Talk:Multiple sclerosis/Archive 3

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The Alternative Treatment Section

Alternative Medicine is a word often related to a lack of insufficient scientific research surrounding a given type of intervention. I think that dietary intervention doesn't belong in there. Bovine milk products for example, have a link to autoimmunity that is widely accepted and well supported. Although I doubt there have been any clinical trials specifically for the treatment of MS using bovine dairy product exclussion, it's not a far stretch to say that evidence for the treatment of MS using dietary means does exist. It's hardly alternative.

If you want any refrences or sugestions about how to change the section then I would be happy to oblige after I have finnished with my exams and have a little free time.

I am not disrespecting alternative medicine at all. I'll point out that just because a given treatment is not supported yet, does not mean it does not work.

(BlackDice572 (talk) 13:50, 11 May 2009 (UTC))

If no high quality articles specific for MS are brought up diets should remain where they are as there is no real or only minor proof of its utility. Bests. --Garrondo (talk) 15:00, 11 May 2009 (UTC)

Steffer A, Schubart A,Storch M, Amini A, Mather A, Lassmann H and Linington C. Butyrophilin, a Milk Protein, Modulates the Encephalitogenic T Cell Response to Myelin Oligodendrocyte Glycoprotein in Experimental Autoimmune Encephalomyelitis. The Journal of Immunology.(2000)165: 2859-2865

The above reference is specific to autoimmunity relating to milk protiens in an experimental condition used to mimic MS. It's unfortunately also done on mice. Not a clinic trail, but still pretty supporting.

Otaegui D, Mostafavi S, Bernard CC, Munain AL, Mousavi P, Oksenberg JR and Baranzini SE. Increased Transcriptional Activity of Milk-Related Genes following the Active Phase of Experimental Autoimmune Encephalomyelitis and Multiple Sclerosis. The Journal of Immunology.(2007)179: 4074-4082

Here's one that talks about how the genes coding for the production of hormones related to the breakdown of milk specific protiens are elevated prior to MS relapses.

Winer, S., I. Astsaturov, R. Cheung, K. K. Schrade, L. Gunaratnam, D. D. Wood, M. A. Moscarello, P. O’Connor, C. McKerlie, D. J. Becker, H. M. Dosch. 2001. T cells of multiple sclerosis patients target a common environmental peptide that causes encephalitis in mice. J. Immunol. 166:4751

This study found raised antibodies in the blood against particular protiens in milk in mice given MS.

(BlackDice572 (talk) 14:53, 12 May 2009 (UTC)).

Pretty supporting is not enough for inclusion per WP:MEDRS. Until there is actual proof of its utility in humans it should not be included. At most some small comment could be included in one of the secondary articles such as Pathophysiology of multiple sclerosis or therapies under investigation for multiple sclerosis. Best regards.--Garrondo (talk) 15:06, 12 May 2009 (UTC)

Okay, fair enough. I do understand. Thanks. (BlackDice572 (talk) 15:12, 12 May 2009 (UTC))

Figures in need for improvement

The figures (especially the epidemiology world map) are too low in resolution and thus far unreadable.

129.13.72.198 (talk) 09:48, 23 January 2009 (UTC)

The figure titled "myelin sheat of a healthy neuron" is one of a peripheral nervous system neuron, with schwann cell myelin. MS does not tend to affect these neurons. The affected myelin in MS, as explained clearly in the text, is oligodendrocytes of the central nervous system neurons. A figure of a central nervous system healthy neuron would therefore be more appropriate --Jarse101 (talk) 21:49, 12 February 2009 (UTC)

Scanning Speech

I know speech problems are mentioned in this article, but nothing related to scanning speech is mentioned.

From FreeOnlineDictionary: Speech characterized by sliding and stretching of words, and slurring of phonation, which is associated with cerebellar defects, often accompanied by inappropriate rate, range, force, and direction of voluntary movements. 74.176.63.102 (talk) 16:13, 1 February 2009 (UTC)

(Neurology registrar) This is because scanning speech is not specific to multiple sclerosis and is a feature of all diseases which produce a pseudobulbar palsy and cerebellar dysfunction. I would not be inclined to include it. —Preceding unsigned comment added by 79.74.145.120 (talk) 20:11, 31 March 2009 (UTC)

MS and Vitamin D

My comments about Vitamin D and MS were taken out with no discussion. I am deeply offended at what I consider capricious editing. I took the information from the lay press. The criticism from the "editor" was that it should be from a peer reviewed journal. Disagree. This is an important development in MS that has reached the general public and should be included. I ask that we do a vote within this discussion section. Thanx, Mwinog2777 (talk) 06:08, 10 February 2009 (UTC)

Could I suggest that you assume good faith rather than going around screaming that you are offended? If you'd paid attention to the edit summary, you would have noticed that the editor who removed the content did not rule out that it should be included. Rather, you have been asked to provide a source that is consistent with the article's other medically reliable sources. ScienceDaily may be fun, but I would not want to use it as a source given the inevitable distortions that occur when journalists try to turn scientific work into news.

Wikipedia doesn't do voting. How about you find out the source of that study, and we can discuss its merits. And yes, do review WP:MEDRS. It will help you understand. JFW | T@lk 20:45, 10 February 2009 (UTC)

CCSVI/MS hypthesis

Recently, a new study was published that strongly associates MS to CCSVI. I cite "MS and venous outflow anomalies were dramatically associated" and "venography demonstrated in MS, and not in controls, the presence of multiple severe extracranial stenosis, affecting the principal cerebrospinal venous segments". The idea is the same as Chronic venous insufficiency for legs. References: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2647682 & http://www.fondazionehilarescere.org/

It think it's worth to add this hypothesis for MS to Wikipedia. As I have no experience writing articles I want to discuss before I change something.

a) Where should I put the information? I could not find an obvious place. Candidates are:

1. Multiple_sclerosis#Causes
2. Multiple_sclerosis#Research_directions
3. Therapies_under_investigation_for_multiple_sclerosis#Other_investigations_on_possible_treatments
4. Multiple_sclerosis#Pathophysiology
5. Pathophysiology_of_multiple_sclerosis
6. add a section Hypothesis to the MS main page where all the hypothesis can be added as in the German Wikipedia MS article

I propose 5.

b) Should I add the link to the foundation? I propose yes, as this site is the central place for further scientific research.

I propose to add the following section to Pathophysiology_of_multiple_sclerosis after section 6 Blood and CSF abnormalities.

There is already a link there to an article by Dr. Zamboni, pointing to CVI. It is inside Pathophysiology of multiple sclerosis#Vascular problems and Blood-brain barrier disruption

--Juansempere (talk) 08:05, 23 September 2009 (UTC)

Hypothesis of venous reflux into skull or spine

The venous reflux hypothesis, that was published in the eighties of the last century, where a venous reflux into skull or spine could cause MS, seems to be very promising. Latest studies seem to show, that a Chronic cerebrospinal venous insufficiency (CCSVI) could be the cause of a "venous MS": Since MS lesions occur in favour aorund brain veins, then it could be, that in these veins a back pressure occurs if the drain to the heart is hindered. Then, MS could be seen as a "varicose veins disease of the brain".

Capra Ibex Ibex (talk) 18:51, 18 July 2009 (UTC)

This sounds like a very preliminary theory. The abstract suggests that this has not previously been studied, and this should be regarded as a hypothesis-generating kind of study. It is clearly important enough to appear in JNNP, but I suggest this is not discussed in the Wikipedia article until this study has been replicated and has been cited in secondary sources. Please have a look at WP:MEDRS, our medical sources guideline. By extension, I don't think we need a link to the website of the foundation. JFW | T@lk 14:05, 19 July 2009 (UTC)

Also, please realise that you cannot adduce proof from the German page if it was you who added the content in question to begin with.[1] I trust your message here will meet with the same response as you received there by Christian2003. JFW | T@lk 14:07, 19 July 2009 (UTC)

I removed my user talk and updated this discussion with the missing information. To the German page: I've done the work in parallel. This is my fault. Currently, I'm discussing in the German Wikipedia with the "medical team" about this topic. I'll await the results there et let you know. BTW, I've already learned a lot how Wikipedia works. Thanks for your advices, --Capra Ibex Ibex (talk) 19:55, 19 July 2009 (UTC)

Chronic cerebrospinal venous insufficiency

I am not very sure that this has enough scientific support among the scientific community as to be included at the same level as the other hypothesis. Although it seems promising the reference used is a primary one, and I have not found any secondary sources on the subject (Which does not mean that they do not exist). Additionally the source main conclussion is "CDMS is strongly associated with CCSVI, a scenario that has not previously been described". Therefore it indicates that this a very new theory, specially since it is a 2009 article. To give it a causative role seems too preliminary until more evidence is found and the theory reviewed by other scientific groups. I believe that per WP:MEDRS and WP:CBALL no matter how promising the finding looks it has no place yet in the MS main article.

I have discussed the matter briefly in Juansempere talk page (person who has added it) in Spanish (is for both of us our mother language); but we have finally decided to discuss it here in English so other people can state their opinion. The question is if it should be kept in the main article or in a secondary one.--Garrondo (talk) 13:17, 9 October 2009 (UTC)

I had not seen it had already been discussed. That is the reason why I have moved my comment here. It seems that at least other editor finds it premature to add it to the article.--Garrondo (talk) 13:30, 9 October 2009 (UTC)

Well, I can only repeat the same argument that I have exposed to Garrondo previously. Maybe it is true that evidence linking CCSVI with MS is weak, but the section in which I have made the addition contains only hypothesis, most of them with less evidence than the new one. And I think that to apply a consistent level to all the hypothesis here presented would force us to remove most of them if CCSVI link is removed.--Juansempere (talk) 23:30, 9 October 2009 (UTC)

The link between MS and venous malfunctions is not new: www.ms-mri.com gives a brief summary and lists two references to publications from 1964 and 1986. The new thing is the localization and the description of these venous malfunctions as CCSVI. I agree with Juansempere that all actively researched hypothesis should be treated the same way. -- Capra Ibex Ibex (talk) 17:58, 11 October 2009 (UTC)

We are not the ones to judge the strength of an hypothesis but how much attention they have received. Chronic cerebrospinal venous insufficiency is (at least for the moment) very minoritatian view. Unless better references are provided (peer-reviewed secondary sources) we will have to wait until more research is done in this subject per WP:MEDRS.

If we judge only the attention that a hypothesis has received, the venous malfunction still wins. It has been investigated at least since 1986, as Capra Ibex Ibex says, and has been moved to a second place only in recent years, after detailed studies could not shown any problem in venous blood flow. And this lack of problems cannot be hold anymore.--Juansempere (talk) 14:40, 14 October 2009 (UTC)

It is true that the given reference is a primary source. Some other items in this article also give primary sources. Nevertheless in this case there is support from secondary sources, like [2].--Juansempere (talk) 16:16, 14 October 2009 (UTC)

I still do not completely agree with it receiving more attention than other theories (the others have mentions in almost any neurology textbook, while the latter I had never heard about it) but that reference is a good start for me. Let's add the ref to the article. Howevever I think that the sentence in the article has to be reworded to match this source. Additionally I might say that it is a "recent hypothesis". Bests.--Garrondo (talk) 07:43, 15 October 2009 (UTC)

OK. fair enough. Could you make the rewording? --Juansempere (talk) 21:58, 15 October 2009 (UTC)

I don't think I'll have time. Too many things to do outside wikipedia... and additionally you are more used to pathophisiology articles than me. If I have time I'll give it a try, but I can not promise anything.--Garrondo (talk) 07:28, 16 October 2009 (UTC)

How about: 'A preliminary hypothesis based in recent findings proposes that MS could be a hemodynamic disorder.'?--Garrondo (talk) 11:54, 16 October 2009 (UTC)

For me it is OK. Would you agree with something longer like:

"For a long time it is known that MS patients show several hemodynamic abnormalities. A preliminary hypothesis based in recent findings proposes that these hemodynamic disorders could be the cause for MS.--Juansempere (talk) 05:59, 17 October 2009 (UTC)

Other possibility would be to consider a previous article like [3] as the primary research, and then the given reference would turn into a secondary research, as an experimental way of confirming the hypothesis--Juansempere (talk) 05:48, 17 October 2009 (UTC)

I quite like your proposal above, although I would eliminate the begining: It is known that MS patients show several hemodynamic abnormalities. A preliminary hypothesis based in recent findings proposes that these hemodynamic disorders could be the cause for MS. If nobody disagrees I would add it today.--Garrondo (talk) 08:46, 19 October 2009 (UTC)

OK--Juansempere (talk) 09:08, 19 October 2009 (UTC)

i think that everyone should take a step back from the current anointing of CCSVI as the one and only cause of MS and ask whether it might not be equally possible that it is a result of MS, just as the plaques are a result of the disease activity. for all you know you could be putting the cart before the horse, which is often the case in medicine.76.71.93.151 (talk) 23:47, 21 November 2009 (UTC)

Garrondo, I would say, for better English, "based ON" rather than "based IN" and I will make this change in the article. 217.166.94.1 (talk) 08:57, 26 November 2009 (UTC)

Go ahead with any changes as that one: me and other editors do not have English as our mother language so we usually make those kinds of mistakes. Improving the language is only a minor edition and we are really happy that you do it: you do not need to comment it in the discussion page. Bests.--Garrondo (talk) 15:21, 26 November 2009 (UTC)

Are we sure that MS is autoimmune?

