Saturday, 28 September 2013

CCSVI-September

Well before the research, I guess you have heard the the US trial on CCSVI by Dr. Gary Siskin has been apparently cancelled, because they could not get enough willing participants from the US, despite the promise of some Health Tourists from Canada.

Were people really unwilling to have the risk of placebo?
Or were people just not sufficiently interested?

Anyway you can debate that amongst yourselves, I am sure all travellers to CCSVI convention in Canada today will be talking about it.

The sad part is there is not answer and so we will these posts so another 1 down 3 to go. 

Zwischenberger BA, Beasley MM, Davenport DL, Xenos ES.Meta-Analysis of the Correlation Between Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis.Vasc Endovascular Surg. 2013 Sep 4. [Epub ahead of print]



Purpose: To determine whether a correlation exists between chronic cerebrospinal venous insufficiency (CCSVI) and multiple sclerosis (MS). 

Materials and Methods: A meta-analysis of the current literature was performed to evaluate the frequency of CCSVI, diagnosed by echo color Doppler criteria, in patients with MS and in normal controls. 

Results: In all, 19 studies were identified from January 2005 through February 2013; however, 3 studies were excluded due to duplicate data and 3 additional studies because 0 patients fulfilled CCSVI criteria in both MS and control groups. In order to improve homogeneity, 4 outlier studies were also removed from the analysis. Analysis of the remaining 9 studies demonstrated a significant correlation between CCSVI and MS (odds ratio 1.885, P < .0001) with no significant heterogeneity of the studies (I2 = 18, P = .279). Conclusions: The meta-analysis demonstrated a correlation between CCSVI and MS. However, there was no evidence that CCSVI has a causative role in MS.



So people with MS can have features consistent with CCSVI it is not causal. I guess we now know this, so the original hypothesis I was likely to be incorrect.

Comi G, Battaglia M, Bertolotto A, Sette MD, Ghezzi A, Malferrari G, Salvetti M, Sormani M, Tesio L, Stolz E, Zaratin P, Mancardi G; the CoSMo Collaborative Study Group.Observational case-control study of the prevalence of chronic cerebrospinal venous insufficiency inmultiple sclerosis: results from the CoSMo study. Mult Scler. 2013 Sep . [Epub ahead of print]

BACKGROUND:Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a possible cause of MS.
OBJECTIVES:The CoSMo study evaluated the association between CCSVI and MS.
METHODS:The primary end-point of this multicentric, case-control study was to compare the prevalence of CCSVI between patients with MS, patients with other neurodegenerative diseases (ONDs) and healthy controls (HCs). Colour-coded duplex sonography was performed by a sonologist and the images were sent to one of three central sonologists for a second reading. Agreement between local and central sonologists or, in case of disagreement, the predominant judgment among the three central readers, was required for a diagnosis of CCSVI. All readings, data collection and analysis were blinded.
RESULTS:The study involved 35 MS centers across Italy and included 1874 subjects aged 18-55. 1767 (94%) were evaluable: 1165 MS patients, 226 patients with ONDs and 376 HCs. CCSVI prevalence was 3.26%, 3.10% and 2.13% for the MS, OND and HC groups, respectively. No significant difference in CCSVI prevalence was found amongst the three cohorts (MS versus HC, OR = 1.55, 95%CI = 0.72-3.36, p = 0.30; OND versus HC, OR = 1.47, 95%CI = 0.53-4.11, p = 0.46; MS versus OND, OR = 1.05, 95%CI = 0.47-2.39, p = 0.99). High negative and low positive agreement was found between the local and centralized readers.
CONCLUSIONS: CCSVI is not associated with MS.

We have reported on this before, the conclusions say it all.