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Bavera PM. Multiple sclerosis and venous angioplasty for chronic cerebrospinal venous insufficiency: a case control study with ten years follow-up with patients at their own control. VEINS AND LYMPHATICS 2021. [DOI: 10.4081/vl.2021.10143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Progressive Neurological Diseases (PND) and Chronic Cerebrospinal Venous Insufficiency (CCSVI) and Multiple Sclerosis (MS) have two terms in common: “progressive and chronic” and shortly mean that there is no definitive therapy, at the moment.
The clinical aspects are built on symptoms, upon which the definition of “progression” is based and hence classified. Changement and worsening of symptoms, allow classification of the disease and adjustments are effectively an “up to date” of the disease itself.
We here resume the ten-year survey of 482 Multiple Sclerosis (MS)-affected patients (314 females, 168 males; mean age =37.8), classified by their Neurology Physicians as Relapse-Remitting (RR), according to the Kurtzke Expanded Disability Status Scale (EDSS), monitoring the parallel presence of CCSVI with clinical MS progression.
Results are present from two homogeneous Relapse-Remitting MS groups of patients divided as “treated and non-treated for CCSVI” with vein angioplasty (vPTA). Furthermore, a Patient’s self-classification based upon symptoms in presence of CCSVI, up to now never implemented, was developed on the basis of both clinical and Duplex vascular issues.
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Bai C, Wang Z, Guan J, Jin K, Ding Y, Ji X, Meng R. Clinical characteristics and neuroimaging findings in eagle syndrome induced internal jugular vein stenosis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:97. [PMID: 32175390 DOI: 10.21037/atm.2019.12.93] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Eagle syndrome is a condition that causes pharyngeal pain, facial pain, swallowing difficulties, and symptoms of arterial impingement due to the elongated styloid process. However, few reports were about eagle syndrome with venous compression up to now. This study aimed to identify the clinical profiles of the internal jugular vein stenosis (IJVS) related eagle syndrome comprehensively. Methods A total of 27 patients, who were diagnosed as IJVS induced by styloid process compression were enrolled. The clinical manifestations and imaging features were analyzed. Results Styloid process compression was presented in all of the 27 IJVS patients, in which, the top three symptoms included insomnia (81.5%), tinnitus (63.0%) and head noises (63.0%). The most vulnerable segment of internal jugular vein (IJV) was J3 segment (96.3%). The average styloid process length in our study was 3.7 cm. Hearing impairment was more common in bilateral IJVS (68.8% vs. 18.2%, P=0.018). One patient reported significant relief of symptoms at 1 year follow-up after underwent styloidectomy combined with stenting. Conclusions Neurological symptoms of eagle syndrome induced IJVS were various, including either arterial or venous issues. Better understanding of this disease entity may be helpful for clinical diagnosis and treatment.
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Affiliation(s)
- Chaobo Bai
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100000, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100000, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100000, China
| | - Zhongao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100000, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100000, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100000, China
| | - Jingwei Guan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100000, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100000, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100000, China
| | - Kexin Jin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100000, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100000, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100000, China
| | - Yuchuan Ding
- Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100000, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100000, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100000, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100000, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100000, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100000, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100000, China
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Jakimovski D, Topolski M, Genovese AV, Weinstock-Guttman B, Zivadinov R. Vascular aspects of multiple sclerosis: emphasis on perfusion and cardiovascular comorbidities. Expert Rev Neurother 2019; 19:445-458. [PMID: 31003583 DOI: 10.1080/14737175.2019.1610394] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. Over the last two decades, more favorable MS long-term outcomes have contributed toward increase in prevalence of the aged MS population. Emergence of age-associated pathology, such as cardiovascular diseases, may interact with the MS pathophysiology and further contribute to disease progression. Areas covered: This review summarizes the cardiovascular involvement in MS pathology, its disease activity, and progression. The cardiovascular health, the presence of various cardiovascular diseases, and their effect on MS cognitive performance are further explored. In similar fashion, the emerging evidence of a higher incidence of extracranial arterial pathology and its association with brain MS pathology are discussed. Finally, the authors outline the methodologies behind specific perfusion magnetic resonance imaging (MRI) and ultrasound Doppler techniques, which allow measurement of disease-specific and age-specific vascular changes in the aging population and MS patients. Expert opinion: Cardiovascular pathology significantly contributes to worse clinical and MRI-derived disease outcomes in MS. Global and regional cerebral hypoperfusion may be associated with poorer physical and cognitive performance. Prevention, improved detection, and treatment of the cardiovascular-based pathology may improve the overall long-term health of MS patients.
