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Results from 823 consecutive Duplex exams for CCSVI in a Vascular Centre

Bavera P. M. 1, Agus G. B. 2, Alpini D. 3, Cecconi P. 4, Guazzoni A. 5, Tori A. 6, Costantini E. 6, Lupattelli T. 7

1 Medick-Up Vascular Surgery and Angiology Lab, Milan, Italy;
2 Unit of Vascular Surgery and Angiology, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy;
3 ENT-Otoneurology Service, Fondazione Don Carlo Gnocchi, Milan, Italy;
4 Radiology and Neuroradiology Imaging Service, Fondazione Don Carlo Gnocchi, Milan, Italy;
5 Department of Diagnostic and Interventional Radiology, San Biagio Hospital, Domodossola,Italy;
6 Vascular Surgery and Endovascular Unit, Busto Arsizio Hospital, Italy;
7 Interventional Radiology Unit, Salus Hospital, Reggio Emilia, Italy

Aim. Ultrasound (US) diagnosis of chronic cerebrospinal venous insufficiency (CCSVI) and its association with MS is highly controversial, perhaps for lack of both training and awareness of what is normal in cervical veins mainly because they are not segments usually investigated in Vascular Labs.
Methods. The work is based upon the results of 823 consecutive Duplex (DU) exams carried out in one year on Multiple Sclerosis (MS) patients. The purpose was to eventually detect and quantify the presence of CCSVI and possible benefits on PTA-treated patients, according to the Zamboni criteria protocol. The authors scanned first a consecutive group of 60 controls, not affected by MS, aged 28-62 years old, in order to improve the personal learning curve in investigating the cervical veins. Therefore they investigated 696 MS patients and 127 MS patients post-PTA treatment for diagnosed CCSVI.

Results. Within the 60 controls, only 3 (5%) showed one flow abnormality according to the Zamboni criteria, considered insufficient for CCSVI diagnosis, while in the remaining 57 (95%) they were totally absent. In the 823 patients affected by MS, 627 (90%) matched with sufficient Zamboni criteria scores. The frequency of CCSVI among MS patients and non-MS controls revealed a higher CCSVI prevalence in the MS group (odds ratio 576.7; 95% confidence interval 286.2-1161.9; χ2=310 and P-value<0.0001). Finally, 88 patients (69%) of the post procedural Duplex examination were negative for CCSVI Zamboni criteria and this result was associated to symptoms improvements. Other previous, but smaller studies, were previously carried out with the aim to investigate CCSVI in MS and the lack of detection in this particular population of patients may be subsequent to insufficient training and completion of an adequate learning curve.

Conclusion. The present study demonstrates in a large survey, the strong association between the two conditions. In addition, PTA may revert abnormal duplex haemodynamics in a large proportion of patients.

What went wrong? The flawed concept of cerebrospinal venous insufficiency

Abstract

In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency (‘CCSVI’).

The diagnosis of ‘CCSVI’ is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration..... Read more - http://www.ms-uk.org/index.cfm/ccsviresearch

Saudi J Anaesth. 2012 Oct;6(4):358-62. doi: 10.4103/1658-354X.105865.
Dexmedetomidine for monitored anesthesia care in patients undergoing liberation procedure for multiple sclerosis: An observational study.
Anand S, Bhatia A, Rajkumar, Sapra H, Gupta V, Mehta Y.
Source
Institute of Critical Care and Anaesthesia Medanta, The Medicity, Gurgaon, Haryana, India.
Abstract
BACKGROUND:
It has been postulated that Multiple sclerosis (MS) stems from a narrowing in the veins that drain blood from the brain, known medically as chronic cerebrospinal venous insufficiency, or CCSVI. It has been proposed that balloon angioplasty should alleviate the symptoms of MS. This procedure is also known as The "Liberation Procedure". Accordingly, a clinical study was undertaken to determine the effects of dexmedetomidine in patients undergoing the liberation procedure.
AIMS:
To assess the effectiveness of dexmedetomidine in providing adequate sedation and pain relief for patients undergoing the liberation procedure.
SETTINGS AND DESIGN:
A prospective, nonrandomized observational study of 60 consecutive adult patients undergoing the liberation procedure under monitored anesthesia care (MAC) who will receive dexmedetomidine as an anesthetic agent.
METHODS:
A total of 60 adult patients were enrolled in the study. Dexmedetomidine was administered to all patients in a loading dose of 1 mcg/kg, which was followed by a maintenance dose of 0.2-0.5 mcg/kg/h. The evaluation of quality of sedation was based on Ramsay Sedation and the quality of analgesia was assessed using the visual analog scale. The following parameters were measured continuously: heart rate, mean arterial pressure and hemoglobin oxygen saturation. Patients were asked to answer the question, "How would you rate your experience with the sedation you have received during surgery?" using a seven-point Likert-like verbal rating scale.
STATISTICAL ANALYSIS:
Repeated measurements were analyzed by repeated measures ANOVA for HR and BP.
RESULTS:
Most of our patients were satisfied with their sedation. In most of the patients, MAP and HR dropped after the bolus dose of dexmedetomidine, and the drop was statistically significant.
CONCLUSIONS:
Dexmedetomidine can be used as a sole sedative agent in patients undergoing the liberation procedure.

a technical study on sedation in ccsvi procedures

Serum carnosinase activity was assayed in five groups of patients with neurological disorders. Enzyme activities in patients with idiopathic epilepsy (mean ± S.E.M., 148 ± 11 nmol/ml per min) and motor neurone disease (155 ± 15 nmol/ml per min) were similar to the control group (161 ± 7 nmol/ml per min). Reduced serum carnosinase activity was observed in patients with Parkinson's disease (109 ± 11 nmol/ml per min, P < 0.005), multiple sclerosis (82.5 ± 10.0 nmol/ml per min, P < 0.005) and patients following a cerebrovascular accident (74.6 ± 5.4 nmol/ml per min, P < 0.001) compared with the control group. Carnosinase activity, 5–10% of that found in serum, was detected in CSF samples. The cause of reduced serum carnosinase activities in central nervous system disorders is unclear, although anoxic damage to carnosinase-producing cells or disruption of the blood-brain barrier may be responsible.