CCSVI RESEARCH here

[hope410]

Assessment of cerebral venous return by a novel plethysmography method.


Authors Zamboni P, et al. Show all Zamboni P, Menegatti E, Conforti P, Shepherd S, Tessari M, Beggs C.

Journal J Vasc Surg.
2012 Apr 20. [Epub ahead of print]

Affiliation Vascular Diseases Centre, University of Ferrara, Ferrara, Italy.

Abstract

BACKGROUND: Magnetic resonance imaging and echo color Doppler (ECD) scan techniques do not accurately assess the cerebral venous return. This generated considerable scientific controversy linked with the diagnosis of a vascular syndrome known as chronic cerebrospinal venous insufficiency (CCSVI) characterized by restricted venous outflow from the brain. The purpose of this study was to assess the cerebral venous return in relation to the change in position by means of a novel cervical plethysmography method.

METHODS: This was a single-center, cross-sectional, blinded case-control study conducted at the Vascular Diseases Center, University of Ferrara, Italy. The study involved 40 healthy controls (HCs; 18 women and 22 men) with a mean age of 41.5 ± 14.4 years, and 44 patients with multiple sclerosis (MS; 25 women and 19 men) with a mean age of 41.0 ± 12.1 years. All participants were previously scanned using ECD sonography, and further subset in HC (CCSVI negative at ECD) and CCSVI groups.

Subjects blindly underwent cervical plethysmography, tipping them from the upright (90°) to supine position (0°) in a chair. Once the blood volume stabilized, they were returned to the upright position, allowing blood to drain from the neck. We measured venous volume (VV), filling time (FT), filling gradient (FG) required to achieve 90% of VV, residual volume (RV), emptying time (ET), emptying gradient (EG) required to achieve 90% of emptying volume (EV) where EV = VV-RV, also analyzing the considered parameters by receiver operating characteristic (ROC) curves and principal component mathematical analysis.

RESULTS: The rate at which venous blood discharged in the vertical position (EG) was significantly faster in the controls (2.73 mL/second ± 1.63) compared with the patients with CCSVI (1.73 mL/second ± 0.94; P = .001). In addition, respectively, in controls and in patients with CCSVI, the following parameters were highly significantly different: FT 5.81 ± 1.99 seconds vs 4.45 ± 2.16 seconds (P = .003); FG 0.92 ± 0.45 mL/second vs 1.50 ± 0.85 mL/second (P < .001); RV 0.54 ± 1.31 mL vs 1.37 ± 1.34 mL (P = .005); ET 1.84 ± 0.54 seconds vs 2.66 ± 0.95 seconds (P < .001).

Mathematical analysis demonstrated a higher variability of the dynamic process of cerebral venous return in CCSVI. Finally, ROC analysis demonstrated a good sensitivity of the proposed test with a percent concordant 83.8, discordant 16.0, tied 0.2 (C = 0.839).

CONCLUSIONS: Cerebral venous return characteristics of the patients with CCSVI were markedly different from those of the controls. In addition, our results suggest that cervical plethysmography has great potential as an inexpensive screening device and as a postoperative monitoring tool.

Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. PMID 22521804

[PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/22521804

[MSUK]

Abstract

Objective: Chronic cerebrospinal venous insufficiency (CCSVI) was hypothesized to play a causative role in multiple sclerosis (MS). The assessment of pediatric-onset MS (POMS) may provide a unique window of opportunity to study hypothesized risk factors in close temporal association with the onset of the disease.

Methods: Internal jugular veins, vertebral veins and intracranial veins were evaluated with extracranial and intracranial ultrasound in 15 POMS and 16 healthy controls. Assessor’s blinding was maintained during the study. We considered subjects positive to CCSVI when at least two criteria were fulfilled.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/1408

[hope410]

Diagnostic accuracy of current sonographic criteria for the detection of outflow abnormalities in the internal jugular veins.

Simka M, Ludyga T, Latacz P, Kazibudzki M.

Journal Phlebology.
2012 Apr 23. [Epub ahead of print]

Affiliation EUROMEDIC Specialist Clinics, Department of Vascular & Endovascular Surgery, Katowice, Poland.

