Clinical trial NCT01384825: Observational Study of the Prevalence of CCSVI in Multiple Sclerosis and in Other Neurodegenerative Diseases
Official title: Observational Study of the Prevalence of CCSVI in Multiple Sclerosis and in Other Neurodegenerative Diseases
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Multiple Sclerosis
Neurodegenerative Diseases
Keywords: Multiple Sclerosis
Other Neurodegenerative Diseases
Chronic CerebroSpinal Venous Insufficiency
Prevalence
Case-control
Lead sponsor: Fondazione Italiana Sclerosi Multipla
Sponsor class: OTHER
Collaborators: name: Opera CRO, a TIGERMED Group Company
First posted: 2011-06-29
Enrollment: 200
Sex: ALL
Minimum age (years): 18
Maximum age (years): 55
Standard ages: ADULT
Accepts healthy volunteers: yes
Observational model: CASE_CONTROL
Time perspective: CROSS_SECTIONAL
Sampling method: NON_PROBABILITY_SAMPLE
Study population: A total of at least 1,200 adults with MS will be included in the study, as well as 400 healthy subjects and 400 subjects with other neurodegenerative diseases.

Brief summary: The presence of abnormalities in the cerebral venous circulation, defined as Chronic Cerebrospinal Venous Insufficiency (CCSVI), has recently been reported in patients with Multiple Sclerosis (MS), in healthy subjects and in subjects with other neurological diseases. These reports have aroused much interest both in the scientific world and, above all, among the communities of patients and Associations having the aim of aiding people with MS and of promoting scientific research into this disease.

In the literature published so far there is a lack of verification in large samples of the prevalence of CCSVI in MS compared with that observed in healthy subjects and in those with other diseases of the nervous system.

This is an observational study investigating the prevalence of CCSVI in subjects with MS and comparing it with the prevalence observed in a control population consisting of Healthy Controls (HC) and in a population affected by other neurological diseases of the central nervous system of degenerative, vascular, inflammatory and autoimmune origin.

A total of at least 1,200 adults with MS will be included in the study, as well as 400 healthy subjects and 400 subjects with other neurodegenerative diseases.

Detailed description: It has been recently reported the possible presence of abnormalities in the cerebral venous circulation of people with MS, in healthy controls and in people with other neurological diseases. These reports have aroused much interest both in the scientific world and, above all, among the communities of patients and Associations having the aim of aiding people with MS and of promoting scientific research into this disease. In particular, the studies by Zamboni and colleagues (Ferrara University) and by Zivadinov and colleagues (University of Buffalo) have suggested an association between CCSVI and MS that was widely reported by the mass media world-wide.

It can be noted that in the literature published so far there is a lack of verification in large samples of the prevalence of CCSVI in MS compared with that observed in healthy subjects and in those with other diseases of the nervous system. The recent and authoritative contributions from the scientific community involved with MS stressing the need for closely controlled and suitably designed clinical studies for investigating the hypotheses suggested with regard to CCSVI (with the necessary thoroughness and with the promptness demanded by the public opinion) are therefore definitely justified.

The possibility that there may be a new pathogenic mechanism underlying the development of MS, not in line with the majority of the experimental data concerning the aetiopathogenesis of this disease, has produced a strong echo throughout the scientific community. Increasingly, in recent months, both the working groups mentioned above and new authors have developed further research studies in order to confirm and extend the results obtained and to lay scientifically sound foundations for possible therapeutic applications for this discovery.

The Fondazione Italiana Sclerosi Multipla (FISM) Onlus, in its capacity as Promoter of this study, wishes, responsibly, to produce the best possible answer for people with MS all over the world. It therefore feels that it is necessary to proceed with the utmost scientific thoroughness, initially by means of a large-scale sample study for evaluating the prevalence of venous abnormalities in MS compared with that observed in normal controls and in controls with other diseases of the nervous system. In this context, the features of this study that distinguish it from previous studies and from the current state of knowledge are the following:

1. Blind multi-Site observational study using the Echo-Color-Doppler equipment assigned to the study;
2. Size of the sample with MS, of at least 1200 study subjects;
3. Evaluation of the prevalence of CCSVI and of other malformations of the venous haemodynamics in the Clinically Isolated Syndrome (CIS), Relapsing-Remitting (RR), Primary Progressive (PP) and Secondary Progressive (SP) forms of MS, using a larger sample than those involved up to the present time.

