Comment on No Evidence of CCSVI at Multiple Sclerosis Onset
(via Alessandro Rasman) 2.5.2011
Annals of Neurology
Comment on No Evidence of CCSVI at Multiple Sclerosis Onset
Robert Zivadinov,1,2, Murali Ramanathan,2, 3, Michael G. Dwyer,1 Karen Marr1, Ralph HB Benedict,2, Bianca Weinstock-Guttman,2
1Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, NY, USA; 2The Jacobs Neurological Institute, Department of Neurology, University at
Buffalo, State University of New York, Buffalo, NY, USA; 3Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY, USA;
Corresponding Author: Robert Zivadinov, MD, PhD
Department of Neurology
School of Medicine and Biomedical Sciences
Buffalo Neuroimaging Analysis Center
100 High St., Buffalo, NY 14203, USA
Tel. 716 859 7031 begin_of_the_skype_highlighting begin_of_the_skype_highlighting
Fax. 716 859 4005
Email: rzivadinov@bnac.net
We read with interest the paper by Baracchini et al., “No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset” published in Ann Neurol (2011;69:90–99). Baracchini et al. concluded that their data do not support a cause-effect relationship between chronic cerebrospinal venous insufficiency (CCSVI) and possible
MS (pMS).
Baracchini et al. reported that 8/50 (16%) of pMS patients presented with CCSVI diagnosis (fulfillment of >=2 individual CCSVI criteria). 1 Based on the data presented in Table 4 there could be a maximum of 1 subject with CCSVI diagnosis 1 in the HC1 and HC2 group. In our post-hoc analyses of the data presented in Table 4, we found a statistically significant difference (?2=10.8, p=0.001) in the frequency of CCSVI diagnosis in pMS (8/50) vs. HC (1/100) groups. Furthermore, Baracchini et al. found reflux (criteria 1) in 12/50 pMS patients vs. 0/100 HC, and proximal IJV stenosis (criteria 3) in 8/50 of pMS patients vs. 0/100 HC. Thus, a review of Table 4 from Baracchini et al. suggests that fulfillment of the individual CCSVI criteria and the CCSVI diagnosis are significantly more frequent in the pMS group compared to the age- and non-age matched HC groups.
The data from the Baracchini et al. study would benefit from presentation of the results for CCSVI diagnosis in the HC1, HC2 and TGA groups along with p-values for all relevant pairwise comparisons involving the pMS group in Table 4. In addition, the Abstract results and conclusions are selectively based on valve incompetence data and do not reflect the results presented in Table 4 or the fulfillment of the individual CCSVI criteria or the CCSVI diagnosis.
Baracchini et al. have generated useful data in their study. However, based on the differences between pMS patients and both HC groups in respect to the individual CCSVI criteria and the diagnosis of CCSVI, we suggest that their results are insufficient to formally exclude an association between pMS and CCSVI in the study sample.
Accordingly, the title of the study is not supported by the study results and should be revised.
References:
1. Zamboni P, Galeotti R, Menegatti E et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 2009;80:392-399
From:
http://onlinelibrary.wiley.com/doi/10.1002/ana.22420/abstract