Why does treatment help so fast ?

[Rosegirl]

I never knew what caused those short "returns to normal". I sure tried, but there was no common thread - they could happen at any time of day.

Like you, all my symptoms are on the left. I was treated in July at Georgetown, and the IR made it clear that he was going to do his thing and didn't even want to know what other IRs were finding.

I guess from his point of pure science, it made sense to control their trial. Can't say I agreed with his approach.

[Cece]

Prof Ivo Petrov postulated on the role of gas exchange to account for immediate patient improvements and is absolutely convinced that: CCSVI is strongly associated with MS
Endovascular treatment of CCSVI is feasible and safe
Methods and strategies reducing late vein restenosis/rethrombosis have to be elaborated.

"the role of gas exchange" - does that mean oxygenation?
This is from the end of October Scotland conference.

http://www.ms-ccsvi-uk.org/home/files/m ... orward.pdf

[David1949]

I'm guessing here but he may be referring to oxygen passing through the capillary to the brain and CO2 going from the brain back through the capillary and into the blood stream.

[Cece]

Is CO2 implicated in this at all?

I bet Cheer knows....

[MarkW]

I have not seen these three factors as roles of CSF mentioned together:
- providing oxygen
- providing nutrients
- removing waste
My gut feel is that removal of waste products by opening of veins plays a significant role. If waste is not removed then the brain slows down in a negative feedback loop. Maybe, opening veins removes waste and permits the brain to work at greater speed, giving the quick recovery in fatigue and brain fog that patients have reported.
This is unlikely to be a simple single effect (our bodies are more complicated that this). It will take the researchers a long time to explain what is happening in CCSVI. Also please remember that if one of the factors is shown to have a role that does not mean the others are excluded. Explaining CCSVI is very complex, please do not try to over simplify it.

Lets remember this simple idea:
CCSVI syndrome has stenosed veins as a symptom. Any extracranial restrictions may be safely de-restricted (de-stenosed) using balloon venoplasty.

Kind regards,

MarkW

[David1949]

Is CO2 implicated in this at all?

I bet Cheer knows....

I don't think CO2 is implicated. My point was that maybe the gas exchange referred to exchanging O2 for CO2. That process would be impeded when blood flow is reduced.

[Cece]

Is CO2 implicated in this at all?

I bet Cheer knows....

I don't think CO2 is implicated. My point was that maybe the gas exchange referred to exchanging O2 for CO2. That process would be impeded when blood flow is reduced.

I don't know, David, CO2 could have a role of some sort. The oxygenation needs are obvious, but the CO2 must be building up as well.

Previous studies (1, 25, 30) indicate that CO2 also has major effects on autoregulation and cerebral blood flow. Specifically, during hypercapnia, the CBF increases and autoregulation is impaired, whereas in hypocapnia, CBF decreases and autoregulation is improved. http://ajpheart.physiology.org/content/286/2/H584.full

(Hypercapnia is when there is too much CO2 in the blood.)

[pairOdime]

Correcting impaired cerebral venous flow apparently restores proper oxygenation, influx of glucose/nutrients, promotes waste removal and may restore proper androgen signaling. If androgen signaling is disrupted it could possibly present another feedback mechanism that negatively impacts CNS function. An androgen factor may not account for the immediate results....I don't know.

Estrogen and testosterone therapies in multiple sclerosis
http://www.ncbi.nlm.nih.gov/pubmed/19660660

Testosterone acts as an efficacious vasodilator in isolated human pulmonary arteries and veins: evidence for a biphasic effect at physiological and supra-physiological concentrations.
http://www.ncbi.nlm.nih.gov/pubmed/19535892

Do androgens play a beneficial role in the regulation of vascular tone? Nongenomic vascular effects of testosterone metabolites.
http://www.ncbi.nlm.nih.gov/pubmed/20228257

Endothelial regulation of eNOS, PAI-1 and t-PA by testosterone and dihydrotestosterone in vitro and in vivo
http://www.ncbi.nlm.nih.gov/pubmed/20547636

[Jugular]

To continue with the oxygen/fuel theories, the jugulars are the exhaust pipes of the brain. Block an exhaust pipe and the engine will have impaired performance.

Add to that that our bodies, like all living things, adapt and improvise. Collaterals, trying different neuropathways would be adaptive measures our bodies could take to try a work around solution or to simply try to make the best out of a bad situation.

Removing an impedance and restoring normal flow might not instantly heal damaged areas, but it could allow damaged areas to operate a bit better which, added to the adaptive measures already taken, translates into a sudden and marked boost in performance.

[onesickrace]

at the risk of sounding completely ridiculous, has anyone on here ever jumped in a hyperbaric chamber? or even a bit further...noticed any differences while being indoors somewhere where the oxygen is a bit more pure. ie vegas hotels/casinos? oxygen bars? i know its a stretch, but... you never know, right?

i might add, i had the procedure done and noticed immediate relief of the following three symptoms in this order. and i had the procedure done with absolutely no sedatives.

cold hands, warmed as soon as they pulled the wire out of my vein
cog fog lifted 10-15 minutes after the wire was pulled
balance was nearly 60-70% better and hour after procedure

but

all symptoms came back three hours after procedure as well...