Abstract

OBJECTIVES: This study was aimed at evaluation of the diagnostic value of Doppler sonography for the assessment of abnormalities in the internal jugular veins (IJVs).

METHOD: One hundred and sixteen IJVs were assessed in 58 patients with associated multiple sclerosis. Findings of Doppler sonography were compared with results of the reference test: catheter venography.

RESULTS: At least one positive extracranial sonographic criterion suggesting venous abnormality was found in 92.2% of the assessed veins. Yet, sensitivity, specificity, positive and negative predictive values of sonography were low: 93.4%, 12.0%, 79.4% and 33.3% for at least one positive criterion, and for at least two positive criteria: 29.3%, 75.0%, 81.8% and 21.7%, respectively.

CONCLUSIONS: Our research has shown that currently used extracranial sonographic criteria for the detection of obstructive venous abnormalities in the IJVs are of limited diagnostic value. For the time being, diagnosis of this vascular pathology should be given using catheter venography.

PMID 22528692 [PubMed - as supplied by publisher]

[hope410]

Chronic cerebrospinal venous insufficiency and venous stenoses in multiple sclerosis.

Authors Blinkenberg M, Akeson P, Sillesen H, Lövgaard S, Sellebjerg F, Paulson OB, Siebner HR, Sørensen PS.

Journal Acta Neurol Scand.

2012 Apr 25. doi: 10.1111/j.1600-0404.2012.01671.x. [Epub ahead of print]

Affiliation Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Abstract

OBJECTIVES: The traditional view that multiple sclerosis (MS) is an autoimmune disease has recently been challenged by the claim that MS is caused by chronic cerebrospinal venous insufficiency (CCSVI). Although several studies have questioned this vascular theory, the CCSVI controversy is still ongoing. Our aim was to assess the prevalence of CCSVI in Danish MS patients using sonography and compare these findings with MRI measures of venous flow and morphology.

METHODS: We investigated cervical and cerebral veins in 24 patients with relapsing-remitting MS (RRMS) and 15 healthy controls, using extracranial high-resolution ultrasound colour Doppler (US-CD) and transcranial colour Doppler sonography (TCDS), as well as magnetic resonance imaging (MRI) and phase-contrast MR blood flow measurements (PC-MR) of the cervical veins.

RESULTS: US-CD could not identify the left internal jugular vein (IJV) in one MS patient, other ultrasound examinations were normal in patients with MS. There was no difference in mean cross-sectional area of the IJV in MS patients compared with controls. Only one patient with MS and two healthy controls fulfilled one CCSVI criterion, and none fulfilled more than one CCSVI criterion. MR venography showed insignificant IJV stenosis (1-49%) in two patients with MS, whereas 50-69% IJV stenosis was detected in two healthy controls. There was no difference in PC-MR measurements of mean IJV blood flow between patients with MS and controls.

CONCLUSION: Our results do not corroborate the presence of vascular pathology in RRMS and we found no evidence supporting the CCSVI hypothesis.

http://www.ncbi.nlm.nih.gov/pubmed/22530753

[MSUK]

Occlusions in cerebrospinal veins imaged with ultrasound and magnetic resonance venography do not appear to be related to multiple sclerosis, researchers said here.

In two reports from an ongoing study at the University of Texas Health Sciences Center in Houston, a significant proportion of participants -- including MS patients and non-MS controls -- showed abnormalities consistent with chronic cerebrospinal venous insufficiency (CCSVI), but it was not more common in the MS patients relative to controls.

Andrew Barreto, MD, who reported the ultrasound findings at the American Academy of Neurology's annual meeting, acknowledged that the results contrasted markedly with those originally reported by Paolo Zamboni, MD, of the University of Ferrara in Italy.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/2944

[MSUK]

'No measurable change’ in MS symptoms from liberation treatment: study



Patients who underwent the so-called liberation treatment for multiple sclerosis experienced no measurable benefit from the procedure, a study commissioned by the government of Newfoundland and Labrador found.

The results of the small, observational study were announced Wednesday in St. John’s by lead investigator William Pryse-Phillips, a professor emeritus of neurology at Newfoundland’s Memorial University.

Pryse-Phillips said he had gone into the study hopeful the treatment might have something to offer his MS patients, but completed it convinced the people who had the vein-opening procedure didn’t experience any gains.