This article states in the first paragraph (with no reference given): "Multiple sclerosis (...) is an autoimmune disease in which the body's immune response attacks a person's central nervous system"

No proof has ever been given of that. I propose to change for "MS is an idiopathic disease, possibly autoimmune or immune-mediated, showing a clear involvement of the immune system," --Juansempere (talk) 08:26, 26 September 2009 (UTC)

Finally I made the change. Now it says "MS is an idiopathic disease, suspected autoimmune--Juansempere (talk) 07:39, 5 October 2009 (UTC)".

And i have changed it to eliminate both words which cause so much grief to so many people. this despite the fact that the autoimmune response is well known and much studied and - until such time as the MS societies and associations world-wide change their own wording - should remain front and centre. every few years a new theory is raised about something and, like sheep, everyone flocks to it. —Preceding unsigned comment added by 76.71.93.151 (talk) 23:09, 21 November 2009 (UTC)

MS is not an autoimmune disease

I am almost sure that MS is not an autoimmune disease. With non conventional NMR changes can be detected on the place of future visuable lesion on conventional NMR lesion quite a time before the blood brain barrier is disrupted. It is quite a pity that I do'nt remember where I read it but it was undoubtely in an scientifical article.

Moreover, this point of view is described extensivily based on other arguments bij Behan, Chaudhuri and Roep (The pathogenesis of multiple sclerosis revisited, 2002). A citation: 'The cause of MS is unknown, as is the exact pathogenesis of the disorder. This point must be stressed since as there is a common recurring statement in virtually every paper and textbook that MS is of autoimmune aetiology.' Another citation: 'Multiple sclerosis remains a disease of unknown aetiology. In recent years most authors have uncritically accepted the hypothesis that it is an autimmune disorder'.

It seems to me that the autoimmune system gets involved after damage has occurred to the nervous system. It seems to me not to be the cause but a 'late' consequence.

Michel soete (talk) 18:06, 2 October 2009 (UTC)

Probably you mean this article [4]. I agree with you that MS doesn't look like autoimmune (and this word is not very well defined), but majority of neurologist agree in that. And we should show here their oppinion, not ours. Until more evidence appears against this trend, I think we should leave in the article that autoimmunity is at least suspected.--Juansempere (talk) 01:00, 4 October 2009 (UTC)

This theory has received immediate criticism[5] and seems to have only a few followers: Behan and Chaudhuri. These papers are not really suitable for citing unless there are further sources that cite them as a bona fide dissenting theory. JFW | T@lk 14:19, 9 October 2009 (UTC)

Prognosis

Hang on a minute...

"Although most patients lose the ability to walk prior to death, 90% are still capable of independent walking at 10 years from onset, and 75% at 15 years."

That doesn't make any sense does it?

82.19.121.79 (talk) 19:08, 28 October 2009 (UTC)

It is probably the other way round. I'll check the reference. Thanks.--Garrondo (talk) 09:29, 16 November 2009 (UTC)

On second reading: it makes perfect sense. Where do you find the problem? --Garrondo (talk) 09:45, 16 November 2009 (UTC)

Map

World map showing that risk (incidence) for MS increases with distance from the equator

I have removed this map as we definitely need something better. Problems include:

• no reference to data it is based up
• no year that data was collected
• colors do not flow from high to low in any meaningful way ( the blue and ref makes it look like rates are low in the former USSR and high in the USA )
• does not add anything to the DALYs map if not improved substantially
• does not define what is high prevalence and what is low prevalence

Doc James (talk · contribs · email) 16:03, 16 November 2009 (UTC)

Sounds reasonable. Maybe we should add a line on Dalys in the text. Right now we have an image that goes completely independently of text. --Garrondo (talk) 08:31, 17 November 2009 (UTC)

If someone has a data set can make a new map.Doc James (talk · contribs · email) 17:17, 17 November 2009 (UTC)

Why removed? Why not replaced with a better map? Sergei Gutnikov (talk) 15:22, 18 November 2009 (UTC)

I was asking if anyone had a data set? The current one is not of sufficient quality to go on the page.Doc James (talk · contribs · email) 07:05, 19 November 2009 (UTC)

Found it. This site give use prevalence and incidence data from 2008 will see about getting it turned into a map. [6]Doc James (talk · contribs · email) 07:15, 19 November 2009 (UTC)

There is a map already MS map 2007. The picture is not much better than the one we had. Russia is still three times lower than the US. And areas are painted without correction for population density. As a result the latitude gradient is even less obvious than on the map we had previously. Sergei Gutnikov (talk) 16:20, 19 November 2009 (UTC)

The new map is actually a lot better. First of all it gives the year of the data set and states a data set. Second much more of the info is evidence based rather than presumed. Finally the colors flow but not a good a they should. I will try to get a new one make that is better than the one above using the full gradient we see in the DALY map.Doc James (talk · contribs · email) 21:21, 19 November 2009 (UTC)

(undent) On further though the DALYs map is age adjusted. I am not sure the other prevalence data is. Do we really need another map on to of the DALYs one?Doc James (talk · contribs · email) 13:36, 20 November 2009 (UTC)

I would say that DALYs and prevalence (which is surely not age adjusted) are very different concepts and that there is no problem having both of them, nevertheless the article is quite well on images so not having it would neither be a problem. Bests.--Garrondo (talk) 15:04, 20 November 2009 (UTC)

The DALYs looks very much like the prevalence map but has more extensive data and a good ref for it. Will not bother creating a prevalence map maybe we can just comment on the data in the text.Doc James (talk · contribs · email) 15:14, 20 November 2009 (UTC)

External Links

How about adding the MS Society to the external links section? --Allie cabab (talk) 10:33, 20 November 2009 (UTC)

Each country has its own national MS organization (Some countries even more than one), and there is no reason to name one but not others in the main article so it was decided to move all of them to a secondary article: See List of multiple sclerosis organizations. The one you mention is already included in the United kingdom section. Bests.--Garrondo (talk) 10:51, 20 November 2009 (UTC)

Marijuana

Something should be said here about how marijuana cures MS

http://video.google.com/videoplay?docid=-9077214414651731007#

24.205.37.167 (talk)

Start by providing a reliable source, preferably a WP:MEDRS. JFW | T@lk 14:09, 22 November 2009 (UTC)

Hype

Long-held beliefs and theories in medicine are not displaced by a single theory by a single person. Zamboni's research has now been added to this article by a number of people using a number of sources. Nobody has been able to explain why CCVI should directly lead to demyelination, nor why immune-based therapies such as interferon and glatiramer are effective in preventing relapses of MS. Can we please agree that unless this finding is confirmed in larger studies and cited in reviews, we should be very cautious in generalising the Zamboni results? JFW | T@lk 20:59, 22 November 2009 (UTC)

EXACTLY. the zeal with which people are jumping onto this "explanation" is similar to the zeal with which people have, over decades, jumped onto the most recent "explanations" of what causes ME/CFS, various cancers and other chronic diseases. the entire basis of measured medical research and publication and reproducible results exists to weed out false positives and false hopes, eventually to reach the truth.76.71.93.151 (talk) 22:08, 22 November 2009 (UTC)

The theory has in fact been around since 1986, when Schelling published about it. Guess where? In Med Hypoth - PMID 3641027. For one thing, why does venous outflow obstruction not lead to intracranial hypertension? JFW | T@lk 21:20, 24 November 2009 (UTC)

I think you'll find PMID 19534716 addresses that question.LeadSongDog come howl 02:32, 25 November 2009 (UTC)

More from the same group, in other words. JFW | T@lk 20:22, 25 November 2009 (UTC)

Sure it's the same group. You asked a direct question. They had already answered it, and I provided a link to that paper.

Of course the article should wait for a review paper per WP:MEDRS. Exceptional claims and all that. But that is not a reason to dismiss the work, merely to be cautious and to defer edits until more conclusive papers are published.

Previous MEDRS papers relating to the theme by other authors include Andeweg's review PMID 8912316 from October 1996 and Simka's review PMID 19442163 from May 2009. Zamboni's own review in J R Soc Med of November 2006 PMID 17082306 (free full text on PMC) provides additional background, particularly on the discussion of trace elements.

The MS Society of Canada has announced they'll be funding additional investigations. No doubt other funders will as well. Certainly larger non-intervention studies (imaging only) should be able to rapidly confirm or refute the claims of a strong correlation between MS and "CCSVI" in short order. LeadSongDog come howl 22:28, 25 November 2009 (UTC)

Good. We can expand the article when the evidence becomes clearer. JFW | T@lk 12:26, 29 November 2009 (UTC)

Trial

I have eliminated the following sentence: "A clinical trial is being planned for testing this hypothesis." since the source does not talk about a clinical trial but simply about replicating the finding that MS patients have a venous insufficiency.

It was me. I forgot to sign: --Garrondo (talk) 10:26, 29 November 2009 (UTC)

I'm not sure who this is since it's unsigned; I removed my sentence from before as it was a little too strident and premature; there are NO clinical trials to test the treatment of liberation; all that's out there right now is the initial publishing paper from Italy and the upcoming imaging trial in Buffalo: http://www.bnac.net/?page_id=517 and that's all - many MS societies worldwide (I've found UK, Canada) are willing to fund it and after contacting them they're seriously seeking proposals. But as of 28 NOV 09, there's no clinical trials. Sorry! My bad.--Cpt ricard (talk) 04:24, 29 November 2009 (UTC)

Not as part of the article, obviously, but an interesting turn of events: it seems that patients with MS are getting the echo done to find the stenosis themselves and getting it treated as a stenotic problem, and then seeing their MS symptoms regress. This is, of course, nothing official, but I found it interesting enough to share here with everyone. How long until clinics open in Mexico and India to do this treatment? --Cpt ricard (talk) 04:53, 29 November 2009 (UTC)

This is absolutely premature... and for common sense it should be a very good idea that they waited to know if it really has any effects. I believe that by WP policies (SEE:WP:MEDMOS) in external links which specifically say that Links to personal experiences or survivor stories are forbidden the link should be deleted even from the talk page since it is not directed to improving the article... Talk pages are to talk about how to improve the article, not to create a forum on multiple sclerosis... Bests.--Garrondo (talk) 10:26, 29 November 2009 (UTC)

I do not usually modify other people's comments, but this time I have made an exception.--Garrondo (talk) 10:26, 29 November 2009 (UTC)

Was completely unaware of that, and many thanks to Garrondo and others for putting up with my learning curve on this one. And of course, I meant to show the situation in terms of how reckless people can be. Incredible. --Cpt ricard (talk) 00:21, 30 November 2009 (UTC)

Precisely. JFW | T@lk 12:26, 29 November 2009 (UTC)

There's a discussion over at Talk:Chronic cerebrospinal venous insufficiency#Comment which might interest editors of this page. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:20, 30 November 2009 (UTC)

One more study in Hamilton, Canada: http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20091120/W5_liberation_091121/20091121?s_name=W5 by Dr. Mark Haake, found halfway down that page. Didn't find anything official though other than that quote. Can't wait to see the results, either way. --Cpt ricard (talk) 18:29, 30 November 2009 (UTC)

Changed "Other causes" by a specific name?

Somebody has changed the previous "Causes/Other causes" by the specific name of CCSVI. The argument is "Let's not pretend that is something different". I do not think anybody is pretending that. When I tried to add the new research I just found that CCSVI didn't fix in any of the sections and I did this one.