[eric593]

at the risk of sounding completely ridiculous, has anyone on here ever jumped in a hyperbaric chamber? or even a bit further...noticed any differences while being indoors somewhere where the oxygen is a bit more pure. ie vegas hotels/casinos? oxygen bars? i know its a stretch, but... you never know, right?

i might add, i had the procedure done and noticed immediate relief of the following three symptoms in this order. and i had the procedure done with absolutely no sedatives.

cold hands, warmed as soon as they pulled the wire out of my vein
cog fog lifted 10-15 minutes after the wire was pulled
balance was nearly 60-70% better and hour after procedure

but

all symptoms came back three hours after procedure as well...

A review of HBOT/MS studies showed no consistent benefit:

http://www2.cochrane.org/reviews/en/ab003057.html

Bennett MH, Heard R.

Hyperbaric oxygen therapy for multiple sclerosis.

Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003057. DOI: 10.1002/14651858.CD003057.pub2

Abstract
Background
Multiple Sclerosis (MS) is a chronic, recurrent and progressive illness with no cure. On the basis of speculative pathophysiology, it has been suggested that Hyperbaric Oxygen Therapy (HBOT) may slow or reverse the progress of the disease.

Objectives
The object of this review was to evaluate the efficacy and safety of HBOT in the treatment of MS.

Search strategy
We searched the Cochrane MS Group trials register (January 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2010), MEDLINE (January 1966 to July 2009) and the National Library of Medicine (NLM) database (January 2010), along with specialised hyperbaric resources and handsearching of relevant journals and proceedings.

Selection criteria
All randomised, controlled trials involving a comparison between HBOT and a sham therapy in MS were evaluated.

Data collection and analysis
Two reviewers independently appraised all comparative trials identified, extracted data and scored them for methodological quality.

Main results
We identified ten reports of nine trials that satisfied selection criteria (504 participants in total). Two trials produced generally positive results, while the remaining seven reported generally no evidence of a treatment effect. None of our three a priori subgroup analyses placed these two trials in the same group and were therefore unable to account for this difference. Three analyses (of 21) did indicate some benefit. For example, the mean Expanded Disability Status Scale (EDSS) at 12 months was improved in the HBOT group (group mean reduction in EDSS compared to sham -0.85 of a point, 95% confidence interval -1.28 to -0.42, P = 0.0001). Only the two generally positive trials reported on this outcome at this time (16% of the total participants in this review).

Authors' conclusions
We found no consistent evidence to confirm a beneficial effect of hyperbaric oxygen therapy for the treatment of multiple sclerosis and do not believe routine use is justified. The small number of analyses suggestive of benefit are isolated, difficult to ascribe with biological plausibility and would need to be confirmed in future well-designed trials. Such trials are not, in our view, justified by this review.

[Cece]

The small number of analyses suggestive of benefit are isolated, difficult to ascribe with biological plausibility and would need to be confirmed in future well-designed trials.

We now have the biological plausibility.

[malden]

...
i might add, i had the procedure done and noticed immediate relief of the following three symptoms in this order. and i had the procedure done with absolutely no sedatives.

cold hands, warmed as soon as they pulled the wire out of my vein
cog fog lifted 10-15 minutes after the wire was pulled
balance was nearly 60-70% better and hour after procedure

but

all symptoms came back three hours after procedure as well...

In my opinion, feeling of warmth in the legs and/or arms, immediate after intervention, is just a known notorious side effect of injection of contrast media - mainly iodine - that is used by int. radiologist to monitor procedure.

[eric593]

...
i might add, i had the procedure done and noticed immediate relief of the following three symptoms in this order. and i had the procedure done with absolutely no sedatives.

cold hands, warmed as soon as they pulled the wire out of my vein
cog fog lifted 10-15 minutes after the wire was pulled
balance was nearly 60-70% better and hour after procedure

but

all symptoms came back three hours after procedure as well...

In my opinion, feeling of warmth in the legs and/or arms, immediate after intervention, is just a known notorious side effect of injection of contrast media - mainly iodine - that is used by int. radiologist to monitor procedure.

This is what Dr. Sclafani said about the warming effects of contrast dye only lasting for a few minutes:

Hello Dr Sclafani,

Please share your thoughts as to why resolving jugular vein blood flow results in improved circulation in one's hands and feet?

Thank you,
pCakes

Or is the warmth commonly felt by people a side effect of the contrast dye used as opposed to improved circulation?

~someone here mentioned this possibility and I see it listed as a possible side effect of contrast dye:

Possible side effects or reactions include headache, dizziness, irregular heartbeat, nausea, warmth, burning sensation, and chest pain

Those affects last a few minutes only. i think this is sympathetic nervous in origin. Sweating also improves.

[malden]

Like dr. Sclafani said above, those warming effects are from contrast dye and from sympathetic nervous in origin. Not from improved circulation as a result from resolving jugular vein blood flow.