Malagoni A M, Galeotti R, Menegatti E, Manfredini F, Basaglia N, Salvi F, Zamboni P
Vascular Diseases Center, University of Ferrara, Ferrara, Italy.
Int Angiol. 2010 Apr;29(2):176-82.
Chronic fatigue (CF) severely affects patients with multiple sclerosis (MS), but its pathogenesis remains elusive and the effectiveness of available treatments is modest. We aimed to evaluate the effect on CF of the balloon dilatation of stenosing lesions affecting the main extracranial veins configuring the chronic cerebrospinal venous insufficiency (CCSVI), a condition strongly associated with MS.
Thirty-one MS consecutive patients (16 males, age 46.2+/-9.4 years) with associated CCSVI and CF underwent the endovascular procedure. Fatigue was assessed using the Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS) at baseline (T0) and one (T1), six (T6) and twelve (T12) months after the procedure. In ambulatory patients (N.=28), mobility was evaluated using the 6-min walking test at T0 and T1.
and MFIS scores significantly improved from preoperative values, and the positive trend was maintained at one year (FSS: T0=5.1+/-1.0 to T12=3.5+/-1.8, P<0.001; MFIS-total score: T0=34.9+/-14.8 to T12=22.5+/-13.7, P<0.001; MFIS-Physical subscale: T0=21.2+/-8.0 to T12=13.5+/-9.7 P<0.001; MFIS-Cognitive subscale: T0=9.2+/-9.5 to T12=6.0+/-6.3, P=0.03; MFIS-Psychosocial subscale: T0=4.5+/-2.1 to T12=2.5+/-2.1, P<0.001). Six-min walking distance (6MWD) at T1 improved significantly (332+/-190m to 378+/-200m, P=0.0002). In addition, an inverted correlation between 6MWD and MFIS-physical subscale variations was found in the subgroup of patients (N.=8) with no lower limb motor impairment (r=-0.74, P=0.035).
The reestablishment of cerebral venous return dramatically reduced CF perception in a group of MS patients with associated CCSVI, suggesting that CF is likely the symptom of CCSVI.
慢性疲劳（CF）严重影响多发性硬化症（MS）患者，但其发病机制仍不清楚，现有治疗方法的效果也一般。我们旨在评估对构成慢性脑脊髓静脉功能不全（CCSVI）的主要颅外静脉狭窄病变进行球囊扩张术对CF的影响，CCSVI与MS密切相关。
31例伴有CCSVI和CF的连续MS患者（16例男性，年龄46.2±9.4岁）接受了血管内手术。在基线（T0）以及术后1个月（T1）、6个月（T6）和12个月（T12）时，使用疲劳严重程度量表（FSS）和改良疲劳影响量表（MFIS）评估疲劳情况。对于能走动的患者（n = 28），在T0和T1时使用6分钟步行试验评估活动能力。
FSS和MFIS评分较术前值显著改善，且在1年时仍保持积极趋势（FSS：T0 = 5.1±1.0至T12 = 3.5±1.8，P < 0.001；MFIS总分：T0 = 34.9±14.8至T12 = 22.5±13.7，P < 0.001；MFIS身体亚量表：T0 = 21.2±8.0至T12 = 13.5±9.7，P < 0.001；MFIS认知亚量表：T0 = 9.2±9.5至T12 = 6.0±6.3，P = 0.03；MFIS心理社会亚量表：T0 = 4.5±2.1至T12 = 2.5±2.1，P < 0.001）。T1时的6分钟步行距离（6MWD）显著改善（332±190米至378±200米，P = 0.0002）。此外，在无下肢运动障碍的患者亚组（n = 8）中发现6MWD与MFIS身体亚量表变化之间呈负相关（r = -0.74，P = 0.035）。
在一组伴有CCSVI的MS患者中，脑静脉回流的重建显著降低了CF感知，提示CF可能是CCSVI的症状。