I think it should stay the previous way, specially because at this moment CCSVI as MS cause is just an hypothesis, and the article's structure should remain flexible enough to accomodate any possible new research in other directions. --Juansempere (talk) 11:38, 4 December 2009 (UTC)

Review and rewrite needed

This article is generally in good shape, although I left some sample edits of issues that should be addressed. More importantly, a review of the use of primary sources (per WP:MEDRS) is urgently needed. The size of the reference list indicates that the article is not sourced primarily to reviews, and this article has tended to take on whatever anyone wants to add, based on primary sources. The article should be rewritten to be sourced mainly to recent secondary reviews. Several of the reviews used are quite old: is nothing newer available? See Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches and WP:MEDRS. Unless this work is done, the article should go to WP:FAR for review. SandyGeorgia (Talk) 15:49, 6 December 2009 (UTC)

A year ago I did an important review of the article, and took a look at the references used; improving most of them. I will try to look again at it. However it would be useful if you posted here the kind of stilistic edits that should be done, since it is far easier to see if they have been addressed. Thanks for the review anyway.--Garrondo (talk) 20:24, 6 December 2009 (UTC)

Yes, I remember that from a year or so ago. I am still watching and will help again. Taking a look at it for MOS issues now. Maralia (talk) 21:00, 6 December 2009 (UTC)

The article is in good shape, but there are unformatted citations, examples:

• ^ search of clinicaltrials.gov data-base for Low dose naltrexone Multiple Sclerosis
• ^ 2007 clinical trial using LDN

and it still uses primary sources in many cases, including drug inserts. See WP:MEDRS; also, are there no recent reviews that could be used to update the article? SandyGeorgia (Talk) 13:00, 7 December 2009 (UTC)

I am going to use PMID 18970977; a 2008 lancet review to review and ref as many facts of the article as possible. Bests.--Garrondo (talk) 14:59, 7 December 2009 (UTC)

Excellent! I'll unwatch then; with Maralia on board, ce needs will be met. SandyGeorgia (Talk) 15:00, 7 December 2009 (UTC)

Epidemiology section before causes

In MS epidemiological studies have been crucial for causal hipothesis and still are. To understand the causes section it is necessary to read first the epidimiology section. As done in most reliable sources I have moved to before the causal section the epidemiology section. I know it breaks the proposed order by MEDMOS but I think is a more reasonable ordering and in accordance to reliable sources.--Garrondo (talk) 08:23, 15 December 2009 (UTC)

I would disagree. I do not see extensive justification for moving the section. Doc James (talk · contribs · email) 08:31, 15 December 2009 (UTC)

For the moment PMID 18970977; which is our most reliable and recent review, but I can find many more reliable sources that use that order. Additionally the historical approach in MS has been that way (epidemiology to causes), and I think that causative theories are easier to understand after you read epidemiology. The opposite (as it stands now) makes an obligation to duplicate a lot of content in both sections. On the other hand you have not given any reasons on why you do not find it reasonable; you have simply reverted.--Garrondo (talk) 08:41, 15 December 2009 (UTC)

Many conditions are presented in the medical literature with epidemiology first. We are not however writing a review article but an encyclopedia and IMO consistency between articles pertaining to diseases is more important. As this is a featured article would wait to get consensus before reorganizing based on another format. Regardless of the order these two topics are presented content will need to be duplicated in both spots. This will just need to be done with different emphasis. So to summarize my reason is you have not provided sufficient justification for not following WP:MEDMOS BWT uptodate has all there pages presented with epidemiology after the introduction. It does put the disease into context. Making a change like this would be a huge undertaking and would need to be discussed extensively. Doc James (talk · contribs · email) 08:54, 15 December 2009 (UTC)

Interesting cultural piece in the medical post on new research

Interesting piece looking at the theory of venous flow in three parts [[7]] Puts it in a better perspective.Doc James (talk · contribs · email) 22:44, 16 December 2009 (UTC) Since I guess most people will not have access here is an abstract

Announcing that CCSVI is the cause of MS is a jump, said Dr. Pierre Duquette, neurologist and director of the MS Clinic at Notre Dame Hospital in Montreal. It is hypothetical to suggest that, due to an obstruction in the flow of blood, iron could seep out of the veins and induce an inflammatory reaction within the surrounding tissue. “Why do the veins get constricted in the first place? In their research papers, they speculate that this is congenital although they have absolutely no proof. So that’s purely hypothetical.”

Doc James (talk · contribs · email) 22:55, 16 December 2009 (UTC)

Unfortunately that article is behind a rather ugly paywall. I believe the same points are covered off accessibly in a balanced article at Burk J, Courtney SW (11 December 2009). "Chronic Cerebrospinal Venous Insufficiency (CCSVI) and Multiple Sclerosis (MS)". Multiple Sclerosis Society of America.. Usable? LeadSongDog come howl 19:13, 21 December 2009 (UTC)

Elimination of media comments on CCSVI

I have eliminated media comments recently added: On the first hand media are by definition optimistical, since the only way of selling news is saying that a cure is close. Saying that there are only small advances does not give share or sell newspaper. On the other hand, media are not reliable sources to comment on medical research: whether they are more positive or not is irrelevant, since they are no experts in the subject. Finally since this is general article on the disease, giving more lines than one to this theory, since it is only based up to this moment in primary research, is giving undue weight, specially if those lines are simply based on media reports. Bests.--Garrondo (talk) 08:30, 17 December 2009 (UTC)

I do agree this does not really belong in the causes section. Maybe under research. The fact the it was published first by a tv documentary and than latter in a journal is telling. Anyway have removed it and discussion should take place before it is readded. Doc James (talk · contribs · email) 14:49, 17 December 2009 (UTC)

Chronic cerebrospinal venous insufficiency 2

Preliminary research conducted in 2009 suggests that MS may be associated with chronic cerebrospinal venous insufficiency. A Canadian television documentary and national newspaper article published on Nov. 21 of 2009 were much more optimistic about the possible link than many researchers. The article upon which the news was based was not published until Dec. 2, 2009.

Doc James (talk · contribs · email) 17:27, 17 December 2009 (UTC)

As this is research is not yet clinically significant enough it does not count as a cause. Maybe under research but the fact that it was a bit of a media stunt needs to be pointed out.Doc James (talk · contribs · email) 21:29, 18 December 2009 (UTC)

Your removal was VERY biased. Specially speaking about a disease of which nobody knows the cause, in a section that gives an overview of current hypothesis. You have removed one of the items that is currently under trial, while leaving intact others with similar or lower levels of support. I really think that is only because you don't like it for some reason. If I am wrong, now please remove the following entries, which have similar level of evidence:

• MS is not considered a hereditary disease. However, a number of genetic variations have been shown to increase the risk of developing the disease (the given reference is primary research).

• The risk of acquiring MS is higher in relatives of a person with the disease than in the general population, especially in the case of siblings, parents, and children. In the case of monozygotic twins, concordance occurs only in about 35% of cases, and half-siblings have a lower risk than full siblings, indicating a polygenic origin (given references are primary research)

• Apart from familial studies, specific genes have been linked with MS. Differences in the human leukocyte antigen (HLA) system—a group of genes in chromosome 6 that serves as the major histocompatibility complex in humans—increase the probability of suffering MS (given reference is primary research)

• Two other genes have been shown to be linked to MS. These are the IL2RA and the IL7RA, subunits of the receptor for interleukin 2 and interleukin 7 respectively. The HLA complex is involved in antigen presentation, which is crucial to the functioning of the immune system, while mutations in the IL2 and IL7 receptor genes were already known to be associated with diabetes and other autoimmune conditions, supporting the notion that MS is an autoimmune disease (all the given references are primary research).

• The risk of acquiring MS is higher in relatives of a person with the disease than in the general population, especially in the case of siblings, parents, and children. In the case of monozygotic twins, concordance occurs only in about 35% of cases, and half-siblings have a lower risk than full siblings, indicating a polygenic origin. (primary research)

• The gene encoding kinesin KIF1B is the first neuronal expressed gene demonstrated to enhance the risk for the disease.

• The hygiene hypothesis proposes that exposure to several infectious agents early in life is protective against MS. MS would be an autoimmune reaction triggered in susceptible individuals by multiple infective microorganisms, with risk increasing with age at infection (speculative)

• Evidence for viruses as a cause includes the presence of oligoclonal bands in the brain and cerebrospinal fluid of most patients, the association of several viruses with human demyelinating encephalomyelitis, and induction of demyelination in animals through viral infection. (it is very different to show an association and to call it a possible cause)

• Varicella zoster virus has been found at high levels in the cerebrospinal fluid of MS patients (primary research)

If you don't remove these entries, and you give no explanation about the special treatment for CCSVI, I will assume that your deletion was just because you don't agree with the theory and I will restore again the article to the previous state.--Juansempere (talk) 00:10, 19 December 2009 (UTC)

My point is that if the commentary as published in the medication post is not allowed than we do not need to leave the remainder which is POV. Let wait for others to comment.Doc James (talk · contribs · email) 01:55, 19 December 2009 (UTC)

OK. Anyway I can see that the piece of text that you removed was quite different from the original. My position is that the text in this section should be reverted to the original short text that was discussed before as a compromise:

===Other possible factors===

It is known that MS patients show several hemodynamic abnormalities. A preliminary hypothesis based in recent findings proposes that hemodynamic disorders could be the cause for certain kinds of MS.

Besides, this would be a good place to discuss all the causes not purely genetic or environmental, specially retroviruses like MSRV.

It seems that Garrondo has started a clean-up of all the information without secundary sources support. If this is the rule for all the topics, I have nothing to complain about anymore. Regards.--Juansempere (talk) 13:07, 20 December 2009 (UTC)

The section dealing with the speculation about CCSVI was written like a piece of journalism and was based on a collection of media reports. As a featured article, MS is expected to meet the standards of our very best articles – and that includes complying with WP:MEDRS. Should there turn out to be any real science behind the media hype, it will no doubt turn up as a secondary source in peer-reviewed journals. That would be the appropriate time to report it in this encyclopedia. --RexxS (talk) 05:03, 19 December 2009 (UTC)

It is primarily media hype. They did not publish a paper till days after its tv preview. "For clinicians, counselling these patients has been difficult, in part because the treatment study mentioned in the documentary was not published until Dec. 2, more than 10 days after the media reports first appeared." BTW here is the result of the UNCONTROLLED trial "Sixty-five MS patients with CCSVI took part in the study: 35 had relapsing-remitting MS (RRMS), 20 had secondary-progressive MS (SPMS) and 10 had primary-progressive MS (PPMS). All patients received the procedure and were followed for an average of 18 months. Not mentioned in either the documentary or newspaper article was the requirement that all patients receive approved disease-modifying therapies at baseline and remain on their treatments for the duration of the study. Results of this uncontrolled, open-label study were not as optimistic as the media reports suggested. Although some benefit was seen among all groups of patients six months after treatment, by 18 months few improvements persisted. At 18 months, disease severity was significantly improved in RRMS patients; however, despite some improvement at six months, at 18 months SPMS and PPMS patients showed no improvement compared with baseline. The annualized relapse rate—comparing the rate of relapse before and after the treatment—in RRMS patients was not significantly different following the procedure."Doc James (talk · contribs · email) 05:23, 19 December 2009 (UTC)

Right now I am doing a major revamping of references in the article, and I have secondary sources for most of the comments mentioned above. I promise to eliminate all who don't. I am not sure on wether a line on CSVI is better or worse than nothing, but the truth is that up to this moment there are no secondary sources on the subject so it is normal to be disccussed (and it is a subject that needs extraordinary sourcing, as if true it will mean a complete paradigm shift). Bests.--Garrondo (talk) 07:54, 19 December 2009 (UTC)

• MS is not considered a hereditary disease. However, a number of genetic variations have been shown to increase the risk of developing the disease: Reference used is a secondary review (review in lancet neurology, a very reputable journal). Additionally I have added a new secondary source
• The risk of acquiring MS is higher in relatives of a person with the disease than in the general population, especially in the case of siblings, parents, and children. In the case of monozygotic twins, concordance occurs only in about 35% of cases, and half-siblings have a lower risk than full siblings, indicating a polygenic origin. (primary research): It used both a primary and secondary source: eliminated primary, added new secondary and reworded.
• I have eliminated all the remaining genetics section since it was as Juansempere says based on primary research.

