other ECTRIMS papers

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

other ECTRIMS papers

Postby Cece » Tue Oct 25, 2011 5:35 pm

http://www.medpagetoday.com/MeetingCove ... RIMS/29266
One study presented at the joint meeting of the European and Americas Committees for Treatment and Research in Multiple Sclerosis, found that eight of 15 children with pediatric MS had venous abnormalities when examined with magnetic resonance venography.

Another, conducted in 45 healthy controls and 133 adult MS patients, found signs of CCSVI in about half the patients -- but also in one-third of the controls.

The other studies all either failed to find CCSVI at all in their participant groups, or it was equally distributed between patients and controls.

The latter included one of the largest studies reported so far, with 160 MS patients and 160 healthy controls. Transcranial echo-color Doppler sonography indicated possible CCSVI in 16 patients, but venography found stenoses in only two patients.
For example, a study by Robert Fox, MD, and other researchers at the Cleveland Clinic found that CCSVI-like sonography findings were exquisitely dependent on how the evaluation is carried out.

Interim findings on 42 individuals (including unstated numbers of MS patients and controls) found that 26% had venous reflux when examined with Quality Doppler Profiles technology, but traditional transcranial Doppler scans did not show reflux.

Also, scanning people when seated rather than lying down made a big difference in findings. The study also found that 60% of participants had some type of structural venous abnormality, such as a flap or septum.

It would be interesting to hear how Dr. Fox's opinions on CCSVI might evolve. His own research has been finding intraluminal abnormalities, both in this mentioned study and his autopsy study.
Cece
Family Elder
 
Posts: 9009
Joined: Mon Jan 04, 2010 4:00 pm

Advertisement

Re: other ECTRIMS papers

Postby Cece » Tue Oct 25, 2011 5:38 pm

Doctors at Mutua Terrassa University Hospital near Barcelona described a patient who suffered femoral venous thrombosis and pulmonary embolism three days after having a bilateral balloon angioplasty of the jugular veins in another country.

The patient survived but suffered brain damage that "continues deteriorating," the authors indicated.

This is the second report of a femoral venous thrombosis that I have heard (the other one being anecdotally from a TiMS member).

Can a pulmonary embolism lead to brain damage? I don't think a femoral vein thrombosis can.

Best hopes to the patient for healing.
Cece
Family Elder
 
Posts: 9009
Joined: Mon Jan 04, 2010 4:00 pm

Re: other ECTRIMS papers

Postby Cece » Tue Oct 25, 2011 5:41 pm

For example, researchers from Heinrich Heine University in Duesseldorf, Germany, evaluated one implication of the CCSVI theory -- that if cerebrospinal venous outflow is low or reversed, then pressure within those veins should be increased.

But ophthalmodynamometry showed that intracranial venous pressure was equal in 30 MS patients and 30 controls.

Now I have a question for DrDiana! What is ophthalmodynamometry?
Cece
Family Elder
 
Posts: 9009
Joined: Mon Jan 04, 2010 4:00 pm

Re: other ECTRIMS papers

Postby Cece » Tue Oct 25, 2011 5:44 pm

Florian Doepp, MD, of Humboldt University in Berlin, took the first shot, outlining what he said were the methodological flaws in Zamboni's initial reports -- such as lack of evaluator blinding -- and the failure to replicate Zamboni's results in multiple independent attempts.

"There is no evidence for CCSVI in MS [and] no evidence for venous angioplasty or stent implantation in MS," he declared.
Proponents of CCSVI and therapies based on it were not much in evidence at ECTRIMS. During the question and answer session following Doepp's presentation, one audience member said it was unbalanced and had given short shrift to other studies that tended to support the CCSVI concept.

For the proponents, you have to come to ISNVD.
Cece
Family Elder
 
Posts: 9009
Joined: Mon Jan 04, 2010 4:00 pm

Re: other ECTRIMS papers

Postby Cece » Tue Oct 25, 2011 5:51 pm

[Aaron Miller, MS, of Mount Sinai School of Medicine in New York City] suggested that the subsequent failures by others to replicate the findings might have put the theory quickly to rest, but the consumer press had already given glowing coverage to Zamboni's reports and patients began demanding evaluation and then treatment.

Miller also identified online chatrooms and blogs as keys to fueling popular support for the CCSVI theory.

Who, us?
We disseminated the information to IRs across the country and the globe. We intrigued IRs into looking, and they saw for themselves what was there to be seen.
We're pretty awesome, and so are our IRs.
Cece
Family Elder
 
Posts: 9009
Joined: Mon Jan 04, 2010 4:00 pm

Re: other ECTRIMS papers

Postby Cece » Tue Oct 25, 2011 5:53 pm

None of the CCSVI-related studies had industry funding. The studies at the Cleveland Clinic were supported by the National MS Society.

