Analysis of patients with chronic cerebro-spinal venous insufficiency and multiple sclerosis: identification of parameters of clinical severity


https://doi.org/10.4081/vl.2015.4570
Vol. 4 No. 1 (2015)
Submitted: 12 July 2014
Accepted: 5 March 2015
Published: 9 April 2015
multiple sclerosis, chronic cerebrospinal venous insufficiency, echo-color-Doppler.
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Authors

  • Sandro Mandolesi
    s.mandolesi@email.it
    Department of Cardio-vascular and Respiratory Sciences, La Sapienza University, Roma, Italy.
  • Aldo d’Alessandro Department of Neuroscience, Imaging and Clinical Sciences, Chieti-Pescara University, Italy.
  • Marco Matteo Ciccone Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy.
  • Annapaola Zito Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy.
  • Ettore Manconi Department of Cardiovascular and Neurological Sciences, University of Cagliari, Italy.
  • Tarcisio Niglio Italian National Health Institute, Roma, Italy.
  • Augusto Orsini Department of Vascular Surgery, Gioia Hospital, Sora (FR), Italy.
  • Dimitri Mandolesi Medicina del Lavoro, La Sapienza University, Roma, Italy.
  • Alessandro d’Alessandro Faculty of Medicine, Foggia, Italy.
  • Francesco Fedele Department of Cardio-vascular and Respiratory Sciences, La Sapienza University, Roma, Italy.
The aims of this study were: i) analysis of clinical severity evolution in multiple sclerosis patients; ii) identification of temporal indicators for clinical worsening. We investigated by echo-color-Doppler (ECD) 789 patients (490 female plus 299 male), aged 45.4 years, with chronic cerebro-spinal venous insufficiency (CCSVI) and multiple sclerosis (MS). All patients tested positive for CCSVI by ECD assessment were divided into three groups, namely: type 1 CCSVI (371) presenting an endo-vascular obstacle to the venous drainage; type 2 CCSVI (40) presenting an extra-vascular obstacle to the venous drainage, for external compression of the vessel; type 3 CCSVI (315) presenting both venous endo-vascular and extra-vascular obstructed drains. We analyzed the morphological and hemodynamic data recorded on computerized map (MEM-net). All data were collected by respecting the Italian Privacy Laws and they are available on the National Epidemiological Observatory on CCSVI website (www.osservatorioccsvi.org). We focused in the three main parameters in all studied patients. First parameter was expanded disability status scale (EDSS) score; second parameter was illness duration; third parameter was CCSVI type. The MS duration values stratified by EDSS grouped values in CCSVItype- 1 and CCSVI-type-3 patients shows that the differences were statistical significant by Kruskal-Wallis test: H=44.2829; degree of freedom= 1 for CCSVI-type-1 (P<0.001); and H=37.3036; degree of freedom=1 for CCSVItype- 3 (P<0.001). The present study confirmed and completed scientific literature about relation between CCSVI and MS. On the same time, we found a strong correlation between MS illness duration and severity of EDSS score. In fact there is a clinical severity worsening after 11 years of illness in MS patients with CCSVI type-1 or type-3 (P<0.001). These data may suggest the influence of chronic vascular disease on MS. Further searches need in order to learn more about this new aspect in MS etiology.

Mandolesi, S., d’Alessandro, A., Ciccone, M. M., Zito, A., Manconi, E., Niglio, T., Orsini, A., Mandolesi, D., d’Alessandro, A., & Fedele, F. (2015). Analysis of patients with chronic cerebro-spinal venous insufficiency and multiple sclerosis: identification of parameters of clinical severity. Veins and Lymphatics, 4(1). https://doi.org/10.4081/vl.2015.4570

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