waldemar Jedynak
- Department of Diagnostic Imaging, Hospital of the West, Jan Paul II, Grodzisk Mazowiecki, Poland
| | - Andrzej Cieszanowski
- 2 Department of Radiology, Laboratory of Magnetic Resonance, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
11
|
Scalise F, Novelli E, Farina M, Barbato L, Spagnolo S. Venous Hemodynamic Insufficiency Severity Score variation after endovascular treatment of chronic cerebrospinal venous insufficiency. Phlebology 2014; 30:250-6. [PMID: 24531803 DOI: 10.1177/0268355514524193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the internal jugular veins (IJVs) and/or azygos veins with disturbed flow and formation of collateral venous channels. The presence of CCSVI has been associated with multiple sclerosis (MS). Percutaneous venous angioplasty (PVA) has been proposed to improve extracranial outflow; however, a non-invasive, post-procedural follow-up outcome measure has not been established. AIM OF THE STUDY To evaluate the short-term hemodynamic follow-up of CCSVI after PVA using color Doppler ultrasound (CDU) and to investigate whether hemodynamic variation correlated with clinical variation. MATERIALS AND METHODS Forty-five patients affected by MS with confirmed CCSVI underwent IJVs PVA. Venous hemodynamic (VH) parameters indicative of CCSVI and the Venous Hemodynamic Insufficiency Severity Score (VHISS) were evaluated by CDU at baseline and 3 months post-PVA. Concurrently, the MS-related disability status (EDSS) was evaluated. RESULTS The VH parameters and VHISS 3 months after IJVs PVA significantly decreased: the VH parameters -32.1% and the VHISS -33.8% (p < 0.001). The EDSS score 3 months after IJVs PVA was significantly lower than the baseline (-5.5%, p < 0.001). Using the median value of the VHISS variation as the cut-off, we were able to identify two groups of patients: responders, group A; and non-responders, group B. The EDSS score variation at 3 months was 0.310 in group A and 0.275 in group B (p = 0.746). CONCLUSIONS CCSVI endovascular treatment can induce an improvement in VH parameters and the VHISS. The neurological disability score (EDSS) also improved after PVA; however, there was no correlation to the VHISS variation after PVA, MS type and duration.
Collapse
Affiliation(s)
- Filippo Scalise
- Cardiac and Vascular Catheterization Laboratory, Policlinico di Monza, Monza, Italy CCSVI Research Center, Policlinico di Monza, Monza, Italy
| | - Eugenio Novelli
- CCSVI Research Center, Policlinico di Monza, Monza, Italy Biostatistics Unit, Policlinico di Monza, Monza, Italy
| | - Massimiliano Farina
- CCSVI Research Center, Policlinico di Monza, Monza, Italy Vascular Surgery, Policlinico di Monza, Monza, Italy
| | - Luciano Barbato
- CCSVI Research Center, Policlinico di Monza, Monza, Italy Cardiovascular Surgery Department, Policlinico di Monza, Monza, Italy
| | - Salvatore Spagnolo
- CCSVI Research Center, Policlinico di Monza, Monza, Italy Cardiovascular Surgery Department, Policlinico di Monza, Monza, Italy
| |
Collapse
|
12
|
Sudau F, Friede T, Grabowski J, Koschack J, Makedonski P, Himmel W. Sources of information and behavioral patterns in online health forums: observational study. J Med Internet Res 2014; 16:e10. [PMID: 24425598 PMCID: PMC3958625 DOI: 10.2196/jmir.2875] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/24/2013] [Accepted: 11/11/2013] [Indexed: 11/30/2022] Open
Abstract
Background Increasing numbers of patients are raising their voice in online forums. This shift is welcome as an act of patient autonomy, reflected in the term “expert patient”. At the same time, there is considerable concern that patients can be easily misguided by pseudoscientific research and debate. Little is known about the sources of information used in health-related online forums, how users apply this information, and how they behave in such forums. Objective The intent of the study was to identify (1) the sources of information used in online health-related forums, and (2) the roles and behavior of active forum visitors in introducing and disseminating this information. Methods This observational study used the largest German multiple sclerosis (MS) online forum as a database, analyzing the user debate about the recently proposed and controversial Chronic Cerebrospinal Venous Insufficiency (CCSVI) hypothesis. After extracting all posts and then filtering relevant CCSVI posts between 01 January 2008 and 17 August 2012, we first identified hyperlinks to scientific publications and other information sources used or referenced in the posts. Employing k-means clustering, we then analyzed the users’ preference for sources of information and their general posting habits. Results Of 139,912 posts from 11,997 threads, 8628 posts discussed or at least mentioned CCSVI. We detected hyperlinks pointing to CCSVI-related scientific publications in 31 posts. In contrast, 2829 different URLs were posted to the forum, most frequently referring to social media, such as YouTube or Facebook. We identified a total of 6 different roles of hyperlink posters including Social Media Fans, Organization Followers, and Balanced Source Users. Apart from the large and nonspecific residual category of the “average user”, several specific behavior patterns were identified, such as the small but relevant groups of CCSVI-Focused Responders or CCSVI Activators. Conclusions The bulk of the observed contributions were not based on scientific results, but on various social media sources. These sources seem to contain mostly opinions and personal experience. A small group of people with distinct behavioral patterns played a core role in fuelling the discussion about CCSVI.
