Percutaneous transluminal angioplasty, or balloon angioplasty, is a beneficial procedure used to provide large and sustained relief of persistent headaches in patients with multiple sclerosis by restoring blood flow of the internal jugular veins, according to a recent study published in PLoS ONE.
This study sought to evaluate the effect of balloon angioplasty intervention on headaches and fatigue in a study population of 286 participants diagnosed with multiple sclerosis and obstructive disease of internal jugular veins (bilateral stenosis >50%). Included were 175 relapsing remitting, 75 secondary progressive, and 36 primary progressive patients with multiple sclerosis. Of the study population, there were 113 headache-positive individuals (82 relapsing remitting, 22 secondary progressive, 9 primary progressive) and 277 fatigue-positive patients (167 relapsing remitting, 74 secondary progressive, 36 primary progressive). These 2 categories were not mutually exclusive and many participants described experiencing both symptoms.
Before and after undergoing the balloon angioplasty procedure, individuals were evaluated using Migraine Disability Assessment (MIDAS) and the Fatigue Severe Scale (FSS). Internal jugular vein blood flow was also measured pre- and post-intervention. To further assess an individual’s internal jugular vein patency, a Duplex ultrasound was performed at 1, 6, and 12 months after undergoing balloon angioplasty and following with yearly assessments.
The relapsing remitting multiple sclerosis and secondary progressive multiple sclerosis cohorts all reported significant reduction (all P<.001) in both MIDAS and FSS scores in the 3 months following the balloon angioplasty procedure. In the follow-up period, these 2 groups showed sustained improvement in MIDAS scores, but only the relapsing remitting group showed sustained improvement in regard to the FSS score. Although the primary progressive multiple sclerosis cohort experienced a significant reduction in FSS scores, their MIDAS scores did not show significant improvement. All groups — with the exception of headache-positive primary progressive participants — showed a significant increase in internal jugular vein blood flow rate after balloon angioplasty intervention.
Analysis of the findings showed significant correlations between the MIDAS scores and blood flow rate measurements in the majority of clinical subgroups. In regard to the FSS scores, however, the clinical benefits of balloon angioplasty show a weakened effect over time. This may suggest that different pathophysiological processes are responsible for the headaches and fatigue experienced by patients with multiple sclerosis.
Limitations in the study design may include a low number of patients with headache-positive primary progressive multiple sclerosis (only 9), the only subgroup that did not reach a significant increase in blood flow rate following the balloon angioplasty intervention, as well as an inadequate understanding of the relationship between fatigue and venous obstruction.
This study shows that new balloon angioplasty therapies can significantly improve quality of life for individuals with multiple sclerosis by increasing internal jugular vein blood flow in the long term and providing sustained relief from headaches.
Beggs CB, Giaquinta A, Veroux M, De Marco E, Mociskyte D, Veroux P. Mid-term sustained relief from headaches after balloon angioplasty of the internal jugular veins in patients with multiple sclerosis [published online January 23, 2018]. PLoS ONE. doi: 10.1371/journal. pone.0191534