“I am disappointed. I had hoped. I cannot recommend this therapy on the basis of these results at this time,” he said during a news conference, the video of which is posted on the Department of Health and Community Service’s website.

The province spent $400,000 on the study, which compared 30 patients with MS who had travelled outside the province to have the therapy and 10 who did not. Participants were subjected to an array of tests before the treatment and then at intervals of one month, three months, six months and one year post-procedure.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/2944

[MSUK]

Percutaneous balloon angioplasty improved flow dynamics in multiple sclerosis patients with chronic cerebrospinal venous insufficiency in a pilot study.

An association has been made recently between multiple sclerosis and chronic cerebrospinal venous insufficiency (CCSVI) that is characterized by stenosis and reflux of the principal extracranial venous drainage, including the internal jugular veins and the azygous veins. But there has been considerable debate about the validity of percutaneous balloon angioplasty in the treatment of this stenosis.

Dr. Manish Mehta of Albany (New York) Medical College and his colleagues conducted the first angiographic study to quantitatively analyze the impact of percutaneous balloon angioplasty on flow dynamics across these lesions. Dr. Mehta shared their results at the Vascular Annual Meeting....Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/2944

[MSUK]

Venous angioplasty in MS: neurological outcome at two years in a cohort of RRMS patients



Abstract
An open study was conducted with the aim of reporting long-term clinical outcome of endovascular treatment for chronic cerebrospinal venous insufficiency (CCSVI) in patients with multiple sclerosis (MS).

Twenty-nine patients with clinically definite relapsing-remitting MS underwent percutaneous transluminal angioplasty for CCSVI, outside a clinical relapse.

All the patients were regularly observed over at least two years before the first endovascular treatment and for at least two years after it (mean post-procedure follow up 30.6±6.1 months).

The following clinical outcome measures were used: annual relapse rate and Expanded Disability Status Scale (EDSS) score.

All the patients were observed intensively (mean 6 hours) on the day of the endovascular treatment to monitor for possible complications (bleeding, shock, heart attack, death).... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/2944

[eric593]

http://www.ncbi.nlm.nih.gov/pubmed/22736752

Mult Scler. 2012 Jun 26. [Epub ahead of print]

Periventricular venous density in multiple sclerosis is inversely associated with T2 lesion count: a 7 Tesla MRI study.

Sinnecker T, Bozin I, Dörr J, Pfueller CF, Harms L, Niendorf T, Brandt AU, Paul F, Wuerfel J.

1NeuroCure Clinical Research Center, Charité - University Medicine Berlin, Germany.

Abstract
Background:Damage to venules in multiple sclerosis was first described decades ago. Today, ultrahigh magnetic field strength T2*-weighted magnetic resonance imaging (MRI) techniques depict very small cerebral veins in vivo with great anatomical detail.

Objective:We aimed to investigate alterations of periventricular small blood vessel appearance in relation to T2 lesion count and distribution in multiple sclerosis and clinically isolated syndrome in comparison with healthy control subjects at 7 Tesla MRI.Methods:We investigated 38 patients (including 16 with early multiple sclerosis and seven with clinically isolated syndrome) and 22 matched healthy controls at 7 Tesla. The protocol included T2*-weighted Fast Low Angle Shot, and T2-weighted Turbo Inversion Recovery Magnitude sequences. We quantified periventricular venous density by a novel region-of-interest-based algorithm, expressing the ratio of 'veins per region-of-interest' as well as of 'periventricular vascular area'.

Results:Our study revealed significantly decreased venous density in multiple sclerosis patients compared with healthy controls. Venous alterations were already detectable in clinically isolated syndrome and early multiple sclerosis, although to a smaller extent. Venous density correlated inversely with periventricular and whole-brain T2 lesion count. Furthermore, we found no indication for cerebral venous congestion in multiple sclerosis.

Conclusion:High spatially resolving anatomical T2*-weighted MRI revealed vascular alterations in early stages of multiple sclerosis, presumably as a part of widespread haemodynamic and metabolic alterations.
PMID: 22736752 [PubMed - as supplied by publisher]

[eric593]

Even progressive forms of MS show periods of "innate improvement" and/or stability naturally, without any treatment at all.

http://www.ncbi.nlm.nih.gov/pubmed/22736751

Mult Scler. 2012 Jun 26. [Epub ahead of print]

Natural, innate improvements in multiple sclerosis disability.

