PT - JOURNAL ARTICLE AU - Andreas Laupacis AU - Erin Lillie AU - Andrew Dueck AU - Sharon Straus AU - Laure Perrier AU - Jodie M. Burton AU - Richard Aviv AU - Kevin Thorpe AU - Thomas Feasby AU - Julian Spears TI - Association between chronic cerebrospinal venous insufficiency and multiple sclerosis: a meta-analysis AID - 10.1503/cmaj.111074 DP - 2011 Nov 08 TA - Canadian Medical Association Journal PG - E1203--E1212 VI - 183 IP - 16 4099 - http://www.cmaj.ca/content/183/16/E1203.short 4100 - http://www.cmaj.ca/content/183/16/E1203.full SO - CMAJ2011 Nov 08; 183 AB - Background: It has been proposed by Zamboni and colleagues that multiple sclerosis is caused by chronic cerebrospinal venous insufficiency, a term used to describe ultrasound-detectable abnormalities in the anatomy and flow of intra- and extracerebral veins. We conducted a meta-analysis of studies that reported the frequency of chronic cerebrospinal venous insufficiency among patients with and those without multiple sclerosis. Methods: We searched MEDLINE and EMBASE as well as bibliographies of relevant articles for eligible studies. We included studies if they used ultrasound to diagnose chronic cerebrospinal venous insufficiency and compared the frequency of the venous abnormalities among patients with and those without multiple sclerosis. Results: We identified eight eligible studies: all included healthy controls, and four of them also included a control group of patients with neurologic diseases other than multiple sclerosis. Chronic cerebrospinal venous insufficiency was more frequent among patients with multiple sclerosis than among the healthy controls (odds ratio [OR] 13.5, 95% confidence interval [CI] 2.6–71.4), but there was extensive unexplained heterogeneity among the studies. The association remained significant in the most conservative sensitivity analysis (OR 3.7, 95% CI 1.2–11.0), in which we removed the initial study by Zamboni and colleagues and added a study that did not find chronic cerebrospinal venous insufficiency in any patient. Although chronic cerebrospinal venous insufficiency was also more frequent among patients with multiple sclerosis than among controls with other neurologic diseases (OR 32.5, 95% CI 0.6–1775.7), the association was not statistically significant, the 95% CI was wide, and the OR was less extreme after removal of the study by Zamboni and colleagues (OR 3.5, 95% 0.8–15.8). Interpretation: Our findings showed a positive association between chronic cerebrospinal venous insufficiency and multiple sclerosis. However, poor reporting of the success of blinding and marked heterogeneity among the studies included in our review precluded definitive conclusions.