CCSVI RESEARCH here

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

Re: CCSVI RESEARCH here

Postby MSUK » Fri Feb 01, 2013 2:54 am

Endovascular treatment of CCSVI in patients with multiple sclerosis: clinical outcome of 462 cases

Abstract

Although it is still debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients underwent endovascular treatment (ET) of CCSVI.

The objective of the study is to evaluate the outcome and safety of ET in Italian MS patients.

Italian MS centers that are part of the Italian MS Study Group were all invited to participate to this retrospective study.

A structured questionnaire was used to collect detailed clinical data before and after the ET.

Data from 462 patients were collected in 33 centers......Read More - http://www.ms-uk.org/index.cfm/ccsviresearch
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Re: CCSVI RESEARCH here

Postby Cece » Sun Feb 03, 2013 3:43 pm

has this been posted?
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.

http://www.minervamedica.it/en/journals ... 12N03A0141
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Re: CCSVI RESEARCH here

Postby MSUK » Thu Feb 14, 2013 1:47 am

Chronic cerebrospinal venous insufficiency in multiple sclerosis: a highly prevalent age-dependent phenomenon

Abstract (provisional)

Background
This study aimed to investigate the prevalence and clinical relevance of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) patients and healthy controls using extra- and intracranial colour Doppler sonography.

Methods
We examined 146 MS patients, presenting with a clinically isolated syndrome, relapsing-remitting, secondary progressive, or primary progressive MS, and 38 healthy controls. Sonographic examination was performed according to Zamboni's protocol and was performed by three independent sonographers. The results of sonographic examination were compared with clinical and demographic characteristics of the patients.......Read More - http://www.ms-uk.org/index.cfm/ccsviresearch
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Re: CCSVI RESEARCH here

Postby Cece » Sun Feb 17, 2013 7:27 pm

Here's another link for the research squiffy posted.
http://www.biomedcentral.com/1471-2377/13/20/abstract and the full pdf http://www.biomedcentral.com/content/pd ... -13-20.pdf
Looks good!
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Re: CCSVI RESEARCH here

Postby MSUK » Mon Mar 04, 2013 5:38 am

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
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Re: CCSVI RESEARCH here

Postby Anonymoose » Mon Mar 04, 2013 6:51 am

squiffy2 wrote: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

This is precisely why we need the ms endocrine issues which likely cause vascular damage, impaired baroreflex, reduced cerebral perfusion and csf flow studied and linked to ccsvi PTA as a mitigating treatment. Ccsvi PTA for ms won't make it on its own because it can not be directly connected to ms. The endocrine issues can.
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Re: CCSVI RESEARCH here

Postby MSUK » Tue Mar 05, 2013 8:48 am

First Published Results from National MS Society-Funded CCSVI Study

Researchers at the University of Texas Health Science Center at Houston have published their first results from a National MS Society-supported study investigating CCSVI (chronic cerebrospinal venous insufficiency) using several different imaging techniques to examine blood outflow from the brain. For the first portion of the study, the team, purposefully unaware of any participant’s diagnosis, used Doppler ultrasound to investigate venous drainage in 276 people with and without MS. They report much less prevalence than previously reported by other groups and no statistical difference between those with MS and those without MS. The study, by Andrew D. Barreto, MD, Jerry S. Wolinsky, MD, and colleagues, was published early online in the Annals of Neurology..........Read More - http://www.ms-uk.org/index.cfm/ccsviresearch
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Re: CCSVI RESEARCH here

Postby MSUK » Fri Mar 15, 2013 7:04 am

MS patients did not benefit from CCSVI intervention, landmark pilot study of 'liberation treatment' finds

The first controlled clinical trial to test the safety and efficacy of interventional endovascular therapy on the symptoms and progression of multiple sclerosis has found that the intervention, sometimes called the “liberation treatment,” which has attracted intense interest in the global MS community, does not improve patient outcomes. In a few cases, the treatment made symptoms worse.

University at Buffalo researchers will present their results in an “Emerging Science” poster session March 20 at the annual American Academy of Neurology meeting in San Diego.......... Read More - http://www.ms-uk.org/index.cfm/ccsviresearch
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Re: CCSVI RESEARCH here

Postby Cece » Sat Mar 30, 2013 6:54 pm

http://www.ncbi.nlm.nih.gov/pubmed/23493652
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
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Re: CCSVI RESEARCH here

Postby CureOrBust » Sat Apr 27, 2013 5:30 pm

Cece wrote:a technical study on sedation in ccsvi procedures

FYI. My first procedure was performed with only a local at the point of entry of the catheter. When they warned me I was about to feel some pressure, I actually felt nothing at all, not even the pressure they said I would.

In my second procedure, the Dr only used the sedation because it was "Hospital Policy" (cannot remember what they used, and of course a local at entry). It was fine until he blew up the balloon. But luckily, just as soon as it was starting to hurt, he let the balloon down. ie he did not appear to leave it inflated for long.

In the third treatment (DR Sclafani), he used anesthesia only delivered at the time/point he was about to balloon (and a local at the entry point). And it didn't seem like enough, as it hurt like hell when he ballooned the vein and left it up for a little while.
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Re: CCSVI RESEARCH here

Postby CureOrBust » Mon Jun 10, 2013 5:05 pm

Although not CCSVI specific, it does show a correlation between MS and a Cerebrovascular accident. Although it's not a medically established fact, if it waddles like a duck and quacks like a duck... :smile:

Basically, carnosinase is pretty low in MS AND Cerebrovascular accidents as compared to normals and even other CNS diseases.