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Affiliation(s)
- Dejan Jakimovski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Matthew Topolski
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA
| | - Antonia Valentina Genovese
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,c Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences , University of Pavia , Pavia , Italy
| | - Bianca Weinstock-Guttman
- b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA
| | - Robert Zivadinov
- a Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, State University of New York , Buffalo , NY , USA.,b Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences , University at Buffalo, The State University of New York , Buffalo , NY , USA.,d Center for Biomedical Imaging at Clinical Translational Science Institute , University at Buffalo, State University of New York , Buffalo , NY , USA
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Ulivelli M, Monti L, Ballerini M, Bartalini S, Cerase A, Cecconi F, Pizzirusso G, Bezzini D, Rossi A, Rossi S. Prospective study of clinical, neurophysiological and urodynamic findings in multiple sclerosis patients undergoing percutaneous transluminal venous angioplasty. Clin Neurophysiol 2018; 130:138-144. [PMID: 30537671 DOI: 10.1016/j.clinph.2018.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 10/06/2018] [Accepted: 10/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Verify whether Percutaneous Transluminal Angioplasty (PTA) may affect neural conduction properties in Multiple Sclerosis (MS) patients, thereby modifying patients' disability, with prospective neurophysiological, urodynamic, clinical and subjective well-being evaluations. METHODS In 55 out of 72 consecutively screened MS patients, the following procedures were carried out before (T0), at 2-6 months (T1) and at 6-15 months (T2) after a diagnostic phlebography, eventually followed by the PTA intervention if chronic cerebrospinal venous insufficiency (CCSVI) was diagnosed: clinical/objective evaluation (Expanded Disability Status Scale, EDSS), ratings of subjective well-being, evaluation of urodynamic functions and multimodal EPs (visual, acoustic, upper and lower limbs somatosensory and motor evoked potentials). RESULTS The number of dropouts was relatively high, and a complete set of neurophysiological and clinical data remained available for 37 patients (19 for urological investigations). The subjective well-being score significantly increased at T1 and returned close to basal values at T2, but their degree of objective disability did not change. Nevertheless, global EP-scores (indexing the impairment in conductivity of central pathways in multiple functional domains) significantly increased from T0 (7.9 ± 6.0) to T1 (9.2 ± 6.3) and from T0 to T2 (9.8 ± 6.3), but not from T1 and T2 (p > 0.05). Neurogenic urological lower tract dysfunctions slightly increased throughout the study. CONCLUSIONS The PTA intervention did not induce significant changes in disability in the present cohort of MS patients, in line with recent evidence of clinical inefficacy of this procedure. SIGNIFICANCE Absence of multimodal neurophysiological and functional testing changes in the first 15 months following PTA suggests that conduction properties of neural pathways are unaffected by PTA. Current findings suggest that the short-lived (2-6 months), post-PTA, beneficial effect on subjective well-being measures experienced by MS patients is likely related to a placebo effect.
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Affiliation(s)
- Monica Ulivelli
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, University of Siena, Italy.
| | - Lucia Monti
- Department of Medicine, Surgery and Neuroscience, NINT Section, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Michele Ballerini
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, University of Siena, Italy
| | - Sabina Bartalini
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, University of Siena, Italy
| | - Alfonso Cerase
- Department of Medicine, Surgery and Neuroscience, NINT Section, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Filippo Cecconi
- Urologia, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | | | - Alessandro Rossi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, University of Siena, Italy; Department of Medicine, Surgery and Neuroscience, NINT Section, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, University of Siena, Italy.