I will continue adding sources and answering comments above soon. Bests.--Garrondo (talk) 08:39, 19 December 2009 (UTC)

I beleive this should be included under research rather than under cause. The comments by the medical post would count as a secondary source ( well not the best ) as they are a medical journal of sorts. We here is cannot have had problems with people who stopped taking there meds as they say this new cure on tv. If you read the study it was based on the trial was not placebo controlled and all subjects were required to continue there meds. Doc James (talk · contribs · email) 15:17, 19 December 2009 (UTC)

Have move it to the research section were it can be worked on.Doc James (talk · contribs · email) 00:36, 20 December 2009 (UTC)

The references need examination. Although they are mainly reports on the theories of Dr Zamboni or primary sources, most would be appropriate in supporting the fact that research is being undertaken in this area, so would be acceptable in this section. I've tried to prune out the most egregious ones, but I'm not sufficiently expert to judge whether an article on "Metal ions and oxidative protein modification in neurological disease", for example, is actually a source used to support the text or just an attempt to push a POV by flooding with spurious references. --RexxS (talk) 01:16, 20 December 2009 (UTC)

I agree with JFD I believe if we add this anywhere it belongs on the research subpage rather than the main page.Doc James (talk · contribs · email) 03:30, 20 December 2009 (UTC)

I don't oppose mentioning CCSVI or other unproven ideas; things that get a lot of media attention are WP:DUE even if they're nonsense. I do oppose pretending that any uncontrolled experiment can prove causation -- especially since the people were on medications that are known to work. That study can't even show that the CCSVI intervention was harmless. After all, they might have received even greater benefits if they had relied solely on the proven medications. WhatamIdoing (talk) 22:57, 20 December 2009 (UTC)

I have added info on CCSVI treating it as a news story, not a "treatment option", etc. It does not matter as to whether it is a valid tx, it is a big news item and as such should be included in this article. Furthermore, it is important that people know that this may not, or most likely is not, a miracle cure for MS. Gandydancer (talk) 04:59, 21 December 2009 (UTC)

I agree and as such it should go under the research section. The medical post has an interesting summary.Doc James (talk · contribs · email) 05:04, 21 December 2009 (UTC)

I agee to leave it under research directions, although the most recent addition is completely against WP:weight. It is simply undue weight and recentism to give this theory more than 3 paragraphs. It should be GREATLY summarized (probably to 1 par).--Garrondo (talk) 08:18, 21 December 2009 (UTC)

I disagree about including news stories. Wikipedia is not journalism and Wikinews is the place for it. This is research and needs to be in context with all the other research that is going on. It is not the purpose of Wikipedia to announce to the world every latest 'miracle cure'. --RexxS (talk) 09:49, 21 December 2009 (UTC)

I agree completely with RexxS. We are building an encyclopedia. I have sumarized content. Is everybody ok with info as it appears now? Any comments?. We are a loosing a lot of time with this, when we could all be improving the MS article using recent high quality secondary sources so it is not taken to Feature Article Review. Bests.--Garrondo (talk) 11:12, 21 December 2009 (UTC)

I agree with both of the above but people will keep returning to the page unless we address the issue in some way. The fact that the actual research is less rosy than the new reports need to be addressed and BTW we do have medical pages like the health of Michael Jackson that are at GA that are built entirely on news reports. I did try to get it deleted without any luck. :-) Doc James (talk · contribs · email) 15:41, 21 December 2009 (UTC)

Infection

Well infections can be classified as an environmental factor. It is not so cut and dried. Infections affect ones genetics via combining into ones DNA and therefore it could be a genetic factor for example. Best to put it in its own group.Doc James (talk · contribs · email) 21:31, 18 December 2009 (UTC)

Even in the case of retroviruses, they are an environmental factor that affects genetics. Therefore environmental. Anyway be it your way. I really think there is no point to discuss about this.--Juansempere (talk) 01:01, 19 December 2009 (UTC)

Sure or we could wait for others to comment... Doc James (talk · contribs · email) 01:56, 19 December 2009 (UTC)

Of course it can be considered environmental, although it is usually considereded a distinct theory of its own, I would leave it as it was.--Garrondo (talk) 07:45, 19 December 2009 (UTC)

The definition at environmental disease may be useful, although different subspecialties may have different standards here. WhatamIdoing (talk) 22:59, 20 December 2009 (UTC)

Thanks WAID that was my impression of the definition. Doc James (talk · contribs · email) 23:08, 20 December 2009 (UTC)

Eliminated from genetics section

I have eliminated most of the primary referenced info, since it did not appear in a recent important review of the disease; and therefore anyway I believe than readding it would probably be undue weight. However I leave it here since it could be of use and secondary sources could be found for them at some point.

Apart from familial studies, specific genes have been linked with MS. Differences in the human leukocyte antigen (HLA) system—a group of genes in chromosome 6 that serves as the major histocompatibility complex in humans—increase the probability of suffering MS. Two other genes have been shown to be linked to MS. These are the IL2RA and the IL7RA, subunits of the receptor for interleukin 2 and interleukin 7 respectively. The HLA complex is involved in antigen presentation, which is crucial to the functioning of the immune system, while mutations in the IL2 and IL7 receptor genes were already known to be associated with diabetes and other autoimmune conditions, supporting the notion that MS is an autoimmune disease. The gene encoding kinesin KIF1B is the first neuronal expressed gene demonstrated to enhance the risk for the disease. Other studies have linked genes in chromosome 5 with the disease.

Cure for MS at last.

Does anybody know if you can die from MS? My best friend's Cousin-in-Law was diagnosed with MS before his Wedding Night and my cousin was diagnosed with MS when her 5 year old daughter was 6 weeks old. Good news. There's a cure for MS, but it hasn't been invsted in yet. For proof y'all can visit http://www.physorg.com/news169211700.htmlMultiple/ . Sincerely, ( ~~71.68.211.187~~ )

I have reverted your addition of a link to the article. We have a policy against adding information in the form of external links, because it is so easy to do that if unchecked it will rapidly turn Wikipedia into a link site rather than an encyclopedia. If you believe that your sources meet WP:RS, you should add the information to the article and use your source as reference. The link is available here on the talk page (in your message) in case anybody else would like to follow up on this. Regards, Looie496 (talk) 16:50, 6 February 2010 (UTC)

"My best friend's Cousin-in-Law"? That's awesome. Human fella (talk) 16:25, 20 April 2010 (UTC)

There is a proven cure for MS: new work and research shows that it's a circulatory problem, not so much an autoimmune disorder. I don't have the gumption to masterfully edit the wiki article, but perhaps this article could inspire others to do so? http://www.theglobeandmail.com/news/national/researchers-labour-of-love-leads-to-breakthrough-in-treating-ms/article1372414/ —Preceding unsigned comment added by 24.137.117.247 (talk) 22:40, 30 May 2010 (UTC)

See elsewhere on this talk page for extensive discussion on Zamboni's theories.-gadfium 23:59, 30 May 2010 (UTC)

Review and rewrite done

Two months ago SandyGeorgia pointed out to the neccessity of doing a review on the article. Main point was the amount of primary sources used (See commented version [here]). In this time I have done a major review to sources, eliminating most primary ones. This has led to a reduction in the number of sources used from 161 to around 70 references, but quality of them has been very much increased. Additionally most content has been reviewed and in some cases redone according to sources. Right now I believe the article issues have been fully addressed.--Garrondo (talk) 11:41, 8 February 2010 (UTC)

Garrondo, looks beautiful! I'm about to write my boards so I haven't had much time to add - but we do need a mention ofgliosis somewhere in there (even though the linking page is very rough and incorrect in some aspects). But incredible push! Here's a reference for gliosis.

http://www.ncbi.nlm.nih.gov/pubmed/19674757?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1

--Cpt ricard (talk) 07:35, 9 February 2010 (UTC)

Pathophisiology is not my strong point so in that section I have mostly left info already present searching for secondary references for them. However I will try to look for gliosis info in the high quality sources we already have (specially lancet one). Bests.--Garrondo (talk) 08:11, 9 February 2010 (UTC)

University of Buffalo Blinded Study into CCVI

Is it OK to add to the section on Chronic Cerebrospinal Venous Insufficiency, the preliminary results of the first blinded study into Zamboni's CCVI hypothesis? Researchers at the University of Buffalo examined 500 participants (280 MS patients) and confirmed an association between CCVI, MS and disease progression. --Diamonddavej (talk) 16:53, 10 February 2010 (UTC)

Please see WP:MEDRS, WP:NOT#NEWS, and particularly the "Citing medical sources" section. This article is at FA status. Adding sources before there are reviews published would undermine that. I'd suggest you provide a PMID for the article here on the talkpage as a placeholder. When it's reviewed, that review will then be just a click away.LeadSongDogcome howl 19:12, 10 February 2010 (UTC)

Elimination of CCSVI critics

I have reverted twice an elimination of a sourced statement were the comment from an expert on CCSVI studies was reproduced as stated in the secondary source. I copy here discussion with the user that eliminated such comments. Lets discuss it here instead of entering an edit war:--Garrondo (talk) 19:22, 26 February 2010 (UTC)

I have reverted your elimination. Being CCSVI such a recent concept the medscape article is the closest thing to a secondary source we have, and in it they consider reliable and relevant Jung's comments as part of the mixed feelings towards the theory from the neurological community.--Garrondo (talk) 16:39, 26 February 2010 (UTC)

I don't agree and reverted it back. See my point in the comment. Sergei Gutnikov (talk) 16:41, 26 February 2010 (UTC)

Of course a feeling is a reason: see feels than the study is not well constructed. She said so, and somebody else reported it. We are only reporting the exact words as she used them and as reported in a secondary source which gives importance to it. There is no problem is sourcing. If you don't like what she thinks and a secondary source reproduces from her as an expert is not a reason to eliminate it. I will revert again since it is sourced and I believe its true, will copy these comments in talk page and lets discuss it there. --Garrondo (talk) 19:22, 26 February 2010 (UTC)

My points are that there are only primary articles for CCSVI. The only secondary source is a not-peered review by an expert in medscape. In this secondary source all articles on CCSVI are commented in a neutral point of view (as we have tried to do in the article). As part of this neutral point of view they ask the opinion of an expert and quote their comments. We simply reproduce here what an expert said as balanced in an secondary source. More comments would be welcome.--Garrondo (talk) 19:28, 26 February 2010 (UTC)

It is speculation at this point. Until a third party review comments on this it does not belong in the main article IMO.Doc James (talk ·contribs · email) 19:34, 26 February 2010 (UTC)

What is speculation? Do you mean the whole concept of CCSVI or just the critiques to the CCSVI studies that the commented editor eliminated? Could you be more clear? Bests.--Garrondo (talk) 19:40, 26 February 2010 (UTC)

Yes sorry the concept CCSVI is speculative and as it has generated such publicity I guess we should have it but the critiques are essential as they are more reliable than the original concept.Doc James (talk · contribs ·email) 19:46, 26 February 2010 (UTC)

"Speculative" somewhat overreaches the mark. Zambonni has a long history of publications on vascular surgery and related topics (see pubmed) that surely establish him as an expert in that field competent to determine, as primary works, if CCSVI exists. I'm sure his long history of published works would meet WP:RS and maybe even WP:MEDRSsufficiently for that. The larger question of whether CCSVI is responsible for (or even contributes to) MS pathology is quite another matter. Even by the accounting of Zamboni's supporters the studies to date are not yet sufficient to make that call, hence their support for further and larger investigations. It certainly will not take long until expanded epidemiologic studies are published, given that all it requires is essentially noninvasive testing. If further such studies bear out the correlation, we may be sure that interventional studies will follow, but unless we have citable RS publications saying so, we cannot make those statements in the article. User:LeadSongDog come howl 20:10, 26 February 2010 (UTC)

To center discussion: I believe right now we have different related questions that we should answer here or elsewhere (WP:MED, WP:MEDRS...)

• 1-Is the medscape article (I believe that not peer-reviewed, but nevertheless a secondary source by an expert reviewing all articles on CCSVI up to the moment and critiques to the theory from experts) a reliable source?
• 2-Is it a better, worse or different source than the primary articles?
• 3-Can it be used to document critiques to Zamboni's theory and recommendations of carefulness by experts? (In this sense this critiques or recommendations are not by itself medical info, but they are medical-related...)
• 4-Any other?

Thoughts? --Garrondo (talk) 20:31, 26 February 2010 (UTC)

I agree that med scape is a reliable source for critiques of the literature. It is a secondary source and therefore somewhat better than the primary research. A critique was also published in the Medical Post. This requires a paid subscription which is why we are not using it. I have received legal threats on my talk page pertaining to this topic. It looks like some people who are involved take this issue a little too seriously.Doc James (talk · contribs ·email) 05:59, 2 March 2010 (UTC)

On the buffalo trial

I have reverted twice the addition of the following link:[8]. User Sergei Gutnikov says it is a secondary source but it is not. Definition of secondary source per WP:MEDRS is in medicine summarizes one or more primary or secondary sources, usually to provide an overview of the current understanding of a medical topic. Literature reviews, systematic review articles and specialist textbooks are examples of secondary sources, as are position statements and literature reviews by major health organizations. The link provided 1- Is not a literature review, nor a specialist textbook, 2-Does not state a position by a major health organization. The link is a summary on CCSVI by an MS organization. As references it uses two articles by Zamboni. However the addition by Sergei is on the Buffalo trial and even the provided reference states: A large study recently began in Buffalo NY looking at how often CCSVI occurs in people with MS and in people without MS. Preliminary results have been released by the study group in a press release and they are detailed below; . The specific press release it talks about can be found at[9]. So this is nothing else than a comment on a press release (which can not be considered reliable sources). When the results are published we will have a primary source. At the moment we have nothing. This issue has already been discussed in the CCSVI talk page. Bests.--Garrondo (talk) 16:16, 3 March 2010 (UTC)

Yes supposedly occurs in more than 55% with MS and more than 25% without. No a very strong association.Doc James (talk ·contribs · email) 20:01, 3 March 2010 (UTC)

Statistically it is strong. Sergei Gutnikov (talk) 23:50, 4 March 2010 (UTC)

A good case of recentism. Again. Hype hype hype hype and potentially something slightly interesting. JFW | T@lk 21:08, 3 March 2010 (UTC)

Recentism, maybe. But in the views in Wikipedia should be balanced. Garrondo insists on inclusion of personalfeelings of one doctor (a contra argument) and exclusion of results of a formal study (a pro argument) -this looks like taking sides, doesn't it? Sergei Gutnikov (talk) 23:50, 4 March 2010 (UTC)

I insist in the inclusion of a secondary reference which in a balanced way includes critiques together with a reliable description of the origin and chronology of the theory (Maybe you have not notices that the source is used not only to source the critiques but the full paragraph). On the other hand I want to exclude a preliminary press release since press releases are not scientific sources and should not be used as such since are very prone to errors (Take a look at the CCSVI discussion where it is explained a probable error in one of the press releases on this same very issue). When the article is published and specially when it is commented in a secondary source it will be most welcome.Bests.--Garrondo (talk) 08:44, 5 March 2010 (UTC)

Garrondo, I respect your contribution to this article, but it does not make it your personal article where you can make decisions what to include and what to exclude at your own discretion. Let me quote WP:MEDRS for you: "[press releases] should always be used with caution". Please note, it says: "should be used", it does not say "should not be used". Sergei Gutnikov (talk) 23:50, 4 March 2010 (UTC)

Without a review all this should be used with caution. If we are going to present this primary research than we should present the views of the scientific community regarding it. The medical post had another article on the topic this week. Well I agree this study is statistically significant the real question is it clinically significant.

