abstracts for 2013 AAN

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

abstracts for 2013 AAN

Postby Cece » Sun Feb 17, 2013 8:33 pm

Abstracts for the 2013 AAN Annual Meeting Scientific Program are now available to view online.

http://www.aan.com/go/home

[P01.085] Evaluation of Cerebral Hemodynamics of Patients with Chronic Migraine: Effects of the Botulinum Neurotoxin-A

Hakan Akgun, Ankara, Turkey, Serdar Tasdemir, Ankara, Turkey, Mehmet Yucel, Istanbul, Turkey, Oguzhan Oz, Ankara, Turkey, Umit Ulas, Ankara, Turkey, Seref Demirkaya, Ankara, Turkey, Yasar Kutukcu, Ankara, Turkey

OBJECTIVE: Migraine is a neurovascular disorder. Change in the diameter of intracranial arteries is thought to be an important underlying mechanism in migraine pathophysiology. Transcranial-Doppler-Ultrasound (TCD) is a non-invasive method to evaluate intracranial vascular system. Recent studies showed that botulinum neurotoxin-A (BoNTA) is an effective treatment choice in migraine headache. BACKGROUND: We aimed to evaluate the changes in middle cerebral artery (MCA) and posterior cerebral artery (PCA) in terms of Mean Blood Flow Velocity, Breath-Holding-Index (BHI) and pulsatility index (PI) in patients with chronic migraiene before and after treatment with BoNTA by using TCD. DESIGN/METHODS: The study included 25 patients with chronic migraine. 12 patients were treated with high-dose (100 IU) BoNTA and 13 patients were treated with low-dose BoNTA (50 IU). BoNT was injected to facial, scalp and neck muscles. Mean blood flow velocity, BHI and PI were measured before and 7 days after BoNTA injection in MCA and PCA bilaterally in both groups. We compared the pre-treatment and post-treatment values. We also evaluated the Visual Analogue Scale (VAS) scores in both groups before and after-treatment. RESULTS: Pulsatility index was significantly decreased in MCA (before treatment PI=0,74±0,13, after treatment PI=0,69±0,10) (p=0.024) and insignificantly changed in PCA after treatment in high-dose group (p>0.05). Differences in Mean blood flow velocity and BHI were insignificant in both groups in both arteries (p>0.05). VAS scores significantly decreased after treatment in both groups (p<0.001). CONCLUSIONS: The PI is a well known indicator of peripheral vascular resistance. Our results suggest that BoNTA treatment may be effective by reducing the resistance in intracranial vascular beds in patients with chronic-migraine.
Category - Headache: Therapeutics

Could this help pwCCSVI as well? It's botox delivered to the facial, scalp and neck muscles. This led to a reduction in intracranial vascular resistance in migraine patients.
http://www.abstracts2view.com/aan/view. ... 3L_P01.085
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Re: abstracts for 2013 AAN

Postby Cece » Sun Feb 17, 2013 9:07 pm

http://www.abstracts2view.com/aan/view. ... 3L_P01.182
[P01.182] Endovascular Treatment for Chronic Cerebrospinal Venous Insufficiency in Patients with Multiple Sclerosis: Patient-Reported Outcomes (PRO)

Moogeh Baharnoori, Toronto, ON, Canada, Stephen C. Wong, Toronto, Canada, Marika Hohol, Toronto, ON, Canada, Paul O'Connor, Toronto, ON, Canada

