vagus nerve compression in CCSVI in MS

[Cece]

I think autonomic nervous system has to be involved, based on the improvements that are seen (sweating, for example).
I did a quick search of some of what Dr. Sclafani posted previously on the autonomic nervous system. This was back in 2010.

The manifestations of MS depend upon which neural tissue is demyelinated. Some have weakness, some have sensory to one area, others to another ara.

I suspect that the cold hands and feet may be a manifestation of sensory damage OR due to damage of the autonomic nervous system that controls constriction of the blood vessels, sweating, etc.

The other day, one of my patients told me that immediately after her treatment her hands were sweating, something that she had not done in many years. The speed of the effect suggests placebo or a vascular autonomic effect. Sometimes vasoconstricting to reduce blood flow and feeling quite cool, othertimes vasodilating and increasing blood flow and feeling quite warm

http://www.thisisms.com/forum/chronic-c ... ml#p100854

the impact of MS on the autonomic nervous system is well known. While other autonomic dysfunctions, such as bladder, bowel and sweating disorders, are more common, or more commonly recognized, effects on cardiac rhythm are well known. The first case of atrial fibrillation during an exacerbation of MS was reported in 1986.
[...] The only complication my patients have had during liberations i have performed (it seems in another lifetime before I got more heavily involved as a writer ) was a young man in early 30s who developed atrial fibrillation immediately after liberation. I suspected a profound change in his autonomic nervous system occured during liberation. the AF reverted to normal within 12 hours but he has been the only patient to need unplanned admission.

hope this helps

http://www.thisisms.com/forum/chronic-c ... ml#p114889

A profound change in autonomic nervous system occurred during the procedure. Caused by normalization of cerebral blood flow? Caused by normalization of cerebrospinal fluid flow? Caused by vagus nerve compression?

[MarkW]

Interesting thread Cece.

I think autonomic nervous system has to be involved, based on the improvements that are seen (sweating, for example).

MW - Agree that the autonomic nervous system is involved. However, examples of autonomic changes immediately after venoplasty need more investigation. A record of fast and slow autonomic changes would be a start. Dr S reported:

The manifestations of MS depend upon which neural tissue is demyelinated. Some have weakness, some have sensory to one area, others to another area.
I suspect that the cold hands and feet may be a manifestation of sensory damage OR due to damage of the autonomic nervous system that controls constriction of the blood vessels, sweating, etc.
The other day, one of my patients told me that immediately after her treatment her hands were sweating, something that she had not done in many years. The speed of the effect suggests placebo or a vascular autonomic effect. Sometimes vasoconstricting to reduce blood flow and feeling quite cool, othertimes vasodilating and increasing blood flow and feeling quite warm.

MW - I do not see evidence for quick neural repair but it would be great if venoplasty did this.

http://www.thisisms.com/forum/chronic-c ... ml#p114889
A profound change in autonomic nervous system occurred during the procedure. Caused by normalization of cerebral blood flow? Caused by normalization of cerebrospinal fluid flow? Caused by vagus nerve compression?

MW - To me, yes something did/is happening (see my Telegraph article). It is similar to the whole CCSVI syndrome debate. Something good is happening to pwMS but I am yet to see evidence that answers 'why'.
Kind regards,
MarkW

[Cece]

The 'why' is a terribly interesting question.
I find it difficult to imagine that the autonomic nervous system improvements seen after CCSVI ballooning are due to vagus nerve compression.

random article
http://ajpheart.physiology.org/content/278/2/H515.full

The autonomic nervous system, specifically efferent sympathetic modulation, causes contraction of smooth muscle of the vessel walls and, along with activation of the skeletal muscle pump, contributes to control of vascular compliance, central venous pressure, and venous return.

How could angioplasty of jugular blockages improve sympathetic vasomotor tone? Can the outflow obstructions directly impair the autonomic nervous system's efforts, so that when the obstructions are diminished, the autonomic nervous system functions as it is supposed to, without the need to imagine that there has been instantaneous neural repair?

[drsclafani]

The 'why' is a terribly interesting question.
I find it difficult to imagine that the autonomic nervous system improvements seen after CCSVI ballooning are due to vagus nerve compression.

random article
http://ajpheart.physiology.org/content/278/2/H515.full

The autonomic nervous system, specifically efferent sympathetic modulation, causes contraction of smooth muscle of the vessel walls and, along with activation of the skeletal muscle pump, contributes to control of vascular compliance, central venous pressure, and venous return.

How could angioplasty of jugular blockages improve sympathetic vasomotor tone? Can the outflow obstructions directly impair the autonomic nervous system's efforts, so that when the obstructions are diminished, the autonomic nervous system functions as it is supposed to, without the need to imagine that there has been instantaneous neural repair?

i would postulate that changes in blood flow improve csf drainage and perhaps leads to less compression of the brainstem

cambodia is nice

[Cece]

Any pictures of Cambodia for us?