Tremlett H, Zhu F, Petkau J, Oger J, Zhao Y; the BC MS Clinic Neurologists.

1Faculty of Medicine, Division of Neurology, University of British Columbia, Canada.

Abstract
Background:Improvements in multiple sclerosis (MS) disability have recently been reported in immunomodulatory drug (IMD) clinical trials and observational studies. However, improvements have rarely been examined in natural history or IMD naive patients. We investigated annual and biennial improvements in Expanded Disability Status Scale (EDSS) scores in British Columbia, Canada.

Methods:The British Columbian MS database was accessed for definite MS patients (1980-2009). Consecutive IMD-free EDSS scores one and two years apart (± 3 months) were examined; improvements (≥0.5,≥1,≥2 EDSS points) and sustained improvements (confirmed at one year) were described. The influence of patient characteristics on improvements was examined using logistic regression.

Results:From 16,132 EDSS scores, 7653 yearly and 5845 biennial EDSS intervals were available for 2961 and 2382 patients respectively. Of the yearly intervals, 14.9% showed an improvement (≥0.5 points), 8.3% ≥1 point and 2.2% ≥2 point improvement, with nearly half being sustained. Corresponding worsenings were observed in 32.9%, 20.5% and 7.9% respectively, with stability in just over half (53%). Biennial findings were similar. Characteristics generally associated with improvements included: female sex, younger age, shorter disease duration, relapsing-onset and presence of moderate disability (compared with mild or advanced) and a previous episode of worsening (disassociated from a relapse). However, improvements were also observed after periods of stability and in primary-progressive MS.

Conclusion:Improvements in MS disability over one or two years are not unusual. We suggest the term 'innate improvements'. Our findings have implication for the design of clinical trials and observational studies in MS targeting improvements on the EDSS.

PMID: 22736751 [PubMed - as supplied by publisher]

[MSUK]

Abstract
Background

Chronic cerebrospinal venous insufficiency (CCSVI) has been associated to multiple sclerosis (MS).

Objective

To evaluate the possible association between CCSVI and MS, using a population-based control design.

Methods

A random cohort of 148 incident MS patients were enrolled in the study. We have also studied 20 patients with clinically isolated syndrome (CIS), 40 patients with other neurological diseases (OND), and 172 healthy controls. Transcranial (TCC) and Echo Color Doppler (ECD) were carried out in 380 subjects. A subject was considered CCSVI positive if ≥2 venous hemodynamic criteria were fulfilled.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/2944

[CureOrBust]

I love the effort they went to in ensuring it was blinded.

Is this "publication" respected and read by neurologists?

[MSUK]

It's PLoS One US National Library of Medicine National Institutes of Health so you would HOPE so

[scorpions]

From the beginning of the CCSVI internet craze I have tried to point out that between the placebo effect and the natural course of MS it is very hard to make the claim that any specific treatment for MS is effective in the first year or two which is why long term studies are criitcal to finding out the truth. Conspiracy? Really? That is so yesterday!

[MSUK]

A Saskatoon man with multiple sclerosis will be the first person sent by the province to the United States to see if he can participate in neck vein therapy clinical trials.

Andrew Dahlen will fly to Albany, N.Y., Monday for a final assessment in order to join a two-year study of the so-called liberation therapy for MS.

The therapy involves using tiny balloons, surgically inserted, to open up constricted veins.

MS is a neurological disease that can seriously affect mobility, vision, speech and bladder function.

Hundreds of people from Canada have gone to the U.S. or overseas for the treatment, and many say it has given them relief from their symptoms.

However, neck vein therapy is controversial, with a number of medical experts saying it doesn't work, or that the relief it provides is temporary or can be explained by the placebo effect.

No Canadian province pays for the procedure for Chronic Cerebrospinal Venous Insufficiency (CCSVI) , which costs thousands of dollars per treatment, so people who leave the country for it must pay out of their own pockets.

Saskatchewan doesn't pay for the procedure either, but it has set aside $2.2 million to have 86 Saskatchewan patients participate in the Albany trials.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/2944