OBJECTIVE: To assess changes in multiple sclerosis (MS) associated symptoms and disability scores (EDSS) in patients with MS after endovascular treatment (ET). BACKGROUND: The chronic cerebrospinal venous insufficiency (CCSVI) hypothesis has been proposed as the causal factor for MS. Contradictory data on the association between CCSVI and MS have been reported to date. CCSVI was defined as impaired extra cranial cerebrospinal venous drainage which leads to the accumulation of cerebral iron deposits causing inflammation and degeneration. DESIGN/METHODS: 82 eligible patients completed a questionnaire regarding changes in their MS symptoms after ET including fatigue, sensory deficits, impairments in mobility, coordination, bladder control and cognition. First, we examined symptom changes within 2 weeks after treatment compared to before. For longitudinal assessment, we divided patients to 3 groups; patients who had ET 1) within past 6 month 2) 6-12 months or 3) more than 12 months. Changes at the time of interview were compared to those before the ET. Their EDSS score was measured before and after ET and analyzed using student t test. RESULTS: Within 2 weeks after treatment, 70% (56/79) reported decreased fatigue. About two-thirds reported improvement in cognition (38/65), mobility (51/79) and perceived warming in their limb temperature (40/63). Half of patients reported improvement in bladder control (34/73), coordination (37/73) and sensory deficits (28/61). Longitudinal assessment of symptoms revealed that initial reported improvement in most symptoms greatly diminished over time. Furthermore, we did not find any significant difference between EDSS scores before and after the ET (P=0.828). CONCLUSIONS: Our findings indicate that ET procedures for CCSVI are associated with subjective reports of improvement of various symptoms by many patients without any corresponding objective change in neurological evaluations as measured by neurologist-derived EDSS scores. These uncontrolled and unblinded observations do not provide any credible evidence of a true benefit from ET for MS.

Within 2 weeks of treatment, 70% of CCSVI-treated patients reported decreased fatigue. That's a high percentage. About 66% reported improvements in cognition, mobility, and warm limbs. 50% reported improvements in bladder control, coordination and sensory deficits. But the improvements faded over time. No EDSS improvements were seen. This was an uncontrolled, unblinded study. Patients were not tested for restenosis if their improvements faded.
For longitudinal assessment, we divided patients to 3 groups; patients who had ET 1) within past 6 month 2) 6-12 months or 3) more than 12 months.

Because of when the study was conducted, the "more than 12 months" group would consist of patients who received treatment during the early days of treatment. The IRs performing the procedures on this group would be less experienced than the same IRs performing the more recent procedures. If experience matters, then this was not a good way to assign the groups. Their findings could be interpreted as showing that patients who received venoplasty in 2011 had better results than those who received venoplasty in 2010. This would be consistent with the apparent learning curve.
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Re: abstracts for 2013 AAN

Postby Cece » Sun Feb 17, 2013 9:17 pm

http://www.abstracts2view.com/aan/view. ... 3L_P05.177
[P05.177] An Assessment of Chronic Cerebrospinal Venous Insufficiency in MS

Robert Fox, Cleveland, OH, Leasa Baus, Cleveland, OH, Claudiu Diaconu, Cleveland, OH, Alia Grattan, Cleveland, OH, Diane Ivancic, Cleveland, OH, Soo-Hyun Kim, Cleveland, OH, Jar-Chi Lee, Cleveland, OH, Mei Lu, Cleveland, OH, Larry Raber, Cleveland, OH, Sneha Ramesh, Cleveland, OH, Alexander Rae-Grant, Cleveland, OH

OBJECTIVE: To conduct an independent assessment of chronic cerebrospinal venous insufficiency (CCSVI) in MS. BACKGROUND: CCSVI is a hypothesis of MS pathogenesis related to venous outflow from the head, with conflicting results from different studies. Recent studies have found a very low prevalence of CCSVI, suggesting that those investigators were performing ultrasound assessments differently than the original reports. DESIGN/METHODS: After obtaining formal training in CCSVI ultrasound techniques, we performed ultrasound assessments on a group of 61 MS subjects (4 CIS, 28 RRMS, 19 SPMS, 10 PPMS; 42 females) and 20 non-MS controls (15 healthy and 5 other neurological diseases; 10 female). Ultrasonographers were blinded to diagnosis, and separate research staff positioned subjects prior to ultrasonographer arrival. Assessments were performed using a Biosound MyLab25, equipped with Quality Doppler Profiles (QDP) technology, and traditional transcranial Doppler. Two published interpretations of CCSVI Criteria were utilized: Narrow Criteria did not include either B-mode intraluminal abnormalities or QDP technology for deep cerebral vein reflux, while Broad Criteria included both of these. RESULTS: Using either Narrow Criteria or Broad Criteria, there were no significant differences between MS subjects and controls (p>0.5 for both comparisons). In both groups, there was a doubling of the proportion of subjects meeting CCSVI criteria when using the Broad Criteria. CONCLUSIONS: Using trained and blinded ultrasonographers and QDP technology, we observed no difference in the proportion of MS subjects meeting CCSVI criteria compared to non-MS controls. Different interpretations of CCSVI criteria altered the proportions of subjects meeting CCSVI criteria, highlighting the importance of criteria interpretations when comparing the prevalence of CCSVI between studies. These observations do not support a significantly increased prevalence of CCSVI in MS and suggest against a pathogenic role of CCSVI in MS. Supported by: Research grant from National MS Society (RC 1004-A-5).

