Original title: Disability caused by multiple sclerosis is associated with the number of extra cranial venous stenoses: possible improvement by venous angioplasty. Results of a prospective study. Reference: M Denislic et al. Phlebology, doi: 10.1258/phleb.2012.012065.
Multiple Sclerosis (MS) is considered a chronic inflammatory disease, progressive and immuno-mediated, demyelinating of the central nervous system.
Its primary cause is still under debate and this study incorporates the vascular aetiology hypothesis. Restricted venous drainage is known as chronic cerebrospinal venous insufficiency (multiple sclerosis of the extracranial veins). The primary goal of this open trial was to detect the occurrence of obstruction in extracranial veins (internal jugular and azygos veins) and associate obstruction patterns with the clinical evolution and physical impairment of MS.
94 patients with MS diagnosis were evaluated and classified according to the three stages of the disease: relapsing/remitting (RR), secondary progressive (SP) and primary progressive (PP). Impairment degree was evaluated with the expanded disability status scale. All patients met at least two of the chronic cerebrospinal venous insufficiency criteria using intra and extracranial Doppler evaluation. Only in two patients (2.1%) venographies did not show any abnormalities. From the rest, 33.7% showed luminal compromise of the three veins and they all showed a compromised jugular. A >50% lesion was treated with balloon angioplasty. Balloon diameter started at 6 mm for the azygos vein and 7-8 mm for jugulars.
A neurological clinical follow up was performed using the disability scale. At 12 months, the group of patients at RR stage showed significative improvement of disability (p=0,001) compared to those at progressive stage (SP or PP) that did not improve. Restenosis using Doppler evaluation was 21.7%.
Conclusion
The correlation between the number of vein lesions and impairment degree supports the vascular hypothesis. Angioplasty could be beneficial in the early stages of the disease.
Editorial Comment:
Though the number of patients was small, it might be difficult to carry out larger trials due to disease prevalence. The vascular aetiology hypothesis and angioplasty treatment of MS appear interesting in the present context of immunomodulatory therapy deficiency.
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