CCSVI increases nine times the likelihood to develop multiple sclerosis

CCSVI increases by nine times the likelihood of developing multiple sclerosis. "This figure is only the latest sensation emerged in the scientific debate about the relationship between CCSVI (chronic cerebrospinal venous insufficiency, venous disease discovered by Paolo Zamboni, (responsible for vascular diseases Center University of Ferrara) and MS. " The is in a statement Gisella Pandolfo, president of the non-profit organization CCSVI SM, adding: "the manner and timing with which it has emerged demonstrating, once again, as not all the stakeholders of this exciting discovery behave in a clear and unassailable way, this is  something profoundly unjust-- in the presence of a highly debilitating disease that strikes in Italy, 60,000 people, mostly young adults. "

The amazing thing, according to Pandolfo, is that "a result of this magnitude has remained in the shadows for many months, because the author of the study that produced it, Claudio Baracchini (Department of Neuroscience, University of Padova), not only do not find, but drew opposite conclusions, resulting in criticism from influential Dr. Robert Zivadinov  (director Neuroimaging Analysis Center, BNAC, University of Buffalo). Now, another scholar, Dr. Avruscio  Giampiero (responsible for Angiology at the Hospital St. Anthony of Padua) expresses the actual results are so far 'silent'. It reinforces the theory of Zamboni, that CCSVI may be one of the causes of MS. "

The President reconstructs the last stages of the main studies on the subject. In the issue of January 2011 issue of Annals of Neurology, Baracchini has published a study on the frequency of CCSVI in a group of patients suffering from possible MS, or CIS (Possible Multiple Sclerosis,  given that a high frequency of the early form evolves into full-blown multiple sclerosis) compared with a group healthy subjects. The conclusions Baracchini make tends to deny the 'association between early MS and CCSVI  and then to deny the possibility that the CCSVI has a causal role in neurodegenerative disease. The publication had wide media coverage and is still often cited as a refutation of the theory of Zamboni.

In the same journal published shortly after Dr. Zivadinov who, revisiting the data Baracchini, shows a highly significant difference between the frequency of CCSVI in the group of PMS than those in healthy subjects. Zivadinov's reproach of Baracchini have somewhat overshadowed this result, central to the stated purpose of the study, and have exemplified in the title and conclusions expressed in the concepts do not correspond to the data presented (".. the results of our study contrasts the 'hypothesis that cerebral venous congestion plays a significant role in the pathogenesis of multiple sclerosis ").

Now comes another strong criticism not so much to the study of Baracchini as to its conclusions. According to Dr. Avruscio Giampiero, using data published by Baracchini an appropriate statistical test, there is a reasonable assurance that the risk of developing PMS increases by 9 times in those who have CCSVI; this, according to Dr. Giampero, can count CCSVI among the factors that contribute to the development of early forms of multiple sclerosis. And supporting the hypothesis of a role at least simultaneously, contribute to the genesis of the disease, countering instead that it might instead be a consequence of inflammation in the brain.

"In short - concluded Gisella Pandolfo - ironically, it seems that the study of Baracchini, despite the opinions of the author, is a mine of data confirming the so-called" Big Idea "by Paolo Zamboni."

HERE IS Dr. Giampiero's Letter to the Editor, published in the Annals of Neurology:

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

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