Another Important New BNAC CCSVI Study

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Re: Another Important New BNAC CCSVI Study

Postby MSBOB » Tue Nov 15, 2011 7:33 pm

All nerves naturally have myelin, including the optic nerve. The optic nerve is myelinated by oligodendrocytes, like all of the nerves in the CNS.

Inflammation causes the blood brain barrier to open using complex local proteases. VEGF is also created at local inflammation.

There is most definitely a breach in barriers. It is a necessary cause of MS. White blood cells can't pass the blood brain barrier, and are not native to the CNS. That is a well established fact. How does hypoxia cause optic neuritus?

If ccsvi causes optic neuritis, it would be expected that the nerve would appear normal, not inflammed. Also, if the neuritis was from ccsvi, both eyes would more often be effected, rather than one eye being more common.

I never thought about that, but it is not an easy question to answer with ccsvi without inflammation.

I think the high association of optic neuritis supports autoimmune theories more than ccsvi theories.
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Re: Another Important New BNAC CCSVI Study

Postby Cece » Tue Nov 15, 2011 8:20 pm

Venous congestion of the eye may be present in CCSVI. This can be observed directly on the fundus. Dr. Diana Driscoll has a study on this, as well as some presentations. She explains it well.

Is it the retina, not the optic nerve, that is unmyelinated? Hmmm. My pars planitis is worse than my optic neuritis, and that's the one that is an unrelated substance (vitreous) that is inflamed, and it is associated with MS. Dr. Diana's explanation of venous congestion in CCSVI in MS explained the inflammation of the vitreous.

The eye drains into veins that drain into the interior jugular. That fits with the vascular hypothesis of MS.
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Re: Another Important New BNAC CCSVI Study

Postby MSBOB » Tue Nov 15, 2011 9:32 pm

I just went through a presentation by Dr Diana Driscoll. I could see the planitis as being plausible, but not the optic neuritis. It seems that she just threw in ..."and optic neuritis" without explaining how. Planitis is also most commonly associated with inflammation and autoimmune disorders. Dr. Driscoll also brought in the hypothesis of mast cell disease and Ehlers-Danlos Syndrome and said she linked them to ccsvi. I had to look up Ehlers-Danlos Syndrome. (whatever)

Do you not believe in inflammation or something?

This is from Dr. Diana:
We’ve tied together:
-mast cell disease,
-reasons for CCSVI to occur and involve the conversion of collagen 1 to collagen 3; why BBB is leaky,
-what is happening to the arachnoid villi,
-the cause of granulomatous uveitis and pars planitis in M.S. patients,
-why M.S. symptoms can wax and wane, the cause of extreme fatigue and brain fog/dementia, G.I. symptoms, numerous other ocular symptoms; Cause of optic neuritis
(end)

She didn't do hardly any of that. Do you have a link you could share?
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Re: Another Important New BNAC CCSVI Study

Postby cheerleader » Tue Nov 15, 2011 9:37 pm

Dr. Dake made a very important point for the CIRSE conference with his in depth essay on the importance of CCSVI research.

Retinal Vein Sheathing in MS-- the veins of the retina in pwMS become enlarged and thickened and there is damage to the retinal nerves. Without myelin. Again, there is no myelin on retinal nerves, but there is immune activation. The optic nerve, which exits the back of the eyeball, does have myelin. The retinal nerve sheath, inside the eyeball, does not.

Here's Dr. Dake---
Underappreciated in the midst of these clashing positions is one other example of a similar venous lesion with potential relevance to MS – sheathing of retinal veins. This cuffing or sheathing of veins can be appreciated on fundoscopic examination of the eyes and may be associated with retinal vein thrombosis, optic neuritis and vision loss. In the majority of cases when it is diagnosed during an evaluation of disturbed vision, it occurs in patients with MS. Studied extensively at the Mayo Clinic, it is not however singularly associated with cases of established MS. Its frequency among MS patients is estimated to range from 11% to 42%. After fluoroscein dye administration, it is possible to observe leakage of dye around the retinal veins and histologically, the veins display a thickened wall similar to appearances observed in other chronically obstructed venous territories.

When contemplating the possible association between venous obstruction, blood-brain barrier leakage, myelin destruction and immune mechanisms responsible for the initiation of MS, it is interesting to note that the retinal nerve fibres are not myelinated in 99% of the population.