Collapse
Affiliation(s)
- Fabian Sudau
- Institute of Computer Science, Georg-August-University Göttingen, Göttingen, Germany.
| | | | | | | | | | | |
Collapse
|
13
|
De Pasquale C, Pistorio ML, Veroux M, Giaquinta A, Veroux P, Fornaro M. Cognitive functioning and subjective quality of life in relapsing-remitting multiple sclerosis patients before and after percutaneous transluminal angioplasty: a preliminary report. Neuropsychiatr Dis Treat 2014; 10:1039-44. [PMID: 24959079 PMCID: PMC4061177 DOI: 10.2147/ndt.s64751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a disease of the nervous system that has profound effects on everyday functioning and quality of life of not only the person who is diagnosed, but also her/his family and acquaintances. Despite this, the uncertainties of the actual etiological basis of MS make it difficult to reach a conclusive statement about the optimal therapeutic management of the disease, which may differ depending on the given case and phase of illness. This has led to an interest in potential novel therapeutic avenues, including percutaneous transluminal angioplasty (PTA). Yet, evidence in support of PTA in the management of MS is scarce and contradictory. The aim of the present study was to provide a preliminary assessment as to whether PTA may impact subjective quality of life and cognitive functioning in severe MS. METHOD Ninety-five MS outpatients were followed-up for 24 months on a scheduled basis using the Milan Overall Dementia Assessment and the short-form 36-item scales, and were clinically evaluated by an appointed neurologist and psychiatrist. RESULTS At end point (month 24), only a minority of patients were still active in the study (n=33 or 34.74%). Among other measures, those who remained in the study until completion showed a significantly better Expanded Disability Status Scale and Milan Overall Dementia Assessment autonomy profile at study entrance compared to those patients who did not remain in the study until completion. Limitations were: a lack of any active control group; small sample size; Berkson's bias; and selection by indication biases. CONCLUSION Given the burden of MS and its high attrition rate, additional studies, including bigger samples, active control groups, and Cox's regression and survival analysis in case of randomization, should shed further light on the actual usefulness of PTA for the most severe cases of MS.
Collapse
Affiliation(s)
- Concetta De Pasquale
- Department of Education Science, University of Catania, Catania, Italy ; Vascular Surgery and Organ Transplant Unit, Department of Surgery Transplantation and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | | | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Surgery Transplantation and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, Department of Surgery Transplantation and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, Department of Surgery Transplantation and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Michele Fornaro
- Department of Education Science, University of Catania, Catania, Italy
| |
Collapse
|
14
|
Ploughman M, Harris C, Hogan SH, Murray C, Murdoch M, Austin MW, Stefanelli M. Navigating the "liberation procedure": a qualitative study of motivating and hesitating factors among people with multiple sclerosis. Patient Prefer Adherence 2014; 8:1205-13. [PMID: 25228799 PMCID: PMC4164287 DOI: 10.2147/ppa.s65483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The debate within the multiple sclerosis (MS) community initiated by the chronic cerebrospinal venous insufficiency (CCSVI) hypothesis and the subsequent liberation procedure placed some people with MS at odds with health care professionals and researchers. OBJECTIVE This study explored decision making regarding the controversial liberation procedure among people with MS. SUBJECTS AND METHODS Fifteen people with MS (procedure, n=7; no procedure, n=8) participated in audiotaped semistructured interviews exploring their thoughts and experiences related to the liberation procedure. Data were transcribed and analyzed using an iterative, consensus-based, thematic content-analysis approach. RESULTS Participants described an imbalance of motivating factors affirming the procedure compared to hesitating factors that provoked the participant to pause or reconsider when deciding to undergo the procedure. Collegial conversational relationships with trusted sources (eg, MS nurse, neurologist) and ability to critically analyze the CCSVI hypothesis were key hesitating factors. Fundraising, family enthusiasm, and the ease of navigation provided by medical tourism companies helped eliminate barriers to the procedure. CONCLUSION Knowledge of factors that helped to popularize the liberation procedure in Canada may inform shared decision making concerning this and future controversies in MS.
