Critical Point of View in Annals of Neurology

A critical article has appeared and another one will be published in the next issue.

  • Experimental multiple sclerosis vascular shunting procedure halted at Stanford. [ana10a]
  • Point of View: Chronic cerebrospinal venous insufficiency and multiple sclerosis. [khan10a]
    • Reply of Ashton Embry: An Open Letter to the Authors of Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis (Khan et al, 2010, Annals of Neurology). PDF

Abstract of Point of View: Chronic cerebrospinal venous insufficiency and multiple sclerosis.

A chronic state of impaired venous drainage from the central nervous system, termed as chronic cerebrospinal venous insufficiency (CCSVI), is claimed to be a pathologic phenomenon exclusively seen in multiple sclerosis (MS). This has invigorated the causal debate of MS and generated immense interest in the patient and scientific communities. A potential shift in the treatment paradigm of MS involving endovascular balloon angioplasty or venous stent placement has been proposed as well as conducted in small patient series. In some cases, it may have resulted in serious injury. In this Point of View, we discuss the recent investigations that led to the description of CCSVI as well as the conceptual and technical shortcomings that challenge the potential relationship of this phenomenon to MS. The need for conducting carefully designed and rigorously controlled studies to investigate CCVSI has been recognized by the scientific bodies engaged in MS research. Several scientific endeavors examining the presence of CCSVI in MS are being undertaken. At present, invasive and potentially dangerous endovascular procedures as a therapy for patients with MS should be discouraged until such studies have been completed, analyzed, and debated in the scientific arena.

Conflict of Interests in Point of View: Chronic cerebrospinal venous insufficiency and multiple sclerosis.

Dr Khan has received research support from the National MS Society (NMSS), the National Institutes of Health (NIH), Teva Neuroscience, Genzyme Corporation, Biogen Idec, Novartis Pharmaceuticals, and Acorda Therapeutics; consultancy and speaking honoraria from Teva Neuroscience, Biogen Idec, Novartis Pharmaceuticals, and Bayer Healthcare.

Dr. Filippi has received research support from Bayer-Schering Pharma, Biogen- Dompé AG, Genmab A/S, Merck Serono, Teva Pharmaceutical Industries Ltd., Fondazione Italiana Sclerosi Multipla (FISM), and Fondazione Mariani; consultancy and speaking honoraria from Bayer Schering Pharma, Biogen-Dompé AG, Genmab A/S, Merck Serono, Teva Pharmaceutical Industries Ltd.

Dr. Freedman has received research support from the Canadian MS Society, EMD Merck- Serono, Genzyme, and Bayer Schering Pharma; consultancy and speaking honoraria from Teva Neuroscience, Bayer Healthcare, and EMD Merck-Serono.

Dr Barkhof has received research support from the Dutch MS Research Foundation and Merck- Serono; consultancy and speaking honoraria from EMD Merck-Serono, Bayer-Schering Pharma, Biogen-Idec, UBC, Sanofi-Aventis, Novo-Nordisk.

Dr Dore-Duffy has received research support from the NMSS and the NIH.

Dr Trapp has received research support from the NIH, NMSS, Canadian MS Society, Ohio Third Frontier, Vertex, and EMD Merck-Serono; consultancy and speaking honoraria from Teva Neuroscience, Biogen Idec and Pfizer.

Dr. Bar-Or has received research support from the MS Society of Canada (MSSC) and the MSSC Research Foundation, The Canadian Institutes of Health Research, the FRSQ, Bayhill Therapeutics, Biogen Idec, Bio MS, Genentech, and Teva Neuroscience; consultancy and speaking honoraria from Biogen Idec, Eli Lilly, Genentech, MerckSerono, Novartis, Roche and Teva Neuroscience.

Dr Lisak has received research support from the NMSS, NIH, Teva Neuroscience, and Questcor; consultancyand speaking honoraria from Teva Neuroscience and Bayer Healthcare.

Drs Siegel, Lassmann, and Zak have nothing to disclose.

Reply of Ashton Embry

An Open Letter to the Authors of Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis (Khan et al, 2010, Annals of Neurology).