CCSVI – another study; dare I say negative or independent?

C
Epub ahead of printBaracchini et al. Progressive multiple sclerosis is not associated with chronic cerebrospinal venous insufficiency. Neurology. 2011 Aug 17. 

Objective: CCSVI could represent a late phenomenon of MS or be associated with progression of disability. Thus, these investigators studied CCSVI prevalence in primary progressive (PP) and secondary progressive (SP) MS, to clarify whether CCSVI characterizes the progressive forms of this disease.

Methods: A total of 35 MS’ers with SPMS, 25 patients with PPMS, and 60 age- and gender-matched normal controls (NC) were enrolled into a cross-sectional study. Extracranial and transcranial high-resolution venous echo color Doppler sonography (ECDS-TCDS) was performed in all MS’ers and NC. Those MS’ers having any abnormal ultrasound finding were asked to undergo selective venography (VGF).
Results:
TCDS was normal in all MS’ers. 
ECDS showed one or more abnormal findings in 9/60 (15.0%) MS’ers (7/35 [20.0%] SPMS, 2/25 [8.0%] PPMS) and in 14/60 (23.3%) NC (p not significant for all comparisons). 
CCSVI criteria were fulfilled in 0 NC and 4 (6.7%) patients with MS: 3 SPMS and 1 PPMS. 
VGF, performed in 6/9 patients, was abnormal only in one case who had bilateral internal jugular vein stenosis.
Conclusion: Their findings indicate that CCSVI is not a late secondary phenomenon of MS and is not associated with disability.
“This study’s findings are self-explanatory; no commentary is necessary.”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

4 comments

  • Baracchini’s got form on poorly analysed CCSVI studies:

    Here’s Dr. Giampiero's Letter to the Editor, published in the Annals of Neurology:

    ANNALS of Neurology – LETTER TO THE EDITOR
    “CCSVI and Susceptibility to Multiple Sclerosis
    Avruscio Giampiero, MD

    I read carefully the article published in the January 2011 issue of Annals of Neurology by Baracchini and colleagues on the prevalence of CCSVI measured with echo color Doppler sonography in patients with high suspicion of initial multiple sclerosis (MS).

    These authors give us very important data that appear underestimated in their report, but are of extreme importance in the scientific debate in progress. In Table 4, they show positive CCSVI Doppler screening in 2% of controls matched for age and gender versus 16% of patients with possible MS.

    This means that the risk of having possible MS is dramatically increased by the presence of CCSVI by >9-fold (odds ratio, 9.3; 95% confidence interval, 1.1–78; p ¼ 0.0180). In contrast to the conclusions of the authors, careful analysis of their results indicates that CCSVI may be among the factors contributing to the development of MS symptoms at onset.”

    In this study CCSVI criteria were fulfilled in 0 normal controls and 4 patients with MS.

    No statement about conflict of interest is made here either, so who knows if he is ‘independent’.

  • Re: "ANNALS of Neurology – LETTER TO THE EDITOR
    “CCSVI and Susceptibility to Multiple Sclerosis
    Avruscio Giampiero, MD"

    Thanks for the post; the letter makes a good point.

    However, I am not sure if doppler screening is good enough to make a diagnosis of CCSVI. What is striking with the second wave of publications is how rare CCSVI is; it is nowhere near the 100% figure reported by Zamboni.

  • You’re welcome. You may also find this of interest:

    http://www.wheelchairkamikaze.com/2011/07/video-ccsvi-doctors-roundtable.html

    It’s a CCSVI doctor’s roundtable discussion at the Society for Interventional Radiology meeting in Chicago in March 2011.

    The video includes some of the big names in CCSVI in the US. It covers a broad range of issues involved with the investigation and treatment of the condition.

    Catheter venography seems to be the current ‘gold standard’ for diagnosis, usually following an initial doppler scan.

  • The information must always be complete: 1. Baracchini et al gave a public answer to Dr Avruscio's critical remarks; this answer is published on Annals of Neurology. Why was it not mentioned by "anonymous"? 2. catheter venography should be peformed blindly as it was done in the studies conducted by Baracchini et al and should be considered the current gold standard; this explains the discrepancies with ultrasound. 3. Zamboni's ultrasound criteria are filled with methodological errors and are derived from studies in different settings (peripheral veins, comatose patients, etc.), so it is not a surprise if catheter venography findings are different than those observed with ultrasound. 4. the conflicts of interest are reported: "anonymous" should read more carefully.

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