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positive remission of MS after CCSVI is treated
Posted: Wed Dec 14, 2011 8:27 am
by Cece
http://www.ncbi.nlm.nih.gov/pubmed/22155803
"In all the cases we observed positive remission of the disease, the first ever documented case of MRI index improvement."
Georgian Med News. 2011 Oct;(199):29-34.
Endovascular treatment of patients with chronic cerebrospinal venous insufficiency and multiple sclerosis.
Kipshidze N, Rukhadze I, Archvadze A, Kipiani V, Kipshidze N, Lapiashvili E, Kaloiani V.
Source
N. Kipshidze Central University Hospital, Tbilisi, Georgia; Franklin and Marshall College, Lancaster, PA, USA; Lenox Hill Heart and Vascular Institute, New York, NY, USA.
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) by an unknown pathogenesis. MR venography and postmortem studies have demonstrated a topographic correspondence between multiple sclerosis (MS) plaques and the cerebral venous system pathology. In recent observational studies performed on patients from distinctive gene pools, the prevalence of chronic cerebrospinal venous insufficiency (CCSVI) in MS ranged from 56% to 100%. Endovascular treatment (percutaneous transluminal angioplasty (PTA) with or without stenting) of CCSVI was reported to be feasible with a minor complication rate. In 4 patients with different forms of multiple sclerosis venography was performed that revealed stenosis of the proximal region of the jugular vein (right or left). Percutaneous transluminal balloon angioplasty (PTA) was performed in all patients. There were no complications and mean stenosis was reduced after PTA from 59,75% to 36,75%. Follow-up included clinical observations and magnetic resonance imaging (MRI). In all the cases we observed positive remission of the disease, the first ever documented case of MRI index improvement. PTA seems to be an effective treatment for patients with CCVI and multiple sclerosis, However, randomized studies are warranted to establish the efficacy of this new treatment for MS.
I think this is the future of our disease! Positive remission. The first ever documented MRI index improvement. An effective treatment for patients with CCSVI and MS. More research warranted.
Re: positive remission of MS after CCSVI is treated
Posted: Wed Dec 14, 2011 2:43 pm
by Jugular
Now you're talking. I think CCSVI fell victim to its own improvement report hype in the sense that, unlike ALL other MS research, success is measured by improvement rather than by halting or slowing progression. If PTA does indeed put the disease into remission then this is the biggest breakthrough EVER.
Period.
Re: positive remission of MS after CCSVI is treated
Posted: Wed Dec 14, 2011 5:38 pm
by Quest56
No doubt good news, but one wonders what MRI index improvement is, how it is measured, and what it is a measurement of.
--Tracy
Re: positive remission of MS after CCSVI is treated
Posted: Wed Dec 14, 2011 6:15 pm
by cheerleader
You can see the MRI pic...there is a huge lesion which is no longer visible.
Page 31 of this Georgian Medical News Journal, a monthly peer-reviewed scientific journal published in Russian and English.
The MRI on the left is from January 2011, the one on the right is June 2011.
The patient is PPMS, and the only thing to change in the patient's regimen was PTA.
http://www.geomednews.org/shared/issues/med199.pdf
cheer
Re: positive remission of MS after CCSVI is treated
Posted: Wed Dec 14, 2011 6:24 pm
by cheerleader
Also, the lead author, Dr. Nicolas Kipshidze, is presenting his work at the International Congress for Endovascular Specialists in February 2012
http://www.iconmeeting.org/program/thur ... ry-16-2012
Dr. Kipshidze is Director at Lenox Hill Heart and Vascular Institute and a physician there, as well as General Director at University Hospital in Tbilisi, Georgia.
Re: positive remission of MS after CCSVI is treated
Posted: Wed Dec 14, 2011 7:00 pm
by ikulo
I'm not sure I see a huge difference in the two MRI's discussed above. The right MRI (after the procedure) may look better on the right side of the brain, but the left side of the brain after the procedure looks significantly worse.
Re: positive remission of MS after CCSVI is treated
Posted: Wed Dec 14, 2011 7:30 pm
by Billmeik
encouraging paper
Re: positive remission of MS after CCSVI is treated
Posted: Wed Dec 14, 2011 7:39 pm
by Cece
ikulo wrote:I'm not sure I see a huge difference in the two MRI's discussed above. The right MRI (after the procedure) may look better on the right side of the brain, but the left side of the brain after the procedure looks significantly worse.
Huh. When I looked at it, I don't think the MRI slices line up exactly. The left side has a smaller ventricle area showing. I guess I'll take the study author's interpretation on this one. That lesion on the right was enormous.
