Wednesday, 12 September 2012

Research: CCSVI is Not Common in Early MS

BACKGROUND: We designed a prospective case-control study of patients with clinically isolated syndrome (CIS) and Relapsing-Remitting Multiple Sclerosis (RRMS) with an Expanded Disability Status Score (EDSS) of ≤2, compared with age-and-sex-matched healthy controls, to test the hypothesis that chronic cerebrospinal venous insufficiency (CCSVI) is more prevalent in patients with CIS or mild MS.

METHODS: All subjects were examined using a Siemens Antares duplex ultrasound machine. The internal jugular, vertebral and intracranial veins were studied in subjects in both supine and sitting postures. The sonographer was blind to the subject's clinical status. Measures included the criteria proposed by Zamboni and volume flow. Presence of CCSVI was defined as ≥2 Zamboni criteria.

RESULTS: Seventy patient-control pairs were recruited, with 11 males and 59 females in each group. Only one subject, a control, satisfied the Zamboni definition of CCSVI; however, 19 patients and 13 controls had abnormalities as defined by Zamboni, the difference largely caused by a higher prevalence in patients of internal jugular vein (IJV) stenosis, defined as a cross-sectional area ≤0.3cm(2). This difference disappeared with a more rigorous stenosis definition. Further analysis revealed there was IJV valve variation in seven patients and one control.

CONCLUSIONS: Our findings indicate that CCSVI, as defined by the Zamboni ultrasound criteria, is not present in CIS and mild RRMS (EDSS ≤2), providing further evidence that CCSVI does not have a causal role in MS; however, we found an apparent increase in IJV variation in patients with CIS or mild MS that would warrant further investigation.


The conclusions suggest that as CCSVI was not present in all early MSers, it is very, very unlikely to be causal. The evidence is stacking up against the Zamboni theory, but this largely matters not as studies are going ahead with venoplasty in Msers. 

We wait to see what the trials of venoplasty will bring......a placebo effect or real therapeutic advantage?

1 comment:

  1. Andy ClarkeWednesday, September 12, 2012 10:30:00 AM

    This is the statement I found interesting "however, we found an apparent increase in IJV variation in patients with CIS or mild MS that would warrant further investigation". The knowledge and the ability of the sonographer and all connected with ccsvi is evolving, I didn't expect this would be concluded definitively in such a short space of time and it appears that is still the case.
    MS as you appreciate is complicated, so if the last 40 to 50 years of modern research is yard stick we still have a long way to go. The exciting area for me is modern imaging, upright mri and 7 tesla I'm sure will reveal a lot more information that was previously undetectable and hopefully will enhance the knowledge still further.

    Regards Andy Clarke ( not sure if this comment has been posted in the correct place, it is meant to be next to your ccsvi post)

    MouseDoctor2Wednesday, September 12, 2012 12:54:00 PM

    Hi Andy
    The reason that comments are not enabled on the CCSVI posts is that on past experience the site gets rapidly hijacked by the pro CCSVI lobby, as has happened on many other MS websites.
    We appreciate everyone's co-operation on this.