MS Society-funded study failed to find as association between MS and CCSVI.
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Re: abstracts for 2013 AAN

Postby Cece » Sun Feb 17, 2013 9:19 pm

http://www.abstracts2view.com/aan/view. ... 3L_P05.183
[P05.183] Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis: Changes in Treatment Patterns and Opinions in a Province-Wide Study

Luanne Metz, Calgary, AB, Canada, Ruth-Ann Marrie, Winnipeg, MB, Canada, Katayoun Alikhani, Calgary, AB, Canada, Gregg Blevins, Edmonton, AB, Canada, Jacqueline Bakker, Red Deer, AB, Canada, Larry Svenson, Edmonton, AB, Canada, Nathalie Jette, Calgary, AB, Canada, Oksana Suchowersky, Edmonton, AB, Canada, Mary Louise Myles, Edmonton, AB, Canada, Winona Wall, Calgary, AB, Canada, James Newsome, Calgary, AB, Canada, Jamie Greenfield, Calgary, AB, Canada, Marcus Koch, Calgary, AB, Canada, Scott Patten, Calgary, AB, Canada, Scott Kraft, Calgary, AB, Canada, Derek Emery, Edmonton, AB, Canada, Mayank Goyal, Calgary, AB, Canada

OBJECTIVE: We aimed to describe the population of Multiple Sclerosis (MS) patients reporting chronic cerebrospinal venous insufficiency (CCSVI) treatment and to describe the change in treatment patterns and opinions over time. BACKGROUND: The CCSVI hypothesis has been of great interest to MS patients. Many Albertans have travelled out-of-country for venous angioplasty. DESIGN/METHODS: Initiated in July 2011, The Alberta Multiple Sclerosis Initiative is a longitudinal observational study that uses online questionnaires to collect patient-reported information about the safety, experiences, and outcomes following CCSVI treatment. All Albertans with MS have been encouraged to participate, irrespective of treatment status. Enrollment is ongoing. RESULTS: This analysis included 733 participants. Mean (SD) age was 47.9 (11.2) years, 76.5% were female, and 63.8% had relapsing remitting MS; 152 participants (20.7%; 95% CI: 17.9-23.9%) reported having CCSVI treatment, beginning in March 2010. Participants were more likely to have undergone treatment in 2010 (66.4%; 95% CI: 58.3-73.9%, n=101) than in 2011 (30.9 %; 95% CI: 23.7-38.9%, n=47), even after controlling for the period of enrolment. Between January and June 2012 only four participants had CCSVI treatment (2.6%; 95% CI: 0.7-6.6%). Older age, male sex, a progressive course, and greater disability were more common in those who had CCSVI treatment. CONCLUSIONS: The number of participants reporting CCSVI treatment is declining. This may indicate that patients who wanted and could afford out-of-country treatment went soon after the CCSVI hypothesis was widely publicized. However, this may also reflect declining patient interest after they observed the outcomes in this earlier group of patients. The sociodemographic and clinical characteristics of participants who received CCSVI treatment will be compared to those who did not receive treatment. Factors that influenced participants' opinions for or against having CCSVI treatment will be compared over time. Supported by: Alberta Health.
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Re: abstracts for 2013 AAN

Postby MrSuccess » Mon Feb 18, 2013 12:17 am

Cece - the Alberta study is interesting . Of course - WHERE - the pwMS went to have the CCSVI treatment is very important . Did they all travel abroad to bonefide medical facility's ? Or medical fly-by-night CCSVI clip joints ? Or both.

