Statement of the german MS society

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Statement of the german MS society

Postby cah » Tue Dec 08, 2009 10:23 am

I translated the recent statement of the German MS society (DMSG) concerning CCSVI. I did this very quickly and roughly, so please don't mind some quirky word orders or single words. I will not comment this yet, having no words for this bullshit. Here it is:

New vascular hypothesis of Multiple Sclerosis?

08.12.2009 - up-to-date response of the medical advisory board of the DMSG [german multiple sclerosis society], federal association, about the hypothesis of a venous induced cause of multiple sclerosis.

The hypothesis of "chronically cerebrospinal venous insufficiency (CCSVI)" as cause of multiple sclerosis is recently discussed in many places and also internet-forums (see www.dmsg.de, www.csvi-ms.net).
Thereby it is assumed that a blockage of venous flow leads to a venous obstruction resp. to an increase of venous blood pressure in the brain, which then could lead to perivenous iron accumulation with subsequent inflammatory reaction. (Zamboni 2006, Zamboni 2009).
These predominantly sonographically, i.e. with ultrasound, raised findings, as well as the recently depicted possible prognostic correlation of with transcranial ultrasound detected hyperechogenities in the brain tissue (Walter 2009), indicate that the value of ultrasonic diagnostics within the diagnostic state investigation of MS-patients is widely unknown.

In the discussion of CCSVI or "venous MS" it should not be overlooked that cerebral venous insufficiencies already were discussed as causal in the past, also for other neurological deseases. The ultrasonic findings made in the process aren't in fact identical with the described findings in the "venous MS", however showed comparable indication for the existence of a migraine and a condition with temporary memory loss (transient global amnesia = TGA), (Sander 2000, Chung 2009).
In 86% of the patients with TGA a venous valve insufficiency of the jugular veins was found (Schreiber 2005). Thus, a venous insufficiency of the jugular vein is not exclusive or typical to MS, thus is not pathognomonic at all, which is wrongly stated often. In the described TGA-study, a venous valve insufficiency could be found even in 33% of the controls. So it is to put into question how specific these findings are for the condition. In our own studies, showed only in poster form until now, we could not prove this. (Krogias 2003).

These facts should be considered in the discussion of a possible venous genesis of MS. The doubtlessly very interesting findings of Zamboni and associates should be traced in a rational and serious scientific work and initially be proved or disproved in other workgroups. Zamboni himself dubbed his hypothesis "the big idea" and thus reveals an irrationality hindering in this process (Zamboni 2006). His promoted implantation of venous stents as a treatment to MS he calls "liberation procedure" and thus raises supposably not accomplishable expectations among MS patients.

In a recent study published in the "Journal of vascular surgery" (December 2009, 6:1348-1358.e3) Zamboni and his staff has performed a treatment with balloon dilalation on 35 RRMS, 20 SPMS and 10 PPMS patients. The authors claim that this procedure has led to an improvement of the clinical outcome in the RRMS patients. There are no controls. If the patients got drugs and if so what drugs the paper doesn't say.

The described improvement initially reflects the natural outcome, as attacks in RRMS regress regularly. In SPMS and particularly PPMS this is not the case, consequently the "liberation procedure" has had no influence.

To our scientific judgement, the published studies of Zamboni et al. lack a solid scientific methodology and thus are valueless and even ethically questionable.

For the scientific advisory board of the DMSG, federal association:

Prof. Dr. med. R. Gold (Vorstandsmitglied)
Direktor der Neurologischen Klinik am St. Josef-Hospital,
Klinikum der Ruhr-Universität Bochum
Gemeinsam federführend mit Dr. med. Christos Krogias
Neurologische Klinik am St. Josef-Hospital,
Klinikum der Ruhr-Universität Bochum

Prof. Dr. med. H.-P. Hartung (stellv. Vorsitzender),
Direktor der Neurologischen Klinik, Heinrich-Heine-Universität Düsseldorf

Prof. Dr. med. H. Wiendl (Vorstandsmitglied)
Leiter der Klinischen Forschungsgruppe für Multiple Sklerose und Neuroimmunologie, Neurologische Klinik, Julius-Maximilians-Universität Würzburg

Prof. Dr. med. K.V. Toyka (Vorsitzender)
Direktor der Neurologischen Klinik, Julius-Maximilians-Universität Würzburg

Prof. Dr. med. R. Hohlfeld (stellv. Vorsitzender),
Direktor des Institutes für Klinische Neuroimmunologie der Ludwig-Maximilians-Universität, München

Prof. Dr. med. Peter Rieckmann (Mitglied des AEB)
Chefarzt Neurologische Klinik Bamberg
Last edited by cah on Tue Dec 08, 2009 11:34 am, edited 1 time in total.
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Postby LR1234 » Tue Dec 08, 2009 10:35 am

Internal Jugular Vein Valve Incompetence Is Highly Prevalent in Transient Global Amnesia
Claudia Cejas MD; Lucia Fernandez Cisneros MD; Roberto Lagos MD; Carlos Zuk MD; and Sebastián F. Ameriso MD*

From the Institute for Neurological Research, FLENI, Ultrasound Laboratory (C.C., F.C., R.L., C.Z.) and the Neurology Department (S.F.A.), Buenos Aires, Argentina.

