Chronic cerebrospinal venous insufficiency,chlamydia and multiple sclerosis

Dear Editor,

I read with concern the recent article by Thibault et al. ¹ Chronic cerebrospinal venous insufficiency has conclusively been demonstrated to be a failed concept. The meta-analysis cited by the authors ² is an early publication whose findings have been conclusively refuted following more rigorous examination.^3–5 Additionally, ‘Liberation Procedures’ aiming to intervene directly with potential venous lesions have consistently been proven to have no efficacy. ⁶

Appraisal of more contemporary literature also fails to support the contention that Chlamydophila pneumoniae infection is important in the pathogenesis of multiple sclerosis (MS).^7–9 Likewise, treatment of C. pneumoniae infection in MS patients has been demonstrated to have no effect on disease progression. ¹⁰

Hence, the authors’ original hypothesis, premised on out-of-date information, is fatally flawed. Additionally, alteration of blood flow is a soft surrogate endpoint that does not warrant attention when clinically relevant endpoints such as relapse rates and disease progression have been thoroughly investigated.