Collapse
Affiliation(s)
- Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John’s, NL, Canada
- Correspondence: Michelle Ploughman, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, 4th floor, LA Miller Centre, 100 Forest Road, St John’s, NL A1A 1E5, Canada, Tel +1 709 777 2099, Email
| | - Chelsea Harris
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John’s, NL, Canada
| | - Stephen H Hogan
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John’s, NL, Canada
| | - Cynthia Murray
- School of Nursing, Memorial University, St John’s, NL, Canada
| | - Michelle Murdoch
- Coalition of Persons with Disabilities, Memorial University, St John’s, NL, Canada
| | - Mark W Austin
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University, St John’s, NL, Canada
| | - Mark Stefanelli
- Department of Neurology, Faculty of Medicine, Memorial University, St John’s, NL, Canada
| |
Collapse
|
15
|
Thibault P, Lewis W, Niblett S. Objective duplex ultrasound evaluation of the extracranial circulation in multiple sclerosis patients undergoing venoplasty of internal jugular vein stenoses: a pilot study. Phlebology 2013; 30:98-104. [PMID: 24321823 DOI: 10.1177/0268355513515473] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Chronic cerebrospinal venous insufficiency (CCSVI) is a condition associated with multiple sclerosis (MS) and manifested by stenoses in the extracranial venous circulation. There is a need for an objective non-invasive assessment of CCSVI that is able to accurately identify the location of stenoses and quantify physiological changes in blood flows following treatment. METHOD A duplex ultrasound method, extracranial duplex ultrasound (ECDU), is described where the internal jugular veins (IJVs) and vertebral veins (VVs) were examined in the supine and sitting position before and after venoplasty in eight patients with clinically diagnosed MS. High-resolution B-mode imaging was used to detect obvious stenoses, intra-luminal membranes, valve abnormalities and vein wall thickening. ECDU was then used to assess blood flow including reflux. To assess obstruction, venous blood volume flows (BVFs) were taken bilaterally from the proximal (J1), mid (J2) and distal (J3) segments of the IJVs and the mid cervical VVs. To assess cerebral perfusion, bilateral BVF measurements were taken, in the supine position only, from the proximal internal carotid arteries (ICA) and mid cervical vertebral arteries (VA). The global arterial cerebral blood flow (GACBF) was then calculated as the sum of the ICA and VA measurements. RESULTS Pre-venography ECDU detected IJV stenoses or obstruction in all patients. Venography findings were consistent with those of the pre-treatment ECDU with the exception of the detection of bilateral IJV stenoses in two patients diagnosed with unilateral IJV stenosis by ECDU. A significant improvement in GACBF was evident following venoplasty (p < 0.05). A trend to improvement in the post-treatment BVFs of both the IJVs and the mid cervical VVs was also observed. This improvement was most marked in the left VVs (p = 0.052) and the J2 segment of right IJVs (p < 0.05). CONCLUSION The ECDU examination described provides a reliable objective assessment of IJV and VV stenoses and, with the use of BVFs, can quantify the degree of obstruction. These results support the use of ECDU as a non-invasive post-operative assessment of the success of venoplasty. The ability of ECDU to measure GACBF provides an additional parameter to monitor vascular pathophysiology in MS patients. The current findings support the view that the early symptomatic benefits observed after venoplasty for stenoses in the extracranial venous circulation may be the result of increased cerebral perfusion.