* To whom correspondence should be addressed. E-mail: sameriso@fleni.org.ar.

Background and Purpose—Transient global amnesia (TGA) is the inability to retain new information and to recall past events during a period of minutes or hours. Its etiology is unclear, and flow disturbances in the mesial temporal lobes secondary to venous congestion have been proposed as a potential cause. Ultrasonographic evaluation of the internal jugular vein (IJV) has demonstrated valvular insufficiency in TGA. The prevalence of valvular insufficiency in the IJV in patients with TGA was assessed. Subjects without TGA of similar sex, age, and vascular risk factor profiles served as controls.

Methods—A group of 142 patients with a clinical diagnosis of TGA within 7 days of the clinical event and 40 controls were prospectively evaluated. Venous Doppler examination of both IJVs was performed at baseline and after a manometer-controlled Valsalva maneuver. Valvular insufficiency was diagnosed when there was reflux for >0.8 seconds during the Valsalva maneuver.

Results—Valve insufficiency was found in at least one jugular vein in 113 of 142 patients with TGA (79.5%) and in 10 of 40 controls (25.0%), P<0.01. The right side was affected more often than the left side, P<0.01, and 26.8% of the patients had bilateral incompetence.

Conclusions—Patients with TGA have a high prevalence of IJV valve insufficiency. This finding may have pathophysiologic implications. Doppler evaluation of the IJVs with dynamic maneuvers may help in the evaluation of this usually benign condition.
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Postby whyRwehere » Tue Dec 08, 2009 12:27 pm

They sound like a merry band of plonkers. Notice how they are all neurologists, and how much have they fixed with all their knowledge over the last how many decades? I don't really care what they think...we should all be funding societies made up of phlebologists,vascular surgeons and interventional radiologists.
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Postby cah » Tue Dec 08, 2009 1:22 pm

I think if you want to have a lession in how to professionally disassemble another one's finding without having too much to do, here you go.

First, don't refer to the title of the person. Continuously call him only by his last name (Zamboni) instead of telling people that he might have learned something and has a position (Professor Zamboni, vascular surgeon, University of Ferrara). Don't tell that there might be other scientist involved, treat them as staff. (I can imagine that this is quite an insult among scientists.)

Next, make some statements that can only be understood with profound background knowledge in the particular case. (3. sentence: "These [...] findings,..." (What findings?)). This prevents anybody who hasn't heard of it yet from further asking questions rather then just flying over the text.

Then, take just anything that comes to your mind and compare it to the case, heavily using seeming logic. Draw conclusions where there aren't any to draw. Things like that.

If you lack some good arguments, make some suspicious statements about something completely irrelevant, e.g. about naming things.

For the finishing touch, repeat the drawbacks of the study, even if they are spotted by the researcher himself. To anyone who isn't familiar with the study, it will look like the researcher has made some mistakes.

At last, put a simple carved-in-stone statement that 1.) stresses your professionalism and 2.) makes a nebulous judgement about the study that can be read as whatever you want but not possitive.

Gee, MS is demyelinating but pigheaded neuros are unnerving.
"There is only one good, knowledge, and one evil, ignorance." Socrates
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Re: Statement of the german MS society

Postby frodo » Tue Dec 08, 2009 2:24 pm

It is nice to see that the names of the responsibles of this paper are at the end. I hope some day they will have to give explanations in front of a court, as responsibles for disabilities in several persons.
At least, because the text have several inaccuracies, misrepresenting the reality, and they can be liable for that. Even more if some economical interest is shown.
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Postby cah » Sun Dec 13, 2009 7:10 am

I've got a question to all of you concerning the statement of the german MS society: They virtually try to disprove Dr. Zamboni's findings "professionally" by comparing it to other studies. Are there any other institutional, professional or otherwise official statements or reports that also name seemingly contrary findings? I haven't found any, so I think the german statement is the only one, but maybe I've overlooked something? Please, if you know of one tell me of it, I know you, like me, don't like those, but it's very important to know, so that we are right when we tell german people who are interested in CCSVI that this is the only one.

Thank you!
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Postby Billmeik » Sun Dec 13, 2009 7:44 am

Zamboni himself dubbed his hypothesis "the big idea" and thus reveals an irrationality hindering in this process (Zamboni 2006). His promoted implantation of venous stents as a treatment to MS he calls "liberation procedure" and thus raises supposably not accomplishable expectations among MS patients.



zamboni is against stents. This is a made up fact. I wonder what promotes this author's irrationality?
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