Extracranial Jugular Venous Insufficiency in Multiple Sclerosis Patients Treated with Interferon Beta

Background: The term „vascular immunology” was created when recent studies have suggested that topographic perivenous pattern of demyelinated MS plaques may be caused by venous congestion. This condition termed as „chronic cerebrospinal venous insufficiency” has raised important issues. Our objective was to investigate the haemodinamics of the internal jugular vein (IJV) using extracranial Color-Doppler (ECD) sonography in MS patients treated with IFN-β.
Methods: 140 patients with MS (mean age: 41.1±9.2, mean EDSS: 2.73±1,96, 68.6 % RRMS and 31.4 % SPMS, mean relapses in the past 12 months: 0.43±0.61 with at least 18 months of IFN-β treatment as unique DMT, underwent ECD with detection of four parameters: A – reflux present in IJV; B – evidence of proximal IJV stenosis; C – flow not Doppler detectable in IJV; D – negative difference in the cross sectional area in IJV supine/sitting postures. We studied which criteria correlate significantly with EDSS, number of relapses, form of MS and time to initiation of therapy.
Results: Thirty patients (21.8 %) had at least 2 unilateral parameters present on IJV. This patients had significantly more frequent SPMS (p=0.02), higher EDSS (p=0.04) and started later IFN-β therapy (p=0.03). Taken separately, the number of parameters C+D correlates significantly with EDSS (p=0.04) and form of MS (p=0.01).
Conclusions: ECDS is non-invasive, repeatable, cost-effective and permits to investigate the cerebral venous outflow. The frequency of ECDS criteria in our patient group is significantly lower compared with the results published by Zamboni et al. The absence of IJV flow and negative difference in the cross sectional area in IJV supine/sitting postures correlates significantly with the patient’s clinical characteristics.