Changes in blood flow lead to improved cerebrospinal fluid drainage (perhaps) and reduced compression of the brain stem (perhaps).
The mathematical models we've been discussing lately might support this.

[1eye]

I don't know, but good questions.
Here's an image of dilatation of the jugular vein in jugular phlebectasia. This is considered a benign condition. If jugular phlebectasia does not compress the vagus nerve, I do not think CCSVI dilatation would. Or am I missing something?

http://www.ijoonline.com/viewimage.asp? ... 324_f2.jpg

i strongly doubt this hypothesis. The pressure in the jugular vein is so low, that it is unlikely to have an affect on the vagus nerve function.

Also the vocal cords are controlled by the vagus nerve and i do not think that patients with ccsvi or m s have hoarse voices very commonly. and that would be affected by vagal nerve in the neck being dysfunctional.

it is far more likely that the cranial nerves are affected by the demyelination intracranially in the brain stem

Dysautonomia is very common in MS but i think its cause is inside the skull

The vagus descends within the carotid sheath, between the internal jugular vein and the internal and common carotid arteries.

They all three run in parallel in sheaths, one on each side of the neck. What if the carotid were expanding in the sheath? Is it above or below the usual place for stenosis? If above, the vein being the next least compressible, there might be two effects:1) compression of the vagus and other nerves co-located alongside the two blood vessels, and 2) forcing of venous blood backwards, upwards, away from the stenosis and towards the BBB.


The whole thing reminds me of something. After the 6-month episode in 1982, which resolved completely, and was nothing but intention tremor on the right and slight dizziness, my first symptom and sign of what was to come, was a numb left pinkie finger. That happened the next day after I had spent a weird night almost sleeping on a couch with wooden arms. I spent the entire night trying to use one of the arms as a pillow. Unfortunately my whole weight almost was taken by the corner of the wood, which was not a good pillow.

I had had one side or the other of the middle of my neck resting on the corner. I could feel the blood in my head backing up, so after a while, I would change sides, just to keep it even. The next day, my neck was not sore, but my pinkie was numb. Unlike any instance of an arm "falling asleep", the sensation never came back. It's still gone.

That was 1989. Pins and needles was all I felt in that digit, from then on. Many other symptoms came and went until I finally got diagnosed in 1997.

[MarkW]

I wish that we could have fMRI images of the neck while venoplasty was performed (I know this is impossible). Then we we could visualise the changes on the cranial nerves and brainstem by relatively small changes produced by venoplasty. The fast autonomic improvements after venoplasty could be the result of small changes in pressure on cranial nerves (vagus is one) and the brainstem. I suspect that rapid/fast improvements on the autonomic system after venoplasty are going to be very difficult to attribute directly to venoplasty, despite many personal case reports recorded by patients and their doctors.
Another reason why I recommend refining the methods of diagnosing and treating CCSVI syndrome by venoplasty, instead of answering the 'why' questions.
MarkW

PS The neural damage in MS is not documented in the detail one would imagine after decades of MRIs. Until recently mainy white matter damage was investigated. Now changes in gray matter are researched. Improvements in gray matter have been recorded post venoplasty.

[msscooter]

Cece,

I saw your post and was reminded of something else about circulation to the hands. When I was young we lived in the Andes @14,000 feet. One of the responses we learned that the body has to hypoxia caused by high altitude is to constrict blood supply to the hands and feet. Maybe the immediate response many of us feel upon receiving angioplasty is because our brain if finally getting adequate oxygen and that hypoxia-constriction response is released.....

Since angioplasty I now regularly have warm hands and I see the veins in my hands most of the time. They were always too shallow and tiny before, did not pop up like most people's do. After 2 years I don't think it is placebo. I also got my handwriting back, can use chopsticks, carry heavy things and do glass art again!

[Anonymoose]

Found this while looking for permanent way to correct hyper-secretion of aldosterone. Reminded me of this conversation.

Changes in Hypothalamic–Pituitary–Adrenal Axis Measures After Vagus Nerve Stimulation Therapy in Chronic Depression
http://www.sciencedirect.com/science/ar ... 230500569X

[Cece]

The fast autonomic improvements after venoplasty could be the result of small changes in pressure on cranial nerves (vagus is one) and the brainstem.

So then we are talking about decompression of the vagus (and other cranial nerves)! Distinct from the idea of compression or manual stimulation by the balloon causing the vagus nerve to improve in function.

Changes in Hypothalamic–Pituitary–Adrenal Axis Measures After Vagus Nerve Stimulation Therapy in Chronic Depression

The study had a group of depressed patients matched with a group of healthy controls, but it did not have a control group of patients with depression who were not treated, nor a group of depressed patients receiving sham treatment.

