New Swedish Study Casts Doubt on MS Vascular Theory

[Motiak]

I think the fact that people without MS have CCSVI indicates that there is more to this than we currently know. There's no way that many healthy controls end up with MS, it's just not realistic. I also don't support getting treatment done now unless you absolutely need it (I know I'm not) because we have had people who get worse after treatment. There are too many things we do not know.

I have no personal stake in CCSVI being proven or disproven, I just want us to make progress on figuring out what this disease is and I feel like CCSVI is currently our best bet. If that's not the case then I hope we find something else soon.

bleh, I editted this post like 4 times, I need to think more before I hit that submit button.

[malden]

I think the fact that people without MS have CCSVI indicates that there is more to this than we currently know. There's no way that many healthy controls end up with MS, it's just not realistic. I also don't support getting treatment done now unless you absolutely need it (I know I'm not) because we have had people who get worse after treatment. There are too many things we do not know.

I have no personal stake in CCSVI being proven or disproven, I just want us to make progress on figuring out what this disease is and I feel like CCSVI is currently our best bet. If that's not the case then I hope we find something else soon.

bleh, I editted this post like 4 times, I need to think more before I hit that submit button.

It's ok to edit post some more times, I do it regulary, so, dont bother yourself. Btw, I agree with what you said. But if this is not the answer, it's better for us to move forward and try some other path.

[patientx]

I think the fact that people without MS have CCSVI indicates that there is more to this than we currently know. There's no way that many healthy controls end up with MS, it's just not realistic.

Well, if you go with the assumption that CCSVI or stenosis is more prevalent in people with MS than in the general population, but is still present in the non-MS population (and we have only 2 studies that show this, which had very different results), then there's a few possibilities.

One is that some other mechanism, in addition to the CCSVI is necessary to get MS. Another is that the CCSVI is not the cause of MS, but is the result of some inflammatory mechanism. In people with MS, it could be that the inflammatory nature of the disease causes stenosis, and in non-MS people with stenosis, some other inflammation causes it. (I'm not saying I think this is what happens, just that maybe it's a possibility.)

These are the only two I can think of, right now. I'm sure there's other possibilities.

[malden]

...
These are the only two I can think of, right now. I'm sure there's other possibilities.

Third one is that CCSVI doesn't exist at all.

[sbr487]

I think the fact that people without MS have CCSVI indicates that there is more to this than we currently know. There's no way that many healthy controls end up with MS, it's just not realistic.

Well, if you go with the assumption that CCSVI or stenosis is more prevalent in people with MS than in the general population, but is still present in the non-MS population (and we have only 2 studies that show this, which had very different results), then there's a few possibilities.

One is that some other mechanism, in addition to the CCSVI is necessary to get MS. Another is that the CCSVI is not the cause of MS, but is the result of some inflammatory mechanism. In people with MS, it could be that the inflammatory nature of the disease causes stenosis, and in non-MS people with stenosis, some other inflammation causes it. (I'm not saying I think this is what happens, just that maybe it's a possibility.)

These are the only two I can think of, right now. I'm sure there's other possibilities.

Another possibility I can think of is that the whole system breaks down and leads to MS only if
1) stenosis is really bad
2) multiple stenosis

Probably the determining factor could be the amount of reflux rather than just stenosis itself ...

To add to the confusion looks like people with other neurological issues seem to also suffer from venous insufficiency ...

[BooBear]

@ Malden:

Blood reflux is not unheard of, let alone physically impossible or even improbable. Saphernofemoral reflux is well documented and recognized.

Saphernofemeroal reflux occurs in veins in the legs. The valves that ensure one-way blood flow in the veins begin to malfunction (due to disease or other issues), resulting in reflux of blood into the vein.

In these cases, the reflux can cause varicose veins, itching and burning sensations, etc.

So what would occur if reflux happened in the same manner into the brain- where papers have shown that abnormal iron levels can lead to oxidative stress? Perhaps MS?

[malden]

@ M:

Blood reflux is not unheard of, let alone physically impossible or even improbable. Saphernofemoral reflux is well documented and recognized.

Saphernofemeroal reflux occurs in veins in the legs. The valves that ensure one-way blood flow in the veins begin to malfunction (due to disease or other issues), resulting in reflux of blood into the vein.