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Zamboni P, Zivadinov R. Extracranial Veins in Multiple Sclerosis: Is There a Role for Vascular Surgery? Eur J Vasc Endovasc Surg 2018; 56:618-621. [DOI: 10.1016/j.ejvs.2018.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
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Marchetti G, Ziliotto N, Meneghetti S, Baroni M, Lunghi B, Menegatti E, Pedriali M, Salvi F, Bartolomei I, Straudi S, Manfredini F, Voltan R, Basaglia N, Mascoli F, Zamboni P, Bernardi F. Changes in expression profiles of internal jugular vein wall and plasma protein levels in multiple sclerosis. Mol Med 2018; 24:42. [PMID: 30134823 PMCID: PMC6085618 DOI: 10.1186/s10020-018-0043-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/24/2018] [Indexed: 02/06/2023] Open
Abstract
Background Multiple sclerosis (MS) is an inflammatory, demyelinating and degenerative disorder of the central nervous system (CNS). Several observations support interactions between vascular and neurodegenerative mechanisms in multiple sclerosis (MS). To investigate the contribution of the extracranial venous compartment, we analysed expression profiles of internal jugular vein (IJV), which drains blood from CNS, and related plasma protein levels. Methods We studied a group of MS patients (n = 19), screened by echo-color Doppler and magnetic resonance venography, who underwent surgical reconstruction of IJV for chronic cerebrospinal venous insufficiency (CCSVI). Microarray-based transcriptome analysis was conducted on specimens of IJV wall from MS patients and from subjects undergoing carotid endarterectomy, as controls. Protein levels were determined by multiplex assay in: i) jugular and peripheral plasma from 17 MS/CCSVI patients; ii) peripheral plasma from 60 progressive MS patients, after repeated sampling and iii) healthy individuals. Results Of the differentially expressed genes (≥ 2 fold-change, multiple testing correction, P < 0.05), the immune-related CD86 (8.5 fold-change, P = 0.002) emerged among the up regulated genes (N = 409). Several genes encoding HOX transcription factors and histones potentially regulated by blood flow, were overexpressed. Smooth muscle contraction and cell adhesion processes emerged among down regulated genes (N = 515), including the neuronal cell adhesion L1CAM as top scorer (5 fold-change, P = 5 × 10− 4). Repeated measurements in jugular/peripheral plasma and overtime in peripheral plasma showed conserved individual plasma patterns for immune-inflammatory (CCL13, CCL18) and adhesion (NCAM1, VAP1, SELL) proteins, despite significant variations overtime (SELL P < 0.0001). Both age and MS disease phenotypes were determinants of VAP1 plasma levels. Data supported cerebral related-mechanisms regulating ANGPT1 levels, which were remarkably lower in jugular plasma and correlated in repeated assays but not between jugular/peripheral compartments. Conclusions This study provides for the first time expression patterns of the IJV wall, suggesting signatures of altered vascular mRNA profiles in MS disease also independently from CCSVI. The combined transcriptome-protein analysis provides intriguing links between IJV wall transcript alteration and plasma protein expression, thus highlighting proteins of interest for MS pathophysiology. Electronic supplementary material The online version of this article (10.1186/s10020-018-0043-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giovanna Marchetti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, via Fossato di Mortara n 74, 44121, Ferrara, Italy.
| | - Nicole Ziliotto
- Department of Life Science and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Silvia Meneghetti
- Department of Life Science and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Marcello Baroni
- Department of Life Science and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Barbara Lunghi
- Department of Life Science and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Erica Menegatti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Massimo Pedriali
- Department of Experimental and Diagnostic Medicine, Sant'Anna University- Hospital, Ferrara, Italy
| | - Fabrizio Salvi
- Center for Immunological and Rare Neurological Diseases, Bellaria Hospital, IRCCS of Neurological Sciences, Bologna, Italy
| | - Ilaria Bartolomei
- Center for Immunological and Rare Neurological Diseases, Bellaria Hospital, IRCCS of Neurological Sciences, Bologna, Italy
| | - Sofia Straudi
- Department of Neurosciences and Rehabilitation, Sant'Anna University- Hospital, Ferrara, Italy
| | - Fabio Manfredini
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, via Fossato di Mortara n 74, 44121, Ferrara, Italy
| | - Rebecca Voltan
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Nino Basaglia
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, via Fossato di Mortara n 74, 44121, Ferrara, Italy
| | - Francesco Mascoli
- Unit of Vascular and Endovascular Surgery, S. Anna University-Hospital, Ferrara, Italy
| | - Paolo Zamboni
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Francesco Bernardi
- Department of Life Science and Biotechnology, University of Ferrara, Ferrara, Italy
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Rasman A. Chronic Cerebro-Spinal Venous Insufficiency in Multiple Sclerosis: Is It the End? Vasc Specialist Int 2018; 34:16-18. [PMID: 29629362 PMCID: PMC5880341 DOI: 10.5758/vsi.2018.34.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/09/2018] [Accepted: 02/13/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alessandro Rasman
- Department of Political and Social Sciences, University of Trieste, Trieste, Italy
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