In this observational study, the prevalence of CCSVI and of other malformations of the venous haemodynamics will be evaluated in different forms of MS and in other diseases of the nervous system. This is therefore an observational study investigating the prevalence of CCSVI in subjects with MS and comparing it with the prevalence observed in a control population consisting of healthy subjects and in a population of people with other neurological diseases of the central and peripheral nervous system of degenerative, vascular, inflammatory and autoimmune origin.

The study is a multi-Site observational study. A total of at least 1,200 adults with MS will be included in the study, as well as 400 healthy subjects and 400 subjects with other neurodegenerative diseases.

Eligibility criteria: Inclusion Criteria:

Group A (MS)

* Age: 18 to 55;
* Subjects of either sex with a diagnosis of MS according to McDonald's criteria and subsequent revisions (38, 39) and patients with CIS;
* Course of the disease: RR - SP - PP - CIS;
* Duration of the disease: from 1 month to 25 years for RR, SP and PP subjects; 5 years at most for the subjects with CIS,
* Not in a period of clinical relapsing of the disease (at least 30 days since the last clinical relapse),
* Subjects treated or not with immunomodulating and immunosuppressive drugs;
* Signature of the informed consent form.

Group B (HC)

* Age: 18 to 55;
* No significant diseases and no familiarity for MS, that is to say healthy controls (HC);
* Signature of the informed consent form. The subjects included in this group may be, for instance, non-blood relatives or spouses of the subjects with MS or with any of the other diseases being studied, or be linked to them by ties of affinity (e.g. a son-in-law with a father-in-law, a husband with his wife's brother, etc.) or accompanying persons or operators from other Sites.

Group C (OND)

* Age: 18 to 55 ;
* Subjects with other non-inflammatory neurodegenerative diseases (OND) such as, by way of example, Parkinson's disease, amyotrophic lateral sclerosis (ALS) and heredoataxia.
* Signature of the informed consent form.

Group D (ONDi)

* Age: 18 - 55
* Patients with other inflammatory neurodegenerative diseases (ONDi) such as, by way of example, optical neuromyelitis (ONM), acute disseminated encephalomyelitis (ADEM), encephalitis, neurolupus, neurological complications of systemic autoimmune diseases.
* Signature of the informed consent form.

Exclusion Criteria:

* Presence of acute or chronic diseases of an invalidating nature or that could interfere with the design and aims of the study;
* Clinically ascertained heart disease (New YOrk Heart AssoCiation (NYHA) Class ≥ I).
* Past episodes of venous thromboembolism (including both Deep Vein Thrombosis and lung embolism).
* Tumours.
* Thrombophilia as defined in the case history.
* Diabetes.
* Primitive or secondary pulmonary hypertension and related treatment.
* Concomitant systemic steroid treatment or in the last 30 days.
* Current or past cerebrovascular disease.
* Episodes of Transient Global Amnesia (TGA).
* Obvious pregnancy.
* Past diagnosis of CCSVI or earlier treatment for CCSVI.

