no CCSVI in Israeli study

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

no CCSVI in Israeli study

Postby eric593 » Tue Aug 09, 2011 9:51 am

J Neurol Sci. 2011

Aug 3. [Epub ahead of print]

Extra-cranial venous flow in patients with multiple sclerosis.

Auriel E, Karni A, Bornstein NM, Nissel T, Gadoth A, Hallevi H.SourceStroke Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Abstract

INTRODUCTION: Recently, a chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI) was claimed to be a pathologic condition exclusively seen in patients with multiple sclerosis (MS), suggesting that cerebral venous congestion plays a significant role in the pathogenesis of MS. This hypothesis has gained enormous attention among patients and physicians but has been questioned since.

METHODS: Twenty seven patients with MS and 32 healthy controls underwent color extra cranial Doppler exam aimed to detect four parameters of abnormal venous flow: no Doppler-detected flow in the IJV or vertebral veins (VV), reflux in the internal jugular veins (IJVs), venous flow stenosis in the IJVz (cross sectional area <0.3cm) or reverted postural control in the IJV.

RESULTS: Except for one healthy patient, blood flow direction in the IJVs was normal in all subjects. When aiming to detect at least one parameter of abnormal venous flow per subject, two parameters or three parameters no significant difference was found between subjects and controls (p=0.707, 0.62, 0.849 respectively).

CONCLUSION: We found no evidence to suggest that MS patients have excess of CCSVI. In addition we failed to observe a typical venous flow pattern in MS patients. Until carefully designed controlled studies to investigate CCVSI have been completed, invasive and potentially dangerous endovascular procedures as therapy for MS should be discouraged.


http://www.ncbi.nlm.nih.gov/pubmed/21820131
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Postby Cece » Tue Aug 09, 2011 10:36 am

Twenty seven patients with MS and 32 healthy controls underwent color extra cranial Doppler exam aimed to detect four parameters of abnormal venous flow: no Doppler-detected flow in the IJV or vertebral veins (VV), reflux in the internal jugular veins (IJVs), venous flow stenosis in the IJVz (cross sectional area <0.3cm) or reverted postural control in the IJV.

By this definition, my right jugular which was 80% stenosed would not have counted as stenosed.

(The CSA of my valve opening was 33 mm which is 3 mm larger than .3 cm. The CSA of the vein itself was 149 mm thus the 80% stenosis.)

EDIT CORRECTION: I calculated 0.3 cm as being 30 mm but really it is 3 mm. That means my 80% stenosed right jugular was still 30 mm2 greater than it needed to be considered stenosed. My 99% stenosed left jugular would count but not by all that much. Could this be a misprint in the article, since it calls it CSA but does not use a mm2 or cm2 as the unit of measurement, as noted by jimmylegs later on?
Last edited by Cece on Thu Aug 25, 2011 8:42 am, edited 1 time in total.
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Postby eric593 » Tue Aug 09, 2011 12:11 pm

Cece wrote:
venous flow stenosis in the IJVz (cross sectional area <0.3cm) or reverted postural control in the IJV.

By this definition, my right jugular which was 80% stenosed would not have counted as stenosed.

(The CSA of my valve opening was 33 mm which is 3 mm larger than .3 cm. The CSA of the vein itself was 149 mm thus the 80% stenosis.)


I believe this is Dr. Zamboni's reference value for his CCSVI criteria of stenosis. This study merely followed his definition of the criteria for CCSVI diagnosis and did not go beyond it. His value was based on prior research on vein size and asymmetry and variations.
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Re: no CCSVI in Israeli study

Postby fogdweller » Wed Aug 10, 2011 4:10 pm

eric593 wrote:J Neurol Sci. 2011

Aug 3. [Epub ahead of print]

Extra-cranial venous flow in patients with multiple sclerosis.

Auriel E, Karni A, Bornstein NM, Nissel T, Gadoth A, Hallevi H.SourceStroke Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Abstract

INTRODUCTION: Recently, a chronic state of impaired venous drainage from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI) was claimed to be a pathologic condition exclusively seen in patients with multiple sclerosis (MS), suggesting that cerebral venous congestion plays a significant role in the pathogenesis of MS. This hypothesis has gained enormous attention among patients and physicians but has been questioned since.

METHODS: Twenty seven patients with MS and 32 healthy controls underwent color extra cranial Doppler exam aimed to detect four parameters of abnormal venous flow: no Doppler-detected flow in the IJV or vertebral veins (VV), reflux in the internal jugular veins (IJVs), venous flow stenosis in the IJVz (cross sectional area <0.3cm) or reverted postural control in the IJV.

RESULTS: Except for one healthy patient, blood flow direction in the IJVs was normal in all subjects. When aiming to detect at least one parameter of abnormal venous flow per subject, two parameters or three parameters no significant difference was found between subjects and controls (p=0.707, 0.62, 0.849 respectively).

CONCLUSION: We found no evidence to suggest that MS patients have excess of CCSVI. In addition we failed to observe a typical venous flow pattern in MS patients. Until carefully designed controlled studies to investigate CCVSI have been completed, invasive and potentially dangerous endovascular procedures as therapy for MS should be discouraged.


http://www.ncbi.nlm.nih.gov/pubmed/21820131


Wow. Very interesting. The evidence on pervasivness of CCSVI in MS vs. nonMS patients was quite varied in different studies, from 100% vx 54%, but this is the only study I've seen that says no difference at all. In fact, it is not clear if in 59 patients, if any, or maybe all, had CCSVI (except reversed blood flow in the IJV. That only existed in one healthy.)This is very negative, of course, but seems at odds with all the studies that showed at least some difference, the disagreement seemed to be over the amount of difference.
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Isn't an Israeli Thing

Postby Squeakycat » Wed Aug 24, 2011 9:39 am

It isn't that Israelis with MS are different than those elsewhere.

