This Is MS Multiple Sclerosis Community: Knowledge & Support

We could put this up as a poll here...we might find quite a few people who want the unproven venoplasty treatment.

Hello Dr. Sclafani,

im a big fan of your presence here, and would like to ask a question.

A neurosonographer has jus published a critical approach to Zamboni's Doppler methodology.
He thinks that 3 out of the 5 Zamboni criterias are completely nonsense, and are not for diagnosing an occlustion in a vein.

He also states that none of the Ultrasound pictures published by Zamboni convinced him that a vein occlusion has been observed.

He gives detailed description about his doubts here:
http://www.thisisms.com/ftopic-11804-0- ... rasc-.html

May i ask your professional opinion about these statements? It would be very important to reply to his opinion, because in hungary we have just started to organize a CCSVI trial... and would like to finish it

thank you very much!
alex

This one requires some thought and discussions before i post

2010/5/23 Salvatore Sclafani

> Ciao Paolo
>
> As I told you, I educate patients about CCSVI on a webside (thisisms.com).
> This is viewed about 15,000 times per week by patients from all over the
> world, from china to canada to europe and US. I have taught them about IRB,
> trial design, ethics of trials, physiology, ballloon design and risks and
> benefits. I encourage them and I empathize with them. They are a remarkable group.
>
> Today I need your help with their questions, becasue this is not my
> expertise and must explain for them the theory in light of a neurosonologist's opinion
> in hungary. Will you help me answer this please? I want some intelligent
> and expert opinion and I cannot give it.
>
> THE PATIENTS WHO HAVE READ MY EDUCATION ON CCSVI HAVE READ IT 119,000 TIMES
> IN NINE WEEKS. iT IS IMPORTANT THAT I CAN EXPLAIN DR GYULA'S OPINION TO
> MAINTAIN THE MOMENTUM AND ALLOW THE PATIENTS TO HAVE CONTINUED HOPE. HOPE IS
> DIFFICULT WHEN ALL THE DOCTORS IN US AND CANADA ARE STRUGGLING TO START THE
> TREATMENTS.
>
> I WILL ATTRIBUTE TO YOU OR NOT AS YOU WISH. BUT T NEED YOUR HELP.
>
> GRAZIE
>
> sal

>>> Paolo zamboni Paolo zamboni 05/23/10 4:39 AM >>>
Sal,

I prefer to answer on scientific journals. The real battle is there. Your
IVUS data are more urgent, in my opinion.However please below find an
answer. Please improve the language

The description of the criteria was made to allow anyone to see
abnormalities of the cerebral venous return that had never been seen by
anyone before. The flow anomalies express the presence of vicarious veno-venous
shunts. This is 'the true essence of CCSVI Doppler hemodynamics. Flows
hampered by septa, membranes, valves, show long lasting abnormal reverse
flow in the direction of lessresistance collaterals, with lower flow/minute.
The presence of these abnormalities correlates with catheter venography, the gold standard
The Doppler studies also correlate well:
With lower CSF dynamics
-With the worsening of MRI perfusion parameters
With-iron accumulation in subcortical gray matter

More specifically
Criterion 1 is not to be measured under Valsalva, but refluxes lasting
seconds have to be detected after normal breaths scanning the entire IJV

Criterion 2 is measured with greater reproducibility using the QDP system. this is specialized, a multigate with> 150 Doppler samples

Criteron 3- was adopted to show that sometimes the jugular is so empty of blood that its diameter can not even be measured. It is completely collapsed

Critereon 4 shows the absence of flow. it is just not t Doppler detectable

Criterion-5 shows an abnormality of postural control of venous return

A recent paper demonstrate the need to be trained to this specific Doppler protocol

Nice Sunday
Paolo

do you see a pattern that would lead you to expectations about abrupt improvements? the easy things to imagine would be type of MS, length of disease, etc.

i'm wondering though about the importance of "little veins", ones that MR can't images at 1.2mm and you can't get at with a catheter.

is there enough of a pattern of brain/spinal lesions that would lead you to expect things more specific than spinal -> azygos?

the correlation between CCSVI and MS seems so high, that it might be the people who don't see dramatic changes are the most interesting cases. they may have just as serious an issue with blockage, but at a finer grain.