Ellen Marder, MD; Pramod Gupta, MD Report No Cerebral Venous Insufficiency in Patients with Multiple Sclerosis

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Multiple sclerosis does not always show chronic cerebral venous insufficiency.

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.

Method

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.

Comment

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.

References