At the University of Buffalo, researchers conducted the first investigation to research risk factors for the vascular condition – chronic cerebrospinal venous insufficiency (CCSVI). The team investigated risk factors for CCSVI in volunteers without neurological disease and found a remarkable similarity between CCSVI and possibility of verified risk factors for multiple sclerosis (MS). The study was published Nov. 30 in PLoS One.

In a large control group of volunteers without known central nervous system disease, the team researched the links between CCSVI and clinical, environmental and demographic risk factors.

Dr Robert Zivadinov, professor of neurology at the UB School of Medicine and Biomedical Sciences, and senior author on the investigation, stated:

“Our results suggest that risk factors of CCSVI in this group of volunteers are remarkably similar to those of possible or confirmed importance to MS, but we do not yet understand the whole story.”




The current investigation which included 252 volunteers “was designed to help provide scientists and the MS patient community with new information that, combined with the results of studies that are still ongoing at UB, will ultimately help explain CCSVI and its relationship to MS,” explained Kresimir Dolic, a radiologist from the Department of Radiology, University Hospital, Split, Croatia, and a lead author on the study. Dolic was a visiting fellow at the Buffalo Neuroimaging Analysis Center, part of UB’s Department of Neurology, where the investigation was carried out.

CCSVI refers to decreased blood flow to the periphery from the central nervous system. Researchers believed that this narrowing of veins decreases blood flow from the brain, changing brain drainage, and might be a contributing factor to brain tissue injury that is connected with MS.

However, even though strong interest about CCSVI has been generated among individuals with MS worldwide, and although independent scientific investigations, including one of the largest to date being carried out by Zivadinov and UB colleagues, have suggested a connection with MS, none have discovered conclusively that CCSVI is connected with MS.

Due to this, the researchers believed it was vital to continue with this prospective investigation to find out the risk factors for CCSVI in people without neurological disease.

The investigation discovered that CCSVI risk factors were more prevalent in:
  • individuals with irritable bowel syndrome (IBS)
  • individuals with a history of mononucleosis, i.e. infected with Epstein-Barr virus
  • individuals with a history of smoking or who smoke
Dr Bianca Weinstock-Guttman, second author on the investigation and professor of neurology at UB, explained: “All three are confirmed risk factors for MS.” Results indicated, people with CCSVI were 3.9 times more likely to have IBS than individuals without CSSVI, 1.98 times more likely to have a history of smoking, and were 2.7 times more likely to have infectious mononucleosis.

Zivadinov said:

“Our finding that a risk factor that is highly significant for MS – Epstein-Barr virus, indicated by history of infectious mononucleosis – is strongly associated with CCSVI, is important.

This is the first time a connection has been found between Epstein-Barr virus and CCSVI. We know that Epstein-Barr virus is associated with an increased risk for MS. We also know that having mononucleosis when you are young increases the MS risk several-fold. So our finding that Epstein-Barr virus is also correlated with CCSVI is a novel finding that must be explored in future studies.”

Furthermore, although heart disease is not a known MS risk factor people with heart disease were 2.7 times more likely to have CCSVI, and individuals with heart murmurs were 4.9 times more likely to have CCSVI. Zivadinov notes that the investigation’s discovery of a weak, protective effect from using dietary supplements was also documented and needs additional research.

The researchers caution that the investigation was preliminary and that further investigations are required in order to confirm and expand these findings.

The individuals who volunteered were all part of the prospective Combined Transcranial and Extracranial Venous Doppler Evaluation study at UB. Volunteers were either independent, or relatives of spouses of MS patients. According to Zivadinov the controls were purposely selected from different sources of recruitment.

Zivadinov explains:

“Spouses had no genetic similarity but may have shared environmental risk factors with MS patients, while relatives of MS patients had shared both genetic and environmental background. However, no differences in risk factors of frequency of CCSVI were found according to the various sources of recruitment.”

All volunteers in the study were screened for medical histories and underwent physical exams and Doppler sonography examinations of the neck. In addition they responded to an extensive environmental questionnaire. Volunteers were believed to have CCSVI if they had at least two positive venous hemodynamic criteria on Doppler sonography.

Written by Grace Rattue