BACKGROUND: It has been proposed by Zamboni and colleagues that multiple sclerosis is caused by chronic cerebrospinal venous insufficiency, a term used to describe ultrasound-detectable abnormalities in the anatomy and flow of intra- and extracerebral veins. We conducted a meta-analysis of studies that reported the frequency of chronic cerebrospinal venous insufficiency among patients with and those without multiple sclerosis. METHODS: We searched MEDLINE and EMBASE as well as bibliographies of relevant articles for eligible studies. We included studies if they used ultrasound to diagnose chronic cerebrospinal venous insufficiency and compared the frequency of the venous abnormalities among patients with and those without multiple sclerosis. RESULTS: We identified eight eligible studies: all included healthy controls, and four of them also included a control group of patients with neurologic diseases other than multiple sclerosis. Chronic cerebrospinal venous insufficiency was more frequent among patients with multiple sclerosis than among the healthy controls (odds ratio [OR] 13.5, 95% confidence interval [CI] 2.6-71.4), but there was extensive unexplained heterogeneity among the studies. The association remained significant in the most conservative sensitivity analysis (OR 3.7, 95% CI 1.2-11.0), in which we removed the initial study by Zamboni and colleagues and added a study that did not find chronic cerebrospinal venous insufficiency in any patient. Although chronic cerebrospinal venous insufficiency was also more frequent among patients with multiple sclerosis than among controls with other neurologic diseases (OR 32.5, 95% CI 0.6-1775.7), the association was not statistically significant, the 95% CI was wide, and the OR was less extreme after removal of the study by Zamboni and colleagues (OR 3.5, 95% 0.8-15.8). INTERPRETATION: Our findings showed a positive association between chronic cerebrospinal venous insufficiency and multiple sclerosis. However, poor reporting of the success of blinding and marked heterogeneity among the studies included in our review precluded definitive conclusions.
BACKGROUND: It has been proposed by Zamboni and colleagues that multiple sclerosis is caused by chronic cerebrospinal venous insufficiency, a term used to describe ultrasound-detectable abnormalities in the anatomy and flow of intra- and extracerebral veins. We conducted a meta-analysis of studies that reported the frequency of chronic cerebrospinal venous insufficiency among patients with and those without multiple sclerosis. METHODS: We searched MEDLINE and EMBASE as well as bibliographies of relevant articles for eligible studies. We included studies if they used ultrasound to diagnose chronic cerebrospinal venous insufficiency and compared the frequency of the venous abnormalities among patients with and those without multiple sclerosis. RESULTS: We identified eight eligible studies: all included healthy controls, and four of them also included a control group of patients with neurologic diseases other than multiple sclerosis. Chronic cerebrospinal venous insufficiency was more frequent among patients with multiple sclerosis than among the healthy controls (odds ratio [OR] 13.5, 95% confidence interval [CI] 2.6-71.4), but there was extensive unexplained heterogeneity among the studies. The association remained significant in the most conservative sensitivity analysis (OR 3.7, 95% CI 1.2-11.0), in which we removed the initial study by Zamboni and colleagues and added a study that did not find chronic cerebrospinal venous insufficiency in any patient. Although chronic cerebrospinal venous insufficiency was also more frequent among patients with multiple sclerosis than among controls with other neurologic diseases (OR 32.5, 95% CI 0.6-1775.7), the association was not statistically significant, the 95% CI was wide, and the OR was less extreme after removal of the study by Zamboni and colleagues (OR 3.5, 95% 0.8-15.8). INTERPRETATION: Our findings showed a positive association between chronic cerebrospinal venous insufficiency and multiple sclerosis. However, poor reporting of the success of blinding and marked heterogeneity among the studies included in our review precluded definitive conclusions.
Authors: E Menegatti; V Genova; M Tessari; A M Malagoni; I Bartolomei; M Zuolo; R Galeotti; F Salvi; P Zamboni Journal: Int Angiol Date: 2010-04 Impact factor: 2.789
Authors: I Bartolomei; F Salvi; R Galeotti; E Salviato; M Alcanterini; E Menegatti; M Mascalchi; P Zamboni Journal: Int Angiol Date: 2010-04 Impact factor: 2.789
Authors: Omar Khan; Massimo Filippi; Mark S Freedman; Frederik Barkhof; Paula Dore-Duffy; Hans Lassmann; Bruce Trapp; Amit Bar-Or; Imad Zak; Marilyn J Siegel; Robert Lisak Journal: Ann Neurol Date: 2010-03 Impact factor: 10.422
Authors: P Zamboni; R Galeotti; E Menegatti; A M Malagoni; G Tacconi; S Dall'Ara; I Bartolomei; F Salvi Journal: J Neurol Neurosurg Psychiatry Date: 2008-12-05 Impact factor: 10.154
Authors: R Filipo; F Ciciarello; G Attanasio; P Mancini; E Covelli; L Agati; F Fedele; M Viccaro Journal: Eur Arch Otorhinolaryngol Date: 2013-12-07 Impact factor: 2.503
Authors: Claudiu I Diaconu; Robert J Fox; Alia Grattan; Alexander Rae-Grant; Mei Lu; Heather L Gornik; Esther Soo H Kim Journal: Neurol Clin Pract Date: 2013-10
Authors: Staley A Brod; Larry A Kramer; Alan M Cohen; Andrew D Barreto; Thanh-Tung Bui; James R Jemelka; Kelly Ton; John W Lindsey; Flavia Nelson; Ponnada A Narayana; Jerry S Wolinsky Journal: Mult Scler Date: 2013-07-04 Impact factor: 6.312
Authors: S Laughlin; C K Macgowan; J Traubici; K Chan; S Khan; D L Arnold; R A Marrie; B Banwell Journal: AJNR Am J Neuroradiol Date: 2013-07-18 Impact factor: 3.825