CCSVI: no evidence of chronic cerebrospinal venous insufficiency at MS onset.

Baracchini et al. Ann Neurol. 2011 Jan;69(1):90-9. doi: 10.1002/ana.22228.

Fifty consecutive patients presenting with a clinically-isolated syndrome (CIS) underwent extracranial and transcranial venous echo-color Doppler sonography (ECDS-TCDS). Those with results suggestive of CCSVI underwent selective venography (the gold standard for diagnosing diseases of blood vessels). Fifty healthy age- and gender-matched controls were studied. Findings: transcranial venous echo-color Doppler sonography (TCDS) was normal in all PwMS. Selective venography performed in 7 of the patients with abnormal TCDS (1 denied consent) did not show venous anomalies. These findings do not support a cause-effect relationship between CCSVI and pMS.

“One criteria of causation is that the causative factor has to have the correct temporal profile in relation to the onset of the disease that it is meant to be causing, i.e. it has to predate the onset of the disease. These data suggests that CCSVI is not present prior to the onset of MS, as it is not present at the earliest event CIS, therefore it cannot be causing the disease. Again these results will need to be confirmed in ongoing studies.”

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  1. ANNALS of Neurology – LETTER TO THE EDITORChronic Cerebrospinal Venous Insufficiency and Susceptibility to Multiple SclerosisAvruscio Giampiero, MD I read carefully the article published in the January 2011 issue of Annals of Neurology by Baracchini and colleagues on the prevalence of chronic cerebrospinal venous insufficiency (CCSVI) measured with echo color Doppler sonography in patients with high suspicion of initial multiple sclerosis (MS).1 These authors give us 2 very important data that appear underestimated in their report, but are of extreme importance in the scientific debate in progress. In Table 4, they show positive CCSVI Doppler screening in 2% of controls matched for age and gender versus 16% of patients with possible MS. This means that:• The prevalence of CCSVI in healthy people is 2%, confirming Zamboni’s data,2 with rates far removed from the 22% recently reported by Zivadinov et al.3• The risk of having possible MS is dramatically increased by the presence of CCSVI by >9-fold (odds ratio, 9.3; 95% confidence interval, 1.1–78; p ¼ 0.0180).In contrast to the conclusions of the authors, careful analysis of their results indicates that CCSVI may be among the factors contributing to the development of MS symptoms at onset.Potential Conflicts of InterestNothing to report.Department of Vascular Medicine, Sant’Antonio Hospital,Padua, Italy

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