Vital News

When it came to Percutaneous venoplasty for chronic cerebrospinal venous insufficiency (CCSVI) in Multiple Sclerosis, the information was presented by Dr Monica Leighton (GP) and Dr John Rose (IR). She described MS as a neurological disease but made no reference to Charcot (1870) who described the condition as vascular. It quickly became clear that CCSVI was a new concept for these two professionals and although they had done some homework it was apparent that they were not familiar with the issues and were having trouble drawing any conclusions about treatment. John Rose admitted that routine venoplasty itself was commonplace and that the risk attached to it were acceptable at 1% or 2%. Regarding CCSVI intervention Monica Leighton remarked on the two negative events that happened early on in the history of the treatment carried out by Dr Dake at Stanford USA, but no mention was made of this as a percentage of procedures carried out to put these negative events into perspective revealing that venoplasty carried out on MS patients has been shown to be 100 times safer than the acceptable risk Dr Rose mentions above. Dr Leighton said there was "a patient reporting bias... I think there is the possibility of interventions not working not being reported". They did mention that the negative side effects of the 300 treatments carried out in this country were minimal.

Dr John Rose, (obviously unaware of Zambonis paper http://www.biomedcentral.com/content/pdf/1741-7015-9-22.pdf) said that he had never found evidence of a change in pressure due to constrictions in the veins of patients with stenosis. The person representing patients with disabilities, Ms Sue Bennett, a wheelchair user herself, said that she was concerned that no harm should be caused to MS patients by this procedure.

Professor Campbell remarked that very little response to the survey had been received from patients who had undergone the intervention in this country. In fact he had only received two replies that very morning and we felt rather disappointed about that as it appeared as if there was not much enthusiasm for this treatment (we later found out that the survey had not been received in time for responses to be heard at the meeting). We thought that the committee was rather short on evidence and it was a shame that the surgeon carrying out the interventions in Scotland was not present. In his report he thought that it was too early for Randomised Controlled Trials and it would have been interesting to hear why he thought that. In earlier discussions on another topic the committee was quite ready to accept the possibility of an intervention that had limited benefits for a patient, however in our case no view was expressed on this aspect of CCSVI treatment.

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