Stenosis and severity of MS correlation

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

Stenosis and severity of MS correlation

Postby LR1234 » Sat Nov 21, 2009 12:43 am

Hi,

The only thing I can't work out is why people who seem to only have maybe 1 jugular occluded can be worse off then say someone who has 2 occluded jugulars.

How comes the number of stenosis found does not relate to the amount of disability

Is it just some people's ability to copensate is better than others?


L
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Re: Stenosis and severity of MS correlation

Postby ErikaSlovakia » Sat Nov 21, 2009 12:46 am

LR1234 wrote:Hi,

The only thing I can't work out is why people who seem to only have maybe 1 jugular occluded can be worse off then say someone who has 2 occluded jugulars.
How comes the amount of stenosis does not relate to the amount of disability

Is it just some people's ability to copensate is better than others?


L

I think it depends on brain deposition not on number of stenosis.
Erika
Aug. 7, 09 Doppler Ultras. in Poland, left Jugul. valve problem, RRMS since 1996, now SPMS,
- Nov.3,09: one stent in the left jug. vein in Katowice, Poland, LDN, never on DMDs
- Jan. 19, 11: control venography in Katowice - negative but I feel worse
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Postby radeck » Sat Nov 21, 2009 6:46 am

L, I'm not sure your premise if fulfilled. Are you sure, and where did you get this impression from?

Erika, one would definitely expect that stenosis severity correlates with amount of iron deposition. Therefore one would also expect that stenosis severity correlates with disability progression.
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Postby ozarkcanoer » Sat Nov 21, 2009 8:52 am

I don't know if I have stenosis. But I have 40 some small lesions and O-bands = 8. My disability below my neck is 0. No lesions (that I know of) on my spine. My self-assessed disability above my shoulders is 6. I don't know about my iron deposition. I am going to Detroit to have Dr Haacke's imaging protocol. Maybe I will find out about my iron and if my jugular and azygous veins are stenosed.

I can't see any correlation between lesions and disability for me, except for all the subjective head things that cannot be seen. I'm anxious to see if Dr Haacke's protocol shows anything at all. I'm afraid he won't :( .

I sure wish I could have the Doppler Ultrasound.

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Postby radeck » Sat Nov 21, 2009 8:55 am

ozark, L's question was not about correlation of lesions and disability, but about correlation of severity of stenosis and disability.

L made the claim that there doesn't seem to be such a correlation, and I asked what this claim is based on.
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Postby LR1234 » Sat Nov 21, 2009 9:56 am

Hi Rad,
Its more of a question than a claim;)

According to Dr Dake (waiting to get this confirmed by Dr Simka)
I have 2 severe stenosis in my jugulars at C2 as well as a further stenosis further down on the left jugular. My disability at this time is not bad compared to others with MS. (I am about an EDSS of 1 and its all sensory and visual probs)

There seems to be people with 1 blocked jugular who have far more disability. My body seems to be adapting better than others with less stenosis.

I have always been very careful about what I eat/drink, I wonder if this has helped.
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Postby chrishasms » Sat Nov 21, 2009 10:32 am

123
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Postby radeck » Sat Nov 21, 2009 10:38 am

Chris, you are wrong. If iron deposits are caused by stenosis, by definition there is a correlation. And btw, there is also no evidence that SPMSers have different stenosis than RRMSers.

Back to the OT. It's important to distinguish between correlation in few individuals versus more meaningful correlation in a large number. Obviously some peoples bodies (like L's) will respond to blockage with less deposition, and some will be earlier in their disease anyway. That's why we need large numbers to say anything.
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Postby ozarkcanoer » Sat Nov 21, 2009 11:11 am

Radek.... Yes... you are right. Large numbers will reveal the correlation (or not) of stenosis vs iron deposition.
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Postby chrishasms » Sat Nov 21, 2009 1:11 pm

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Postby patientx » Sat Nov 21, 2009 5:37 pm

radeck wrote:And btw, there is also no evidence that SPMSers have different stenosis than RRMSers.


Interesting, because this directly contradicts what Dr. Zamboni stated in his paper entitled "Chronic Cerebrospinal Venous Insufficiency in Patients with Multiple Sclerosis":

"Particularly, the location of venous obstruction seems to be a key element influencing the clinical course of the disease. Types A and B correlated with a RR course (83%) with a conversion in the SP course in 70% of cases. In contrast, the PP forms occurred more frequently in the type D pattern (75%). "

And, "Finally the conversion to SP course was consistently observed in type A, B C patterns (95%), but proportionally higher in patients with both the IJVs blocked (56% type C)."
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Postby radeck » Sat Nov 21, 2009 7:17 pm

Thanks patientx. You're right, SPMSers are more likely to have bilateral jugular vein stenosies, but I had gotten the impression from looking at a table in the paper (I think it was table 4) that this was not statistically very significant. However the difference in CCSVI pattern between RR&SP on one side, and PP on the other, is very obvious.

Basically the slight difference between RR and SP, if confirmed in larger studies, fits perfectly in the picture, the amount of stenosis is correlated with disability. In that picture, RRMS patients with unilateral stenosis take longer to convert to SPMS, and some never do in a normal human life span.
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