Interesting read... Maybe neuros are coming around..???

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

Interesting read... Maybe neuros are coming around..???

Postby orion98665 » Sat Aug 25, 2012 8:50 pm

Autonomic dysfunction: A unifying MS theory, linking CCSVI, vitamin D3, and Epstein-Barr virus
Abstract
Multiple sclerosis (MS) is a disease with multiple etiologies. The most recent theory of the vascular etiology of MS, Chronic Cerebrospinal Venous Insufficiency (CCSVI), suggests that cerebral venous obstruction could lead to cerebral venous reflux, promoting local inflammatory processes.

This review article offers strong evidence that the route of the observed narrowing of cerebral veins arises from autonomic nervous system dysfunction, particularly cardiovascular autonomic dysfunction.

The dysfunction of this system has two major effects: 1) the reduction of mean arterial blood pressure, which has the potential to reduce the cerebral perfusion pressure and the transmural pressure, and 2) the failure of cerebral autoregulation to maintain constant cerebral blood flow in the face of fluctuations in cerebral perfusion pressure. Alterations in cerebral autoregulation could in turn raise the critical closure pressure, indicated to be the cerebral perfusion pressure at which the transmural pressure will be sub-sufficient to overcome the active tension imparted by the smooth muscle layer of the vessel. These two effects of autonomic nervous system dysfunction (reduction in arterial blood pressure and alterations in cerebral autoregulation), when combined with inflammation-induced high levels of nitric oxide in the brain, will lower transmural pressure sufficiently to the point where the threshold for critical closure pressure is reached, leading to venous closure.

In addition, cerebral vessels fail to overcome the closure as a result of low central venous pressure, which is also regulated by autonomic nervous system function. Furthermore, through their neuroregulatory effects, infectious agents such as the Epstein-Barr virus and vitamin D3 are able to alter the functions of the autonomic nervous system, influencing the rate of CCSVI occurrence.

The absence of CCSVI specificity for MS, observed in recent clinical studies, may stem from a high prevalence of autonomic nervous system dysfunction in control groups which were recruited to these studies. Future studies should investigate CCSVI in relation to cardiovascular autonomic function.

Abbreviations
ANS, autonomic nervous system; BBB, blood brain barrier; BP, blood pressure; CCSVI, chronic cerebrospinal venous insufficiency; CIS, clinically isolated syndrome; CP, chronic progressive; CrCP, critical closure pressure; EBV, Epstein-Barr virus; EDSS, expanded disability status scale; HR, heart rate; IJV, internal jugular vein; MBP, myelin basic protein; PTA, percutaneous transluminal angioplasty; RR, relapsing remitting; SLE, systemic lupus erythematosus; Vit D, 1,25-dihydroxyvitamin D

Zohara Sternberg, Department of Neurology, Baird MS center, Jacobs Neurological Institute, 100 High St. Buffalo, NY 14203, USA


http://www.msrc.co.uk/index.cfm/fuseact ... pageid/707


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Re: Interesting read... Maybe neuros are coming around..???

Postby Cece » Sat Aug 25, 2012 11:29 pm

This frustrates the heck out of me -- and I think you're right that it is, in a small way, a neuro at least engaging with the idea of CCSVI and coming to a not altogether negative conclusion. But it is so 2009. Back in 2009 there was talk of CCSVI as venous stenosis meaning narrowing of the vein walls. Starting in 2010, we became acquainted with the idea of CCSVI as intraluminal abnormalities. The Fox autopsy study agreed with this, and nearly everything I'm seeing in the images that Dr. Sclafani shares is a bad valve or a septum which are intraluminal abnormalities. So it is frustrating to read the neuro perspective of MS causing venous stenosis through autonomic dysfunction when we are not talking about narrowed veins, we are talking about obstructions within veins blocking the flow.

Even the healthy controls in the Fox autopsy study had venous stenosis equal to what was seen in the MS patients. What they did not have was the intraluminal abnormalities that the MS patients had. It is interesting to talk about the effect of autonomic dysfunction (which is absolutely present in MS patients) on vein walls and on blood flow but it seems to stem from a misunderstanding of what CCSVI is.
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