I agree that this is not Garrondo's article but two other editors ( myself and JFW ) agree with him on this point. One needs to get consensus before re adding this. Doc James (talk · contribs · email) 01:16, 5 March 2010 (UTC)

In addition to the use of reliable sources we have to attain a balanced article in which all parts are in equilibrium and none is given undue weight. To give a full paragraph to a theory which is based in around 4 primary articles is more than enough for a general article on the disease. To use low-quality sources and give more space to CCSVI is to give it undue weight. This does not mean that the info you comment should not appear in wikipedia (As a matter of fact it was me how added the press release into the CCSVI article before you trying to add it here). It simply means that this is not the place. Additionally if you disagree the way to discuss it is not to re-add the reference one time and another but try to talk it here in the talk page. --Garrondo (talk) 08:39, 5 March 2010 (UTC)

I've re-written the paragraph and replaced the reference with an updated one. Now the parapgraph is short, contains facts (not feelings), and is balanced. Sergei Gutnikov (talk) 09:28, 5 March 2010 (UTC)

Well done: you have the merit to have found the first secondary source on CCSVI and you have written a really nice paragraph. That is the kind of source I was looking for. I have done only a minor tweak (eliminating the "as of..."), since as soon as other sources change the view in the subject we will change the article. Wikipedia is per se (and specially FA articles with lots of people following it) as of "today", tomorrow if facts change we will acordingly change the article.--Garrondo (talk) 10:00, 5 March 2010 (UTC)

Only a remark: I have not found the article in pubmed. It may not yet be there as it is too new. Could you put out here the pubmed id as soon as it comes out if I do not do it?--Garrondo (talk) 10:00, 5 March 2010 (UTC)

Yes I agree that what is currently there is well done and well sourced. I now support its inclusion without any hesitation in the main article.Doc James (talk · contribs · email) 10:57, 5 March 2010 (UTC)

Thank you, gentlemen! I'm glad we've reached the consensus on the balance of views. Sergei Gutnikov (talk) 11:09, 5 March 2010 (UTC)

Additional papers on CCSVI

April has brought a rash of new papers, though no new reviews. Perhaps the most interesting is PMID 20351674 which provides evidence of a correlation between the place and type of malformation imaged and the reported symptoms. At PMID 20386873 is a German report that suggests CCSVI accounts for pathogenesis of at most 20% of MS cases in an unselected cohort. At PMID 20351671 is a finding in a small study (n=14) that "iron may serve as a biomarker of venous vascular damage in multiple sclerosis. The backward iron accumulation pattern seen in the basal ganglia and thalamus of most MS patients is consistent with the hypothesis of venous hypertension." User:LeadSongDog come howl 19:09, 20 April 2010 (UTC)

Surgery is not being allowed for CCSVI

An interesting piece in the globe and mail. [10] Doc James (talk · contribs · email) 10:14, 4 May 2010 (UTC)

Last additions to CCSVI

In the last two days there has been a lot of movement in the section due to last articles and news. As this comment is edited the section is as follows:

• Zamboni's finding that CCSVI differentiates patients from controls has been replicated. In April of 2010 some US hospital banned the surgical procedure until more evidence to support its use is available.

My thoughts are that all this is really too much for the section and it would be best to eliminate it since this is a general article and the info is already in the CCSVI article. The first sentence and ref does not really add anything to what we have in this article: The diagnostic article (relationship between CCSVI and MS) has been replicated; but this does not change the fact that it is still current research and that further studies, specially in the treatment of CCSVI are needed (which is what is said in the article using a secondary source). I want to make clear that I do consider this replication really important, and I believe that it may be a breaktrough in the CCSVI debate, but the general article is not its place. Right now it is being used here as a way to debunk conclussions of a secondary article saying that more studies are needed: but the fact is that more studies are needed.

Similarly occurs with the piece of news: Of course it is relevant for the CCSVI article that such procedure has been banned in some hospitals as a treatment temporarily, but it is not really relevant for the main article where we are just saying that it is under research (which it is) and that more research is needed.

From my point of view the most balanced version was previous to these additions although of course further tweaks can be performed.

I would like to hear other's opinions, specially from those who have not been involved in adding the info. Bests.--Garrondo (talk) 11:15, 4 May 2010 (UTC)

Yes I agree. Best to keep this in the subarticle.Doc James(talk · contribs · email) 11:18, 4 May 2010 (UTC)

I'm undecided about the replication study, but I have slashed the news article as it does not really reflect on anything apart from a local disturbance. JFW | T@lk 18:12, 4 May 2010 (UTC)

New reason to leave it out: I have found another article from last month also trying to replicate results but with the opossite outcome (CCSVI only found in 20% of patients). See PMID 20386873.

In the CCSVI article I have added the following line "In 2010 there were conflicting results when evaluating the relationship between MS and CCSVI" but I believe that is clearly excessive for this page, since it leaves us at exactly the same point: we do not know yet the relevance of the concept. If we were to leave the info I would change the sentence to something similar to above, but I would rather leave it out. Bests.--Garrondo (talk) 18:32, 4 May 2010 (UTC)

I agree we should slash it then. JFW | T@lk 21:53, 4 May 2010 (UTC)

The role of diet, in particular cereals

I just read Lierre keith book (the vegetarian myth) and I see that a researcher called Cordain is having some strong points about an important link between MS and wheat conssumption. I do not undestand why this link is not discussed in the article. Some MS association seems to start taking this very seriously. Lierre keith sums sup very well the potential mechanism: lectins are not friendly to the guts, there are protective molcules synthesized by seeds used as a defense from potential eaters. Human tolerate it, but tolerate seems to be the word. They damage the gut and trigger antimyelin reaction since lectin can convey such trigger sequences from degraded food through the gut. Off course this seems incredible since wheat seems so neutral, but 2000 years ago, in france for instance, it was triticum spelta and not wheat that was produced, and triticum spelta is known for its much higher quality of protein, robustness, easy culture, but incompatibility with fertilizer, lower yield and more difficult processing.

This is very strange omission since if you type lectin sclerosis you will hit a couple of peer review paper claiming they find significant trace of lectin in the brain of MS patients..... Besides this would explain a lot of geographic and ethnic deifferences without taking genes into account.

So ? —Preceding unsigned comment added by129.16.137.100 (talk) 12:35, 19 May 2010 (UTC)

So...major reviews (See for example the lancet article, which is the main source used) do not mention this link (neither with wheat nor with specifically with lectine). You would have to bring here reviews in reliable secondary sources that make the especific link with wheat consumption and even then, consensus would have to be reached if it is giving undue weight to a minoritarian point of view (and in that case info would most probably belong to a secondary article) or not and fits in the article.Bests.--Garrondo (talk) 12:56, 19 May 2010 (UTC)

If you type "Wheat multiple sclerosis" in pubmed you get only 6 results and no reviews so I would hardly say that this theory is notable.--Garrondo (talk) 12:59, 19 May 2010 (UTC)

Looks like no one else has joined these dots together yet. Squeaky wheels get grease, and this doesn't appear to be squeaky enough yet! A better point to make would be one relating to diet and the effectiveness of the so called 'cave-man' diet. Shtanto (talk) 22:35, 26 March 2012 (UTC)

Opinion of the neurological community

The opinion of the neurological community currently is one of skepticism therefore "initial" which implies that now it is different should not be used IMO.Doc James (talk · contribs · email) 20:24, 19 May 2010 (UTC)

Well, I've removed the POV comments from the statement, and kept what the source for the statement really backs up: the recommendation of no treatment until the evidence for the connection is there. As to it being "heavily criticized" (most MS societies are funding research into it) and whether that sentence should be in there at all since it's a primary publication (see the FA and article requirements above) and not to mention an _opinion_ I leave open to the community. History has shown that criticism from the mainstream does not imply falseness in the claims made - pick your example; that's why we've moved to evidence-based medicine --Cpt ricard (talk) 22:14, 25 May 2010 (UTC)

Yes I agree with this change. Evidence for this idea is not sufficient to justify it us. One must now wait for the studies to be done.Doc James (talk ·contribs · email) 01:06, 26 May 2010 (UTC)

Vitamin D review

doi:10.1016/S1474-4422(10)70086-7 (PMID 20494325) is a Lancet Neurol review entirely about vitamin D and MS. Probably warrants including. JFW | T@lk 23:08, 27 May 2010 (UTC)

Don't forget to mention that Lymphocytes have vitamin D receptors. Shtanto (talk) 01:47, 16 April 2012 (UTC)

Life expectancy

Life expectancy of patients is nearly the same as that of the unaffected population.[7] The life expectancy of people with MS is 5 to 10 years lower than that of unaffected people.[1] Nearly the same? —Preceding unsignedcomment added by 96.20.73.10 (talk) 23:12, 31 May 2010 (UTC)

The statement 'Almost 40% of people with MS reach the seventh decade of life.[64]' is a mistaken reading of the statement in the cited article at best, excruciatingly misleading at worst. It implies that 60%+ MS patients die before the age of 60 (the 60s are the seventh decade of life). The original, cited article's abstract states that of the (statistically insignificant) 216 deaths of MS patients (solely located in North East Scotland), 37% of the deaths took place in the seventh decade (eg in their 60s). The direct quote alluded to is actually this "A third of the patients survived for over 30 years after onset. The age at death ranged between 25-80 years, with majority of the deaths occurring in the seventh decade (37%)."

All that states is that of all the other decades one could die in, the seventh decade (or 60s) saw the most mortality in total. We are left with 63% who *didn't* die in their 60s/seventh decade and could have died either before or after. It does not give decade-specific death rates as a percentage of the whole for any other decade. The point being, the cited paper merely lists which decade of life had the highest percentage of mortality in this tiny sample while making NO claim as to the percentage who survived to that decade or beyond.

I'll leave it in for ongoing discussion. For the data of a tiny, regional survey written before the advent of disease modifying treatments (1987) to be mentioned at all as if it has relevance for the current international reading audience on such an important point as life expectancy, much less in the misleading way currently presented, I think this is adequate grounds for removal. I think this is valid for any statement in the entire article involving this source, currently numbered 64. Shn525 (talk) 12:26, 31 October 2012 (UTC)

June 2010 Discovery article

This looks like a real breakthrough, finding that MS along with HERV-W retrovirus family in 30% of people with acute schizophrenia. Keith Henson (talk) 03:25, 1 June 2010 (UTC)

Could you give a more specific citation? thanks.--Garrondo (talk) 07:15, 1 June 2010 (UTC)

The Discovery article is [11], I believe. The article links to this article, and some additional cites are in HERV: this and this. I've no idea how widely accepted this idea is, but I think it'd be best not to rely on the Discovery article which seems to sensationalized. --89.204.153.102 (talk) 21:43, 25 November 2010 (UTC)

Named Before 1955

In the article is says: "The disease did not receive its current name until 1955.[1]" I pulled the referenced paper, and it does indeed make that claim. However, I have read at least one paper from 1935 by Tracy J. Putnam entitled "Studies in Multiple Sclerosis" (Archives of neurology and Psychiatry. Volume 33, May 1935, pages 929-940) the paper also says it was funded by the "Harvard Multiple Sclerosis Fund". Putnam also was a founding member of the "National Multiple Sclerosis Society" in 1946 (Ref: http://oac.cdlib.org/findaid/ark:/13030/tf1n39n78s under "Biographical Sketch"). So unless I am mistaken it received the name "Multiple Sclerosis" well before 1955. I didn't want to remove the statement though without discussing since it had a source. I have no idea when it was named, just pretty sure it wasn't 1955.SBarnes (talk) 07:45, 8 June 2010 (UTC)

Although I have a close eye on the MS article I did not see your comment on naming until today. Since what you say seems well sourced independently of what the Compston source says I am going to eliminate the line on naming. Thanks for the point.--Garrondo (talk) 19:55, 1 July 2010 (UTC)

WP:MEDRS and WP:RECENTISM

This edit added a primary source, based on a very small sample and not yet subject to secondary review. I suggest reversion, and a review of the entire article for similar. SandyGeorgia (Talk) 16:24, 12 August 2010 (UTC)

PMID 20496445 is a secondary review of meds/treatment for which full text is freely available-- primary sources not published in secondary reviews should be removed.

