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(ECTRIMS) Relationship between CCSVI & MS

 
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PostPosted: Sun Oct 06, 2013 4:17 pm    Post subject: (ECTRIMS) Relationship between CCSVI & MS Reply with quote

Presented at the annual ECTRIMS conference in Copenhagen, October 2-5, 2013:

Quote:
Chronic cerebro-spinal venous insufficiency (CCVI)

Thursday, October 03, 2013, 15:45 - 17:00

Determining the relationship between chronic cerebrospinal venous insufficiency (CCSVI) and multiple sclerosis (MS)

F. Costello, J Modi, M. Goyal, J. Scott, D. Lautner, D. Bhayana, J. Trufyn, R. Frayne, J. Davenport, J. Mah, M. Hill (Calgary, CA)

Introduction:

The chronic cerebrospinal venous insufficiency (CCSVI) hypothesis proposes that multiple sclerosis (MS) patients have detectable abnormalities in venous hemodynamics. The purpose of this study was to explore the validity of the CCSVI hypothesis by comparing the venous outflow between MS patients and healthy controls.

Methods:

120 MS patients and 60 age and sex-matched controls were enrolled in a prospective cross-sectional study designed to compare the proportion of MS patients and controls with extracranial ultrasound (US) (Phillips IU-22 unit) and 3T (GE Healthcare) gadolinium- enhanced magnetic resonance venography (Gd- MRV) evidence of venous outflow obstruction in the internal jugular (IJVs) and vertebral veins (VVs). Imaging data were interpreted by radiological experts blinded to the clinical status of study participants.

The primary outcome measure was the proportion of cases and controls with extra-cranial US (defined as 1 or more of the published Zamboni criteria) and Gd-MRV evidence of cranial venous outflow obstruction by proposed criteria.

Results:

The MS group (mean age 45.7 years; 74% females) included 86 relapsing-remitting, 17 secondary-progressive, 12 primary progressive, 1 neuromyelitis optica, and 4 clinically isolated syndrome patients. There were no significant differences in Gd-MRV measures of IJV dominance/ flattening; collateral vein formation; transverse sinus dominance; or intracranial vessel stenosis in MS patients relative to controls. Similarly, no differences were noted between MS patients and controls with any of US criteria employed including: (1) the presence of reflux in one or more veins (44% of MS patients versus 50% of control subjects); (2) B-mode evidence of proximal IJV stenosis (23% of MS patients versus 13% of control subjects); (3) absent Doppler detected flow in the IVJ or VVs (2% of MS patients versus 2% of control subjects); and/or (4) negative cross sectional area in the IJV in the sitting versus supine position (18% of MS patients versus 10% of control subjects). Overall, 61% of MS patients and 63% of control subjects fulfilled > 1 of 5 criteria proposed for CCSVI.

Conclusions:

We detected no Gd-MRV or extracranial US measured differences in venous outflow between MS patients and controls.

___________________

Dr. Fiona Costello has received funding as an advisory board consultant from Questcor and Allergan. Dr. Costello has receiving funding as a speaker from EMD Serono.

Dr. J. Modi has nothing to disclose

Dr. M. Goyal has nothing to disclose

Dr. J. Scott has nothing to disclose

Dr. D. Lautner has nothing to disclose

Dr. D. Bhayana has nothing to disclose

Dr. Jean Man has nothing to disclose

Dr. Richard Frayne has nothing to disclose

Dr. Jeptha Davenport has nothing to disclose

Miss Jessie Trufyn has nothing to disclose

Dr. Michael Hill has nothing to disclose
______________________
This study was funded by the MS Society of Canada.


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