Primary outcomes:
measure: Prevalence of CCSVI
timeFrame: The primary outcome will be assessed at enrollment (day 1). No follow-up is planned.
Secondary outcomes:
Other outcomes:
Locations:
city: Ancona
country: Italy
facility: Azienda Ospedali Riuniti - Div. di Neurologia - Centro Studi Sclerosi Multipla
city: Bari
country: Italy
facility: Università di Bari - Ospedale Consorziale Policlinico - Dip. Scienze Neurologiche e Psichiatriche
city: Bologna
country: Italy
facility: Azienda USL Città di Bologna - Distretto Santo Stefano Savena - Centro Sclerosi Multipla
city: Brescia
country: Italy
facility: Azienda Ospedaliera Spedali Civili Presidio Montichiari - Centro Studi Sclerosi Multipla
city: Cagliari
country: Italy
facility: Università degli Studi di Cagliari - Centro Sclerosi Multipla - Ospedale Binaghi
city: Catania
country: Italy
facility: Azienda Ospedaliera "Garibaldi" - U.O. Neurologia
city: Catania
country: Italy
facility: Azienda Ospedaliera Universitaria "Policlinico Vittorio Emanuele" - Istituto Scienze Neurologiche
city: Cefalù
country: Italy
facility: Istituto San Raffaele Giuseppe Giglio - Centro Sclerosi Multipla
city: Chieti
country: Italy
facility: Ospedale Universitario G. D'Annunzio - Centro Sclerosi Multipla
city: Empoli
country: Italy
facility: Azienda Ospedaliera San Giuseppe - Centro Scl. Multipla - U.O. Neurologia
city: Ferrara
country: Italy
facility: Università degli Studi di Ferrara Arcispedale Sant'Anna - Clinica Neurologica
city: Ferrara
country: Italy
facility: Università degli Studi di Ferrara Arcispedale Sant'Anna - Istituto di Clinica Neurologica
city: Firenze
country: Italy
facility: Azienda Ospedaliero Universitaria Careggi - Centro di Riferimento Regionale per la Sclerosi Multipla
city: Firenze
country: Italy
facility: Azienda Ospedaliero Universitaria Careggi - Centro Sclerosi Multipla
city: Foggia
country: Italy
facility: Azienda Ospedaliera Universitaria Ospedali Riuniti - Centro Sclerosi Multipla
city: Gallarate
country: Italy
facility: Ospedale S. Antonio Abate - Centro Studi Sclerosi Multipla
city: Genova
country: Italy
facility: Azienda Ospedaliera Universitaria San Martino
city: La Spezia
country: Italy
facility: Ospedale S. Andrea - Divisione di Neurologia
city: Merano
country: Italy
facility: Ospedale Tappeiner - Div. Neurologica
city: Messina
country: Italy
facility: IRCCS Centro Studi Neurolesi "Bonino Pulejo" di Messina
city: Messina
country: Italy
facility: Azienda Ospedaliera Universitaria "G. Martino" - Dipartimento Neuroscienze Psichiatria e Anestesiologia
city: Milano
country: Italy
facility: Università degli Studi di Milano - Dipartimento di Neurologia - Ospedale S. Raffaele - Via Olgettina , 60
city: Milano
country: Italy
facility: Fondazione Ist. Neurologico Besta - Centro Sclerosi Multipla
city: Milano
country: Italy
facility: Fondazione Don Carlo Gnocchi, IRCCS Santa Maria Nascente - Unità Operativa Sclerosi Multipla
city: Milano
country: Italy
facility: Ospedale Niguarda Cà Granda - Centro Sclerosi Multipla
city: Napoli
country: Italy
facility: Università Federico II - Clinica Neurologica II
city: Orbassano
country: Italy
facility: Azienda Ospedaliera S. Luigi - Centro Sclerosi Multipla - Divisione Universitaria di Neurologia
city: Padova
country: Italy
facility: Policlinico Az. Ospedaliera - Clinica Neurologica I
city: Palermo
country: Italy
facility: Università degli Studi di Palermo - Istituto di Neuropsichiatria - A.O.U.P. "P. Giaccone"
city: Palermo
country: Italy
facility: Azienda Ospedaliera Villa Sofia C.T.O. - Neurologia Padiglione Geriatrico
city: Pavia
country: Italy
facility: Istituto Neurologico C. Mondino - Divisione di Neurologia
city: Reggio Emilia
country: Italy
facility: Arciospedale S. Maria Nuova - Centro Studi Sclerosi Multipla
city: Roma
country: Italy
facility: Università Tor Vergata - Clinica Neurologica - Dipartimento di Neuroscienze
city: Roma
country: Italy
facility: Ospedale Sant'Andrea - Neurologia e Centro Neurologico Terapie Sperimentali
city: Sassari
country: Italy
facility: Università di Sassari - Clinica Neurologica
city: Siena
country: Italy
facility: Università degli Studi di Siena - Dip. di Neuroscienze - Sez. Neurologia
city: Siena
country: Italy
facility: Università degli Studi di Siena - Dip. di Neuroscienze - U.O. Neurologia e Malattie Neurometaboliche
city: Torino
country: Italy
facility: Azienda Ospedaliera Universitaria S. Giovanni Battista - Centro Sclerosi Multipla - Dipartimento di Neuroscienze
city: Treviso
country: Italy
facility: Azienda Ospedaliera "Ca Foncello" - Dipartimento di Neuroscienze - U.O. Neurologia
city: Trieste
country: Italy
facility: Ospedale di Cattinara - Istituto Clinica Neurologica
city: Vicenza
country: Italy
facility: Ospedale S. Bortolo - Divisione di Neurologia - Centro Sclerosi Multipla
city: Vittoria
country: Italy
facility: Azienda Sanitaria Provinciale di Ragusa Ospedale "R. Guzzardi" - U.O.C. Neurologia e Neurofisiopatologia, Stroke Unit
city: Timisoara
country: Romania
facility: Opera Contract Research Organization SRL
state: Timis
Study officials:
affiliation: Università di Genova - Dipartimento di Neuroscienze, Oftalmologia e Genetica - Via De Toni, 5 - Genova
name: Giovanni L Mancardi, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Divisione di Neurologia e Servizio di Neurofisiologia, Ospedale San Raffaele di Milano
name: Giancarlo Comi
role: PRINCIPAL_INVESTIGATOR
References: