Multiple Sclerosis Drives Patients to Vein Surgery

Multiple sclerosis (MS) patients with progressive, longstanding disease are most likely to seek controversial cerebrospinal venoplasty treatment, according to a new study.

Researchers at the University of Manitoba (Winnipeg, Canada) analyzed early data from a prospective observational study of 716 MS patients in the province of Alberta (Canada), including 141 who reported undergoing venoplasty. The study reviewed patients' clinical and demographic characteristics, and patients who had obtained venoplasty were also asked about their experiences and outcomes, but those data were not included in the current analysis. For additional reference, the researchers drew on similar clinical and demographic data collected in 2006 from 1,717 MS patients, before the venoplasty boom; the characteristics of the two groups were nearly identical.

The results showed that patients who reported having cerebrospinal venoplasty intended to treat MS were significantly more likely to have progressive forms of the disease and to have lived with MS for at least five years. The researchers also found that compared with patients who had never used disease-modifying MS drugs, those who had tried them in the past were 51% more likely to have obtained venoplasty treatment. Current use of disease-modifying drugs was similarly associated with venoplasty treatment.

The researchers found a weak trend toward a lower likelihood of venoplasty treatment in patients with comorbidities. Depression was most common, reported in 28% of the overall sample; high cholesterol, hypertension, and migraine were each seen in about 15%. Stronger associations with venoplasty were seen for MS type and disease duration, such as secondary progressive MS, primary progressive MS, and disease duration. The degree of disability was also a significant factor, with each grade in the Patient-Determined Disability Steps (PDDS) scale associated with a 14% increase in likelihood of venoplasty. The study was presented at the CMSC-ACTRIMS Joint Meeting, held during May-June 2013, in Orlando (CA, USA).

“Patients in the province of Alberta who reported having cerebrospinal venoplasty intended to treat MS were significantly more likely to have progressive forms of the disease and to have lived with MS for at least 5 years,” concluded lead author and study presenter Ruth Ann Marrie, MD, PhD.

Interest in cerebrospinal venoplasty exploded after an Italian vascular surgeon published a report describing a theory called chronic cerebrospinal venous insufficiency (CCSVI) in 2009 that claimed that MS patients had obstructions in veins draining the brain and upper spinal cord, and that percutaneous interventions to remove the blockages could lead to rapid relief of MS symptoms. The theory quickly divided the MS community into skeptics and fierce advocates.

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University of Manitoba