Many other studies concur that VNS is indeed efficacious in treating depression. However, these findings do not take into account improvements over time in patients without the device. In the only randomized controlled trial VNS failed to perform any better when turned on than in otherwise similar implanted patients whose device was not turned on.[6]

http://en.wikipedia.org/wiki/Vagus_nerve_stimulation
Otherwise this would be an interesting line of inquiry, since depression is present in many MS patients. Both situational depression and organic/neurological depression.

[Cece]

Cece,

I saw your post and was reminded of something else about circulation to the hands. When I was young we lived in the Andes @14,000 feet. One of the responses we learned that the body has to hypoxia caused by high altitude is to constrict blood supply to the hands and feet. Maybe the immediate response many of us feel upon receiving angioplasty is because our brain if finally getting adequate oxygen and that hypoxia-constriction response is released.....

Since angioplasty I now regularly have warm hands and I see the veins in my hands most of the time. They were always too shallow and tiny before, did not pop up like most people's do. After 2 years I don't think it is placebo. I also got my handwriting back, can use chopsticks, carry heavy things and do glass art again!

At high altitudes, colors are also dimmed. One of my first improvements was the bright bright colors that I hadn't been seeing as bright.

I'd forgotten about the hypoxia constriction effect. Very relevant.

[Anonymoose]

The fast autonomic improvements after venoplasty could be the result of small changes in pressure on cranial nerves (vagus is one) and the brainstem.

So then we are talking about decompression of the vagus (and other cranial nerves)! Distinct from the idea of compression or manual stimulation by the balloon causing the vagus nerve to improve in function.

Changes in Hypothalamic–Pituitary–Adrenal Axis Measures After Vagus Nerve Stimulation Therapy in Chronic Depression

The study had a group of depressed patients matched with a group of healthy controls, but it did not have a control group of patients with depression who were not treated, nor a group of depressed patients receiving sham treatment.

Many other studies concur that VNS is indeed efficacious in treating depression. However, these findings do not take into account improvements over time in patients without the device. In the only randomized controlled trial VNS failed to perform any better when turned on than in otherwise similar implanted patients whose device was not turned on.[6]

http://en.wikipedia.org/wiki/Vagus_nerve_stimulation
Otherwise this would be an interesting line of inquiry, since depression is present in many MS patients. Both situational depression and organic/neurological depression.

Hm. Regardless of study controls etc, it remains an interesting and possibly relevant idea. Maybe the Vns implant didn't have to be turned on to stimulate the nerve. Maybe that makes it even more like what could happen in ccsvi angioplasty and the vagus nerve. The balloon could cause the nerve to be touched like the implant touches it. If there is swelling (no idea about this in angioplasty) maybe the vagus is touched for days until the swelling subsides. Maybe the extra blood flow in the expanded vein causes the vagus to be touched more...

[Anonymoose]

Had to add...

If you've ever had an epidural, you probably remember the anesthesiologist warning you that you may feel an electric shock in your leg if he touches a nerve in your spine. I remember the warning and my leg shooting straight out (with a huge needle in my spine! Ack!) when he hit a nerve. It seems if touching a nerve in your spine can evoke such a response, touching a nerve in your brain might do something similar.

Just thinking...

[1eye]

The neurology community has said all along, in various voices, that reactions to the procedure for CCSVI are placebo responses. This is a nice way of calling it snake oil. If anyone says that these responses have been definitively proved not to be placebo, they'd better be certain as well. Recently there was a posting about HRV tests showing it IS vulnerable to a placebo response, and I went on record supporting that conclusion from my own experience, as an 18-year-old.

The thing about that HRV story is that it sets a measuring point in my mind. The thought that "MS" is something that you could as easily convince people they had been cured of, as you could convince a test subject they had drunk alcohol, is very preposterous. Sure, just give them valium and they'll think we cured them. A likely story. Tell me another.

I thought the autonomic nervous system was just that: autonomous, and so by definition not placebo.

Maybe some things affected by autonomic nerve pathology get more automatic, and some less. Then wouldn't it depend on individual physiological differences, and how they affect specific nerves? And be predictable, but only in a particular individual?

Not only genetic makeup, but life history as well? Does the vagus predominate in the symptoms? Is it involved in intention tremor, which was among my earliest symptoms? Where do eyeballs fit in? Vision is pretty voluntary, so not placebo. In fact, aren't most eyesight improvements very testable, outside of placebo concerns? You can't turn it off without blinking.

[1eye]

I wish that we could have fMRI images of the neck while venoplasty was performed (I know this is impossible).

Unless everything used in the procedure were non-magnetic. Then it would be a matter of immobilizing head and neck, or depending on the conscious patient not to move.