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Shayk wrote:All

It looks like there's an opportunity for people to comment on the news release here.

I haven't tried to comment but if they're using the American University in Beirut data I would remind people that study found something like over 90% of people with RRMS (over 10 years duration) had jugular stenosis. I don't know if they even checked the azygous vein, and hence they may not have even evaluated for CCSVI. So, to indicate in a news release

"According to preliminary data generated by current research," underlined Dr. Marc Girard, President of the Québec Association of Neurologists, "it would also seem that the venous obstructions appear late into the progression of the illness. As such, these findings show that the obstructions are not the cause of multiple sclerosis

seems like a bit of a stretch.

Since when did RRMS become "late into the progression of the illness"? Have they not heard of SPMS or EDSS? As I recall, no EDSS scores were given for that RRMS cohort. It was however quite clever IMO for the Beirut researchers to use the label "late MS".

And, since the stenosis appear "late", they're not the cause of MS? Really, where's the scientific logic and evidence to come to that conclusion?

I don't think cancer in cigarette smokers occurs until "much later". I wonder if these same experts would then automatically conclude with such certainty that cigarette smoking doesn't cause cancer. (No need for extraneous comments here please, I hope the info stands on its own.)

Can you tell I'm agitated. I would hope that future press releases from the "experts" contain data and references.

Take care all

Sharon

Jugular wrote:Another conclusion that the study suports is that MS causes stenosed veins as nearly all LMS patients had it.

Apart from that, they would have to follow the same subjects over time to see if they developed stenoses to truly validate their hypothesis. In other words, the presumption is that the patients' veins in the LMS group would look the same as the patients' veins in the CIS group if they had been tested ten years earlier.

If opening stenosed veins can be shown to improve ms symptoms, then it may be the case that MS causes stenosis causes disability.

Mult Scler. 2010 Nov;16(11):1341-8.

Extracranial venous stenosis is an unlikely cause of multiple sclerosis.
Yamout B, Herlopian A, Issa Z, Habib RH, Fawaz A, Salame J, Wadih A, Awdeh H, Muallem N, Raad R, Al-Kutoubi A.

Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon. yamoutba@idm.net.lb.

Abstract
Background: Extracranial venous stenosis (EVS) has recently been implicated as the primary cause of multiple sclerosis (MS). Objective: The aim of this study was to determine the presence of EVS in MS patients. Methods: We performed selective extracranial venography on 42 patients with early MS (EMS): clinically isolated syndrome (CIS) or relapsing-remitting MS (RRMS) of less than 5 years duration, and late MS (LMS): RRMS of more than 10 years duration. Magnetic resonance imaging (MRI) and clinical relapse data were reviewed for all patients with EVS. Results: EVS was present in 7/29 patients with EMS and 12/13 patients with LMS, a highly significant statistical difference (p< 0.001). Only 3/42 patients (all in the LMS group) had two vessel stenoses, while the rest had only one vessel involved. EVS was seen in 1/11 patients with CIS compared with 6/18 RRMS patients of less than 5 years duration. Disease duration was greater in patients with EVS overall (p < 0.005). LMS remained an independent predictor of EVS following multivariate adjustment for gender, age at disease onset and Expanded Disability Status Scale (EDSS) (Adjusted Odds Ratio = 29 (3-298); p = 0.005]. Within the EMS group, patients with (n = 7) and without (n = 22) EVS had similar EDSS and disease duration, suggesting similar disease severity. No clear correlation could be found between site of EVS and anatomic localization of either clinical relapses or MRI gadolinium-enhancing lesions. Conclusions: We conclude that EVS is an unlikely cause of MS since it is not present in most patients early in the disease and rarely involves more than one extracranial vein. It is likely to be a late secondary phenomenon.

dunkempt wrote:Not settled, though; Simka's much larger study suggests the opposite.

-d

drsclafani wrote:

Sotiris wrote:

Cece wrote:Hmmm. I think they used MRVs, when they'd need to use Doppler if they were measuring reflux directly.

I also could be completely off with this!
Beirut study:

Selective extracranial venous angiography=selective venography= gold standard. However, even with the gold standard, some problems may be missed. Assuming that they performed the SV without missing any problem, could that mean that apart from aging there is also another factor that deteriorates the venous system?

don't read much into an abstract. The devil is in the details

drsclafani wrote:

Cece wrote:Hmmm. I think they used MRVs, when they'd need to use Doppler if they were measuring reflux directly.