I say ..... show me ALL of your homework . :wink:


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Re: abstracts for 2013 AAN

Postby Cece » Mon Feb 18, 2013 11:24 am

Agreed, MrSuccess. I think that information is even more important to the Toronto study that is assessing the results of venoplasty done at any number of different clinics or hospitals all using different techniques.

The Alberta study, let's see...
Participants were more likely to have undergone treatment in 2010 (66.4%; 95% CI: 58.3-73.9%, n=101) than in 2011 (30.9 %; 95% CI: 23.7-38.9%, n=47), even after controlling for the period of enrolment. Between January and June 2012 only four participants had CCSVI treatment (2.6%; 95% CI: 0.7-6.6%). Older age, male sex, a progressive course, and greater disability were more common in those who had CCSVI treatment.

There was some real pent-up demand that got met in 2010 when the procedure first became more widely available.
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Re: abstracts for 2013 AAN

Postby MrSuccess » Mon Feb 18, 2013 12:43 pm

Cece - looks like a bit of " spin doctoring " to my jaded eyes. :twisted:

Has it developed like this ?
2008 Dr.Zamboni brings his CCSVI study results into the public eye. He CAUTIONS against having this procedure [ CCSVI ] outside of carefully controlled clinical settings. Dr.Zamboni also stress' .... no stenting . Both of his cautions are ignored. The MS world goes bananas and pwMS go everywhere and pay anything to anybody .... to have CCSVI treatment.

2009. Dr.Dake has a stent migrate in one of his CCSVI patients . The previously easily obtained procedure ..... grinds to a halt.

In spite of all of this ...... growth in CCSVI expands . The procedure [ although still NOT in any Clinical Trial situation ] continues to expand with many superior medical experts now treating pwMS for CCSVI. This is wonderful . Unfortuneatly ... the Fly-by-nighters .... and medical tourism opportunists continue to " get in on the act ".

It appears the people in Calgary have " lumped together " all the CCSVI results into one pile. :twisted: I find this irresponsible. BIG PHARMA is delighted . :evil:


2013 CCSVI is still being treated . pwMS are now better informed . Expectations are now tempered . A rule of "Thirds " .... seem to be accepted as a general result. More or less .... the CCSVI Stampede .... [ Calgary Stampede ? :lol: ] ..... is slowing .

And that's a GOOD thing.


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Re: abstracts for 2013 AAN

Postby Cece » Mon Feb 18, 2013 2:06 pm

There's also the Google Trends to look at.
It shows that google searches for CCSVI started in 2009 and peaked in October 2010. Relative to that peak (which is marked as '100'), the searches are now a '14' level.
http://www.google.com/trends/explore#q=ccsvi
Yes, the stampede has slowed!
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Re: abstracts for 2013 AAN

Postby happydance » Mon Feb 18, 2013 2:21 pm

CONCLUSIONS: The number of participants reporting CCSVI treatment is declining. This may indicate that patients who wanted and could afford out-of-country treatment went soon after the CCSVI hypothesis was widely publicized. However, this may also reflect declining patient interest after they observed the outcomes in this earlier group of patients. The sociodemographic and clinical characteristics of participants who received CCSVI treatment will be compared to those who did not receive treatment. Factors that influenced participants' opinions for or against having CCSVI treatment will be compared over time. Supported by: Alberta Health.


Or could it be people have lost faith and respect in the neurologists and are not telling them they have had the procedure done.
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Re: abstracts for 2013 AAN

Postby MrSuccess » Mon Feb 18, 2013 2:25 pm

Cece - I much prefer an orderly forward movement ..... you can get killed in a stampede !

For the record : I stand FIRM on my position that MS is indeed related to CCSVI.

I support the numerous CCSVI medical professionals .

I believe TRAUMA causes CCSVI which opens the door to MS.

I am puzzled why the NMSS lists so much MS research [ turning over
numerous stones - looking for an answer ] but is hesitant to look
under or turn over the CCSVI stone .........