Collapse
Affiliation(s)
- P Thibault
- CCSVI Diagnostic Clinic, New South Wales, Australia
| | - W Lewis
- Vascular One Ultrasound, New South Wales, Australia
| | - S Niblett
- University of Newcastle, Teaching & Research Unit, Gosford Hospital, New South Wales, Australia
| |
Collapse
|
16
|
Abstract
Objective This study is the first in a series investigating the relationship between autonomic nervous system dysfunction and chronic cerebrospinal venous insufficiency in multiple sclerosis patients. We screened patients for the combined presence of the narrowing of the internal jugular veins and symptoms of autonomic nervous system dysfunction (fatigue, cognitive dysfunction, sleeping disorders, headache, thermal intolerance, bowel/bladder dysfunction) and determined systolic and diastolic blood pressure responses to balloon angioplasty. Methods The criteria for eligibility for balloon angioplasty intervention included ≥50% narrowing in one or both internal jugular veins, as determined by the magnetic resonance venography, and ≥3 clinical symptoms of autonomic nervous system dysfunction. Blood pressure was measured at baseline and post-balloon angioplasty. Results Among patients who were screened, 91% were identified as having internal jugular veins narrowing (with obstructing lesions) combined with the presence of three or more symptoms of autonomic nervous system dysfunction. Balloon angioplasty reduced the average systolic and diastolic blood pressure. However, blood pressure categorization showed a biphasic response to balloon angioplasty. The procedure increased blood pressure in multiple sclerosis patients who presented with baseline blood pressure within lower limits of normal ranges (systolic ≤105 mmHg, diastolic ≤70 mmHg) but decreased blood pressure in patients with baseline blood pressure above normal ranges (systolic ≥130 mmHg, diastolic ≥ 80 mmHg). In addition, gender differences in baseline blood pressure subcategories were observed. Discussion The coexistence of internal jugular veins narrowing and symptoms of autonomic nervous system dysfunction suggests that the two phenomena may be related. Balloon angioplasty corrects blood pressure deviation in multiple sclerosis patients undergoing internal jugular vein dilation. Further studies should investigate the association between blood pressure deviation and internal jugular veins narrowing, and whether blood pressure normalization affects Patient's clinical outcomes.
Collapse
Affiliation(s)
| | - Prabhjot Grewal
- Dept. of Neurology, Stroke Center, Buffalo Medical Center, Buffalo, NY, USA
| | - Steven Cen
- Dept. of Neurology, Stroke Center, Buffalo Medical Center, Buffalo, NY, USA
| | | | - Jinhee Yu
- Synergy Health Concepts, Newport Beach, CA, USA
| | - Michael Arata
- Dept. of Neurology, Stroke Center, Buffalo Medical Center, Buffalo, NY, USA
| |
Collapse
|
17
|
Laukontaus SJ, Kagayama T, Lepäntalo M, Atula S, Färkkilä M, Albäck A, Inoue Y, Tienari P, Venermo M. Doppler ultrasound examination of multiple sclerosis patients and control participants: inter-observer agreement and association with disease. Eur J Vasc Endovasc Surg 2013; 46:466-72. [PMID: 23920002 DOI: 10.1016/j.ejvs.2013.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 07/05/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a major risk factor for multiple sclerosis (MS). The aim of this study was to assess inter-observer agreement between two ultrasound examiners and to compare findings in MS patients and control participants. METHODS A prospective, blinded, controlled study of MS patients diagnosed within 2 years (MS ≤ 2, n = 39), patients diagnosed more than 10 years ago (MS > 10, n = 43) and age- and sex-matched control participants (n = 40). Ultrasound examinations were performed by two independent examiners. CCSVI criteria 1, 3, 4 and 5 as proposed by Zamboni were explored: (1) reflux in the internal jugular (IJV) and vertebral veins (VV), (3) IJV cross-sectional area (CSA) ≤0.3 cm(2), (4) absence of flow in IJV and VV, and (5) reverted postural control of venous outflow. RESULTS Criteria 1, 4 and 5 were met in less than 10% of the MS patients and control participants as studied by both examiners. The level of inter-observer agreement was poor for all parameters except assessment of the CSA of IJV at the thyroid level. Findings meeting CCSVI criterion 3 (CSA ≤ 0.3 cm(2)) were observed in 18/40 (45%) of the control participants, in 24/37 (65%) of MS ≤ 2 patients (p = 0.09 vs. control participants) and in 30/43 (70%) of the MS > 10 patients (p = 0.022 vs. control participants). CONCLUSIONS The feasibility of the CCSVI criteria for common use is questionable because of low inter-observer agreement. Small-calibre IJVs meeting the CCSVI criterion 3 appear common in both Finnish control participants and MS patients, but the clinical significance of this finding is questionable.