Over on the Facebook site, Arlene Hubbard commented in response to this research that the Hubbard Foundation has a paper that had a few revisions necessary but also with very positive results.
It feels like this next year, we might begin to see a good number of research papers coming out!!
It should also be noted that this paper had an extremely small sample size of 4 patients.
Lesions on MRIs is in the MacDonald criteria for diagnosing MS. For CCSVI treatment to have an impact on MRI lesions is a very big deal.
Re: positive remission of MS after CCSVI is treated
Posted: Thu Dec 15, 2011 8:58 am
by munchkin
From what I hear from the neurologists in Canada, they will only consider changes in MRI as proof. This seems to be a major step in having PTA recognized as a valid treatment. The more evidence of changes in our MRI's will only make it easier to prove PTA is effective.
Although, I'm sure here in Canada it will still be considered the placebo effect and various other reasons on why this cannot be true. I just attended a lecture by an Asst. Professor who is also practicing at the local MS Clinic. It was like being in a room with Dr. Freedman, I was extremely disappointed but not surprised. If I was in the medical field I would be furious for wasting my time listening to a rant. As a patient, my frustration will be dealt with by a letter to the MS Clinic director, the Minister of Health, possibly the local paper, and the University.
Re: positive remission of MS after CCSVI is treated
Posted: Thu Dec 15, 2011 7:10 pm
by marcstck
Lesions seen on the MRIs of MS patients quite often wax and wane on their own. Not so much with PPMS patients, but there's no hard fast rule on that either.
All of the currently approved MS drugs were approved based on the fact that they reduce lesions, so this is a valid criteria. Certainly, this isn't the first time improvements on MRIs have been noted in the history of MS treatment, so I'm not sure what the researchers are referring to.
Still, promising research, especially on the progressive patients. Would be interesting to know what the clinical outcome was. Based on the large volume of e-mail I get from patients who have undergone CCSVI treatment, folks with progressive disease generally have very disappointing results. Of course, that's just a small sample, and not a random one at that. Maybe the only people compelled to write me are the ones who are disappointed with their outcomes.
It does suck to be accused of promoting a treatment that doesn't work, which is happened on a number of occasions. I suppose some people need to take their frustrations out on someone. I've always tried to give a very balanced view of CCSVI on Wheelchair Kamikaze, and don't think I've really promoted anything, other than a flow of information. Can't please everyone, I guess…
Re: positive remission of MS after CCSVI is treated
Posted: Thu Dec 15, 2011 7:16 pm
by marcstck
The MRI images presented do seem a bit confusing. While the right side does seem better, the left side certainly has more lesions then before. And as Cece noted, the slices don't seem to match up, which could make a huge difference.
Also, the lesion load seems unusual for a PPMS patient. PPMS is generally seem to have less brain lesions, and more spinal activity. The amount of lesions in this person's brain is quite significant, more than might be expected for a typical PPMS sufferer, but nothing about MS is usually "typical"…
The paper is also far from specific about what kinds of clinical improvements were seen in the PPMS patient. The paper itself is odd, and seems to do more with CCSVI hypothesis in general than with this trial itself, reading almost like a "Brief Intro to CCSVI". Lots of typos, also, but that could be because it is published in a Georgian Russian medical Journal, and English is not a first language…
Re: positive remission of MS after CCSVI is treated
Posted: Thu Dec 15, 2011 11:15 pm
by MrSuccess
and such a small study .... only 4 pwMS ?
It's a start ...... 4 is better than none.
MrSuccess
Re: positive remission of MS after CCSVI is treated
Posted: Fri Dec 16, 2011 6:56 am
by KateCW
The whole lesion thing doesn't mean much to me- I appRently have very subtle lesions with little inflammation and really no change over the past 6 years. However, I have continued to get worse and am now EDSS of 8. Lesion load seems useless as a measurement for PPMS. I that's one of the many challenges in studying progressive forms of MS.
Re: positive remission of MS after CCSVI is treated
Posted: Fri Dec 16, 2011 4:31 pm
by LR1234
I went through 14 years of symptoms with nothing showing up on MRI's and my symptoms were quite severe and getting worse.....the damage was def going on but not on the MRI's.
What are the MRI's not picking up??
Re: positive remission of MS after CCSVI is treated
Posted: Fri Dec 16, 2011 4:56 pm
by CureOrBust
I think its about time we saw papers attempting to include effects on MRI's, as this is the "language" used by neurologists to compare existing treatments; which we want neurologists to investigate CCSVI as a possibility. I personally will not be taking this paper to my neurologists, as it has not been published in what he would call a "respected journal", and 4 participants would really screw up any confidence intervals. Don't misunderstand me, I do think this is a giant leap forward in method, and hope it has raised the bar for others.