Chronic fatigue and cognitive dysfunction were notable examples as many patients spoke of them as being improved post venoplasty.

Many videos referred to ‘brain fog’ – a subjective description of cognitive dysfunction characterized by memory loss and a lack of ability to think clearly – as a problem that was alleviated post treatment: ‘It’s like I have a whole fog of cob webs lifted off’ (experiential video diary; female channel 1: video A). Circulation and sensory Nintedanib mouse changes, and the amelioration of vision difficulties and chronic pain were also frequently mentioned: ‘I used to have very cold feet. Freezing feet. And they are warm’ (commercial patient experience video; female; channel 2; video A). A wide variety of symptoms were discussed across the videos and while changes post treatment differed ZD1839 solubility dmso greatly, they were usually described as being significant to the patient. Moreover, in cases where the improvement was not what the patient had hoped

for (i.e. to be able to walk), CCSVI and the ‘liberation’ procedure were still usually presented in a positive light. Whereas symptoms – ‘a disease manifestation of which the patient complains’ [33] – were presented in videos, signs were also incorporated (especially in personal treatment evidence videos). There is an important distinction between the two in clinical medicine: signs are ‘a manifestation of disease perceptible to an observer’ [33] and are generally considered to be indicative of some underlying pathology. Subjectively experienced symptoms differ between people, and are elicited during history taking in the medical encounter; signs are normally elicited during a professional’s physical examination. Clinical signs shown in the videos through self-examination performed to the camera included nystagmus Roflumilast (involuntary eye movement), intranuclear opthalmoplegia (problems in eye adduction often resulting in double vision), and balancing and touching fingertips to the nose. While the demonstration of signs was of varying success (sometimes tests were performed incorrectly or video quality prevented the viewer actually seeing the result), it

is significant that elements of formal neurological examinations were performed as online ‘proof’ with the video poster sometimes directly referencing and imitating tests typically conducted in clinical contexts, noting, for instance, ‘this is what your neurologist will get you to do in his office’ (personal treatment evidence video; female, channel 3; video A). Tests such as the Rhomberg test (a component of a neurological examination that involves standing with eyes closed to test balance) or walking heel to toe to check for gait ataxia were common [10]. Although less frequent, patients drew on disability and quality of life measures to provide a more ‘objective’ measurement of their improvement (e.g. the Kurtzke Expanded Disability Status Scale [34] and [35]).