Endovascular Treatment for Chronic Cerebrospinal Venous Insufficiency in Patients with Multiple Sclerosis
- Volume 9 - Issue 9 - September 2012
- Posted on: 9/5/12
- 1 Comments
- 9026 reads
Marian Simka, MD1, Piotr Janas, MD1, Tomasz Ludyga, MD1, Paweł Latacz, MD2, Marek Kazibudzki, MD1
ABSTRACT: Objective. The aim of this study was to evaluate the impact of endovascular treatment for chronic cerebrospinal venous insufficiency on chronic fatigue in multiple sclerosis patients. Methods. Severity of fatigue was measured with Fatigue Severity Scale (FSS) in 340 patients before the treatment and after 6-month follow-up. Results. We found statistically significant improvement of fatigue. After the treatment, mean FSS score dropped from 4.7 to 3.8. However, these post-procedural changes were not evenly distributed. While the patients with no fatigue (FSS<2.0) or mild/moderate fatigue (FSS 2.0-3.9) did not report significantly changed fatigue, the patients with severe fatigue (FSS≥4.0) experienced a statistically significant drop of FSS scores, which in this subgroup was 1.21. Such variables as the patients’ gender, age, duration of the disease, or localization of vascular lesions did not influence the level of postprocedural improvement of fatigue. Conclusion. Our results confirm the findings of the previous studies that have found a positive effect of endovascular treatment on chronic fatigue in multiple sclerosis patients. Despite all limitations of our study, improved fatigue, especially when severe, appears to be an encouraging finding, which warrants further study in this area.
VASCULAR DISEASE MANAGEMENT 2012:9(9):E149-E154
Key words: endovascular therapy, neurovascular interventions, quality of life
Chronic fatigue (CF) is one of the most common and the most troubling manifestations of multiple sclerosis (MS), the chronic and debilitating disease of the central nervous system.1,2 MS is believed to be an autoimmune disorder, which means that disease is caused by autoimmune attack against nervous tissue antigens.3 Efficacy of pharmacological and other treatments for MS is primarily evaluated in terms of such objective parameters as the plaque load or relapse rate, while the quality-of-life impairments related to this disease are poorly addressed by mainstream research. The new idea that MS may be related to stenoses in the veins draining the brain and spinal cord, the so-called chronic cerebrospinal venous insufficiency (CCSVI),4 and that alleviation of these vascular blockages may improve patients’ clinical status and their quality-of-life, is currently hotly debated by the scientific community. In this paper we present the results of an open-label study on clinical impact of endovascular procedures for CCSVI in the patients with associated MS, with focus at fatigue improvement after such a treatment.
Patients and methods
This open-label study was aimed at the assessment of safety and clinical efficacy of endovascular procedures in CCSVI patients with associated MS. Quality-of-life changes following venous angioplasties were measured with: Multiple Sclerosis Impact Scale-29, Fatigue Severity Scale (FSS), Epworth sleepiness and heat intolerance questionnaires.
This report focuses at fatigue improvement after endovascular treatment for CCSVI. There were assessed 340 patients, 191 women and 149 men, with clinically defined MS. The diagnosis of MS was given according to the revised McDonald criteria5 and this diagnosis, if determined elsewhere, was confirmed by the consulting neurologist at our institution. The patients were aged 15-68 years, with a median age of 42 years. They suffered from MS for 0.5 to 47 years, with a median duration of the disease of 9 years. In all these patients catheter venography of extracranial veins draining the central nervous system (the internal jugular veins and the azygous vein) was performed, followed by angioplasty of narrowed veins in a case of detection of vascular pathology. The following venographic flow patterns were regarded abnormal and, if technically feasible, warranting angioplasty: