BNAC venoplasty trial--improvement in CSF flow

[cheerleader]

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


Linked above is the abstract for part of the one year results from the BNAC CCSVI study, as to be presented at the ECTRIMS meeting in France.
This particular study looked at pwMS and CCSVI who were treated with venoplasty.
There were two groups studied--ALL were given venoplasty.
One group was treated immediately, or the "immediate treatment group" of 8 --ITG
the second group was treated six months later, or the "delayed treatment group" of 7--DTG


Please note that this study is not looking at how venoplasty affects MS symptoms, or MS progression. It is simply looking at what happens to cerebrospinal fluid velocity in the brain. This is a very important area of study, because it is a tangible, measurable change in brain perfusion. We are now learning how CSF movement is essential for brain health, and how detrimental CSF stasis, or lack of movement, can harm the brain.


Here is a study from Dr. Zamboni from the beginnings of his research, where he noted that the severity of CCSVI was related to alterations in cerebrospinal fluid dynamics.
http://www.ncbi.nlm.nih.gov/pubmed/20018140


Here's a breakdown of the abstract--

Chronic cerebro-spinal venous insufficiency (CCVI)
Thursday, October 11, 2012, 15:30 - 17:00
Cine cerebrospinal fluid imaging changes in patients with multiple sclerosis after venous angioplasty. A 1-year follow-up study
R. Zivadinov, C. Magnano, R. Galeotti, C. Schirda, B. Weinstock-Guttman, E. Menegatti, J. Hagemeier, A.M. Malagoni, D. Hojnacki, C. Kennedy, I. Bartolomei, C. Beggs, F. Salvi, P. Zamboni (Buffalo, US; Ferrara, IT; Bologna, IT; Bradford, UK)

Background: Chronic cerebrospinal venous insufficiency (CCSVI) is associated with multiple sclerosis (MS). Percutaneous transluminal angioplasty (PTA) of duplex-detected lesions (in the internal jugular and/or azygos veins) was previously applied in a pilot study of 15 MS patients to preliminarily assess whether PTA reduced MS disease activity, when used in addition to standard medical treatment. The higher percent brain volume change decrease over the first 6 months (-1.27%) in the immediate treatment group (ITG) suggested a more pronounced pseudoatrophy effect compared with the delayed treatment group (DTG) (-0.57%), possibly because of a potential anti-inflammatory effect of PTA or alternatively, due to a decrease in brain volume or improvement in cerebrospinal fluid (CSF) flow because of better venous drainage following angioplasty.

--This is an important thing BNAC noted. The immediate affect of venoplasty in the ITG group was to cause a small and temporary brain volume decrease--they call it "pseudoatrophy" because it isn't real brain tissue loss, it's just that the brain temporarily appears smaller due to increased cerebrospinal fluid flow and better venous drainage. (Jeff and I know about this from his firsthand experience. He had some nasty headaches after venoplasty at Stanford, which could be relieved when he lay down. These positional headaches were no doubt due to the change of fluid levels in his brain. As Dr. Dake said to him, it's as though his brain became a wrung out sponge---the fluid levels were being altered, and he was getting CSF headaches. Eventually, the headaches became less regular, and then disappeared. And he has no signs of any brain atrophy.)

Objectives: To investigate changes in cine cerebrospinal fluid (CSF) pulsatile flow and velocity measures in patients with relapsing-remitting (RR) MS who underwent venous angioplasty. Methods: This was a prospective cohort study, that included 15 patients with RRMS and duplex-detected CCSVI. Eight patients had PTA in addition to medical therapy (ITG) immediately following baseline assessments, while 7 had delayed treatment with PTA after 6 months of medical therapy alone (DTG).

CSF pulsatile flow and velocity measures were quantified over 32 phases of the cardiac cycle, using a semi-automated method. These outcomes were compared between ITG and DTG at baseline, 6 and 12 months of the study.

This explains the objective, or reason for the study. BNAC wanted to look at how cerebrospinal fluid flowed throught the brain during the cardiac cycle. They measured this on MRI during the phases of one complete filling and then emptying of the heart with blood.

Results: At baseline, there were no significant differences between ITG and DTG in CSF pulsatile flow (p=0.474) or velocity (p=0.714) measures. However at month 6, significant improvement in CSF pulsatile flow (p<0.001) and velocity (p=0.013) was detected in the ITG compared to DTG. T

When they started, before treatment at baseline measurements, all of the 15 patients showed similar rates of CSF pulsatile flow. But at 6 months after the first group was treated, there became a significant difference in flow velocity when they compared the treated group to the non-treated group. And this difference continued....when the delayed group was treated at 6 months, the group that had been treated 12 months ago still showed a bit better flow. And the newly treated group showed increases in CSF velocity and flow.

No significant within-group changes were found for velocity in both treatment arms. Conclusions: This study shows that in MS patients with CCSVI, PTA treatment has a beneficial effect on CSF flow and velocity measures. This improvement could be due to better venous drainage following angioplasty.

This is interesting, because it appears that EVERYONE who was treated with venoplasty had this improvement in cerebrospinal fluid flow. BNAC posits that this is due to better venous drainage.

So, here we have a measurable improvement following venoplasty for CCSVI----better cerebrospinal fluid flow.
Better cleansing of the delicate brain tissues, better transport of nutrients, better cerebral pressure regulation.
That sounds like something people with a neurodegenerative disease might find beneficial, don't you think?
Thanks to BNAC for moving CCSVI research forward at ECTRIMS,
cheer

[Cece]

It's so good to see real research presented at ECTRIMS. Not all the back-and-forth imaging studies where some studies find CCSVI and some studies don't.

It's interesting that the 12 month group had better CSF flow than the delayed group even after the delayed group had the procedure. Maybe this is something where it continues to improve over time?

[1eye]

Doesn't it give yet another reason insurance companies might benefit (from improved claimant health)? My health continued to improve over time.

I tricycled 6k yesterday. It might have been the cooler weather, but I did not feel wasted afterward, like I usually do. I was up till 2:30 the last 2 nights, transferring records, and we had gone to see a play at our local little theater the night before last.

My last cognitive test was pretty basic, but I passed without a hitch.

[Rogan]

Thank u oneeye. U have shown us the one way.

[cheerleader]

It's interesting that the 12 month group had better CSF flow than the delayed group even after the delayed group had the procedure. Maybe this is something where it continues to improve over time?

Cece and oneye...I do think this is the sort of thing that seems to improve over time. And if venous flow can be maintained, it's a virtuous cycle of improvement. You feel energized, you move more, CSF flow increases, you are more energized. And so on....

Similarly, an increase in CBF during brain activation elicited by exercise has been shown with near-infrared spectroscopy (NIRS) (42) that, based on a different physical principle from fMRI, also evaluates the ratio between oxyhemoglobin and hemoglobin.
Further support for the dynamic behavior of the CBF response to exercise is the finding that CBF increases during exercise as shown both by 133Xe clearance (49, 51, 99) and the TCD-determined mean flow velocity (Vmean) in large basal cerebral arteries (49, 51), and with little elevation in mean arterial pressure during dynamic exercise, the increase in flow represents an almost as large increase in cerebral vascular conductance

http://www.jappl.org/content/104/1/306.full

Hope BNAC is still following the CSF levels in those 15 people.
cheer

[gibbledygook]

I wonder also that if the change in cerebro spinal fluid is massive after, say, the stenting of the left renal vein and azygous ballooning, then symptoms may initially deteriorate...

[1eye]

Thank u oneeye. U have shown us the one way.

I am very cynical about this. I did say I continued to improve, not that I am continuing to improve now. I am not. It has pretty much come to an end. But I was not tricycling or going to plays before the procedure, that's for sure. Now I am hoping increased Vitamin D will help.

I have few options left. I hope no-one thinks I can show them the one way. I need a much stronger flashlight, and I can't see well enough to find one.

I am glad Dr. Zivadinov continues to elucidate the role of CSF in this.

[jimmylegs]

hey there iima 1eye, what's your total supplement regimen at this time?

[MarkW]

An important finding as it gives a good reason for pwMS to undergo venoplasty. However it is only a piece in the jigsaw not the whole picture. Please do not think that changing CSF flow explains all changes after venoplasty. Changes in fatigue could well be related to CSF flow (clearing the waste products in the brain). Other improvements are more likely to be due to vagal nerve changes but it likely to take years to explain why venoplasty works for many pwMS. Lets show venoplasty helps pwMS, saying why can wait for the boffins to do their research.
MarkW