Update on: Clinical correlates of CCSVI in MS

by CCSVI in MS Toronto on Thursday, October 14, 2010 

Clinical correlates of chronic cerebrospinal venous insufficiency in multiple sclerosis

B. Weinstock-Guttman, G. Cutter, K. Marr, D. Hojnacki, M. Ramanathan, R.H.B. Benedict, C. Morgan, E.A. Yeh, E. Carl, C. Kennedy, J. Reuther, C. Brooks, M. Elfadil, M. Andrews, R. Zivadinov

Jacobs Neurological Institute (Buffalo, US); University of Alabama (Birmingham, US); Buffalo Neuroimaging Analysis Center (Buffalo, US); Department of Pharmaceutical Sciences (Buffalo, US)

Objectives:

To evaluate the clinical correlates of chronic cerebrospinal venous insufficiency (CCSVI) in a large cohort of patients with multiple sclerosis (MS).Background: CCSVI is a complex vascular condition characterized by anomalies of the primary veins outside the skull (Zamboni et al, JNNP, 2009). We previously showed in a pre-planned Combined Transcranial (TCD) and Extracranial Venous Doppler Evaluation (CTEVD) blinded study that the prevalence of CCSVI was significantly higher in the MS cohort vs. healthy controls (HC) (56.1% vs. 22.7%, p<0.001).

Results:

This study enrolled 499 subjects; 163 HC, 289 MS patients, 21 CIS patients, 26 subjects with other neurological disorders underwent a clinical examination and a combined Doppler and TCD scan of the head and neck. Thirty patients that were defined as borderline (technical limitation for criteria 2 and not meeting definition of CCSVI) were considered negative for this analysis.

CCSVI prevalence was significantly higher in more advanced MS disease subtypes:

89.5% in relapsing secondary-progressive (SP), 67.2% in non-relapsing SP, 54.5% in primary-progressive (PP), 49.2% in relapsing- remitting (RR) and 38.1% in CIS (p¼0.033).

The mean venous haemodynamic insufficiency severity score (VHISS) was higher for subjects diagnosed with CCSVI (mean VHISS_SD: 4.05_1.4, n¼218) than for subjects without CCSVI (1.20_1.0, n¼281; p<.001). Criteria 2, 4 and 5 showed significant associations with an EDSS_4.0 (Criteria 2: OR of 2.25, p¼0.005; criteria 4: OR: 3.28, p¼0.004 and Criteria 5 OR: 2.67, p¼0.008).

MS subjects with CCSVI had significantly higher Pyramidal (p¼0.020), Cerebellar (p¼0.049), and Brain Stem (p¼0.010) EDSS sub-scale score than subjects without CCSVI. Subjects with CCSVI were significantly older than subjects without CCSVI (p¼0.04).

However, the mean Multiple Sclerosis Severity Score (MSSS) trended higher for subjects with CCSVI (4.22_2.6, n¼160) than for subjects without CCSVI (3.63_2.4, n¼127), but this difference was not significant (p¼.073).

Conclusions:

The presence of CCSVI in MS patients was associated with more advanced MS disease subtypes and more severe motor, cerebellar and brainstem involvement.

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