_____________________________________________________________

Lesions that look like MS lesions, occuring on nerves that do not have myelin. Leaking veins....in people who develop MS. "Cuffs" that contain immune cells around these leaking veins.
https://www.facebook.com/notes/ccsvi-in ... 0042067211

RETINAL VENOUS SHEATHING IN OPTIC NEURITIS
ITS SIGNIFICANCE FOR THE PATHOGENESIS OF MULTIPLE SCLEROSIS
S. LIGHTMAN, W. I. McDONALD1,2, A.C. BIRD1, D.A. FRANCIS2,3, A. HOSKINS1,J.R. BATCHOLER3 and A.M. HALLIDAY2
The occurrence of perivenular abnormalities in a region free of myclin and oligodendrocytes provides evidence that the vascular changes in MS can occur independently of contiguous demyelination, and may be the primary event in the formation of a new lesion.

http://brain.oxfordjournals.org/content ... 5.abstract
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dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: Another Important New BNAC CCSVI Study

Postby MSBOB » Wed Nov 16, 2011 2:03 am

Everything suggests that the presence of retinal abnormalities, whenever these may have occurred with respect to the recent onset of optic neuritis, carries the same significance for subsequent clinical conversion as does clinical or laboratory evidence for a lesion outside the visual system; and the retinal vascular abnormalities indicate that the pathological process underling demyelination of the CNS is already active during this inaugural event.


The above is from the oxford pub on the link you left. This is really interesting. Thank you for sharing. I read the whol thing. The case is well made that the retinal abnormalities presented along side optic neuritis have a similar predictive power for future MS diagnosis as finding a lesion on the brain at onset of optic neuritis.

The retinal artery is perhaps inflamed in the abnormal cases. That's why the cuffing is happening, I assume. I can now see the plausibility of ccsvi contributing to optic neuritis. I wonder about the inflammation in context to the cerebral blood flow. During inflammation, the vessels dialate to allow that perivascular cuffing. At the same time the luekocytes are being called in to help protect and repair. Backing up a little, those vessels coming in and out of the eyes are also the same viens responsible for signaling the muscles in the jugulars to speed up or slow down the blood flow to the head. That there is a lot to think about.

Thanks for the friendly conversation and the new links.
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Re: Another Important New BNAC CCSVI Study

Postby cheerleader » Wed Nov 16, 2011 8:33 am

MSBOB wrote: Backing up a little, those vessels coming in and out of the eyes are also the same viens responsible for signaling the muscles in the jugulars to speed up or slow down the blood flow to the head. That there is a lot to think about.

Thanks for the friendly conversation and the new links.


You got it, Bob. First became interested in this angle because my husband never had optic neuritis, but he has drusen (bumps on the optic disc), raised optic discs and he lost his peripheral vision as a kid (10). He has complete tunnel vision. We talked to Dr. Dake about this, and he's consulted with Dr. Diana and other eye specialists. Venous stasis is related to retinal vein sheathing and vision loss like what my husband has. When we saw how damaged his jugular veins were, it all made sense. He has not regained any peripheral vision since venoplasty to fix his jugulars (almost 3 years ago), because that damage has been long-standing. BUT his retinas now look good on his latest OTC scan, and he has no more vision loss progression. It is lots to think about, but know that some great minds, like Dr. Dake and Dr. Driscoll, are putting the pieces together for pwMS. Hope it can help others,
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Re: Another Important New BNAC CCSVI Study

Postby Cece » Wed Nov 16, 2011 8:37 am

cheerleader wrote:Dr. Dake made a very important point for the CIRSE conference with his in depth essay on the importance of CCSVI research.

Retinal Vein Sheathing in MS-- the veins of the retina in pwMS become enlarged and thickened and there is damage to the retinal nerves. Without myelin. Again, there is no myelin on retinal nerves, but there is immune activation. The optic nerve, which exits the back of the eyeball, does have myelin. The retinal nerve sheath, inside the eyeball, does not.

Here's Dr. Dake---
Underappreciated in the midst of these clashing positions is one other example of a similar venous lesion with potential relevance to MS – sheathing of retinal veins. This cuffing or sheathing of veins can be appreciated on fundoscopic examination of the eyes and may be associated with retinal vein thrombosis, optic neuritis and vision loss. In the majority of cases when it is diagnosed during an evaluation of disturbed vision, it occurs in patients with MS. Studied extensively at the Mayo Clinic, it is not however singularly associated with cases of established MS. Its frequency among MS patients is estimated to range from 11% to 42%. After fluoroscein dye administration, it is possible to observe leakage of dye around the retinal veins and histologically, the veins display a thickened wall similar to appearances observed in other chronically obstructed venous territories.