Collapse
Affiliation(s)
- S J Laukontaus
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Scalise F, Farina M, Manfredi M, Auguadro C, Novelli E. Assessment of jugular endovascular malformations in chronic cerebrospinal venous insufficiency: colour-Doppler scanning and catheter venography compared with intravascular ultrasound. Phlebology 2013; 28:409-17. [PMID: 23155132 DOI: 10.1258/phleb.2012.012079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Chronic cerebrospinal venous insufficiency (CCSVI) is a malformative condition characterized by several anomalies of the azygos and/or internal jugular veins (IJVs). Recommended diagnosis of CCSVI is performed with colour-Doppler (CD) sonography. Though catheter venography (CV) is considered as the gold standard for determining vascular anatomy, its uniplanar point of view does not allow an overall evaluation of endoluminal structures. This limit could be addressed by intravascular ultrasound (IVUS). The aim of this report is to evaluate, in patients with multiple sclerosis (MS), the accuracy of CD sonography and CV versus IVUS in estimating the diameter and the cross-sectional area (CSA) of the IJVs and in detecting jugular endoluminal malformations (JEM). METHOD Forty-five MS patients with CCSVI, diagnosed by CD sonography, were submitted to CV during IJVs angioplasty. Twenty-five subjects were also examined with IVUS. The IJVs maximum diameter (MAXD) and CSA were estimated. CD and CV data were compared with IVUS data with the Bland-Altman method. RESULTS The mean difference in IJV MAXD recorded by CD and IVUS was -0.5 mm. The mean difference in IJV MAXD recorded by CV and IVUS was 3.36 mm. The mean difference in IJV CSA recorded by CD and IVUS was -11.2 mm(2). JEM recorded by IVUS were detected by CD sonography and CV with 88% and 32% accuracy, respectively. CONCLUSIONS CV was significantly inferior to CD sonography and IVUS in detecting JEM. Differences between IVUS and CD sonography in detecting JEM and in quantifying jugular diameters were not significant. The IJV CSA was underestimated by CD sonography compared with IVUS. CD sonography was proven to be important in the anatomical characterization of CCSVI, providing useful information for correct intravascular treatment.
Collapse
Affiliation(s)
- F Scalise
- Cardiovascular Catheterization Laboratory
| | | | | | | | | |
Collapse
|
19
|
Alpini D, Bavera PM, Di Berardino F, Barozzi S, Cesarani A. Bilateral sudden sensorineural hearing loss and chronic venous cerebrospinal insufficiency: a case report. Phlebology 2013; 28:231-3. [PMID: 22490722 DOI: 10.1258/phleb.2012.012009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We report a case of bilateral sudden sensorineural hearing loss (SSHL) in a patient suffering from chronic venous cerebrospinal insufficiency (CCSVI). METHODS Audiometric testing confirmed bilateral sensorineural hearing loss with hypoexcitability to caloric stimulation on the left side and echo-colour Doppler examination showed abnormal cerebral venous deficiency. RESULTS The patient's condition improved after 15 days following medical treatment. CONCLUSIONS CCSVI may explain the anatomical background which provides a predisposing factor for SSHL although further studies are needed to verify whether this observation is casual or coincidental.
