Research shows no link between CCSVI and development of multiple sclerosis


Two important new studies challenge the controversial hypothesis that venous congestion—chronic cerebrospinal venous insufficiency (CCSVI)—contributes to the development of multiple sclerosis (MS). This theory has resulted in many MS patients receiving experimental endovascular angioplasty, a treatment for MS unproven by clinical trials. The studies refuting the CCSVI theory with the first negative medical evidence on the subject, are available today in Annals of Neurology, a journal published by Wiley-Blackwell on behalf of the American Neurological Association.

For nearly 150 years it has been known that focal MS lesions tend to develop around cerebral veins that are thought to the portal by which inflammatory cells targeting myelin enter the brain. However, a 2009 study by Zamboni et al. offered an alternative theory suggesting that chronically impaired venous drainage (blood flow) from the central nervous system—a term that he labeled Chronic Cerebrospinal Venous Insufficiency or CCSVI—leads to MS development.1 Zamboni et al. also claimed that endovascular angioplasty was markedly effective in MS patients.2 Zamboni's work gained much attention in the press, especially their report that ultrasound diagnosis of CCSVI perfectly matched an MS diagnosis with 100% sensitivity and 100% specificity.

"These two papers should add a note of caution for MS patients and physicians who are contemplating interventions for possible venous abnormalities based on the findings of Zamboni. At this time, the theory must be considered unconfirmed and unproven. Such interventions carry risk, and several people have already been harmed by the inappropriate application of venous angioplasty and stenting for MS," says Stephen L. Hauser, M.D., the Robert A. Fishman Distinguished Professor and Chair of the Department of Neurology at the University of California, San Francisco, and editor-in-chief of the Annals of Neurology. A previously published review of the evidence in the Annals by Khan et al. noted that treatment procedures, based upon these findings, have included placing stents in the jugular veins of MS patients which led to serious injury in some cases.

In the current issue of the Annals, Florian Doepp, M.D., and colleagues in Germany performed an extended extra- and trans-cranial color-coded sonography study on 56 MS patients (36 female; 20 male) and 20 control subjects (12 female; 8 male). The analysis included extra-cranial venous blood volume flow (BVF), internal jugular vein (IJV) flow analysis during Valsalva maneuver (VM), as well as tests included in the CCSVI criteria.

Results showed that blood flow direction was normal in all participants, excluding one subject with relapsing-remitting MS. Furthermore, the research team noted that blood volume flow (BVF) in both groups were equal in the supine body position. In summary, the researchers determined that none of the study participants fulfilled more than one criterion for CCSVI.

"Our results call into question the existence of CCSVI in a large proportion of patients with MS," said Dr. Doepp. "We did not find supporting evidence that cerebral venous congestion plays a significant role in the development of MS. Further studies are needed to clarify the difference between MS patients and healthy subjects in blood volume flow regulation," concluded Dr. Doepp.

A second study by researchers at Umeå University in Sweden also concluded that CCSVI does not contribute to the development of MS. The Swedish research team led by Peter Sundström, M.D., Ph.D., tested the vital component of the CCSVI theory—the obstructed IJV flow—in 21 MS patients and 20 healthy controls using magnetic resonance imaging with phase contrast (PC-MRI).

"Using PC-MRI, we were not able to reproduce the findings by Zamboni et al. which suggest CCSVI contributes to the development of MS," said Dr. Sundström. The researchers found no significant differences between the MS group and control group relating to total IJV blood flow. "Our study found no support for using endovascular procedures such as angioplasty or stenting to treat MS patients," Dr. Sundström affirmed.

SOURCE Wiley-Blackwell

Comments

  1. Glen Glen United Kingdom says:

    I don't know about the Swedish study, but the German study (Doepp et al) did not employ the correct protocol, they did not scan the length of the jugular vein.

  2. Suzanne Augustt Suzanne Augustt United Kingdom says:

    What about the tens of hundreds of MS'ers who have had the Liberation procedure done and seen very positive results.....I know lots of people who have had the procedure and in some cases these people have been in wheelchairs and using canes before the procedure...during the procedure they noticed improvements and they continued to improve...I also know some who had the procedure and after initial improvements they returned to pre-procedure state...fairly obvious to me that there jugulars re-stenosed. The people are seeing with there own eyes the benefits of treating CCSVI, the internet is connecting them in a way probably never seen before and the real truth will win. Thank you.

  3. Edward Murray Edward Murray Israel says:

    How insightful and as the Anals noted, "important."

    How does it advance the science of this if you don't actually attempt to replicate the work of Dr. Zamboni?

