This Is MS Multiple Sclerosis Community: Knowledge & Support

"CCSVI was significantly more frequent among MS subjects with a disease duration longer than 144 months (26.1% versus 12.6% of patients with duration shorter than 144 months; p = 0.03) and among patients with secondary progressive (SP) and primary progressive (PP) forms (30.2% and 29.4, respectively) than in patients with relapsing remitting (RR) MS (14.3%)".

During ECTRIMS 2011, which was held in Amsterdam October 19 to 22, a prominent Italian neurologist told the press that "the frequency of CCSVI was confirmed in less than 10% of pwMS" and "already the interim analysis of the COSMO study has completely deflated the hypothesis that CCSVI is a significant cause or significant contibuting factor in MS."

These statements have generated considerable buzz that they were not supported by any posters or abstracts the researchers normally present during the conference, and that the doctor who issues this statement is a relentless opponent of the theory of Professor Zamboni and has a major conflict of interest because of his relationships with pharmaceutical companies, which is easy to document.

All of this raises a number of important questions about the validity and fairness of the COSMO study, which was funded by the Italian Multiple Sclerosis Foundation , which over a year ago saw the controversy of the resignation of Dr. Zamboni from the scientific committee. The discoverer of CCSVI resigned because of failure of the commitee to comply with his diagnostic protocol.

Perhaps it would be useful to carefully reflect on the subject by the Scientific Committee of the AISM in the interest of patients and their families.

This group decided against using the protocol developed by Dr. Zamboni in 2010, ...

ECD and TCC ultrasonographies were performed by a single experienced vascular sonographer who attended a course on CCSVI held by Dr Zamboni at the University of Ferrara in 2011. In order to correctly apply the ECD ultrasonograph Zamboni’s criteria for the diagnosis of CCSVI, before the beginning of the study, he also received a further training at the same University.

A GE Vivid E Ultrasound system (GE Healthcare, Horten, Norway), equipped with a 8L-RS (4–12 MHz) linear array transducer was employed for the study of internal jugular vein (IJV) and vertebral veins (VVs) while a 3S-RS Sector Array Probe (1.5–3.6 MHZ) was used for the study of the deep cerebral veins (DCVs). Furthermore a special C-RS Microconvex Ultrasound Probe was used to study internal jugular veins (IJV) under clavear points.

Following the Zamboni’s procedures [7], the exam comprised orthostatic and clinostatic evaluations of both the IJV and vertebral veins (VVs), and the direction of the flow in the internal cerebral vein, the vein of Rosenthal and the vein of Galeno.

The following five parameters were evaluated for each case and control subjects

Reflux in the IJV and/or VVs in sitting and supine posture;
Reflux in the DCVs;
High-resolution B-mode evidence of IJV stenosis;
Flow not Doppler detectable in the IJVs and/or VVs;
Reverted postural control of the main cerebral venous outflow pathways.

In agreement with literature data, presence of CCSVI was defined as the presence of at least two out of the five parameters [7].