When contemplating the possible association between venous obstruction, blood-brain barrier leakage, myelin destruction and immune mechanisms responsible for the initiation of MS, it is interesting to note that the retinal nerve fibres are not myelinated in 99% of the population.


_____________________________________________________________

Lesions that look like MS lesions, occuring on nerves that do not have myelin. Leaking veins....in people who develop MS. "Cuffs" that contain immune cells around these leaking veins.
https://www.facebook.com/notes/ccsvi-in ... 0042067211

RETINAL VENOUS SHEATHING IN OPTIC NEURITIS
ITS SIGNIFICANCE FOR THE PATHOGENESIS OF MULTIPLE SCLEROSIS
S. LIGHTMAN, W. I. McDONALD1,2, A.C. BIRD1, D.A. FRANCIS2,3, A. HOSKINS1,J.R. BATCHOLER3 and A.M. HALLIDAY2
The occurrence of perivenular abnormalities in a region free of myclin and oligodendrocytes provides evidence that the vascular changes in MS can occur independently of contiguous demyelination, and may be the primary event in the formation of a new lesion.

http://brain.oxfordjournals.org/content ... 5.abstract
cheer

Yes, that was what I was trying to remember!
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Re: Another Important New BNAC CCSVI Study

Postby Cece » Wed Nov 16, 2011 8:48 am

cheerleader wrote:After fluoroscein dye administration, it is possible to observe leakage of dye around the retinal veins and histologically, the veins display a thickened wall similar to appearances observed in other chronically obstructed venous territories.

This part is of interest because of my not-full understanding of Dr. Beggs' presentations at the NY symposium last July. He put out there that, in addition to resistance to flow from the extracranial stenoses in the jugulars, we may have developed resistance to flow within the capillaries of the brain. He offered this as a theoretical explanation for why some patients do not have any improvements after venoplasty. If veins of the brain develop a thickened wall, due to chronic obstruction, that could be the cause of this resistance. I don't know that this thickening can be undone, but that would be a goal if it is indeed part of the problem.

Do the retina veins actually look completely normal again once they've had a chance to heal after CCSVI syndrome has been treated?
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Re: Another Important New BNAC CCSVI Study

Postby cheerleader » Wed Nov 16, 2011 9:07 am

Cece wrote:
Do the retina veins actually look completely normal again once they've had a chance to heal after CCSVI syndrome has been treated?


Good question, Cece. Jeff's do. In fact, the doctor said his retinal nerve fibers looked beautiful and healthy, there was no thinning.... although his optic disc is still scarred from the drusen. Jeff's only had OCT after his venoplasty, however. We didn't know about all of this beforehand, since his drusen showed up in regular eye exams. Dr. Dake wants to follow Jeff's OCT tests, to see if there's more healing ahead.

Note that the rate of retinal thinning is related to brain atrophy, which is why this test is a good biomarker for MS. Jeff's had gray matter atrophy reverse since venoplasty (as documented on MRI.)

Here's more on optical coherence tomography and its use for MS--

A Johns Hopkins-based study of a group of 40 multiple sclerosis (MS) patients used a process called optical coherence tomography (OCT) to scan the layers of nerve fibers of the retina in the back of the eye, which become the optic nerve. The process, which uses a desktop machine similar to a slit-lamp, is simple and painless. The retinal nerve fiber layer is the one part of the brain where nerve cells are not covered with the fat and protein sheathing called myelin, making this assessment specific for nerve damage as opposed to brain MRI changes, which reflect an array of different types of tissue processes in the brain.

Results of the scans were calibrated using accepted norms for retinal fiber thickness and then compared to an MRI of each of the patient's brains - also calibrated using accepted norms. Experimenters found a correlation coefficient of 0.46, after accounting for age differences. Correlation coefficients represent how closely two variables are related -- in this case MRI of the brain and OCT scans. Correlation coefficients range from -1 (a perfect opposing correlation) through 0 (no correlation) to +1 (a perfect positive correlation). In a subset of patients with relapsing remitting MS, the most common form of the disease, the correlation coefficient jumped to 0.69, suggesting an even stronger association between the retinal measurement and brain atrophy.

