Cerebral circulation time in MS is double that of normals

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cheerleader
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Cerebral circulation time in MS is double that of normals

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New, blinded research shows cerebral circulation in pwMS takes twice as long as in normals, and this slowed blood flow does not correlate with EDSS or disability, or lesions and inflammation.

full paper in pdf form
http://www.plosone.org/article/fetchObj ... tation=PDF
The present study reported a significant CCT (cerebral circulation time) increase in MS patients compared to control subjects, indicating a consistent condition of cerebral hypoperfusion. Increase of CCT, and the fol- lowing cerebral hypoperfusion, vary with blood in-flow reduction due to stenosis and/or parenchymal high resistance, changing PaCO2, or alteration of the cerebral perfusion pressure.
The strong CCT value difference between control group and MS patients explains hypoperfusion, which preempts myelin breakdown and MRI detectable white matter lesions.
The absence of a significant association between CCT and disease duration, disease onset, lesion and brain volume, EDSS and age could suggest that the high intravascular resistance is a constant finding in MS patients, possibly taking place at an early stage of the disease. Therefore, cerebrovascular changes are not solely the result of a late chronic inflammatory process. Indeed, if the microvascular dysfunction was a consequence of lesion load or brain atrophy, high CCT values would be expected to increase with EDSS and disease duration.
In conclusion, the absence of a correlation between lesion volume and CCT confirms that hemodynamic alteration is not related to parenchymal lesion and other MS-linked clinical fea- tures, but rather, is a pathognomonic feature of disease.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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cheerleader
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Re: Cerebral circulation time in MS is double that of normal

Post by cheerleader »

Slowed cerebral circulation = death of neurons, also known as neurodegeneration.
Slowed cerebral circulation = hypoxia and low glucose delivery, which can create white matter lesions (we see this in CO2 poisoning, high altitude, cocaine addiction and other hypoxic situations.)

Both are hallmarks of MS, both are hallmarks of slowed blood flow to and from the brain.

Anyone want to read it and discuss?
This is a pretty big, blinded discovery, published in a major medical journal. The full paper is available.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: Cerebral circulation time in MS is double that of normal

Post by 1eye »

I agree that explanations for this faulty circulation must be sought if we accept this study's conclusions. We might want to seek answers to these questions:

What was blinded, how was it blinded?
Are there any built-in biases or confounding factors?
Are there any faults in collection of data or in conclusions made from the data?
Logically fallacious arguments?
Statistical flaws?
Are there any measurements which suggest a possible alternate explanation to the one suggested?

In short, how is this study assailable?

If it is not, do we want to spend the money to try to reproduce it? Find a less invasive method?

If it is reproducible, bulletproof, supported by others, and money might be spent on CCSVI procedures that do nothing, or worse, how likely is that to happen?

What level of skill is needed to have a good chance of success with CCSVI procedures?

Are there any other conclusions which can be drawn from the data? I.E is this condition correlated at all with any therapies, or lack of?

We should keep good detailed track of the results of CCSVI venoplasty procedures to treat this slowed circulation, to analyze the probability of benefit, the quantity of benefits to be reasonably expected, and what risks are involved.

What steps can be taken to minimize this risk?

Is this procedure going to help, hinder, or render irrelevant current drug therapies, or will it make no difference to their effects on patients?
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cheerleader
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Re: Cerebral circulation time in MS is double that of normal

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As far as blinding, 1 eye:
Two blinded observers, an interventional neuroradiologist (SC) who performed the exam (8 years experience) and a neuroradiologist (LM) (22 years experience), performed a detailed interpretation of DSA.
This is similar to the blinded Stanford MRV study, where the neuroradiologist who assessed the test results was blinded--since he was just looking at images, not individuals. And the exam is performed by a blinded neuroradiologist on patients who are on their backs, immobile and on a table.
Here's that blinded Stanford study from 2012.
http://www.ajnr.org/content/early/2012/ ... 7.abstract

I'm not sure how we can discuss statistical flaws or bias. This paper was peer reviewed and edited by Orhan Aktas, an MS neuroimmunologist from the University of Dusseldorf, submitted 6/14 and published 2/15 and it's not by Dr. Zamboni. Does that help? :)
At a certain point, people with MS need to ask for answers for themselves, and to be tested and treated for venous malformations, if they have them and wish to be treated. My family is beyond that point (unbelievably, now six years)--but I keep hoping the evidence will eventually tip the cart for more people to get help. But if no one else cares to ask why their cerebral circulation is slowed or if they can be helped by lifestyle, nutrition, exercise, venoplasty, etc-- at a certain point, I guess it's time to move on.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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