A recent study conducted by Ellen Marder, MD; Pramod Gupta, MD; Benjamin M. Greenberg, MD et al. claim that chronic cerebral venous insufficiency does not exist in patients with Multiple Sclerosis (MS). The study has since been published in the Archives of Neurology.
Aim of Study
The main objective of the study was to verify whether patients with Multiple Sclerosis (MS) exhibited chronic cerebral venous insufficiency as proposed and proved by Zamboni et al. Thus, in effect, the purpose of the study included reproduction of the results obtained by Zamboni and his coworkers, on their ultrasonography observations of US veterans of armed forces suffering from MS.
Patients with multiple sclerosis and clinically isolated syndrome (CIS) were matched on same age and sex with those suffering from migraine or no neurological disease. The control group was recruited from the VA migraine clinic. All patients involved in the study had confirmed MS as diagnosed adhering to McDonald’s criteria.
- 18 (15 men and 3 women) patients with MS took part in study
- Mean age of patients was 55.2 years.
- Reference population included 11 (4 women and 7 men) age and sex matched subjects.
Cerebral venous insufficiency was determined by using ultrasonography, 4-dimensional color Doppler ultrasonography and the five parameters of venous outflow by Zamboni et al were also examined.
Five parameters of venous outflow as proposed by Zamboni et al include:
- IJV or vertebral vein reflux
- Deep cerebral vein reflux
- IJV stenosis
- Absence of flow in IJVs or vertebral veins
- Change in cross-sectional area of IJV with postural change
Results and Conclusion
The researchers were unable to detect significant difference in venous flow both in terms of number and type in patients with multiple sclerosis when compared with control subjects. Thus, the study failed to prove existence of chronic cerebral venous insufficiency in patients with MS as proposed by Zamboni et al.
The study follows suit with a number of other investigators which have unsuccessfully attempted to reproduce Zamboni et al results. Thus, whether cerebral venous insufficiency can be considered a significant therapeutic target in people with multiple sclerosis remains a question yet to be answered.
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