In spite of the findings of this study, a number of Israelis have been abroad for CCSVI treatment and were found to very clearly have venous malformations of the type described by Zamboni and it is all nicely documented on Venography CDs, not that information like that would be of any interest to those who are hellbent on disproving CCSVI exists.
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Postby MrSuccess » Wed Aug 24, 2011 11:43 am

oh dear ....what a coincidence ..... this anti-CCSVI study-report comes out of Israel ........ which as we know ....... also is the homebase of a very large and powerfull Big Pharma MS drug company.

Their product [ drug for MS ] was and is ......faultering in the market.

like I said ....... gee ........ what a coincidence. :twisted:

It's a smaller town than you think .......

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Postby jimmylegs » Thu Aug 25, 2011 6:54 am

why are CSA measurements not in units squared?
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Postby cheerleader » Thu Aug 25, 2011 8:02 am

jimmylegs wrote:why are CSA measurements not in units squared?


huh. Good question, JL. I'm not sure about how Dr. Zamboni figures cross sectional areas in veins...if he uses the circle equation Circle = (pi)r^2
but it's math, and gives me hives. Maybe Cece knows.

As far as this new study, Dr. Zivadinov addressed most of the new negative studies in his review published yesterday. He states that until there is an accepted method of measuring, and trained technicians, these studies are just showing how variable and subjective doppler technology is.
There is an urgent need to define and validate the spectrum of cranial/extracranial venous anomalies and to establish reliable, diagnostic gold-standard test(s).

http://www.thisisms.com/ftopict-17676.html
It's a really good paper....worth the $. He does the whole history, all of the studies and what he and Dr. Zamboni have learned, in 12 pages.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby Cece » Thu Aug 25, 2011 8:32 am

CSA should be measured in mm2 (mm squared). I am not sure why the article didn't note that. I see that in my post too I wrote mm instead of mm2. I was busy focusing on the conversion of cm to mm! I put .3 cm as being 30 mm but shouldn't .3 cm be 3 mm? Oy.

CSA = pi * r * r

pi = 3.14
r = radius
* = times
CSA = cross sectional area
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Postby MrSuccess » Thu Aug 25, 2011 1:30 pm

I'm ruling out Cogfog in your case , Cece. :wink:


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Postby jimmylegs » Thu Aug 25, 2011 2:09 pm

the 33 thing was what made me notice the units. i was like no wait, it's 30mm off not 3mm off. and then i looked at 149mm and i was like whaaat 14.9 cm??? lol that's almost 6 inches.

so the CSA of 149mm2 is a circle approximately 14mm diameter, and a CSA of 33mm2 is a circle just under 7mm diameter.

to get below 0.3cm2, aka 30mm2 the vein can only have a diameter of a just over 6mm.

EDIT: i screwed up with the units squared conversions, duh. thanks NHE :) should have seen it. fixed now!
Last edited by jimmylegs on Fri Aug 26, 2011 6:49 am, edited 1 time in total.
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Postby Cece » Thu Aug 25, 2011 5:47 pm

Here are average jugular sizes, in comparison:
The mean size of the IJV was 1.42 ± 0.344 cm (range 0.5–2.2) on the right side and 1.22 ± 0.379 cm (range 0.33–2.4) on the left side. Overall, the right IJV was significantly larger than the left IJV (P < .001). There was no difference in the size of the veins between the two study groups. The mean IJV size on the right was 1.48 cm in men and 1.27 cm in women; the corresponding figures for the left side were 1.37 cm and 1.17 cm. The vein was significantly larger in men than in women on both sides (P < .05).

www.ncbi.nlm.nih.gov/pmc/articles/PMC1421212/

I've been saying that the mean size of a jugular is 1 cm but here it's larger than that at 1.42 and 1.22.

To get an average sized 14.2 mm vein down to 2 mm, it must be 86% stenosed. On the left side, to get a 12.2 vein down to 2 mm, it must be 84% stenosed.
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Re: no CCSVI in Israeli study

Postby frodo » Fri Aug 26, 2011 6:54 am

eric593 wrote:
... invasive and potentially dangerous endovascular procedures as therapy for MS should be discouraged.


http://www.ncbi.nlm.nih.gov/pubmed/21820131[/quote]

Are they trying to stablish a relationship between MS and CCSVI or trying to educate people about what they think is a good behavior? Comments like this in a serious scientific article should never appear. It is not the right place. If they want educate people, a divulgative TV program would be more appropiated.

About their results, maybe they claim that Zivadinov has psychic superpowers, as he is able to deduce MS just looking at the veins in blinded studies and they claim that it is not because the blood flow.
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Postby jimmylegs » Fri Aug 26, 2011 6:55 am

my bad cece, i should have said approx 6mm (a little over). brain fart. that takes the % stenosis down a ways.
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Postby Cece » Fri Aug 26, 2011 10:33 am

6 mm? That is practically roomy.
6 mm to an average vein size of 14.2 mm is a 58% stenosis.
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