Sunday, 1 February 2015

CCSVI rise of the pheonix or the death throws of times since past


Tromba L, Blasi S, Vestri A, Kiltzanidi D, Tartaglia F, Redler A. Prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: a blinded sonographic evaluation. Phlebology. 2015 Feb;30:52-60.


OBJECTIVES: To verify the prevalence of chronic cerebrospinal venous insufficiency in patients affected by different clinical forms of multiple sclerosis and in healthy subjects using the Zamboni ultrasound protocol combined with M-mode ultrasound examination.


MATERIALS AND METHODS: We enrolled 112 patients with multiple sclerosis and 67 healthy subjects from 20 to 67 years of age. All the patients underwent Duplex and color-Doppler sonography of the neck vessels, transcranial colour duplex sonography, M-mode study of the valve system and of venous abnormalities. Subjects were positive for chronic cerebrospinal venous insufficiency when at least two of five hemodynamic criteria of the Zamboni protocol were fulfilled. Chronic cerebrospinal venous insufficiency condition was further analyzed by a multivariate analysis including age, sex, disease duration, subtypes of multiple sclerosis and expanded disability status scale score as independent variables.


RESULTS: No healthy subjects was positive for chronic cerebrospinal venous insufficiency, while in the sample of patients affected by multiple sclerosis the diagnosis was made in 59.8% of cases (p < 0.0001). The first criterion was the most frequent in patients affected by multiple sclerosis and chronic cerebrospinal venous insufficiency (respectively 54.4% and 76.1%, p < 0.001). The second, third and fourth criteria were never present in healthy subjects but were detected in patients with multiple sclerosis. The positivity of the second criterion was associated with diagnosis of chronic cerebrospinal venous insufficiency in 100% of cases. The third criterion had a prevalence of 52.2% in the subgroup of chronic cerebrospinal venous insufficiency patients. It was positive in 36 multiple sclerosis patients and was associated with chronic cerebrospinal venous insufficiency diagnosis in all cases except one. The multivariate analysis showed that age, disease duration, sex, subtypes of multiple sclerosis and expanded disability status scale score were not considered predictors of this haemodynamic condition.


CONCLUSION: Chronic cerebrospinal venous insufficiency is a haemodynamic condition strongly associated with multiple sclerosis and is not found in normal controls. The addition of M-mode ultrasound to the diagnostic protocol allows improved observation of venous valve abnormalities.




Having terminated CCSVI saturday many months ago, because of the dwindling research interest, to avoid the labelling of being thought control:-), here is some more fuel, to claim venous abnormalities in many MSers, but not healthy individuals. However, is this a phoenix or just the death throws as interests peters-out on a story that has largely been discredited, by independent, researchers. Trials were halted and what ever happened to the Bards trial or the money collected for the trial? There may be vascular changes in MS and people may get some transient relief from angioplasty, but is this telling us much about the pathogenesis of MS. I am still waiting to see something compelling as an observer with no vested interest

You should all aware of CCSVI and the mischief that this caused, because it was just on fad treatment and there will be others. This is based on idea that can gain traction within the MS community and then the scammers prey on the lack of progress by the medical fraternity. The MS societies get pulled in to investigate and there are loads of pointless research studies. Based on one largely unsubstantiated CCSVI paper, it set up a cottage industry of scammers ready to take money for unproven treatments and create a them (neuros) and us (pwMS & radiologists) attitude. MS Societies had to respond and spend millions of dollars largely refuting the original claims. Fuelled by a vocal, minority, claiming a conspiracy any nay sayer was villified and caused us to turn off comments on the blog and moderate comments. 

Stem cell transplants can avoid the "them" (neuros) and create a new "us" (pwMS & Haematologists), which is not pharma driven, which could make people liable to scammers also. There are places that do treatment for cash with no reported follow-up in the scientific literature. Yes there is a scientific rational and I realise that in many countries all medicine is treatment for cash and that is the basis of private medicine, so what is the difference?  When you have to get health tourism for something that is not approved....the people that really benefit are the dogey docs. 

Sure we get to see the success stories on youtube but what about the horror stories where things don't work, without proper follow-up the stories of health tourists remain stories an it would be good to have an independent place were people could register their before and after experiences so we can learn from this.