Other useful review articles, with free full text available, are at:

PMID 20303880

PMID 20182576

PMID 20112218

PMID 19877743

PMID 19671369

We should be using mostly recent, secondary reviews here, and when free full text is available, that's an additional benefit to our readers. Primary sources should be minimized; there are many many recent high quality reviews of MS on PubMed-- these are just a few samples. SandyGeorgia (Talk) 16:40, 12 August 2010 (UTC)

SG is of course correct, however this source is too recent for the realistic expectation of published reviews andCCSVI is highly topical. It is authored by several widely published authors, particularly Ferlini, Neri, and Zamboni who each have well established track records in their fields. I've added something of a caveat in the text and in the citation. I hope that will suffice for now, pending a revisit in a few months when reviews become available. That said, if the inclusion really endangers the FA status of the article, I'd support excising it for the meanwhile.LeadSongDog come howl! 17:36, 12 August 2010 (UTC)

No, it doesn't endanger the FA status, but I am concerned overall about the use of primary sources when so many secondary reviews are available. SandyGeorgia (Talk) 18:39, 12 August 2010 (UTC)

It's another paper from the Zamboni zone. Given the intense skepticism amongst most neurologists, I don't think we should admit any primary studies from those quarters until they have been quoted in a mainstream review. I agree with Sandy that we should try to update this article with the most recent reviews if possible. But I'd be loath to disturb Garrondo while he's working on Parkinson's disease. JFW | T@lk 19:09, 12 August 2010 (UTC)

By all means, lets use a review to replace that ref you deleted as soon as available. Can you source one?LeadSongDog come howl! 19:21, 12 August 2010 (UTC)

To use such article is to give undue weight to a minor point of view study... until its relevancy is not reflected in other sources I would be against using it in the main MS article.--Garrondo (talk) 08:11, 13 August 2010 (UTC)

LeadSongDog, I think you misunderstand "review" here. This is a very recent paper. Not every paper needs to be mentioned immediately on Wikipedia. This risks WP:RECENTISM, and in this case ignores the significant controversy that surrounds all work from the Zamboni zone. Reviews appear once every little while, and if by that time a paper has not received coverage in these reviews then they can be presumed not to have been accepted by the medical community. This approach has worked very well for all areas of medicine (e.g. see some medical good articles such as diabetic ketoacidosis) and the WP:MEDRS guideline has very wide consensus amongst medical contributors.JFW | T@lk 09:28, 13 August 2010 (UTC)

When you type "multiple sclerosis genetics" into pubmed you get more than 6000 articles, of which 1000 are reviews, right now we only have one in CCSVI and genes and no reviews. It may be the most important article on the genetics of the disease or it may fall into oblivion if replications are unsuccesful. However we can not know and we are not the ones to judge its importance, but experts in the field writing tertiary sources are. We will have to wait as they form their opinion on the relevancy of this finding... Otherwise so as to give the same weight we could (should?) cite the 5000 primary sources on MS and genes, independently of their true relevance. Since wikipedia is not a crystalball the article has no place in the main MS page (while it has it probably has its place in the CCSVI article) until others decide. Bests.--Garrondo (talk) 10:15, 13 August 2010 (UTC)

I agree with SG and JFD. With such a controversial matter we must stick with reviews articles. Most of the scientific community is not yet convinced by Zamboni et al.Doc James (talk · contribs ·email) 11:10, 13 August 2010 (UTC)

Inconsistency on life expectancy

The last sentence of the lede says Life expectancy of patients is nearly the same as that of the unaffected population. In the prognosis section it says The life expectancy of people with MS is 5 to 10 years lower than that of unaffected people. This was mentioned earlier in the talk page without resolution. Which is it?JCO312 (talk) 03:29, 1 September 2010 (UTC)

According to at least one review, there "is only slightly higher" mortality, particularly in the elderly and those who have lived many years with MS.

• Ragonese P, Aridon P, Salemi G, D’Amelio M, Savettieri G (21 Jan 2008). "Mortality in multiple sclerosis: a review". doi:10.1111/j.1468-1331.2007.02019.x. PMID 18217882. {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: multiple names: authors list (link)

However, one study which looked at historical mortality in Denmark found the 10 year figure had significantly declined since 1950.

• Brønnum-Hansen H, Stenager E, Hansen T, Koch-Henriksen H (2006 May). "Survival and mortality rates among Danes with MS". Int MS J. 13 (2): 66–71. PMID 16635423. {{cite journal}}: Check date values in: |date= (help)CS1 maint: multiple names: authors list (link)

Another study followed 150 MS-definite patients in Saskatoon from 1977-2007 and found "a decreased life expectancy of 7.7 and 12.8 years" for men and women respectively.

• Hader WJ (2010 Jan). "Disability and survival of multiple sclerosis in Saskatoon, Saskatchewan". Can J Neurol Sci. 37 (1): 28–35. {{cite journal}}: Check date values in: |date= (help)

Both these latter are primary sources, while the first is a review per wp:MEDRS. I don't have full access to read the first, my quote is from the PubMed abstract. LeadSongDog come howl! 17:54, 1 September 2010 (UTC)

I changed yesterday to 5 to 10 in the lead since it is more specific than "similar" (is 5 to 10 similar?, what does similar mean?) and because the fact appears in a very reliable source. Bests.--Garrondo (talk) 06:28, 2 September 2010 (UTC)

Hookworms?

According to an NPR Radiolab series from 2009 (http://www.radiolab.org/2009/sep/07/ ) hookworms *may* help with MS. Has there been any follow up on this? —Precedingunsigned comment added by 72.207.237.162 (talk) 05:08, 7 September 2010 (UTC)

There is only some primary research, commented in the subarticles on treatments, but not here in the main article.--Garrondo (talk) 16:47, 7 September 2010 (UTC)

What is the definition of MS?

By now there is no definition for MS in the article. It is important to decide what is MS and what is not for several reasons.

The McDonald criteria seem to use a lesion-based definition when they say that "the only proved diagnosis of MS can be made upon autopsy, or occasionally upon biopsy, where lesions typical of MS can be directly detected through standard histopathological techniques"

Would everybody agree in such a lesion-based definition? I mean, if somebody with a negative result in McDonald's criteria shows MS lesions in his brain after autopsy, Would you agree he had MS?. And the reversal. If somebody with a positive in McDonald's show no lesions after autopsy, Would you agree that he had no MS? Do we agree that MS definition is based in the presence of lesions?--Juansempere (talk) 21:09, 26 September 2010 (UTC)

Any set of criteria has false positives and false negatives. There's not much point in belabouring that point in this article specifically. Parkinson's and Alzheimer's are other examples of diagnoses that can only be made with certainty after death. JFW | T@lk 18:50, 27 September 2010 (UTC)

Yes. I know that. That's why the definition is important. How can we evaluate a golden criteria if it is not against a definition of the disease?--Juansempere (talk) 12:49, 30 September 2010 (UTC)

The McDonald criteria is the standard definition for MS. While it might be contested by some controversy is not big enough for the main article.--Garrondo (talk) 06:42, 28 September 2010 (UTC)

No. McDonald criteria is not a definition. Is a diagnosis criteria. And as any diagnosis criteria is based on a definition (so that false positives and negatives can appear). In the case of the McDonald original article he contrast his criteria with the presence of lesions in autopsy. I QUOTE again the McDonald's sentence: "the only proved diagnosis of MS can be made upon autopsy, or occasionally upon biopsy, where lesions typical of MS can be directly detected through standard histopathological techniques"--Juansempere (talk) 12:49, 30 September 2010 (UTC)

I would say that McDonald criteria can also be considered a "clinical" definition. Nevertheless you can try to take a look into the sources we have to see if there is something more specific (right now I do not have the time).

Hmm, perhaps this review:

• JM Nielsen, T Korteweg, CH Polman (2007). MS: Recent Guidelines and Future Goals Focusing on Magnetic Resonance Imaging "Diagnosing MS: Recent Guidelines and Future Goals Focusing on Magnetic Resonance Imaging". Int MS J. 14 (1): 29–34. PMID 17509251. {{cite journal}}: Check |url= value (help)CS1 maint: multiple names: authors list (link).

It also raises the topic of differential diagnoses. I believe we could make use of:

• Miller DH, Weinshenker BG, Filippi M, Banwell BL, Cohen JA, Freedman MS, Galetta SL, Hutchinson M, Johnson RT, Kappos L, Kira J, Lublin FD, McFarland HF, Montalban X, Panitch H, Richert JR, Reingold SC, Polman CH (2008 Nov). "Differential diagnosis of suspected multiple sclerosis: a consensus approach". Mult Scler. 14 (9): 1157–74. doi:10.1177/1352458508096878. PMC 2850590. PMID 18805839. {{cite journal}}: Check date values in: |date= (help)CS1 maint: multiple names: authors list (link)

LeadSongDog come howl! 15:24, 30 September 2010 (UTC)

Thanks, but again, a diagnosis procedure can never be considered a definition. They would have 100% sensitivity and specifity if they were (by definition!). Besides, there is no such a thing of "clinical definition" except in colloquial talking.

For sure, it is great to have differential diagnosis criteria as the one you posted, but, against what criteria are tested their sensitivity and specifity? Directly or indirectly they have to be tested against autopsy confirmed cases.

I still think this article needs to define what is MS and what is not, and the presence of lesions in the CNS is a good candidate even for McDonalds. --Juansempere (talk) 23:53, 30 September 2010 (UTC)

There are at least two different definitions of MS

It seems that a lot of people considers McDonald criteria as a "clinical definition" (McDonald criteria). The problem is that there is also a "pathological definition", based in the presence of lesions, and they are not exactly the same. In fact, they are not. McDonald says "the only proved diagnosis of MS can be made upon autopsy, or occasionally upon biopsy, where lesions typical of MS can be directly detected through standard histopathological techniques"

This ambiguity should be at least stated in the article. Besides, according to some authors as Hans Lassmann, the pathological definition should be preferred because the clinical definitions have problems with differential diagnosis

--Juansempere (talk) 11:17, 2 November 2010 (UTC)

Any clinical diagnosis has a sensitivity and a specificity. Angina pectoris is a clinical diagnosis, and so isParkinson's disease. If you are aware of data that compared clinical diagnosis with postmortem data then please share this with us. JFW | T@lk 11:44, 2 November 2010 (UTC)

I am not claiming that I have data comparing clinical and pathological definitions. I am just claiming that both definitions exist, and I am giving you a reference. If you consider it invalid for any reason, please state your reasons.--Juansempere (talk) 14:14, 2 November 2010 (UTC)

Sadly I cannot view Lassmann's article due to access problems, but I am really unsure what you are suggesting. I don't think many neurologists would support brain biopsies to diagnose or exclude MS. Nor do I think this will happen for clinical trial purposes for the obvious reasons. As I said, all diagnostic criteria suffer from this weakness.JFW | T@lk 00:05, 3 November 2010 (UTC)

Of course am not trying to suggest that people should be diagnosed with a biopsy!!!. I am just saying that McDonalds is not a real definition, but just a diagnostic criteria, and therefore is susceptible to false positives, as you said. This should be explained in the article.

I quote the part that I find interesting from the article, in which Lassmann besides gives further references to support his point: "Pathology is generally regarded as the gold standard in defining different forms of inflammatory demyelinating diseases (Adams and Kubik, 1952; Alvord, 1985; Wegner, 2005)".--Juansempere (talk) 23:28, 4 November 2010 (UTC)

Lots of diseases are "defined" by clinical criteria. For instance, myocardial infarction is not diagnosed pathologically but by a combination of symptoms, electrocardiography and biochemistry. According to your line of reasoning, the gold standard (and therefore "definition") would be pathological examination of the heart muscle. I think you are placing too much emphasis on a single author's perspective, and I would not recommend any changes to the article currently. Alternatively, why don't you make an edit and we'll see if it looks reasonable.JFW | T@lk 10:42, 5 November 2010 (UTC)

Well, it is not just one author. It is an author quoting three more. Anyway I am not requesting to remove all references to McDonald as clinical definition. I am only saying that the pathological definition should also be taken into account. --Juansempere (talk) 01:56, 6 November 2010 (UTC)

Proposal of a change

To be accurate with the status of the clinical diagnosis respect the pathological one, I propose a change. Inside Diagnosis section, I propose to change the sentence:

"Currently, the McDonald criteria focus on a demonstration with clinical, laboratory and radiologic data of the dissemination of MS lesions in time and space"

By

"Currently, the McDonald criteria focus on a demonstration with clinical, laboratory and radiologic data of the dissemination of MS lesions in time and space for non-invasive MS diagnosis, though the only proved diagnosis of MS is autopsy, or occasionally biopsy, where lesions typical of MS can be detected through histopathological techniques.

