Funding CCSVI research is/was a waste of valuable time, money and intellectual energy: Yes

Abstract

ProposalIn the history of medicine it is not unusual that positive research findings are not replicated by others; this also frequently happens in multiple sclerosis (MS). Some years ago anti-myelin oligodendrocyte glycoprotein (anti-MOG) antibodies were found to have a high prognostic value in predicting the risk of MS after a first demyelinating episode; subsequent studies were unable to confirm these initial positive results. The presence of Epstein-Barr virus in the central nervous system (CNS) of MS patients has been demonstrated by some authors but not confirmed by others: The lack of reproducible evidence of this virus in the brain, together with its suggested possible pathogenetic role, is a stimulus to further investigation on this topic.In 2006 Zamboni published a fascinating paper proposing that defective venous outflow from the brain, found in one MS patient and subsequently confirmed in other cases, could be pathogenic in MS. 1 It was suggested that this effect might be related to iron deposition caused by extravasation of red blood cells, triggering the cascade of immunological factors typically involved in MS. Zamboni called this discovery "The Big Idea." 1 Some years later Zamboni and others described the detection of venous abnormalities by means of high-resolution echo color Doppler (ECD) and transcranial color-coded Doppler sonography (TCCS) and proposed this as an ideal method by which to investigate the hemodynamics of cerebral venous return. 2 Five anomalous venous hemodynamic patterns affecting cerebrospinal venous return were presented, the so-called five TCCS-ECD criteria of abnormality. It was suggested that this test was the gold standard for diagnosis of chronic cerebrospinal venous insufficiency (CCSVI) that can be made if at least two criteria are fulfilled. 3 Zamboni and his colleagues found CCSVI in all MS patients they examined, with a sensitivity, specificity, positive and negative predictive value of 100%. No other diagnostic test has ever obtained such positive results.The existence and the prevalence of CCSVI have been subsequently examined in many studies, with conflicting results: highly positive, some of them; weakly positive or totally negative in others. Moreover, CCSVI has also been found in normal subjects and in patients with other neurological disorders in some studies, although with a lower frequency. The most relevant studies are summarized in a recent review. 4 The significant variability in reported findings in CCSVI research can be explained by several factors, including the high operator-dependence, the lack of blinding and the methodological and scientific quality of the study.In medical science in order to establish a cause-andeffect relationship between two phenomena, the so-called Bradford Hill criteria must be fulfilled, 5 namely: 1) the strength of association (the larger the association, the more likely that the relationship is causal); 2) the consistency (the reproducibility of results in spite of different observers, places and samples); 3) the specific...

Potential involvement of the extracranial venous system in central nervous system disorders and aging

“…The major amount of knowledge regarding MS points toward immune etiopathogenesis [202]. A number of recent studies examined a cause-and-effect relationship between MS and CCSVI by applying the so-called Bradford Hill criteria [4,52,203]. The Bradford Hill criteria examines the strength of the association, the consistency, the specificity, the temporality, the biological gradient and plausibility, the coherence, the experiment and the analogy between the two phenomena [204].…”

“…The Bradford Hill criteria examines the strength of the association, the consistency, the specificity, the temporality, the biological gradient and plausibility, the coherence, the experiment and the analogy between the two phenomena [204]. In the case of MS and CCSVI, all of these criteria are partially or not fulfilled [4,52,203]. However, the precipitating role of extracranial venous abnormalities in facilitating immune attack, mediated by host-viruses in genetically predetermined individuals, cannot be excluded, in our opinion at this time completely, and should be further investigated.…”

“…The CCSVI hypothesis has provoked great controversy and debate in the MS research community since it was first presented [28,50,52-57]. Whether CCSVI is a syndrome or condition that is primarily characterized by symptoms, such as headache, fatigue, sleep disturbances, autonomic dysfunctions and so on, that can be improved using endovascular treatment and possibly independent from the other underlying disease process is unclear at this time [51].…”

“…Given that substantial resources by various governments and funding agencies have been devoted to studying the concept of CCSVI, it was recently proposed that funding of CCSVI research should be immediately abandoned because it is a waste of valuable time, money and intellectual energy [52-56]. Nevertheless, the concept of CCSVI has triggered an intense and rapid accumulation of knowledge over the past four years and has stimulated the need for further research to better understand the function and potential role of the extracranial venous system in CNS disorders and aging [57].…”

Navigating the “liberation procedure”: a qualitative study of motivating and hesitating factors among people with multiple sclerosis

“…The debate in the MS community initiated by the liberation procedure has been unprecedented 6. Many people with MS, upon hearing of the initial surgical results and anecdotal evidence, have strongly endorsed the procedure, often placing them at odds with health care providers and researchers 7.…”