In these cases, the reflux can cause varicose veins, itching and burning sensations, etc.

So what would occur if reflux happened in the same manner into the brain- where papers have shown that abnormal iron levels can lead to oxidative stress? Perhaps MS?

It can't "happened in the same manner into the brain..." simple because there is no registrated change in presure gradient that can redirect blood flow in neck veins toward the brain (flow is allways from high presure to low). In legs veins situation is diferent, blood must flow upstairs, there is no aditional pump in the feet to pull it up, legs muscules contraction and valves do the job - blud is climbing to the hart step by step. In neck it just fall down.

[BooBear]

@ Malden: I am not sure that it makes a difference.

All our veins have valve to ensure only one flow- including the IJVs. If blood could never flow into the brain, as you theorize below, why are the valves there?

[malden]

@ M: I am not sure that it makes a difference.

All our veins have valve to ensure only one flow- including the IJVs. If blood could never flow into the brain, as you theorize below, why are the valves there?

Valve in vein is primary for helping blood below hart level to climb up to the hart. Blood above hart level can return to the hart without asistence of the valves, simply by gravitation. And in many cases is reported that neck veins dont have valves or valves are undeveloped or incompetent (cannulation and catheterization of the IJV may cause persistent incompetence of the IJV valve).

[PCakes]

would you allow that there may be reflux in the case of an inverted valve, a membrane obstuction, a narrowed/stenosed vein or anything other that might impede blood flow?

[malden]

would you allow that there may be reflux in the case of an inverted valve, a membrane obstuction, a narrowed/stenosed vein or anything other that might impede blood flow?

Yes there may be reflux, in those cases:
shortened url

IN approximately 90% of human internal jugular veins (IJVs) there is a valve. It is situated directly above the termination of the IJV in the inferior bulb, the position of which may vary slightly from being almost directly posterior to the head of the clavicle to a position 3 cm further inferior and 3 cm further lateral. The valve prevents backward blood flow toward the brain when the intrathoracic pressure acutely increases and can create transvalvular gradients of up to 100 mmHg. The competence of the valve has been found to be crucial for developing a transcranial blood pressure gradient during cardiopulmonary resuscitation with closed-chest compression. In addition, this valve prevents sudden increases in the IJV pressure during coughing or positive pressure ventilation and may thus protect the brain from acute increases in intrathoracic pressure

...but not in case of a narrowed/stenosed vein.

[dreddk]

One interesting point the authors raise is that we should expect to see transient global amnesia (tga) in ms sufferers if ccsvi was widespread. Impairments in cerebral venous flow are associated with tga.

Again this troubles me somewhat that what one might expect to be acute symptoms of impaired venous flow are not seen, yet chronic ones are theorized to exist.

http://www.ncbi.nlm.nih.gov/pubmed/17629610

[L]

One interesting point the authors raise is that we should expect to see transient global amnesia (tga) in ms sufferers if ccsvi was widespread. Impairments in cerebral venous flow are associated with tga.

Again this troubles me somewhat that what one might expect to be acute symptoms of impaired venous flow are not seen, yet chronic ones are theorized to exist.

http://www.ncbi.nlm.nih.gov/pubmed/17629610

The formation of collateral veins would ensure that the thalamus, amygdala and hippocampus (relevant areas of the brain, I just read) would not be starved of oxygen by poor blood flow. After all, the theory isn't that the brain becomes starved of oxygen, it's that iron builds up as a result of reflux.

[Motiak]

One interesting point the authors raise is that we should expect to see transient global amnesia (tga) in ms sufferers if ccsvi was widespread. Impairments in cerebral venous flow are associated with tga.

Again this troubles me somewhat that what one might expect to be acute symptoms of impaired venous flow are not seen, yet chronic ones are theorized to exist.

http://www.ncbi.nlm.nih.gov/pubmed/17629610

Without doing any reading (it's way too early in the morning) I think we covered that transient amnesia thing a long time ago where the reflux found in those patients was only while doing the valsalva maneuver while CCSVI is without vasalva.

[dreddk]

Found it thks http://www.thisisms.com/ftopic-9863-0-d ... rasc-.html