Being the given reference the same article that defines the McDonalds criteria I think is necessary to make the remark. --Juansempere (talk) 23:00, 10 November 2010 (UTC)

If the McDonald article says that I fully agree. It is similar to what is said in the Alzheimer's disease and Parkinson's disease diagnosis subsections. --Garrondo (talk) 07:21, 11 November 2010 (UTC)

Not completely sure on how to integrate the info from the article: the full paragraph in the source is : Whereas it might be said that the only proved diagnosis of MS can be made upon autopsy,21 or occasionally upon biopsy, where lesions typical of MS can be directly detected through standard histopathological techniques, MS is essentially a clinical problem and can be diagnosed using clinical and paraclinical criteria. Biopsy is a diagnostic technique that can confirm that a lesion is inflammatory and demyelinating (though it cannot on its own lead to a diagnosis of MS) and should rarely be undertaken. Interpretation by neuropathologists experienced in the demyelinating diseases is essential in avoiding misdiagnosis.

It seems the authors partly disagree with the sentence above, which has been proposed by others. Maybe it is better to downgrade the sentence to: Currently, the McDonald criteria focus on a demonstration with clinical, laboratory and radiologic data of the dissemination of MS lesions in time and space for non-invasive MS diagnosis, though some have stated that the only proved diagnosis of MS is autopsy, or occasionally biopsy, where lesions typical of MS can be detected through histopathological techniques.--Garrondo (talk) 12:53, 11 November 2010 (UTC)

You are right. Reading it now a second time it seems clear to me that the authors are stating a disagreement with some previous ones. This shows in fact that there is a problem of clinical vs. pathological definitions for MS. I think your paragraph is perfect because it shows clearly that there is some disagreement among the authors in this point. If nobody disagrees, I will put this into the article in a couple of days.--Juansempere (talk) 22:50, 13 November 2010 (UTC)

non-CCSVI vascular theories

A thing I miss in the article is the lack of information about vascular theories. One of them (CCSVI) is properly covered at the end of the article, but it is not the only one ever proposed, and though it is promising, it could be eventually a failure.

A serious review of MS causes should cover the non-CCSVI vascular theories. For example, there is a good review of them freely available here [12][13]that we could use as a reference. It was written in 2006, before the CCSVI discovering, and covers what was relevant at its time.

Vascular theories have been proposed at several points in history by renowned people, like Eduard von Rindfleisch orTracy Putnam and they have never been confirmed or proved false, and therefore they are still valid hypothesis. The field of non-CCSVI vascular research is still alive and there have been several publications recently like or.

--Juansempere (talk) 21:19, 20 December 2010 (UTC)

Proposal

I would like to add the non-CCSVI vascular possibilities into the article. I have thought about the following change:

"Most likely MS occurs as a result of some combination of genetic, environmental and infectious factors, and possibly others factors like vascular problems. Epidemiological studies of MS have provided hints on possible causes for the disease. Theories try to combine the known data into plausible explanations, but none has proved definitive."

--Juansempere (talk) 13:35, 31 December 2010 (UTC)

Don't forget that MS was indeed first described as a vascular condition: . Is it worth mentioning the history?

Here's a CCSVI lecture as well. One of the better ones: Shtanto (talk) 22:17, 26 March 2012 (UTC)

Charcot described MS as cardiovascular. Funny that we're now investigating CCSVI as a factor. Is it worth mentioning the thyroid gland? It's situated in your neck, so I thought it might play a role since that's where a lot of your lymphocytes live - Gilenya tells them to stay home as it were.

Here's another good site with links to papers on HHV-6 and how it messes with veins: http://www.hhv-6foundation.org/associated-conditions/hhv-6-endothelial-cell-dysfunction-arteriopathies —Preceding unsigned comment added by Shtanto (talk •contribs) 00:22, 17 May 2012 (UTC)

New study on barriers to adherence and coping strategies, please integrate as you see fit

JFDWolff suggested it would be more appropriate for a 3rd party to integrate the findings from our recently published study to avoid COI. It's in an open-access journal so you can read the whole thing and decide where, if anywhere, it should fit. My original text below:

Patients use a variety of coping strategies to cope with consequences of needle-based therapies, such as icing the injection site; increased use of coping strategies like this are associated with better adherence to their treatment regimen and oral medications that do not rely upon needles have recently been approved by the FDA.

Cheers, --PaulWicks (talk) 14:36, 28 January 2011 (UTC)

The study is not a secondary source and therefore is best avoided per WP:MEDRS. Some other content in the same section is also based on non-MEDRS sources, and I would recommend that it is revised. I am also doubtful about the relevance of a study on influenza A in the explanation of flu-like symptoms. JFW | T@lk 15:55, 28 January 2011 (UTC)

In that case I'd suggest citing the recent GAP study too? There won't be a secondary source reviewing adherence in MS including this much data from both studies across all DMTs for quite some time. (http://www.ncbi.nlm.nih.gov/pubmed/20561039) --PaulWicks (talk) 20:41, 28 January 2011 (UTC)

Animal model

Should there not be some discussion of EAE animal models in the article? Consider, for instance, PMID 20862553 and PMID 20807309 for two recent examples. LeadSongDog come howl! 05:06, 18 February 2011 (UTC)

I am not sure if we should enter to debate deeply if EAE is a good model or not: for most neurological diseases there is a far from perfect animal model but usually better than nothing. However I agree completely that some lines on EAE, which right now is not even mentioned in the article, is an important improvement. Probably the place for it would be the research directions section. Right now I am hands-full with Parkinson's disease at FAC so I do not think I will be able to help much this time. Could you try to write a paragraph on it? Bests.--Garrondo (talk) 07:22, 18 February 2011 (UTC)

Incidence Numbers

I noticed data for prevalance of MS but not incidence. If agreeable, we could add: "The worldwide incidence of MS is rising, and is currently estimated to be about 3.6/100 000 person-years in women and 2.0/100 000 person-years in men" Reference: C.A. Young, Factors predisposing to the development of multiple sclerosis QJM (2011). PMID: 21382923. First published online March 7, 2011 doi:10.1093/qjmed/hcr012. I'm having trouble incorporating so please insert this or more updated worldwide incidence as you see fit. Nikipap (talk) 15:06, 6 April 2011 (UTC)

Defacement

There is vandalism that can't be edited out on the top of the article. TekBoi [Ali Kilinc](talk) 02:17, 6 June 2011 (UTC)

Could you be more specific? I can't see what you're referring to. JFW | T@lk 06:28, 6 June 2011 (UTC)

Already fixed by a bot. GregorB (talk) 12:58, 9 June 2011 (UTC)

Is it MS a disease or a condition?

Some authors define it as a disease. Some others as a condition. Given that the word condition is more general (medical condition includes all the diseases, disorders, syndromes and injuries, and that in fact, we do not know nowadays what MS is, I think the introductory text should present MS as a condition. The text will still be valid if MS gets universally classified as a disease someday.--Juansempere (talk) 11:41, 19 June 2011 (UTC)

If someone has evidence of demyelinating plaques on neuroimaging, in different time and place, but is completely asymptomatic, would you label that MS? I would struggle to. MS is the clinical disorder that results from demyelination.

I do not dispute that some might be of the view that MS is a "condition" rather than a "disease", but using a separate reference to emphasise this point seems to me like an example of overkill. JFW | T@lk 18:38, 19 June 2011 (UTC)

One might be able to argue more or less equally for syndrome, diagnosis, or medical condition, but givenwp:crystal I'd say the others are premature. I'd be interested to see refs discussing the question though.LeadSongDog come howl! 19:16, 19 June 2011 (UTC)

Are you expecting a reference specifically about whether MS is a disease, a disorder, a syndrome, a condition, an affliction etc? Fat change. Also of very limited relevance in practical terms. It won't keep people out of wheelchairs.JFW | T@lk 22:42, 19 June 2011 (UTC)

Not really expecting one, just saying I'd like to see one. And no, it's not very practically useful.LeadSongDog come howl! 03:44, 20 June 2011 (UTC)

Here there is an article, which besides is a review, describing MS as an inflammatory condition. Given that "medical condition" is a broad term that includes all the other alternatives, I think it is the term that should be used. --Juansempere (talk) 22:42, 21 June 2011 (UTC)

I will continue to disagree. If someone has demyelination without any symptoms, there is a "condition" but no "disease". MS is caused by the demyelinating condition, but one cannot say that it is the demyelinating condition.JFW | T@lk 23:10, 21 June 2011 (UTC)

I understand from your text that you want to use the word "disease" in order to exclude subclinical MS cases from the scope of this article. I think they should be included. Do you have any reason to exclude them? There is at least a group of authors that includes them inside the MS scope.

Anyway, even if subclinical cases should be excluded, the use of the word "condition" instead of "disease" does not include them automatically. It just leaves the sentence open to interpretation, which at this moment reflects quite well the status of the disagreement between different research groups.

--Juansempere (talk) 15:11, 23 June 2011 (UTC)

A 4-patient report doesn't really do it in terms of distinguishing "asymptomatic" demyelination from clinically apparent disease. Again I don't dispute the use of the word "condition", but I think a specific reference for the use of the term is entirely unnecessary. JFW | T@lk 16:40, 23 June 2011 (UTC)

I just made the change --Juansempere (talk) 22:37, 1 July 2011 (UTC)

And I reverted. No one agrees with you. A condition is a defective state of health that may or may not be related to some causal factor, whereas a disease is distinguished by definitive signs and symptoms. If you want to make such a change, bring WP:MEDRS and significant support. You have none here. OrangeMarlin ^{Talk•Contributions} 00:28, 2 July 2011 (UTC)

These people agrees with me. I suppose you can find a lot of references calling it a disease, but I remind you that condition is a broader term, and therefore this redaction does not contradict them. Do you have any reference saying that it is NOT a condition?— Preceding unsigned comment added byJuansempere (talk • contribs)

You have no consensus for such a change. The paper under discussion is about symptomatic patients only, hence it is not a representative source for this discussion, as per WP:WEIGHT. JFW | T@lk 05:13, 5 July 2011 (UTC)

Juan, I lack a citation that says it is not caused by eating peanuts. So, I guess if I change the Causes section to include MS is caused by eating peanuts, you can't delete it because you cannot bring a source that says "MS is not caused by eating peanuts." That's Argumentum ad ignorantiam, that is, providing an argument that because I cannot disprove something, that something is true. The fact is, you provide a total of ONE citations, of marginal relevance, and use it as your "proof" that it should be "condition." I've got to ask you Juan...do you have some agenda here? I never assume good faith, so my only assumption is that you're beating this to death because being classified as a "disease" somehow offends you personally. Well, get over it. We don't care about your "opinion", only what can be verified by MEDRS.OrangeMarlin ^{Talk• Contributions} 06:53, 5 July 2011 (UTC)

Barring better evidence, we should go with the ICD-10 classification. Call it a disease because that's what the classifying experts called it.LeadSongDog come howl! 14:43, 5 July 2011 (UTC)

Case closed. Next. OrangeMarlin ^{Talk•Contributions} 16:24, 5 July 2011 (UTC)

There is no hidden agenda at all. There are more sources that call it condition. Do you really want a list? My only point is that research is pointing to heterogeneous ethiology and to call MS a disease is to pretend too much knowledge about it. Besides, currently is widely accepted McDonald criteria as a clinical definition, and therefore according to this, MS would not be a disease, but a clinical condition.

