Aa
Aa
A
A
A
Close
382218 tn?1341181487

Research shows no link among CCSVI and development of multiple sclerosis

http: //www. news-medical .net/news/20100802/Research-shows-no-link-among-CCSVI-and-development-of-multiple-sclerosis.aspx

Research shows no link among CCSVI and development of multiple sclerosis
2. August 2010


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
2 Responses
Sort by: Helpful Oldest Newest
293157 tn?1285873439
I didn't see this one...thanks for the link...
I have to check this out too..
wobbly
Helpful - 0
198419 tn?1360242356
Thanks for posting this Db.
I'm definintely going to check out the link..

-shell
Helpful - 0
Have an Answer?

You are reading content posted in the Multiple Sclerosis Community

Top Neurology Answerers
987762 tn?1671273328
Australia
5265383 tn?1669040108
ON
1756321 tn?1547095325
Queensland, Australia
1780921 tn?1499301793
Queen Creek, AZ
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease