In this interview, Robert Zivadinov, MD, PhD, discusses the relationship between multiple sclerosis and chronic cerebrospinal venous insufficiency and his recent study finding similar risk factors for the two conditions.
The relationship between chronic cerebrospinal venous insufficiency (CCSVI) and multiple sclerosis (MS) has been a matter of great controversy in recent years. CCSVI, which involves reduced blood flow from the central nervous system to the periphery, was first defined in 2009 by the Italian vascular surgeon Paolo Zamboni, MD, of the University of Ferrara, in a study that purported to have found nearly total overlap between the condition and MS. Since then, Zamboni and others have promoted percutaneous transluminal angioplasty, also known as liberation therapy, as a treatment for MS.
To test Zamboni’s findings, a team led by Robert Zivadinov, MD, PhD, professor of neurology at the University at Buffalo, State University of New York, has conducted the Combined Transcranial and Extracranial Venous Doppler (CTEVD) study. The study’s first phase found a CCSVI prevalence of 56.1% in MS patients, 42.3% in those with other neurological disorders, and 22.7% in controls. Another recent study found a CCSVI prevalence of 36% in healthy controls.
In late November, Zivadinov’s team published partial results of the second phase of the CTEVD study in PLoS One, investigating risk factors for CCSVI in those without known neurological disorders. Among the risk factors found were several that are known or suspected risk factors for MS: irritable bowel syndrome, history of infectious mononucleosis, and history of smoking. To gain a better understanding of the relationship between CCSVI and MS, MD Magazine: Peers & Perspectives recently spoke to Zivadinov. Click below to listen to our interview with him. To read more about Zivadinov's study in PLoS One, click here.
1. Zamboni P, Galeotti R, Menegatti E, et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009;80:392-399.
2. Zivadinov R, Marr K, Cutter G, et al. Prevalence, sensitivity, and specificity of chronic cerebrospinal venous insufficiency in MS. Neurology. 2011;77(2);138-144.
3. Centonze D, Floris R, Stefanini M, et al. Proposed chronic cerebrospinal venous insufficiency criteria do not predict multiple sclerosis risk or severity. Ann Neurol. 2011;70(1);51-58.
4. Dolic K, Weinstock-Guttman B, Marr K, et al. Risk factors for chronic cerebrospinal venous insufficiency (CCSVI) in a large cohort of volunteers [published online ahead of print November 30, 2011]. PLoS One. Accessed December 8, 2011.