    I personally tested the CCSVI theory using tarot cards and was "not able to reproduce the findings by Zamboni et al. " I should submit my results to the growing evidence that CCSVI is not real at least when you don't actually test for it.

  4. Hopka Hopka Canada says:

    Is it possible that the venous congestion is a result of MS?  Perhaps treating the venous congestion as a separate issue is what is needed to help MS patients.  Then attack the MS disease.  Certainly those who have been through treatment have had their quality of life improved.  Isn't that the goal until a "cure" is found??

    • Shirley Renshaw Shirley Renshaw Canada says:

      The Multiple Sclerosis Societies have turned their backs on people who would like a better quality of life.  They obviously are not and looks like never have stood for their mission statement.  I am reading now that these people treat those who have angioplasty like dirt now.  If you even want to discuss CCSVI they dismiss you.  People who get treated for Cancer are not told to wait they get treated alongside while doing research.  Don't get me started on a cure for Cancer and Big Pharma !!!

  5. ???
    bruce sumner bruce sumner Canada says:

    I'm a little confused.  What do these 2 studies have to do with the MS Society?  Is this the Conspiracy Theorist speaking about the Shadow Cabinet keeping the Cure from the People.  Mwa Ha Ha!  

  6. Paul Paul Canada says:

    For those people claiming to be cured by the "Liberation Treatment" go to Youtube and put "faith healing cures multiple sclerosis" and see the videos of people saying they have been cured by Dr. Jesus and they are walking without canes. Really we are seeing the combination of hope, expectation, suggestibility and the placebo effect producing short term effects. Also the Swedish protocol did show normal flow, if there was really an obstruction at some point in the cranial circulation system blood flow reduction would have been seen. It is telling that only the originator of the hypothesis can see the effect (sort of like Bolduc and N rays in 1900).

    • Shirley Renshaw Shirley Renshaw Canada says:

      CCSVI is NOT a cure.  I wonder why people like you find words that are not spoken but by nay sayers.  Come on, you should know better.  It's things that you write that gives ME a bad name. I resent that and forgive you on your ignorance.  I want you to prove to me that the Swedish study was NOT a farce.  You seem to know so I want it spelled out.  What protocols, equipment and other factors were used to prove CCSVI wrong?  Why do you say it's a placebo effect?  How do you know it is only for a short term effects?  AND who is Dr. Jesus?  See once again you are writing things that are not true.  When you write crap it makes your comments NOT CREDIBLE.  Use facts to prove your point not silly terminology.

  7. Ron Ron United States says:

    Something strange is going on here.  People are getting treated and feeling and functioning a lot better (to the point where even if it is a placebo effect, bring it on!).  On the other hand, a few studies that seem not to have replicated Zamboni's techniques or objects of study (the jugular vein is only one vein that Zamboni implicated and he did more than just MRI) do not support his results.  I am wondering, is the placebo effect that powerful, or are some scientists just stupid? (hint: scientists are human)

    • David David Canada says:

      Yes, the placebo effect is very powerful - but only for illnesses that are psychological (or are exacerbated by psychological factors). All chronic illnesses have psychiatric components and MS is no exception. By all means we should definitely explore psychological factors more, but we really do need to figure out whether or not the patients feeling better is actually due to CCVSI or not - otherwise you are just selling them snake oil!

  8. Bruce Sumner Bruce Sumner Canada says:

    As a person without MS and having friends that do, I have followed the CCSVI information and resultant dialogue with interest.  I support clinical trials that will hopefully get to the bottom of things.  However, I am tired of the slagging and flaming of anything negative to the CCSVI Pro-Zamboni Lunatic Fringe by its adherents.  It is emotional and irrational.  You are doing only a disservice to your cause by trolling the boards and hammerblowing your opinions.  It is turning people off and you have turned me and my friends off.

    • Suzanne Augustt Suzanne Augustt Ireland says:

      Emotional.....yes. Irrational.....No. If a person's veins are blocked, narrowed, occluded or twisted regardless of whether or not they have MS then it makes sense to fix these veins. If a vein was blocked from any major organ in the body, e.g. the heart, liver, kidney then they would be fixed, why then should a person with problems in their veins draining from the most vital organ, the brain, not be fixed. They say treating CCSVI is a risky procedure....there are risks with any surgical procedure...there are even risks taking a paracetemol...what do you think are the risks with not treating blocked veins and the possibility of never having those known blocked veins fixed..Unfortunately clinical trials are going to take years to complete and people with MS don't have those years to wait..they need to be fixed ASAP. The MSer's commenting have been studying CCSVI solidly for months on end and that's why they appear to get annoyed when other less informed people comment. I myself do not have MS my husband has and both his jugular veins are stenosed.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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