Address of the institution where the work was carried out at St. Elisabeth Hospital, PO Box 90151, 5000 LC Tilburg, The Netherlands.
Occurrence of CCSVI in patients with MS and its relationship with iron metabolism and varicose veins
Article first published online: 12 NOV 2012
© 2012 The Author(s) European Journal of Neurology © 2012 EFNS
European Journal of Neurology
Volume 20, Issue 3, pages 519–526, March 2013
How to Cite
Van den Berg, P. J., Van den Berg, G. B., Westerhuis, L. W. and Visser, L. H. (2013), Occurrence of CCSVI in patients with MS and its relationship with iron metabolism and varicose veins. European Journal of Neurology, 20: 519–526. doi: 10.1111/ene.12010
- Issue published online: 14 FEB 2013
- Article first published online: 12 NOV 2012
- Manuscript Accepted: 10 SEP 2012
- Manuscript Received: 29 JUN 2012
- chronic cerebrospinal venous insufficiency;
- echo colour Doppler;
- iron metabolism;
- multiple sclerosis
Background and purpose
A new treatable venous disorder, chronic cerebrospinal venous insufficiency (CCSVI), has been proposed in patients with multiple sclerosis (MS). Its relationship with iron metabolism is suggested, but has not been examined prospectively.
We performed extra- and transcranial echo colour Doppler (ECD) in 90 patients with MS and 41 healthy controls (HC). Indices of iron metabolism and the presence of peripheral signs of impaired venous flow were also examined.
The ECD examination showed CCSVI in 8 (9%) of the 90 patients with MS and 0 HC (P = 0.11). The 8 CCSVI-positive MS patients were older (P = 0.02), had less often relapsing–remitting-MS (P = 0.02) and had more neurological disability assessed by expanded disability status scale (EDSS, P = 0.001) and longer duration of disease (P = 0.02) in comparison with the 82 CCSVI-negative MS patients. Multivariate analysis revealed that EDSS remained an independent factor associated with CCSVI (odds ratio 1.89, 95%CI 1.17–3.05, P-value = 0.009). CCSVI MS patients more often had bilateral telangiectasia at the legs (P = 0.008), reticular veins (P = 0.006) and venous stasis dermatitis (P = 0.004). No relationship was found between CCSVI and impaired iron metabolism in patients with MS.
CCSVI is uncommon and is a secondary epiphenomenon in MS and related to more neurological disability and the presence of varicose veins at the legs.