Letter written in late October 2010, shortened at Editors' request to:
Report of extracranial venous stenoses in relapsing–remitting multiple sclerosis patients
Mark A Walker - Chair, Multiple Sclerosis Therapy Centre, Oxford, UK
Yamout et al.’s paper1 is welcomed by many people with multiple sclerosis (pwMS), as it reports that people with relapsing–remitting MS (RRMS) for more than 10 years are highly likely (12 of 13 subjects or 92%) to have extracranial venous stenoses (EVSs).
This study made an error in combining results from RRMS and clinically isolated syndrome (CIS) subjects, naming them early MS (EMS). Such a grouping does not follow the McDonald criteria, as CIS is not MS in this classification. Excluding results for CIS from the data means results for a group of RRMS is obtained. This revised data shows that 18 RRMS subjects have stenosed veins within the subset of 31 subjects with RRMS. The resulting correlation factor of 0.58 is similar to the initial results from the Buffalo Neuroimaging Analysis Center (BNAC) Buffalo, NY, USA, which reported a correlation factor of 0.55.2 Research deriving from a theory by Professor Paolo Zamboni, University of Ferrara, Italy3,4 has been investigated by vascular specialists, in countries as diverse as Jordan5 and Poland6 with results of 0.84,5 0.9,6 and 0.9.3
Many pwMS are not concerned at the exact correlation coefficient value, and they are indifferent if their vein restrictions are a cause or a later product of MS as Yamout et al. propose.1 The simple question asked by pwMS, ‘Is there are a correlation between MS and EVS?’ and the results from Yamout et al.1 give an unequivocal ‘yes’.
Research neurologist Dr David Hubbard comments that globally, over 2000 pwMS have already received testing and therapy for CCSVI.7 It appears that a significant number of pwMS are acting on early findings, rather than waiting for further research.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement
↵ Yamout B, Herlopian A, Issa Z, Habib RH, Fawaz A, Salame J, et al. Extracranial venous stenosis is an unlikely cause of multiple sclerosis. Mult Scler 16(10): 1156–1172.
↵ Zivadinov R, Marr K, Ramanathan M, Zamboni P, Benedict RRHB, Cutter G, et al. for the Combined Transcranial and Extracranial Venous Doppler Evaluation (CTEVD Study). Description of the design and interim results of an epidemiological study of the prevalence of chronic cerebrospinal venous insufficiency in MS and related diseases. Neurology 2010; 74: A545–A545.CrossRef
↵ Zamboni P, Galeotti R, Menegatti E, Malagoni AM, Tacconi G, Dall'Ara S, et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80: 392–399.Abstract/FREE Full Text
↵ Zamboni P, Galeotti R, Menegatti E, Malagoni AM, Gianesini S, Bartolomei I, et al. A prospective open-label study of endovascular treatment of chronic cerebrospinal venous insufficiency. J Vasc Surg 2009; 50: 1348–1358.CrossRefMedlineOrder article via InfotrieveWeb of Science↵ Al-Omari MH, Rousan LA. Internal jugular vein morphology and hemodynamics in patients with multiple sclerosis. Int Angiol 2010; 29: 115–120.MedlineOrder article via InfotrieveWeb of Science
↵ Simka M, Kostecki J, Zaniewski M, Majewski E, Hartel M. Extracranial Doppler sonographic criteria of chronic cerebrospinal venous insufficiency in the patients with multiple sclerosis. Int Angiol 2010; 29: 109–114.MedlineOrder article via InfotrieveWeb of Science
↵ Dr Hubbard connects MS to CCSVI theory. http://www.komonews.com/home/video/106175483.html
(accessed 29 October 2010).
Mark Walker - Oxfordshire, England. Retired Pharmacist. 12 years of study around MS.
Mark's CCSVI Comment: