CCSVI associated with PP and SP and duration of disease

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

CCSVI associated with PP and SP and duration of disease

Postby Cece » Mon Aug 06, 2012 10:22 am

http://www.plosone.org/article/info:doi ... ne.0041227
The entire paper is available. Just published 8/3/12.

The research was done by Doppler ultrasound, looking at patients with MS, CIS, other neurological diseases, and healthy controls. The conclusion is that a higher frequency of CCSVI is seen in MS patients, especially those with advanced disease, suggesting that CCSVI could be related to MS disability.

Although the association between CCSVI and MS was statistically significant, the actual number of MS patients found to have CCSVI was unexpectedly low: 28 out of 148, or 18.9%. I see this as more evidence that the Doppler is not the most reproducible or reliable way of measuring CCSVI.
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Re: CCSVI associated with PP and SP and duration of disease

Postby happy_canuck » Mon Aug 06, 2012 9:29 pm

Cece,

The ratio of CCSVI frequency, though, is identical to Dr. Zivadinov's blinded study, which I think was ~58% pwMS and ~22% "healthy" controls. Any blind study where one group is over twice as likely to show something than another has got to be statistically significant (I teach stats!). I agree a strict Doppler protocol is the most conservative measure to assess CCSVI, but if these ratios hold with more sensitive tests, we coud still be looking at ~40% controls when we near 90-95% frequency in pwMS. I think this study also shows that we should always expect -- and be prepared to explain -- why "healthy" cotrols test positive. When I was at ISNVD, Dr. Zivadinov said he found 42 other neurological conditions associated with CCSVI and 7 or 8 of them had equal or slightly higher prevalence than MS.

Fascinating!

~Sandra
National CCSVI Society: <strong><br /><a href="http://tinyurl.com/44znbct">http://tinyurl.com/44znbct</a> ~Website<br /><a href="http://tinyurl.com/3wzmkmg">http://tinyurl.com/3wzmkmg</a> ~Facebook</strong><br />
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Re: CCSVI associated with PP and SP and duration of disease

Postby MarkW » Tue Aug 07, 2012 3:03 am

Interesting data which confirms that CCSVI syndrome is found in neurological conditions. The data which says CCSVI is more prevalent later in the disease confirms another study. I remain at the 'diagnose and treat the syndrome' stage for CCSVI. Where CCSVI fits into neurological and immunological diseases is a question far into the future.
MarkW
Mark Walker - Oxfordshire, England. Registered Pharmacist (UK). 11 years of study around MS.
Mark's CCSVI Report 7-Mar-11:
http://www.telegraph.co.uk/health/8359854/MS-experts-in-Britain-have-to-open-their-minds.html
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Re: CCSVI associated with PP and SP and duration of disease

Postby masci » Tue Aug 07, 2012 7:47 am

Cece, 19.6% of positive CCSVI is ridiculous. Authors correctly say "A higher frequency of CCSVI has been found in MS patients", as the percentage of the healthy control group is 5%.
Furthermore, they suggest that "CCSVI could be related to MS disability" and not vice versa.
"CCSVI was significantly more frequent among MS subjects with a disease duration longer than 144 months (26.1% versus 12.6% of patients with duration shorter than 144 months; p = 0.03) and among patients with secondary progressive (SP) and primary progressive (PP) forms (30.2% and 29.4, respectively) than in patients with relapsing remitting (RR) MS (14.3%)".
The usual 'chicken and egg' problem.
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Re: CCSVI associated with PP and SP and duration of disease

Postby questor » Tue Aug 07, 2012 9:28 am

masci wrote:"CCSVI was significantly more frequent among MS subjects with a disease duration longer than 144 months (26.1% versus 12.6% of patients with duration shorter than 144 months; p = 0.03) and among patients with secondary progressive (SP) and primary progressive (PP) forms (30.2% and 29.4, respectively) than in patients with relapsing remitting (RR) MS (14.3%)".

I predict that eventually a connection will be made between CCSVI and MS disease activity in the brain stem and medulla.

One of the functions of the medulla is vasomotor control of the body, which includes blood vessel diameter and blood flow. Lesions in this area of the brain could have a direct causal relationship with vascular stenosis.

--Tracy
CCSVI Procedure 9/16/2009 at Stanford
Stent in left and right IJVs
SPMS
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Re: CCSVI associated with PP and SP and duration of disease

Postby cervocuit » Thu Aug 16, 2012 1:49 am

This is the new device in 3D, developped by Pr. Zamboni himself, to detect CCSVI 100% of the time.
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Re: CCSVI associated with PP and SP and duration of disease

Postby cheerleader » Thu Aug 16, 2012 7:04 am

This study, with lead investigator Patti, is part of the larger COSMO study. This group decided against using the protocol developed by Dr. Zamboni in 2010, and is being headed up by Comi---an Italian neurologist who is a very outspoken opponent of CCSVI studies. His ECTRIMS presentation last year was mentioned in the Italian press for his vitriol.
During ECTRIMS 2011, which was held in Amsterdam October 19 to 22, a prominent Italian neurologist told the press that "the frequency of CCSVI was confirmed in less than 10% of pwMS" and "already the interim analysis of the COSMO study has completely deflated the hypothesis that CCSVI is a significant cause or significant contibuting factor in MS."

These statements have generated considerable buzz that they were not supported by any posters or abstracts the researchers normally present during the conference, and that the doctor who issues this statement is a relentless opponent of the theory of Professor Zamboni and has a major conflict of interest because of his relationships with pharmaceutical companies, which is easy to document.

All of this raises a number of important questions about the validity and fairness of the COSMO study, which was funded by the Italian Multiple Sclerosis Foundation , which over a year ago saw the controversy of the resignation of Dr. Zamboni from the scientific committee. The discoverer of CCSVI resigned because of failure of the commitee to comply with his diagnostic protocol.

Perhaps it would be useful to carefully reflect on the subject by the Scientific Committee of the AISM in the interest of patients and their families.
http://mediterranews.org/2011/10/metodo ... -dellaism/

This is only one location out of fifty in the COSMO study, and we can expect similar papers in the coming months.
http://clinicaltrials.gov/ct2/show/NCT01384825

(As fas as Tracy's posit--it may be in some cases, but Jeff has no medulla or brainstem involvement. He did have optic disc swelling and possible CSF and blood stagnation which is now gone, and his slight gray matter atrophy (as shown by enlarging ventricles) has reversed. His case looked more like normal pressure hydrocephalus (as indicated by papilladema) which resolved with stenting, but it may be different for others.) See the Dr. Frohman, NPH thread for more info.

This is obviously, a case by case situation---and there seem to be many different presentations. More research is essential. There are exciting discoveries being made every day.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: CCSVI associated with PP and SP and duration of disease

Postby cervocuit » Thu Aug 16, 2012 7:46 am

cheerleader wrote: This group decided against using the protocol developed by Dr. Zamboni in 2010, ...
I read the opposite in the study description...
ECD and TCC ultrasonographies were performed by a single experienced vascular sonographer who attended a course on CCSVI held by Dr Zamboni at the University of Ferrara in 2011. In order to correctly apply the ECD ultrasonograph Zamboni’s criteria for the diagnosis of CCSVI, before the beginning of the study, he also received a further training at the same University.

A GE Vivid E Ultrasound system (GE Healthcare, Horten, Norway), equipped with a 8L-RS (4–12 MHz) linear array transducer was employed for the study of internal jugular vein (IJV) and vertebral veins (VVs) while a 3S-RS Sector Array Probe (1.5–3.6 MHZ) was used for the study of the deep cerebral veins (DCVs). Furthermore a special C-RS Microconvex Ultrasound Probe was used to study internal jugular veins (IJV) under clavear points.

Following the Zamboni’s procedures [7], the exam comprised orthostatic and clinostatic evaluations of both the IJV and vertebral veins (VVs), and the direction of the flow in the internal cerebral vein, the vein of Rosenthal and the vein of Galeno.

The following five parameters were evaluated for each case and control subjects

Reflux in the IJV and/or VVs in sitting and supine posture;
Reflux in the DCVs;
High-resolution B-mode evidence of IJV stenosis;
Flow not Doppler detectable in the IJVs and/or VVs;
Reverted postural control of the main cerebral venous outflow pathways.

In agreement with literature data, presence of CCSVI was defined as the presence of at least two out of the five parameters [7].
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