It appears the big bully's on the beach [ BIG PHARMA ] forbid our
beachcombers to NOT even look at the CCSVI stone ..... :twisted:

We will prevail .


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Re: abstracts for 2013 AAN

Postby cheerleader » Mon Feb 18, 2013 2:31 pm

Thanks for posting, Cece.
It's incredibly discouraging to see these abstracts---but if researchers are not interested in understanding cerebral perfusion and how it effects aspects of MS that are not reflected by the EDSS scale (cog fog, heat intolerence, fatigue, spasms), then there really is no future for CCSVI studies by MS specialists.
And if Fox and Cleveland Clinic do not wish to further understand the novel venous valve that they discovered, we're sunk.
http://ms.about.com/b/2011/10/25/a-ccsv ... ink-so.htm

BNAC will release info from the Premise study later this year. They found improvements in CSF flow, and it will be interesting to see if they monitored gray matter atrophy over the year.
http://registration.akm.ch/einsicht.php ... KEN_ID=900
As long as MS research is beholden to EAE and white matter lesions, there will be a continuing stream of disease modifying drugs with increasingly concerning side effects, but not much else.

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Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: abstracts for 2013 AAN

Postby MarkW » Mon Feb 18, 2013 2:59 pm

cheerleader wrote:It's incredibly discouraging to see these abstracts---but if researchers are not interested in understanding cerebral perfusion and how it effects aspects of MS that are not reflected by the EDSS scale (cog fog, heat intolerence, fatigue, spasms), then there really is no future for CCSVI studies by MS specialists.

MS experts have closed minds, Cheer (a handful of exceptions to prove the rule). Feel sorry for them rather than be discouraged.
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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: abstracts for 2013 AAN

Postby Cece » Mon Feb 18, 2013 3:42 pm

This one isn't CCSVI related, but it was interesting:
[P04.034] Aerobic Exercise Increases Hippocampal Volume and Improves Memory in Persons with Multiple Sclerosis: Pilot Findings from a Randomized Controlled Trial

Victoria Leavitt, West Orange, NJ, Amanda Cohen, West Orange, Amanda Farag, West Orange, Christopher Cirnigliaro, West Orange, NJ, Nancy Chiaravalloti, West Orange, NJ, James F. Sumowski, West Orange, John DeLuca, West Orange

OBJECTIVE: Aerobic exercise improves memory and promotes hippocampal neurogenesis in non-human animals. Its efficacy has not been verified in a memory-impaired neurologic sample. Here, a randomized controlled trial of aerobic versus non-aerobic exercise was piloted in multiple sclerosis (MS) patients with memory impairment. BACKGROUND: MS leads to prominent hippocampal atrophy: as much as 10% reduction of hippocampal volume is seen in persons with relapsing-remitting MS (RRMS), even after only five years. Hippocampal atrophy is linked to memory deficits; indeed, more than 50% of MS patients suffer memory impairment, with negative consequences for quality of life. There are currently no effective memory treatments for MS, either pharmacological or behavioral. DESIGN/METHODS: Pilot data were collected from two ambulatory, memory-impaired MS participants randomized to non-aerobic (stretching) and aerobic (stationery cycling) conditions. Baseline and follow-up measurements: high-resolution MRI (neuroanatomical volumes), fMRI (functional connectivity), and memory assessment. Intervention was 30 minute sessions 3 times per week for 3 months. RESULTS: Aerobic exercise resulted in a 16.5% increase in hippocampal volume and a 53.7% increase in memory, as well as a large increase in hippocampal resting-state functional connectivity. In contrast, non-aerobic exercise resulted in relatively no change in hippocampal volume (2.8%) or memory (0.0%), and no changes in hippocampal resting-state functional connectivity. Effects of aerobic exercise were specific to the hippocampus and memory, as there were no comparable changes in overall cerebral gray matter (2.4%) or in non-hippocampal deep gray matter structures (thalamus, caudate: -4.0%), nor were there any changes in non-memory cognitive functioning (mean change: 0.0%). CONCLUSIONS: This is the first evidence for aerobic exercise to increase hippocampal volume, hippocampal connectivity, and improve memory in MS. Aerobic exercise represents a cost-effective, widely available, natural, and self-administered treatment with no adverse side effects that may be the first effective memory treatment for MS patients.
Category - Neural Repair/Rehabilitation: Clinical: Multiple Sclerosis

A randomized controlled trial showing that aerobic exercise is good for memory and good for the hippocampus in people with MS.
Ernst was just talking about exercise in a different thread. I know I'm more able to exercise now (because of improvements in fatigue and sweating and well-being) than I was before venoplasty.