None of the CCSVI-related studies had industry funding.
Funding still has to come from somewhere, and I believe CCSVI research is underfunded.
Cece
Family Elder
 
Posts: 9009
Joined: Mon Jan 04, 2010 4:00 pm

Re: other ECTRIMS papers

Postby Cece » Tue Oct 25, 2011 5:56 pm

http://registration.akm.ch/einsicht.php ... KEN_ID=900
Ultrasound assessment of chronic cerebrospinal venous insufficiency
R. Fox, L. Baus, C. Diaconu, A. Grattan, I. Katzan, S. Kim, M. Lu, L. Raber, A. Rae-Grant (Cleveland, US)

--------------------------------------------------------------------------------
Background: Chronic cerebrospinal venous insufficiency (CCSVI) is a new theory of MS pathogenesis involving alterations in extracranial and intracranial venous outflow. Proposed diagnostic criteria for CCSVI is derived from ultrasound assessments, although different studies have found varying incidence of MS patients and non-MS controls meeting CCSVI criteria.

Objective: To perform an independent, blinded study of CCSVI in MS and non-MS controls.

Methods: After obtaining formal training in ultrasound assessment for CCSVI, we performed CCSVI assessment in MS and non-MS controls. All ultrasounds were conducted using a Biosound MyLab25Gold machine, which included Quality Doppler Profiles (QDP) technology for assessment of flow in the deep cerebral veins. The internal jugular, vertebral, and deep cerebral veins were assessed in both supine and sitting positions. Both QDP and traditional Doppler were used to assess intracranial venous flow in the deep cerebral veins. Ultrasound technicians were blinded to diagnosis, including the use of separate research staff to position patients prior to arrival of the technician. All ultrasounds were over-read by a trained physician, who was also blinded to the MS diagnosis.

Results: The study is ongoing, but initial pooled results from the first 20 subjects found that 6 (30%) met >=2 criteria for CCSVI. 1 subject met 3 criteria. Four subjects met no criteria. No subjects met criteria for reverted postural control of cerebral venous outflow. Nine subjects (45%) had a flap and/or septum/abnormal valve. No flow in the IJV was observed in only one patient. Deep cerebral vein reflux was observed in 7 (35%) of subjects using QDP, but never using transcranial color Doppler (TCCD).

Additional ultrasound evaluations are ongoing, and results according to diagnosis (MS vs. non-MS controls) will be presented.

Conclusion: Initial pooled results found that 30% of subjects met criteria for CCSVI. A high proportion of subjects (45%) had valvular or intraluminal abnormalities on B-mode. Surprisingly, no subjects were found to have reverted postural control. Identification of deep cerebral vein reflux depended upon the ultrasound technique: QDP found reflux in half of subjects, but traditional Doppler found reflux in none. This observation highlights the importance of ultrasound methodology in performing and interpreting deep cerebral vein assessments. Ongoing studies will help clarify the potential relationship between CCSVI and MS.
Cece
Family Elder
 
Posts: 9009
Joined: Mon Jan 04, 2010 4:00 pm

Re: other ECTRIMS papers

Postby Cece » Tue Oct 25, 2011 5:58 pm

http://registration.akm.ch/einsicht.php ... KEN_ID=900

CCSVI prevalence in a northern Italian population of MS patients and controls
P. Cavalla, M. Vercellino, M. Matta, A. Romagnolo, A. Mattioda, S. Masera, F. Dematteis, L. Di Maggio, D. Rossato, G. Gandini, L. Lopiano, L. Pinessi (Turin, IT)

--------------------------------------------------------------------------------
Introduction: Recent studies assessing chronic cerebrospinal venous insufficiency (CCSVI) prevalence by means of venous ecocolordoppler (ECD) in MS patients and controls have led to widely variable and conflicting results (1, 2, 3). In this study, we wished to assess CCSVI prevalence in a population of MS patients and controls from Northern Italy, with a blinded ECD study design.

Materials and method: This study was performed on 45 healthy subjects (HS) and 133 MS patients (relapsing –remitting MS 79.7%, secondary progressive MS 18.0%, primary progressive MS 1.5%, CIS 0.8%). Median age was 38 years in HS (range 21-64), 40 years in MS patient (range 23-70). An informed consent was obtained for all MS patients and HS. ECD was performed by experienced and trained sonologists, blinded to patient/control status, using an Esaote Vinco Lab scanner. CCSVI Zamboni’s criteria (1) were used; a sonologic pattern of CCSVI was considered present when two out of five criteria were fulfilled. Venous hemodynamic insufficiency severity score (VHISS) was also evaluated.

Results: CCSVI was present in 33,4% of HS and 53.4% of MS patients (p = 0.02). No significant differences were noted between CCSVI and non- CCSVI MS patients regarding gender, disease duration, age, age of onset, EDSS, disease course. Mean VHISS was higher in secondary progressive MS (3.12 vs 2.29; p = 0.015) than in relapsing-remitting MS; a weak correlation between VHISS and EDSS was also observed.

Discussion and conclusion: In our population, CCSVI assessed by ECD appears to be more frequent in MS patients than in controls; however, CCSVI is found in more than one third of normal controls. These data are similar to those obtained with a similar protocol in a larger North American population (3). The issue of anomalous venous drainage in MS needs to be further clarified, also evaluating patients affected by other neurological diseases. The high frequency of CCSVI also in healthy controls suggests poor specificity of the current CCSVI criteria. [Epub ahead of print]
Cece
Family Elder
 
Posts: 9009
Joined: Mon Jan 04, 2010 4:00 pm


Return to Chronic Cerebrospinal Venous Insufficiency (CCSVI)

 


  • Related topics
    Replies
    Views
    Last post

Who is online

Users browsing this forum: No registered users


Contact us | Terms of Service