French Society of Phelbology-CCSVI exists.

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

French Society of Phelbology-CCSVI exists.

Postby cheerleader » Wed Oct 19, 2011 2:53 pm

In Paris, November 17-19, the French Society of Phlebology will have many presentations and discussions on CCSVI--Here is their recent journal publication.
Thanks, Alessandro!
http://www.revue-phlebologie.org/donnee ... hp?cid=274

via google translate:


Editorial:
The presentation of the work of Paolo Zamboni and his team of Ferrara [1] on the origin of the venous sclerosis at the World Congress of UiPàMonaco in September 2009, and various publications of the same team [2] had been a bomb in vascular physicians and neurologists. But that was nothing compared to their effect on the general public!
In practice, the rapid dissemination of information on the web has had a major impact on patients and their associations, and demand for diagnosis and care then exploded.
That multiple sclerosis may be due to a disturbance in the territories venous hemodynamics internal jugular, vertebral, azygos, inferior vena cava or ascending lumbar, and angioplasty of abnormal veins can cause such striking clinical improvement was prodigious.
We had so severely disabled patients face a possible miracle, the response was easy to imagine.

What about two years later?
Many patients have been diagnosed ultra sound and many of them received angioplasty, sometimes with stenting.
Many communications, consumer articles and scientific publications have appeared in the press or on the net, but the subject is still not consensual.
With sinusoidal variations, going from excitement to disappointment and even the harsh criticism of a possible scandal, then back to hope.
It is true that the issues are of importance in this disease severely debilitating, painful, progressive, in other words desperate and for which, to date, drug treatments are - with the exception of corticosteroid during flares [3 ] - disappointing.
To date, however, the situation seems to approach an equilibrium phase because even Neurology published an editorial acknowledging (though granting a limited involvement in MS) [4].

To date, the questions that arise are:
• The venous lesions and venous hemodynamic abnormalities described by Zamboni et al. and others exist?
- In fact, they had already been observed in selective venography and described long enough (Aboulker [5], Leriche [6], Aubin [7]) in association with various neurological diseases.
- Zamboni and colleagues have re-emphasized, they described the Doppler diagnosis and treatment with angioplasty. Some authors deny the possibility of detecting echo-Doppler (ED) [8], but their publications are not based on a methodology satisfactory and most are based on small cohorts and are therefore inconclusive [9].
- We observed these lesions, they exist.
- The recent publication of Zivadinov of 499 subjects [10] shows that there is a higher prevalence of CCSVI in patients with MS and other neurological conditions. The lower incidence and lower specificity of the observed ED Zivadinov compared with the figures of Zamboni princeps can be explained by different detection limits in the ED, a different panel of operators, and also equipment and ED another type of software, especially for transcranial Doppler.
• The pathophysiology of CCSVI and its entanglement with MS (and other neurological conditions) are demonstrated? is it the cause of MS?
- With regard to the mechanisms put forward by Zamboni, such as hemosiderin deposition, histological indisputable arguments exist.
- But there are also other mechanisms, particularly autoimmune and viral cause of disease is certainly multi factorial, the CCIVS acts certainly at least as a factor facilitating / aggravating.
- It's probably not the cause of MS, certainly a contributing factor.
• Treatment with angioplasty (and perhaps surgery) of these lesions is beneficial?
- Initial results and several open studies report very encouraging results, complications of treatment (other than stents, however there are no devices to date specific) are rare in trained hands.
- The cost of angioplasty treatment and side effects compare with those without shame of certain drug treatments of MS such as monoclonal antibodies.
- Do not forget it is in an indication of compassionate type.
- For patients, the prohibition of the procedure - as is the case in some countries - is seen as a scandal.
• What studies should we make?
- First of randomized controlled trials and several are in progress.
- Some authors [11] call for randomized controlled trials, double-blind (SHAM interventions), it would be attractive, but it's pretty questionable ethically, even more difficult to achieve, and therefore full of recruitment bias.
- Asked studies must be added the difficult problem of evaluation criteria and the evolution in time.
• Who can diagnose and treat CCSVI?
- The technical difficulty of the diagnosis as Doppler ultrasound (rather obvious difficulty when analyzing the various conflicting studies) that the selective catheterization of the internal jugular veins and azygos, as well as angioplasty, require extensive training and very good theoretical and practical knowledge.
- Are we sure that all the teams doing their advertising (at discount) on the internet are fully trained and competent?
In total the problem is far from settled but the subject is fascinating and should be exposed with seriousness and professionalism, far from parochial.
We will try to answer all these questions and arguments to the various theories in the form of a communications session and debate during the
Annual Congress of the French Society of Phlebology
Sofitel Vaugirard, Paris, 17-19 November 2011
References
1. Menegatti E., et al. Echo-color-Doppler Criteria for diagnosis of chronic cerebrospinal venous insufficiency, Abstract World IPU meeting, Monaco 2009. (Other presentations without abstracts: Simka M.: CCSVI and Multiple Sclerosis: Theoretical and Practical issues. Haacke M.: Cerebral veins and iron deposits Explored by advanced MRI-SWI. Galeotti R.: Imaging and Endovascular Treatment of CCIVS. Salvi F. : Treatment of CCIVS: clinical results are associated multiple sclerosis).
2. Zamboni P, Galeotti R, Menegatti E, et al. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 2009, 80: 392-9.
3. Goodin, et al. Disease-modifying therapies in multiple sclerosis. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines DS Neurology 2002, 59: 169-80.
4. Fox RJ, Rae-Grant A. Chronic cerebro spinal venous insufficiency: have we found the cause and cure of MS? Neurology 2011, 77: 1-3.
5. Aboulker J., et al. Intraspinal venous hypertension due to multiple anomalies cave system. A major cause of myelopathy. Acta Radiol. 1975, Suppl. 347: 395-401.
6. H. Leriche, Aubin ML, J. Aboulker Cavo-spinal phlebography in myelopathies. Stenosis of the internal jugular veins and azygos. Acta Radiol. 1975, Suppl. 347: 415-7.
7. Aubin ML, et al. Cavo-spinal phlebography in myelopathies of venous origin. Development of the method on 115 cases. Acta Radiol. 1975, Suppl. 347: 403-13.
8. CA Mayer, et al. The perfect crime? CCIVS not leaving a trace in MS. J. Neurol. Neurosurg. Psychiatry 2011, 82: 436-40.
9. Doepp F., et al. No Cerebrocervical Venous Congestion in Patients with Multiple Sclerosis. Ann. Neurol. 2010, 68: 173-83.
10. Zivadinov R., et al. Prevalence, sensitivity and specificity of chronic cerebro spinal venous insufficiency in MS. Neurology 2011, 77: 138-44.
11. Machan L. Is the CCIVS real? Venous News. June 2011, 50: 30.
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: French Society of Phelbology-CCSVI exists.

Postby Ruthless67 » Wed Oct 19, 2011 7:50 pm

Cheer,

Thank you for this post.

I look forward to reading the "answer all these questions and arguments to the various theories."

More pieces of "the puzzle".

Lora
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