“This is an encouraging result,” says Johns Hopkins neurologist Peter Calabresi, M.D., lead author of the study, which appears in the October 2007 issue of Neurology. “MRI is an imperfect tool that measures the result of many types of tissue loss rather than specifically nerve damage itself. With OCT we can see exactly how healthy these nerves are, potentially in advance of other symptoms.”

http://www.news-medical.net/news/2007/10/16/31252.aspx
cheer
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dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: Another Important New BNAC CCSVI Study

Postby MSBOB » Wed Nov 16, 2011 9:55 pm

I really like the information from these studies you recently posted. I think obstruction and inflammation of the vascular offer another checken or egg scenario. From past readings, i remember that inflammation has been long suspected to precede infiltration. Also the inflammation itself causes demyelination, compounded by later sensitization of white blood cells to myelin. Then later, the white blood cells have the duel purposes of cleanup and repair. But, some other white blood cells are sensitized and programmed to attacking myelin.

I think it is still difficult to rule out autoimmune, autoregulatory, vascular, or other suspected causes. We can say what we see, and be very conservative about what we associate with MS. I honestly did not expect ccsvi to be defined in a strict enough sense to be a useful term. I now see value in having a paradigm in which to study the vascular impacts of MS. Still, none of the data i have seen have ruled out any suspect causes.
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Re: Another Important New BNAC CCSVI Study

Postby Cece » Wed Nov 16, 2011 11:05 pm

I now see value in having a paradigm in which to study the vascular impacts of MS

what about a paradigm to study the neurological impacts of CCSVI?
I think obstruction and inflammation of the vascular offer another checken or egg scenario.

Have you read up on truncular vascular malformations and intraluminal abnormalities? This is what is proposed as being present in CCSVI. These conditions are congenital in nature, meaning from birth, meaning they came first. What is proposed could still be wrong but I think it's important to discuss CCSVI as it has been proposed. One of the first CCSVI papers I read and understood was the consensus paper stating CCSVI consisted of truncular malformations. There are exceptions to the rule such as the subclavian stenosis caused by a chemo port but rules come before exceptions.
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Re: Another Important New BNAC CCSVI Study

Postby MrSuccess » Wed Nov 16, 2011 11:44 pm

good exchange of ideas and information . As you know , there has been a long held view that -trauma - has been long suspected as the trigger for MS. I suspect that X % of children born ..... suffer some form of neck trauma , in the birthing process.

If you have ever witnessed forcep deliveries ...... you might agree with this point of view.


Has anyone done followup study's on children delivered by the forcep method ?

I do wonder how many go on to have CCSVI ..... then ..... MS.



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Re: Another Important New BNAC CCSVI Study

Postby CureOrBust » Thu Nov 17, 2011 1:53 am

MSBOB wrote:White blood cells can't pass the blood brain barrier, and are not native to the CNS.
I always thought that white blood cells DO cross the BBB, but in a more "controlled" manor. :? I would think PML would be a problem across the board if they did not, and were not "native" to the CNS.
MSBOB wrote:Then later, the white blood cells have the duel purposes of cleanup and repair.

So what would do the clean up if white blood cells do not cross the BBB? MS is not the only kind of brain damage that requires "clean up" by the white blood cells.
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Re: Another Important New BNAC CCSVI Study

Postby ErikaSlovakia » Thu Nov 17, 2011 2:07 am

MrSuccess wrote:good exchange of ideas and information . As you know , there has been a long held view that -trauma - has been long suspected as the trigger for MS. I suspect that X % of children born ..... suffer some form of neck trauma , in the birthing process.

If you have ever witnessed forcep deliveries ...... you might agree with this point of view.


Has anyone done followup study's on children delivered by the forcep method ?

I do wonder how many go on to have CCSVI ..... then ..... MS.



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Aug. 7, 09 Doppler Ultras. in Poland, left Jugul. valve problem, RRMS since 1996, now SPMS,
- Nov.3,09: one stent in the left jug. vein in Katowice, Poland, LDN, never on DMDs
- Jan. 19, 11: control venography in Katowice - negative but I feel worse
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Re: Another Important New BNAC CCSVI Study

Postby Robnl » Thu Nov 17, 2011 3:31 am

I January 2012 i'll get a 2nd Gdx test (Jan2011 was the first) I March 2010 i got an OCT test before treatment. Because the difference in OCT and GDX the eyedoc would not speak out loud, but she thought the gDX looked better than the OCT.

I really hope that the 2nd gdx will look better than the 1st....,fingers crossed
(BTW August 2011 my azygous was dilated)
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