Does the venous pressure theory of multiple sclerosis pathophysiology deserve a second chance?

doi:10.1016/j.msard.2021.103262

Multiple Sclerosis and Related Disorders

Volume 56, November 2021, 103262

https://doi.org/10.1016/j.msard.2021.103262 Get rights and content

Summary

The theory that multiple sclerosis is related to venous pressure has been discredited due to previous operator dependent diagnostic criteria and premature attempts at treatment. (1) An elevation in venous pressure may only be a component of the compliance changes found in MS. (2) The neck veins may only supply a component of the venous pressure elevation found intracranially. Although a more targeted approach towards neck angioplasty (both towards disease subtype and those with more favorable stenoses) may be beneficial, we would advocate caution. We encourage others to give the venous pressure theory a second chance and to replicate our work.

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We thank Drs Beggs and Zamboni for their thoughtful comments regarding our most recent paper as published in MSARD (Bateman et al., 2021). We would like to respond to several of their points. We agree that the theory that venous pressure is related to the underlying pathophysiology of multiple sclerosis (MS), has had a checkered history. Unfortunately, the original paper where the venous theory was first put forward (Zamboni et al., 2009) was rapidly followed by an attempt to bring about a

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The incidence of transverse sinus stenosis in multiple sclerosis: further evidence of pulse wave encephalopathy
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Prevalence of extracranial venous narrowing on magnetic resonance venography is similar in people with multiple sclerosis, their siblings, and unrelated healthy controls: a blinded, case-control study
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G.A. Bateman et al.
Comparison of the sagittal sinus cross-sectional area between patients with multiple sclerosis, hydrocephalus, intracranial hypertension and spontaneous intracranial hypotension: a surrogate marker of venous transmural pressure?
Fluids Barriers CNS
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G.A. Bateman et al.
A comparison between the pathophysiology of multiple sclerosis and normal pressure hydrocephalus: is pulse wave encephalopathy a component of MS?
Fluids Barriers CNS
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There are more references available in the full text version of this article.

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Cerebral veins are responsible for the outflow drainage of brain interstitial fluid (ISF). The importance of cerebral venous drainage has been emphasized in various neurological diseases. Impaired venous outflow may lead to brain edema, blood–brain barrier (BBB) disruption, inflammatory responses and hemorrhagic complications. With the development of imaging technologies, several imaging-based signs for venous assessment are proposed. Therapies targeting cerebral venous drainage have shown beneficial outcomes in cerebral venous sinus thrombosis (CVST) in clinic, however more insight into the cellular and molecular level should be elucidated. Here we review the pathological changes following cerebral venous drainage impairment, summary the advances in image-based evaluation, address the potential molecular mechanisms, and discuss venous drainage-focused therapies. A better understanding of cerebral venous drainage and its underlying mechanism will promote the pharmacological development and clinical management of CVST.
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Does the venous pressure theory of multiple sclerosis pathophysiology deserve a second chance?

Summary

Section snippets

Reply

Mult. Scler. Relat. Disord.

Mult. Scler. Relat. Disord.

Can. Assoc. Radiol. J.

Comparison of the sagittal sinus cross-sectional area between patients with multiple sclerosis, hydrocephalus, intracranial hypertension and spontaneous intracranial hypotension: a surrogate marker of venous transmural pressure?

Fluids Barriers CNS

A comparison between the pathophysiology of multiple sclerosis and normal pressure hydrocephalus: is pulse wave encephalopathy a component of MS?

Fluids Barriers CNS