I also could be completely off with this!
Beirut study:

Chronic cerebrospinal venous insufficiency is an unlikely cause of multiple sclerosis

B. Yamout, A. Herlopian, Z. Issa, R.H. Habib, A. Fawaz, J. Salameh, H. Wadih, H. Awdeh, N. Muallem, R. Raad, A. Al-Kutoubi (Beirut, LB)


Introduction: A state of chronic cerebrospinal venous insufficiency (CCSVI) secondary to extracranial venous stenosis (EVS) was suggested as a possible cause of multiple sclerosis (MS).
Methods: In this study we performed selective extracranial venous angiography (SV) on 42 patents with early MS (EMS): clinically isolated syndrome (CIS) or relapsing remitting MS (RRMS) of less than 5 years duration, and late MS (LMS): RRMS of more than 10 years duration. We also reviewed available MRI and clinical relapse data in patients with documented EVS.

Results: EVS was present in 7/29 (24%) patients with EMS and 12/13(92%) patients with LMS, a highly significant statistical difference (p<0.0001). Only 3/42 (7%) patients (all in the LMS group) had 2 vessel stenosis, while the rest had only 1 vessel involved. The incidence of EVS in CIS was 9% compared to 33% in RRMS of less than 5 years duration. The most important factor in determining presence of EVS was disease duration: mean=9.4±6.8 years in 19 patients with EVS compared to 3.2±4.1 years in patients without (p<0.005), which stayed significant after controlling for age at disease onset and gender (p<0.002). Within the EMS group, patients with (n=7) and without (n=22) EVS had similar EDSS (1.43±2.13 and 0.8±0.008, p=0.85) and disease duration (mean =2.1 and 2.4 years, p=0.521), suggesting similar disease severity. The 7 EMS patients with stenosis had a total of 14 relapses since disease onset. No clear correlation could be found between site of EVS and relapse anatomical localization. A total of 97 spine and brain MRIs available since disease onset on all 19 patients with stenosis were reviewed. Again no clear correlation could be seen between the location of gadolinium enhancing (Gd+) lesions and site of EVS.

Conclusion: CCSVI is an unlikely cause of MS since it is not present in most cases early in the disease, and in only a minority of MS patients affects more than 1 extracranial vein. It is likely to be a late secondary phenomenon, possibly related to chronic central nervous system (CNS) disease and atrophy.

post from drsclafani with what can be seen on doppler vs MRV:
http://www.thisisms.com/ftopicp-113877.html#113877

drsclafani wrote:on Doppler and ECU, one sees hemodynamic evidence of abnormal flow and anatomical abnormalities of the jugular vein

on MRvenography one sees evidence of collapse of veins, collaterals and some real stenoses

The abstract appears to be speaking about catheter venography but the techniques are unclear as are which findings of ccsvi were detected

drsclafani wrote:

Sotiris wrote:

Cece wrote:....

...The Beirut study finds that CCSVI is less common in pwCIS and more common in pwMS. So they argue that this may mean that CCSVI is a late secondary phenomenon, possibly related to chronic central nervous system (CNS) disease and atrophy. I ask if this could also mean that having MS, there may also be another factor for the deterioration of veins (e.g. a virus) or if this could be a property of the malformations (truncular vs. extratruncular). I know there are no clear answers yet, but I would like to know what Dr. Sclafani thinks about it.

i doubt that ms causes ccsvi. my original thought was that ms caused ccsvi caused by inflammation of the veins. It is not an inflammatory process in the veins. but a malformation. marlforamations occur in the fetus

ikulo wrote:Here we have an independent study, as the skeptics have been requesting, that confirms that venous stenosis exists and, at the very least, is a part of late-stage MS. Yet, all we can argue about is about what causes what. I think the authors, and some of the posters, should take a step back and realize that they just concluded that CCSVI is likely a late-stage phenomenon of MS. Shouldn't that in itself be a ground-breaking piece of research? I would expect the next NMSS magazine cover headline to read: "Independent Study Finds Venous Stenosis in 92% of Late Stage PwMS."

dreddk wrote:Study conducted using venography (gold standard?).


http://www.ncbi.nlm.nih.gov/pubmed/21041329


"Conclusions: We conclude that EVS is an unlikely cause of MS since it is not present in most patients early in the disease and rarely involves more than one extracranial vein. It is likely to be a late secondary phenomenon."