One of the more skeptical papers I've read, which I post here, then direct the reader to another article (Multiple Sclerosis, a Vascular Etiology? (Candaidan Journal of Neurological Sciences)

Read the full paper here

A chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI), is claimed to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS). This has invigorated the causal debate of MS and generated immense interest in the patient and scientific communities. A potential shift in the treatment paradigm of MS involving endovascular balloon angioplasty or venous stent placement has been proposed as well as conducted in small patient series. In some cases, it may have resulted in serious injury. In this Point of View, we discuss the recent investigations that led to the description of CCSVI as well as the conceptual and technical shortcomings that challenge the potential relationship of this phenomenon to MS. The need for conducting carefully designed and rigorously controlled studies to investigate CCVSI has been recognized by the scientific bodies engaged in MS research. Several scientific endeavors examining the presence of CCSVI in MS are being undertaken. At present, invasive and potentially dangerous endovascular procedures as therapy for patients with MS should be discouraged until such studies have been completed, analyzed, and debated in the scientific arena.


There is also the possibility that the development of venous flow abnormalities may be secondary to other disease processes in MS. This could be partly addressed by examining patients for the presence of CCSVI in the earliest stages of the disease, that is, CIS or children with MS. The role of the autonomic nervous system and the technical variations in the application of transcranial Doppler (TCD) studies as it may apply to MS have to be carefully considered.46–48 Future TCD studies should involve multiple sites, to overcome the well-known limitations of single site studies, especially in the application and acceptance of abnormal parameters of cerebrospinal venous flow, because there is no published consensus on standardized criteria for normal venous return using ECD-TCCS.

Studies employing magnetic resonance venography (MRV) to examine venous stenosis in MS will have to examine both caliber and hemodynamic flow abnormalities, as well as determine the significance of these potential findings. In contrast to studies examining carotid artery stenosis and its clinical significance, 49,50 there are no such data for IJV or AV. Meticulously conducted MRV studies from multiple centers may be needed to provide insight into CCSVI and its potential relationship with MS. The inclusion of a carefully selected control population in these studies cannot be overemphasized. Correlation of CCSVI with the well-established clinical, immunologic, histopathologic, and imaging features of MS needs to be investigated.


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