Yeah, it is discouraging that the neurologists are going to read these abstracts and it will reinforce what they already believe. What can you do. I am hoping for good things in the ISNVD abstracts next week.
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Re: abstracts for 2013 AAN

Postby Cece » Mon Feb 18, 2013 4:15 pm

http://www.abstracts2view.com/aan/view. ... 3L_S40.004
[S40.004] Non-Invasive Vagus Nerve Stimulation (nVNS) for Acute Treatment of Migraine: An Open-Label Pilot Study

Peter Goadsby, San Francisco, CA, Richard Lipton, Bronx, NY, Roger Cady, Springfield, MO, Alexander Mauskop, New York, NY, Brian Grosberg, Bronx, NY

OBJECTIVE: Assessment of a novel, non-invasive, portable VNS device for acute treatment of migraine. BACKGROUND: Despite many acute treatment options for migraine, substantial unmet need remains. VNS is promising, but relatively unexplored. DESIGN/METHODS: Participants with migraine with or without aura, as defined by the International Classification of Headache Disorders- second edition, were eligible for an open-label, single arm, multiple attack study. Participants acutely treated up to 4 migraine attacks with a portable VNS within 6 weeks. Treatment consisted of two, 90-second doses, at 15-minute intervals delivered to the right cervical branch of the vagus nerve. Subjects were asked to self-treat once pain became moderate or severe, or after 20 minutes of mild pain. RESULTS: Of 30 enrolled patients, (5M, 25F, average age 39), 26 eligibly treated 79 migraine headaches . At two hours, headache response rate (pain mild or absent at 2 hours) was 46/79 (58%), and 22/79 (28%) were pain free. Average initial pain level was a 1.84 (0-no pain, 1-mild, 2-moderate, 3-severe pain), and dropped 35%, to 1.20 (p<0.0001) by 2 hours . At two hours, 76 of 79 (96%) were improved or had not worsened over baseline. Of 26 patients 20 (77%) responded, i.e., reported mild or nor pain at 2 hours, for at least one treated headache. Among this subset of 20 patients 47/61 (77%) of their treated headaches responded. Treatment related adverse effects were limited to transient muscle or local tissue irritation, and two reports of light headedness, most of which resolved immediately after treatment, and all within two hours of treatment. CONCLUSIONS: These results suggest that nVNS may be an effective and well-tolerated acute treatment for migraine in a responsive subgroup. Randomized controlled trials are warranted. Supported by: ElectroCore, LLC.

A noninvasive portable vagus nerve stimulator? Could this be used for the treatment of autonomic nervous system dysfunction in CCSVI/MS?
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Re: abstracts for 2013 AAN

Postby Anonymoose » Mon Feb 18, 2013 4:28 pm

So...what if ccsvi PTA improves MS symptoms because it is eliminating one of multiple causes of perfusion and csf flow issues? I think cheer is on the right track by staying on top of endothelial health. It scares me that MS isn't ccsvi and people are depending completely upon PTA. What if the MS related factors just take some years to accumulate enough damage to the endothelium and gray matter to the point that even PTA that sticks doesn't help anymore?

To me, it seems like non-ccsviers eventually progress to the point that they appear to have symptoms associated with ccsvi. I think such progression is in part due to endothelial damage that PTA won't help. Maybe that explains the less successful PTA results in "old ms."

@Cece...that last seems more attractive than leeches or botulism. I wonder if it works on compressed nerves though. Artificial stimulation might be just as static-y as normal nerve impulses.
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