ISNVD Abstract Book

WEDNESDAY – FEBRUARY 22, 2012 3:00pm-3:20pm
Is CCSVI a disease? (Robert Zivadinov, USA)
A condition called chronic cerebrospinal venous insufficiency (CCSVI) has been proposed and reported with
high frequency in patients with multiple sclerosis (MS), although the condition was also found in patients with
other CNS diseases and subjects without known CNS pathology. More recent reports suggest that some non-
CNS diseases (especially of the bowel system) may be associated with CCSVI. CCSVI is described as a vascular
condition characterized by anomalies of the main extra-cranial cerebrospinal venous routes that possibly
interferes with normal blood outflow of brain parenchyma. In order for CCSVI to be a disease, a phenotype of
clinical symptoms associated with this condition needs to be determined. The rate of transfer of nutrients
(primarily oxygen and glucose) from the capillary bed into the brain fluid is proportional to the rate of blood
flow through the capillary bed. An obstruction of the extra-cranial venous drainage pathways may significantly
reduce the supply of brain nutrients and potentially result in hypoxia. In a recent prospective, 12-month,
Endovascular Venous Treatment for MS (EVTMS) follow-up study that enrolled 15 MS patients, we noticed that,
post intervention, the majority of treated patients reported immediate temporary improvements in subjective
complaints of fatigue and cognitive impairment. In another recent study, the reestablishment of cerebral
venous return reduced chronic fatigue perception in a group of 31 MS patients with CCSVI who underwent the
endovascular procedure, suggesting that fatigue could likely be associated with CCSVI. Neither study was
randomized, controlled or blinded; however, both suggest that the impact of removing an obstruction in the
IJV or azygos veins could increase blood flow through the cerebral capillary bed, with consequent increase in
the transfer of oxygen, glucose and other nutrients into the brain, which may result in immediate temporary
reduction of subjective complaints of fatigue and cognitive impairment. Additional improvement of symptoms
may be related to PTA of extra-cranial veins. These include headache, sleep disturbances, brain fog, and
heating. It remains to be determined whether the presence of CCSVI is characterized by a particular clinical
phenotype in patients with CNS and non-CNS diseases. The clinical phenotype will likely depend on the
regional predilection of CCSVI pathology.
Financial Disclosure: Teva Pharmaceuticals, Biogen Idec, EMD Serono, Genzyme, Bracco, Questcor, Greatbatch