Chronic cerebrospinal venous insufficiency and multiple sclerosis

@article{Khan2010ChronicCV,
  title={Chronic cerebrospinal venous insufficiency and multiple sclerosis},
  author={Omar A. Khan and Massimo Filippi and Mark Steven Freedman and Frederik Barkhof and Paula Dore‐Duffy and Hans Lassmann and Bruce Trapp and Amit Bar-Or and Imad T. Zak and Marilyn J Siegel and Robert P. Lisak},
  journal={Annals of Neurology},
  year={2010},
  volume={67}
}
A chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI), is claimed to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS). This has invigorated the causal debate of MS and generated immense interest in the patient and scientific communities. A potential shift in the treatment paradigm of MS involving endovascular balloon angioplasty or venous stent placement has been proposed as well as conducted… 
Chronic cerebrospinal venous insufficiency and the doubtful promise of an endovascular treatment for multiple sclerosis
TLDR
This commentary will examine the origin of the CCSVI theory, the data supporting and refuting its existence, and provide constructive recommendations about whether or not endovascular therapy represents a reasonable option at this point in time for patients with MS.
No endovascular innovation without evaluation in chronic cerebrospinal venous insufficiency: a call for the IDEAL model.
TLDR
In the largest C CSVI study to date, an evaluation of 499 subjects in which echo-color Doppler raters were blinded, a higher frequency of CCSVI was found in patients with MS than in healthy control subjects, suggesting that CCS VI is unlikely to be an initiating factor in MS pathogenesis.
Reported outcomes after the endovascular treatment of chronic cerebrospinal venous insufficiency.
TLDR
A brief review of CCSVI and its association with MS is presented and the available literature to date is reviewed with a focus on outcomes data.
Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in people with multiple sclerosis.
TLDR
There was moderate-quality evidence to suggest that venous PTA did not increase the proportion of patients who had operative or post-operative serious adverse events compared with the sham procedure, and there was no effect of venousPTA on disability worsening measured by the Expanded Disability Status Scale.
The controversy on chronic cerebrospinal venous insufficiency
TLDR
Taking into account the current epidemiological data, including studies on catheter venography, the autoptic findings, and the relationship between CCSVI and both hypo-perfusion and cerebro-spinal fluid flow, it is concluded that C CSVI can be definitively inserted among the medical entities.
Influence of chronic cerebrospinal venous insufficiency on demyelinating diseases
TLDR
After careful review of all obtained data, it is concluded that great variability in prevalence of CCSVI in MS patients can be a result of different methodologies used in vein assessment, training, application of unapproved diagnostic criteria, or different approach to the problem itself.
Chronic Cerebrospinal Venous Insufficiency In Multiple Sclerosis (CCSVI-MS) , Between The Phantom Hope Of Miraculous Endovascular Treatment And The Truth Of The Need For More Radical Treatment.
TLDR
The source of the CCSVI theory is examined, the current data calling for or refuting its existence is discussed, and recommendations about whether or not endovascular treatment represents a reasonable option at this point of time for MS patients are provided.
Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis patients.
TLDR
There is currently no high level evidence to support or refute the efficacy or safety of percutaneous transluminal angioplasty for treatment of CCSVI in people with multiple sclerosis.
Chronic cerebrospinal venous insufficiency and multiple sclerosis
TLDR
It is of critical importance that evidence of association is not misrepresented as evidence of causation, because the media, understandably eager to have identified an apparently easily remediable cause for MS, can drive patients to undergo risky procedures for highly uncertain gain.
...
...

References

SHOWING 1-10 OF 80 REFERENCES
A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency.
Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis
TLDR
CDMS is strongly associated with CCSVI, a scenario that has not previously been described, characterised by abnormal venous haemodynamics determined by extracranial multiple venous strictures of unknown origin.
Anomalous Venous Blood Flow and Iron Deposition in Multiple Sclerosis
  • A. V. SinghP. Zamboni
  • Medicine, Psychology
    Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism
  • 2009
TLDR
The hypothesis that iron deposits in MS are a consequence of altered cerebral venous return and chronic insufficient venous drainage is supported and several recently published studies support the hypothesis that MS progresses along the venous vasculature.
The anatomy of collateral venous flow from the brain and its value in aetiological interpretation of intracranial pathology
TLDR
Simultaneous hindrance of principal and collateral venous outflow will lead to elevated venous pressure and eventual insufficiency of cerebral blood flow (CBF), which will cause increased intracranial pressure, and ventricular enlargement due to periventricular atrophy.
Treatment of cerebral venous and sinus thrombosis.
TLDR
The strength of evidence reported in the literature to support the use of anticoagulants, thrombolysis, and symptomatic therapy including control of seizures and elevated intracranial pressure is reviewed and treatment recommendations based on the best available evidence are provided.
Doppler haemodynamics of cerebral venous return.
TLDR
The authors have summarized the current knowledge of the Doppler haemodynamics of the cerebrovenous system and proposed a list of reproducible clinical parameters for its sonographic evaluation that could be of singular interest in iron-related inflammatory and neurodegenerative disorders like multiple sclerosis.
Human radicular veins: Regulation of venous reflux in the absence of valves
TLDR
Surprisingly, a large number of radicular and perimedullary veins appeared to be filled with Araldite CY 221 mixture, after injection of this material into the vertebral venous system, implicating reflux via the radicular veins and suggesting insufficiency of the presumed anti‐reflux mechanism.
Aetiology of transient global amnesia
Greater loss of axons in primary progressive multiple sclerosis plaques compared to secondary progressive disease.
TLDR
Examining the cervical spinal cord in patients with primary and secondary progressive multiple sclerosis suggests axonal loss is the pathological substrate of progressive disability in both primary progressive and secondarygressive multiple sclerosis with a common plaque-centred mechanism.
...
...