Collapse
Affiliation(s)
- D Alpini
- Scientific Institute S. Maria Nascente, Don C. Gnocchi Foundation, Italy
| | | | | | | | | |
Collapse
|
20
|
Ghezzi A, Annovazzi P, Amato MP, Capello E, Cavalla P, Cocco E, Falcini M, Gallo A, Patti F, Perini P, Rodegher ME, Rovaris M, Rottoli MR, Comi G. Adverse events after endovascular treatment of chronic cerebro-spinal venous insufficiency ( CCSVI) in patients with multiple sclerosis. Mult Scler 2013; 19:961-3. [PMID: 23380649 DOI: 10.1177/1352458513475491] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although it is debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients undergo endovascular treatment (ET) of CCSVI. A study is ongoing in Italy to evaluate the clinical outcome of ET. Severe adverse events (AEs) occurred in 15/462 subjects at a variable interval after ET: jugular thrombosis in seven patients, tetraventricular hydrocephalus, stroke, paroxysmal atrial fibrillation, status epilepticus, aspiration pneumonia, hypertension with tachicardia, or bleeding of bedsore in the remaining seven cases. One patient died because of myocardial infarction 10 weeks after ET. The risk of severe AEs related to ET for CCSVI must be carefully considered.
Collapse
Affiliation(s)
- A Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Lazzaro MA, Zaidat OO, Mueller-Kronast N, Taqi MA, Woo D. Endovascular therapy for chronic cerebrospinal venous insufficiency in multiple sclerosis. Front Neurol 2011; 2:44. [PMID: 21808631 PMCID: PMC3139170 DOI: 10.3389/fneur.2011.00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/28/2011] [Indexed: 11/13/2022] Open
Abstract
Recent reports have emerged suggesting that multiple sclerosis (MS) may be due to abnormal venous outflow from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI). These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment.
Collapse
Affiliation(s)
- Marc A Lazzaro
- Department of Neurology, Froedtert Hospital and Medical College of Wisconsin Milwaukee, WI, USA
| | | | | | | | | |
Collapse
|
22
|
Hartel M, Kluczewska E, Simka M, Ludyga T, Kostecki J, Zaniewski M. Magnetic Resonance Venography of chronic cerebrospinal venous insufficiency in patients with associated multiple sclerosis. Pol J Radiol 2011; 76:59-62. [PMID: 22802817 PMCID: PMC3389902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 01/27/2011] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease with not well understood etiology. Recently, a possible association of MS with compromised venous outflow from the brain and spinal cord has been studied (chronic cerebrospinal venous insufficiency - CCSVI). Angioplasties of internal jugular veins (IJV) and azygous vein (AV) have given promising results, with improvements in patients' clinical status. MATERIAL/METHODS 830 patients with clinically defined MS were scanned from the level of sigmoid sinuses to the junction with brachiocephalic veins, as well as at the level of AV. T2-weighted, 2D TOF and FIESTA sequences were used. RESULTS The examination revealed a slower blood flow in IJVs, in 98% of patients: on the right side - in 6%, on the left side - in 15%, on both sides with right-side predominance - in 22%, on both sides with left-side predominance - in 34%, bilaterally with no side predominance - in 19%. In 2%, there was a slower blood flow in IJVs, vertebral veins and subclavian veins and also in the left brachiocephalic vein. Moreover, in 5% of patients there was a decreased blood flow in the azygous vein. CONCLUSIONS Abnormal flow pattern in IJVs is more common on the left side. Less often it can be found in azygous vein and in brachiocephalic veins. Further research is needed to investigate the significance of CCSVI in MS patients. The protocol we described can be used for most of modern magnetic resonance units.
Collapse
Affiliation(s)
- Marcin Hartel
- MCD Voxel, MRI Department, Zabrze, Poland,Author’s address: Marcin Hartel, Reta 39G Str., 43-190 Mikołów, Poland, e-mail:
| | - Ewa Kluczewska
- MCD Voxel, MRI Department, Zabrze, Poland, Radiology Department in Zabrze, Medical Uniwersity of Silesia, Katowice, Poland
| | - Marian Simka
- EUROMEDIC Specialist Clinics, Department of Vascular & Endovascular Surgery, Katowice, Poland
| | - Tomasz Ludyga
- EUROMEDIC Specialist Clinics, Department of Vascular & Endovascular Surgery, Katowice, Poland
| | - Jacek Kostecki
- General and Vascular Surgery Department in Tychy, Medical University of Silesia, Katowice, Poland
| | - Maciej Zaniewski
- General and Vascular Surgery Department in Tychy, Medical University of Silesia, Katowice, Poland
| |
Collapse
|