Chronic cerebrospinal venous insufficiency and multiple sclerosis

A comprehensive meta-analysis of case-control studies

Georgios Tsivgoulis, Theodoros N. Sergentanis, Theodora Psaltopoulou, Andrew Chan, Ralf Gold, Christos Krogias, Konstantinos Voumvourakis, Nikos Triantafyllou

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

Chronic cerebrospinal venous insufficiency (CCSVI) has recently been implicated in the pathogenesis of multiple sclerosis (MS). This comprehensive meta-analysis of case–control studies investigates the association of CCSVI with MS. Methods: Through Medline, EMBASE and Cochrane database searches, case–control ultrasound studies comparing CCSVI frequency among patients with MS and healthy controls were identified. Results: We identified 19 eligible studies including 1250 patients with MS and 899 healthy controls. The pooled analysis showed that CCSVI was associated with MS [odds ratio (OR) 8.35; 95% confidence interval (CI) 3.44–20.31; p < 0.001) with considerable heterogeneity across studies (I2 = 80.1%). This association was substantially attenuated in sensitivity analyses excluding studies that were carried out by the group that originally described CCSVI, included investigators who had also been involved in publications advocating endovascular procedures for CCSVI treatment, or were conducted in Italy. Our most conservative sensitivity analysis combining different exclusion criteria yielded no association of CCSVI with MS (OR 1.35; 95% CI 0.62–2.93; p = 0.453) without any heterogeneity (I2 = 0%). There is considerable heterogeneity across different case–control studies evaluating the association of CCSVI and MS. The greatest factor contributing to this heterogeneity appears to be the involvement of investigators in other publications supporting endovascular procedures as a novel MS treatment.

Original languageEnglish (US)
Pages (from-to)114-136
Number of pages23
JournalTherapeutic Advances in Neurological Disorders
Volume7
Issue number2
DOIs
StatePublished - Jan 1 2014

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Venous Insufficiency
Multiple Sclerosis
Meta-Analysis
Case-Control Studies
Endovascular Procedures
Odds Ratio
Research Personnel
Confidence Intervals
Italy
Publications
Databases
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Neurology
  • Clinical Neurology

Cite this

Chronic cerebrospinal venous insufficiency and multiple sclerosis : A comprehensive meta-analysis of case-control studies. / Tsivgoulis, Georgios; Sergentanis, Theodoros N.; Psaltopoulou, Theodora; Chan, Andrew; Gold, Ralf; Krogias, Christos; Voumvourakis, Konstantinos; Triantafyllou, Nikos.

In: Therapeutic Advances in Neurological Disorders, Vol. 7, No. 2, 01.01.2014, p. 114-136.

Research output: Contribution to journalReview article

Tsivgoulis, Georgios ; Sergentanis, Theodoros N. ; Psaltopoulou, Theodora ; Chan, Andrew ; Gold, Ralf ; Krogias, Christos ; Voumvourakis, Konstantinos ; Triantafyllou, Nikos. / Chronic cerebrospinal venous insufficiency and multiple sclerosis : A comprehensive meta-analysis of case-control studies. In: Therapeutic Advances in Neurological Disorders. 2014 ; Vol. 7, No. 2. pp. 114-136.
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abstract = "Chronic cerebrospinal venous insufficiency (CCSVI) has recently been implicated in the pathogenesis of multiple sclerosis (MS). This comprehensive meta-analysis of case–control studies investigates the association of CCSVI with MS. Methods: Through Medline, EMBASE and Cochrane database searches, case–control ultrasound studies comparing CCSVI frequency among patients with MS and healthy controls were identified. Results: We identified 19 eligible studies including 1250 patients with MS and 899 healthy controls. The pooled analysis showed that CCSVI was associated with MS [odds ratio (OR) 8.35; 95{\%} confidence interval (CI) 3.44–20.31; p < 0.001) with considerable heterogeneity across studies (I2 = 80.1{\%}). This association was substantially attenuated in sensitivity analyses excluding studies that were carried out by the group that originally described CCSVI, included investigators who had also been involved in publications advocating endovascular procedures for CCSVI treatment, or were conducted in Italy. Our most conservative sensitivity analysis combining different exclusion criteria yielded no association of CCSVI with MS (OR 1.35; 95{\%} CI 0.62–2.93; p = 0.453) without any heterogeneity (I2 = 0{\%}). There is considerable heterogeneity across different case–control studies evaluating the association of CCSVI and MS. The greatest factor contributing to this heterogeneity appears to be the involvement of investigators in other publications supporting endovascular procedures as a novel MS treatment.",
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