OK...two negative studies, the same two studies we've been discussing on here for three months. Nothing new, nothing has changed...they're just getting regurgitated in the press now.
1. German/Doepp/Doppler Study:
In the current issue of the Annals, Florian Doepp, M.D., and colleagues in Germany performed an extended extra- and trans-cranial color-coded sonography study on 56 MS patients (36 female; 20 male) and 20 control subjects (12 female; 8 male). The analysis included extra-cranial venous blood volume flow (BVF), internal jugular vein (IJV) flow analysis during Valsalva maneuver (VM), as well as tests included in the CCSVI criteria.
As I've said before, the problem with the Doepp study was position of the doppler wand. It assessed jugular vein narrowing in the “sagittal” plane (the ultrasound probe is placed parallel to the length of the vessel). The Zamboni technique uses the “transverse” plane ( the probe is placed at a 90 degree angle to the length of the vessel) to look for narrowing, webs, or abnormal valves that Dr. Zamboni believes are often missed in the sagittal plane examination.
If the wand is used in the sagittal manner--it picks up collateral flow...that's how the doppler technician at Stanford gave Jeff a "normal" result, but MRV showed it was a tortuous collateral, not the jugular vein (which was 95% gone) taking the blood back.
Here's Dr. Brandes on it--via Dr. Zamboni: http://healthblog.ctv.ca/post/When-stud ... mples.aspx 2. Amsterdam/VU/MRV study
The problem with the VU (all MRV) study was addressed by Dr. Roel Beelen of Belgium. He questioned the statistical significance of a small study and the independence of the researchers.
He wrote an open letter to the VU-team, questioning the statistical power and the method of their research. Dr. Beelen MD, checked 107 patients with MS and discovered ccsvi in about 90% of the cases. He also did treatment, including some stents. No complications. Publication will follow later.
Here is his letter---and the link to the thread discussing this on ThisIsMS.com http://www.thisisms.com/ftopic-11029-15.html
"Through a journalist my attention was just drawn to a report in a Dutch current affairs program on CCSVI.
In this report, there are quite a few disturbing elements.
1. They conclude from a very limited group of 20 people that there is no causal link. I wonder, what's the objective "statistical power" of a series of 20 patients.
2. The evaluation of the 20 patients, was it all done by the same team? Were the results independently verified?
Although our series is a long follow-up, I would like to show some results of our series of patients:
107 patients with confirmed MS were screened for CCSVI, in 97 patients CCSVI non-invasive (CT, Duplex) diagnosed (independently diagnosed by vascular surgeon and radiologist).
* 64-balloon dilatation
* 2 Valvulotome
* 8 cutting balloon
* 7 stenting
29 patients are monitored, using Doppler and using an internationally validated questionnaire (MSQOL-54 instrument) and after treatment as reported by every individual of these 29 patients, the quality of life has improved. Statistically, this is even more significant.
When the last patient in this group has reported, (one year follow up) results will be openly published.
Despite these figures both by us and in other centers, how can you, with a much smaller number of patients, go on saying that there is no link between MS and CCSVI? Would't it be logical to consider this theory, because of the spectacular results? Currently I still believe that CCSVI may not be the primary cause of MS, but in certain forms of MS it surely plays a very important role in the development of MS. I therefore call for a comprehensive inter-disciplinary dialogue so that the MS patients by a combination of classical pharmacological treatment and interventional treatment, can get the optimal treatment of the moment.
Roel Beelen, M.D.
We could go back and forth forever...and there will be studies saying aye and studies saying nay. Dr. Brandes' column (linked above) explains this eloquently. My main concern is that when the vascular doctors publish their studies, will they receive the same media and medical community publicity?
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
dual stents placed 5/09
CCSVI in MS