ANNALS of Neurology - LETTER TO THE EDITOR

Chronic Cerebrospinal Venous Insufficiency and

Susceptibility to Multiple Sclerosis

Avruscio 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 Interest

Nothing to report.

Department of Vascular Medicine, Sant’Antonio Hospital,

Padua, Italy

REFERENCES

1. Baracchini C, Perini P, Calabrese M, et al. No evidence of chronic cerebrospinal venous insufficiency at multiple sclerosis onset. Ann Neurol 2011;69:90–99.

2. 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.

3. Zivadinov R, Marr K, Cutter G, et al. Prevalence, sensitivity and specificity of chronic cerebrospinal venous insufficiency in multiple sclerosis. Neurology (WNL.0b013e318212a901; published ahead of print April 13, 2011).

DOI: 10.1002/ana.22451 VC 2011 American Neurological Association 1

Source:

http://onlinelibrary.wiley.com/doi/10.1002/ana.22451/abstract

http://www.ncbi.nlm.nih.gov/pubmed/21674590