Normals - 161
MND - 155
Epilepsy - 148
Parkinsons - 109

Multiple Sclerosis - 82.5
Cerebrovascular accident - 74.6

Serum carnosinase activities in central nervous system disorders
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.

http://www.ncbi.nlm.nih.gov/pubmed/8033354

Although it is an invasive test (CSF fluid) maybe it could be used as another bio-marker/diagnostic for MS or possibly an indicator for those that would / will respond best to CCSVI treatment.
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Re: CCSVI RESEARCH here

Postby MSUK » Tue Jun 11, 2013 12:18 am

Don't dismiss CCVSI yet, expert says

Doctors should encourage their patients with multiple sclerosis (MS) who are curious about chronic cerebrospinal venous insufficiency (CCVSI) to "hold off" getting the related procedure until results are in from what some view as a potentially definitive trial on the merits of this intervention, according to Alexander Rae-Grant, MD, neurologist and chair, Neurological Education, Cleveland Clinic, Ohio......... Read More - http://www.ms-uk.org/index.cfm/ccsviresearch
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Re: CCSVI RESEARCH here

Postby frodo » Wed Jun 19, 2013 11:50 am

I have not seen this paper here. It is about replicating the FONAR discovery, and they report a success.


Source: http://www.torna.do/s/Cine-cerebrospina ... sclerosis/

Cine cerebrospinal fluid imaging in multiple sclerosis 2012
Journal of magnetic resonance imaging : JMRI



PURPOSE: To investigate cerebrospinal fluid (CSF) dynamics in the aqueduct of Sylvius in multiple sclerosis (MS) patients and healthy controls (HC) using Cine phase contrast imaging.

MATERIALS AND METHODS: In all, 67 MS patients (48 relapsing-remitting [RR] and 19 secondary-progressive [SP]), nine patients with clinically isolated syndrome (CIS), and 35 age- and sex-matched HC were examined. CSF flow and velocity measures were quantified using a semiautomated method and compared with clinical and magnetic resonance imaging (MRI) disease outcomes.

RESULTS: Significantly decreased CSF net flow was detected in MS patients compared to HC (-3.7 vs. -7.1 μL/beat, P = 0.005). There was a trend for increased net positive flow between SP, RR, and CIS patients. Altered CSF flow and velocity measures were associated with more severe T1 and T2 lesion volumes, lateral and fourth ventricular volumes, and third ventricular width in MS and CIS patients (P < 0.01 for all). In CIS patients, conversion to clinically definite MS in the following year was related to decreased CSF net flow (P = 0.007). There was a trend between increased annual relapse rate and altered CSF flow/velocity measures in RRMS patients (P < 0.05).

CONCLUSION: CSF flow dynamics are altered in MS patients. More severe clinical and MRI outcomes in RRMS and CIS patients relate to altered CSF flow and velocity measures.
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Re: CCSVI RESEARCH here

Postby frodo » Tue Jul 02, 2013 2:08 am

Incidence and distribution of extravascular compression of extracranial venous pathway in patients with chronic cerebrospinal venous insufficiency and multiple sclerosis.

Source: http://www.ncbi.nlm.nih.gov/pubmed/23761866

OBJECTIVE:

To examine the incidence and distribution of extravascular compression of the extracranial venous pathway (the jugular and/or azygous veins) in multiple sclerosis patients with chronic cerebrospinal venous insufficiency evaluated by mulitislice computer tomographic angiography.

METHODS AND RESULTS:

Study group consisted of 51 consecutive patients with multiple sclerosis in whom chronic cerebrospinal venous insufficiency was diagnosed by color Doppler sonography (CDS). Mulitislice computer tomographic angiography was performed in all patients, and it revealed significant extravascular compression (>70%) of extracranial venous pathway in 26 patients (51%), while in 25 patients (49%) no significant extravascular compression was seen. Extracranial compression due to transverse processus of cervical vertebrae was seen in 23 patients, carotid bulb compression was seen in two patients, and in one case, compression presented as a thoracic outlet syndrome.

CONCLUSION:

Our data indicate that extravascular compression of the extracranial venous pathway is frequent in multiple sclerosis patients with chronic cerebrospinal venous insufficiency, and that it is mainly due to compression caused by transverse processus of cervical vertebrae. Further studies are needed to evaluate potential clinical implications of this phenomenon.
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Cerebrovascular hemodynamic changes in multiple sclerosis pa

Postby frodo » Tue Jul 02, 2013 1:34 pm

Cerebrovascular hemodynamic changes in multiple sclerosis patients during head-up tilt table test: effect of high-dose intravenous steroid treatment.

Abstract

Demyelination in multiple sclerosis (MS) may cause damage to the vegetative nervous system. Our objective was to examine cerebral autoregulation assessed via blood pressure and cerebral blood flow velocity fluctuations during head-up tilt table testing. We also investigated the effects of high-dose intravenous corticosteroid treatment.

Transcranial Doppler registration of middle cerebral artery blood flow velocity and continuous blood pressure and heart rate monitoring were performed at rest and during tilt table testing in 30 MS patients. Ten age-matched healthy subjects were also examined as controls. Correlations between mean arterial blood pressure (MBP) and cerebral blood flow velocity (CBF) fluctuations were averaged, yielding the correlation coefficient index Mx.

For a subgroup of 11 patients with acute exacerbations, results were also evaluated before and after methylprednisolone treatment (1 g/day intravenously for 5 days). No significant differences in the autoregulatory indices were seen between patients and controls, or between pre- and post-steroid results. Modeling CBF velocity changes associated with a 1-mmHg increase in MBP, significant differences (p < 0.05) were detected in patients vs. controls, and also after vs. before steroid administration.

We conclude that cerebrovascular autoregulation impairments are detectable in early phase MS. Corticosteroid treatment has a significant effect on hemodynamic changes in acute exacerbations.
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