I really have to complain about your behaviour during this discussion. You refused to participate in the original dialog, and when I was allowed by others to made the change (and after waiting for a week) you reverted it claiming (falsely) a lack of sources. Besides you have not read anything about the previous discussion or you have decided to ignore it. Speaking about agendas, do you have one? --Juansempere (talk) 15:31, 7 July 2011 (UTC)

Juansempere, we have supplied arguments why it might not be a good idea to refer to MS as a "condition". Yes, there are sources, but none seem to directly address the point. We are reaching the point where the whole thing turns into splitting hairs. JFW | T@lk 16:00, 7 July 2011 (UTC)

As you can see, I have respected the last change and I have stopped arguing my point. My last complain was not about the change, but about the behaviour of Mr. Orangemarlin and his arguments inviting dialog, like "Case closed. Next", or his false statements. I would like to read an answer from him explaining his reasons.--Juansempere(talk) 18:19, 10 July 2011 (UTC)

Many of us have expressed at user talk:Orangemarlin our hopes that he is soon again able to do so. Meanwhile, please focus on what the best available sources say.LeadSongDog come howl! 19:15, 10 July 2011 (UTC)

Additional arguments against using the word disease

My pro argument for calling it a condition is due to nature of problem. A disease can be caught and harm you rather quickly but q conidtion is something you were born with and with changes in lifestyle you can be normal and live in spite of condition. disease souds too final and in some ways makes us feel like we did something to contract it Maybe this discussion was closed but I am still in disagreement with the word disease for a condition like MS with unknown. I know that previous arguments were not strong enough to persuade most of you, but maybe this new argument will change some of your minds. Basically, this time I want to remark the possibility of heterogeneity, discussed for example here [14].

If MS is finally a set of diseases (and there is a real possibility), this article is giving an inconsistent statement. I think this is an important reason why we should use neutral words as "condition"

Is there somebody there that would support this change? --Juansempere (talk) 12:24, 15 August 2011 (UTC)

That pdf is from

• Robert Herndon (2002). "14: The pathology of multiple sclerosis and its variants". Immunology, Pathology and Pathophysiology (PDF). pp. 185–97. ISBN 9781888799620.

which is certainly a wp:MEDRS, though perhaps getting a bit dated. Could you please clarify the statement you would like the article to make, which you would then use that source to support? Certainly Herndon's conclusion makes no bones about using the term disease, even while discussing the possibility that it may be one or more disorders. See his p.193 "Conclusion". LeadSongDog come howl! 17:10, 15 August 2011 (UTC)

Juansempere will you please give this a rest? The opening word of the chapter is "diseases", and the table (14.1) on the next page is titled "Demyelinating Diseases". Demyelination is a disorder, multiple sclerosis is a disease as it has a clinical substrate. JFW | T@lk 18:59, 15 August 2011 (UTC)

I am sorry if this discussion bothers you, but you don't have to participate if you don't want. I promise not to make any change in the article in this subject. But I do really have the right to try to convince others for making the change.

My point is just that I really find the current redaction restrictive. If I say "hepatitis is a disease that ..." or "diabetes is a disease that ..." probably most of you would complain, because they are collections of diseases with similar behaviours. There is a real possibility that MS is in the same situation.

--Juansempere (talk) 20:57, 17 August 2011 (UTC)

It sounds as if you are confusing "disease" with "infection". We don't make up content here, we reflect what the best available sources say. The term they use is "disease".LeadSongDog come howl! 16:55, 4 October 2012 (UTC)

Low Dose Naltrexone

I currently take Low Dose Naltrexone or LDN as it's more commonly known for treating my MS. It'd be great if a section or link to LDN could be added to this page. There's a conference about LDN coming up soon in the Clarion Hotel in Liffey Valley near where I live in Dublin. The real problem with getting it researched is the pharmacorps won't get any return on investment because the drug has been out of patent for so long. Folks with all sorts of diseases take it and it really helps, everything from cancer to fibromyalgia. — Precedingunsigned comment added by 46.7.165.130 (talk) 19:45, 1 September 2011 (UTC)

That is an oft-repeated canard. There are some very large international MS charities that would happily fund a treatment that is likely to make a difference.

The fact that LDN is used for so many diseases makes it a little bit suspect.

We can include it in the article when there are solid WP:MEDRS-compliant secondary sources that either show benefit or evidence of widespread use by practicioners. JFW | T@lk 20:24, 1 September 2011 (UTC)

I recently updated the page on Low dose naltrexone, and needless to say there are very few MEDRS compliant sources available. Those that are say that it is way too early to support its use, and I would not support the inclusion of a discussion in this article for WP:WEIGHT reasons. Yobol (talk) 20:32, 1 September 2011 (UTC)

I understand - you need references to back up claims. That's fair enough, but those things cost a lot of money. As for MEDRSA compliant sources, all I can offer are first hand testimonials from patients and doctors like Dr. Pat Crowley, Dr. Gilhooly, Dr. Phil Boyle and the original paper by Dr. Bihari. Life means impressing sceptics, something I'm no good at. Is it fair to say that LDN and CCSVI offer eqipoise versus current therapies? My neuro didn't mention them off hand, but I did get a prescription. 10 years doing a phase 3 trial is 10 years of suffering. Medical tourism of your test subjects who get themselves healthy again by any means necessary doesn't help either. LDN is much safer than any of the CRAB drugs, so it's always worth a punt. and it'll work with anything along side it. Shtanto (talk) 20:59, 26 March 2012 (UTC)

We have no reviews. The best available source on LDN for MS is PMID 20534644, a primary study on just 96 subjects which says "Variables including presence of pain, energy, emotional well-being, social, cognitive, and sexual functions, role limitation due to physical and emotional problems, health distress, and overall QoL did not show any meaningful statistically difference between the two groups." In simple language, we have no good reason to think it works.LeadSongDog come howl! 21:29, 26 March 2012 (UTC)

I suppose testimonial weight doesn't matter here. I take it every day and can say it works, but that won't cut it. Seems a shame that truth is so expensive, too often beyond the means of the many. This website documents trials where LDN is tested. I'll keep an eye out for any relating to MS. http://www.lowdosenaltrexone.org/ldn_latest_news.htmShtanto (talk) 02:45, 17 May 2012 (UTC)

This is hardly the only place that discounts testimonials, they are nearly the worst form of evidence. Clearly you knew what you were taking. You are a sample of one. You are reporting on your own observations. You are deciding whether or not to make the report, what (and how much) to say in it. None of these things leads to neutral, objective, comprehensive reporting. The site you link offers a primary-source report on a tiny single-blind study, in a very new journal which as yet is not even pubmed indexed. We'd be hard-pressed to treat that as a wp:MEDRS. But if there is something to it, a proper double-blind randomized trial will eventually be conducted and results published. When someone decides it is worth describing that publication in a review, we'll have an article here that can discuss it. Meanwhile there is wp:NODEADLINE. We can wait.LeadSongDog come howl! 20:35, 18 May 2012 (UTC)

Clive Burr is dead. His time is up. Mine is running out. I shouldn't bother you or waste time. I'm sorry. I have to try though. I won't bother you any more. — Precedingunsigned comment added by 176.61.28.141 (talk) 22:28, 15 March 2013 (UTC)

Neurodegeneration and MS disability load

I think that this article is missing a significant piece MS pathogenesis: neurodegeneration. Basically, MS is a biphasic disease. While demyelination is certainly one aspect of the disease, it would seem from current research that the majority of the disability load is caused by neurodegeneration of the CNS neurons. I added this because I read the article and could only find one sentence mentioning neurodegeneration. Good start would be Trapp, 2008 in the Annual Review of Neuroscience. A really excellent discussion about what MS actually is. Right now I don't have time to do this but I think the article is horribly incomplete without this additional work. — Precedingunsigned comment added by Ng90 (talk •contribs) 07:07, 4 August 2011 (UTC)

Do you refer to the NAWM? Maybe this paragraph from the pathophysiology page could be adapted into the pathophysiology section: "Damage occurs in two phases. First some MRI-abnormal areas with hidden damage appear in the brain and spine (NAWM, NAGM, DAWM), followed later by leaks in the blood-brain barrier where immune cells infiltrate causing the known demyelination".

--Juansempere (talk) 23:27, 15 October 2011 (UTC)

Comments? Is there anybody against the inclusion of the previous paragraph into the article?

--Juansempere (talk) 17:29, 17 October 2011 (UTC)

The source is insufficient. For an article like this, I would expect a secondary source that meets the criteria set out in WP:MEDRS. JFW | T@lk 19:34, 17 October 2011 (UTC)

The question seems to be in reference to Trapp BD, Nave KA (2008). "Multiple sclerosis: an immune or neurodegenerative disorder?". Annu Rev Neurosci. 31: 247–69. PMID 18558855., which clearly is a review, and which has been cited in other reviews, such as Glass CK, Saijo K, Winner B, Marchetto MC, Gage FH (2010 Mar 19). "Mechanisms underlying inflammation in neurodegeneration". Cell. 140 (6): 918–34. PMC 2789848. PMID 19775910. {{cite journal}}: Check date values in: |date= (help)CS1 maint: multiple names: authors list (link) and Lin W, Popko B (2009 Apr). "Endoplasmic reticulum stress in disorders of myelinating cells". Nat Neurosci. 12 (4): 379–85. PMID 19287390. {{cite journal}}: Check date values in: |date= (help) LeadSongDog come howl! 21:34, 17 October 2011 (UTC)

So why does Juansempere propose an addition based on an inadequate source? The Trapp, Glass and Lin sources all seem reasonable. JFW | T@lk 22:24, 17 October 2011 (UTC)

I just think that NAWM should be mentioned in the article. Use the source you like the most.

--Juansempere (talk) 21:02, 18 October 2011 (UTC)

For a recent review on NAWM, would PMID 20227191 be suitable? I've only seen the abstract, but it seems clear that the question of the chicken and the egg has yet to be unambiguously resolved to the full satisfaction of the research community.LeadSongDog come howl! 13:21, 19 October 2011 (UTC)

Personally I would prefer a pathological review like PMID 18594554, but I agree about the chicken and egg problem being unsolved. --Juansempere (talk) 18:21, 19 October 2011 (UTC)

That goes back more than three years in a field where activity is very robust. PMID 21683931 is more current, and includes discussion of the CCSVI hypothesis too. LeadSongDog come howl! 19:03, 19 October 2011 (UTC)

Allright. Go on with that one if you want, but it deals with CCSVI which is controversial. I think it would be better to find one just about NAWM.--Juansempere (talk) 20:27, 24 October 2011 (UTC)

Alice Miller's theory of chronic diseases

Would anyone mind if I added a few lines under "Causes" about Alice Miller's work? In her book The Body Never Lies she describes many celebrated cases of chronic disease or infirmity. She argues that in each case the patient's body revolted because of the patient's perverse attachment to parents who had systematically abused them as children. In another book, Paths of Life, she mentions hearing from many such abused children who later developed M.S.

My wife has multiple sclerosis, and Miller's theory fits her case like a glove. Apparently the literature of multiple sclerosis has ignored Miller. But since conventional medicine has failed to find a cause for M.S., I think that Miller's work deserves mention here. Sicherman (talk) 03:33, 30 December 2011 (UTC)

It is not accepted by the scientific community as a cause for multiple sclerosis, so no I don't think it should be discussed. JFW | T@lk 06:47, 30 December 2011 (UTC)

Normally I would agree. But science does not investigate patients' emotional conflicts. The scientific community has not even considered Miller's theory, while the psychological community shows growing respect for it. The art of healing is more than just science! Sicherman (talk) 16:26, 1 January 2012 (UTC)

This is a serious scholarly work. When this theory is published in reliable sources for medical claims we can re-address the issue. Yobol (talk) 16:40, 1 January 2012 (UTC)

I guess you're right. Indeed, Compston and Coles (reference 1) state flatly, "Multiple sclerosis is triggered by environmental factors in individuals with complex genetic-risk profiles." But is this true? I don't have access to their article so I don't know how the authors justify their statement. The Wikipedia article's paragraph under Causes > Environmental Factors suggests that environmental theories of the cause of multiple sclerosis are speculative and dubious.Sicherman (talk) 22:56, 12 January 2012 (UTC)

We can be fairly confident that MS doesn't have a singular genetic component. Any mention of Vitamin D in this article?Shtanto (talk) 21:04, 26 March 2012 (UTC)

(←) That does not justify inclusion of a non-notable theory, as you were suggesting before. Are you changing the subject?JFW | T@lk 00:12, 13 January 2012 (UTC)

I am withdrawing my suggestion, on the principle of keeping Wikipedia's medical content reliable and verifiable. I agree that the larger issue of what Wikipedia can say reliably and honestly about the cause of multiple sclerosis belongs under a separate heading, and am willing to drop the current one. For those of you who would like to look into Miller's theory on your own, here is a reference for The Body Never Lies. Sicherman(talk) 15:54, 19 January 2012 (UTC)

Chickenpox and multiple sclerosis

Is there any research into a link between chickenpox and the onset of multiple sclerosis? Chevara (talk) 20:05, 11 February 2012 (UTC)

This talk page is for making suggestions for improving the article, not for a general discussion of the topic. The reference desk for asking general questions is thataway. Yobol(talk) 20:09, 11 February 2012 (UTC)

No research yet. Even if there was, I'm sure someone would find a problem with it or the way it was done. I will say however that I did happen to get really bad chickenpox as a kid. I'll add it to my prezi. Shtanto (talk) 22:26, 26 March 2012 (UTC)

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