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CCSVI and MS: no meaning, no fact

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Abstract

A condition called “chronic cerebrospinal venous insufficiency” (CCSVI) has been postulated to play a role in the pathogenesis of multiple sclerosis (MS). This hypothesis implies that a complex pattern of extracranial venous stenosis determines a venous reflux into the brain of MS patients, followed by increased intravenous pressure, blood–brain barrier breakdown and iron deposition into the brain parenchyma, thus triggering a local inflammatory response. In this review, we critically analyze the scientific basis of CCSVI, the current literature on the relationship between CCSVI and MS, as well as the ultrasound methodology that has been claimed to provide evidence of impaired cerebral venous drainage. We show that no piece of the CCSVI theory has a solid supportive scientific evidence. The CCSVI appears to be a rather alien condition and its existence should be definitely questioned. Finally, no proven (i.e., based on strict scientific methodology and on the rules of evidence-based medicine) therapeutic effect of the “liberation” procedure (unblocking the extracranial venous obstruction using angioplasty) has been shown up to date.

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Conflict of interest

Dr. C. Baracchini serves on the executive committee of the European Societyof Neurosonology and Cerebral Hemodynamics; has received funding for travel and speaker honoraria from Pfizer-Inc, Sanofi-Aventis, Laboratori-Guidotti S.P.A. and Novartis; serves as an Associate Editor for BMC Neurology. Dr. M. Atzori reports no conflict of interests. Prof. P. Gallo serves on scientific advisory boards for and has received funding for travel or speaker honoraria from Biogen-Idec, Merck-Serono, Bayer-Schering-Pharma, Sanofi-Aventis, and Novartis; and receives research support fromBiogen-Idec, Merck-Serono, Bayer-Schering-Pharma, Sanofi-Aventis, Novartis and the Italian Ministry of Public Health.

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  1. Department of Neuroscience-SSPNRR, Stroke Unit, First Neurology Clinic, University of Padova, via Giustiniani, 5, 35128, Padua, Italy

    Claudio Baracchini

  2. Department of Neuroscience-SSPNRR, Multiple Sclerosis Centre of the Veneto Region, First Neurology Clinic, University of Padova, via Giustiniani, 5, 35128, Padua, Italy

    Matteo Atzori & Paolo Gallo

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Baracchini, C., Atzori, M. & Gallo, P. CCSVI and MS: no meaning, no fact. Neurol Sci 34, 269–279 (2013). https://doi.org/10.1007/s10072-012-1101-2

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