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CCSVI Update

Adapted from UK MS Trust website and journal articles as cited.

What is it?

Chronic cerebro-spinal venous insufficiency (CCSVI) is a theory proposed by Professor Zamboni in Italy. He suggests that abnormal narrowing in veins taking blood from the brain causes a build-up of iron which crosses the blood-brain barrier damaging cells in the central nervous system.

Prof Zamboni's study reportedly found CCSVI in 95% of the 65 participants with MS, but not in a control group of healthy people and people with other neurological conditions.

As a result of this many centres around the world immediately offered interventional procedures of unproven efficacy and for uncertain reasons, involving the dilation of the presumed narrowings. Some serious side effects occurred and a small number of deaths.

Around the world specialist neurologists and vascular surgeons, including Prof Comi and, Prof Zamboni, called for more research based evidence that this abnormality existed and was relevant in MS and that until proven no surgical procedures should be carried out due to unacceptable risk.

Several million dollars has been committed around the world to perform testing in several countries to confirm if this condition really exists in people with MS. So far the findings do not support the presence of the condition in most people with MS who were screened; hence its relevance is questioned.

The most recent study to emerge from Italy (Baracchini et al.) was reported in the Annals of Neurology 2011 and it followed earlier negative investigations. They summarised their initial results "our findings do not support a cause-effect relationship between CCSVI and MS. Further studies are warranted to clarify if it is associated with later disease stages..." They found venous anomalies present in only 5 of 50 patients tested, but also in people without MS.

A study from the Netherlands (M.Wattjes and others), published in the British Medical Journal, commented "findings suggestive of anomalies of cranial venous flow were observed in both MS patients and healthy controls. ... It is likely these findings reflect anatomical variants of venous drainage rather than clinically relevant venous outflow obstructions".

The results of more studies will be published in the near future and we eagerly await more research based evidence and relevance, if any, of CCSVI to MS. We will provide updated information on the MSWA web page and through the Bulletin or you can contact the Society for web links.

Input and editing from Prof Bill Carroll and Prof Allan Kermode.

An update on the Canadian CCSVI trials is available under the Latest News section.

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