May symptoms of chronic cerebrospinal venous insufficiency be improved by venous angioplasty? An independent 4-year follow up on 366 cases

Abstract

The aim of the study was to collect results from 366 chronic cerebrospinal venous insufficiency (CCSVI) affected patients that were regularly Duplex controlled after having received vein angioplasty following diagnosis for CCSVI. The procedures were all performed in the same Centre and same equipment. The patients were divided into three groups according to the attributed severity of the associated multiple sclerosis: 264 relapse-remitting (RR) (72%): 179 females (67.8%) and 85 (32.2%) males; 62 secondary progressive (17%): 37 (59.7%) females and 25 (40.3%) males; 40 primary progressive (11%): 22 (55%) females and 18 (45%) males. A data base revealed eleven most frequent disturbs and symptoms, together with working capacities, and was kept up-todate at every Duplex control aiming to establish a novel rapid CCSVI symptoms questionnaire assessment in 4 years follow up. The symptoms were: diplopia, fatigue, headache, upper limb numbness/mobility, lower limb numbness/mobility, thermic sensibility, bladder control, balance coordination, quality of sleep, vertigo, mind concentration.Results, as follows, appear to be significantly good in the RR group, also the biggest one. upper limb numbness and mobility in 20/24 (83.3%) (P=0.0002); lower limb numbness and mobility 13/15 (86.7%) (P=0.0087); thermic sensibility 3/4 (75%) [P: not significant (n.s.)]; bladder control 2/3 (66.6%) (P: n.s.).In contrast in the progressive cases results are quite different where, nevertheless, some useful considerations were collected and statistically significant, too.In addition, venous angioplasty appears to be safe, side effects were observed only in seven patients (0.19%) that grew a monolateral Jugular thrombosis but still were regularly controlled and above all did not suffer worsening of the disease. Finally, the overwhelming percutaneous transluminal angioplasty results in the RR group lead to say that the correct criteria should be the sooner the better.

CCSVI in multiple sclerosis: is it the end?

“…They also demanded that venoplasty for MS should be covered by the Italian healthcare system, as it is for other vascular pathologies. Reported responses to CCSVI treatment were as varied as the MS population itself -some patients experienced lasting benefits in terms of renewed energy, better balance, and improved bladder control [3]. In others, early improvements vanished with time, while some patients did not improve, or even experienced complications.…”

Time to Revisit Non-Pharmacological Research Approaches to Ameliorate Multiple Sclerosis Symptoms

“…Indeed, there are many studies demonstrating decreased intracranial compliance in MS patients, reviewed in ref. [26] and I will not dwell on this further except to state that the most recent study examining the long-term effects of venous angioplasty to correct for impaired venous return concluded that there were significant long-lasting symptom relief for remitting-relapsing MS patients and only transient relief for progressive MS patients [27].…”

“…©Copyright iMedPub Find this article in: www.jneuro.com patients than in controls [53][54][55]. These observations can only be explained by a decrease in intracranial compliance associated with a decreased movement of CSF from the subarachnoid space to the dural venous sinuses, see [26] for more details.…”

“…An increase in the pulsatility of CSF flow through the aqueduct can be explained by more of the arterial pulse pressure wave penetrating the microvessels. Further, a decrease in intracranial compliance can result from: 1) an increase in the hardness of the cerebral tissue, possibly due to MS lesion scarring; 2) a reduction of CSF flowing away from the intracranial compartment to the spinal compartment and/or 3) obstruction of the venous return [26]. in more of the arterial pulse pressure wave penetrating the microvasculature.…”

“…This topic is discussed in greater detail in ref. [26]. Clearly Reekers and colleagues [40] are not correct in that obstructed venous return "does not fit into the existing bulk of scientific data concerning the pathophysiology of MS".…”