NEW: Angioplasty study presented at European Neuro Society

[cheerleader]

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Multiple sclerosis: clinical aspects

Sunday, May 29, 2011, 12:00 - 13:00
Extracranial venous vessel pathology in multiple sclerosis

M. Denislic, Z. Milosevic, M. Zorc, O. Mendiz, M. Leskosek, D. Ravnik (Ljubljana, SI; Buenos Aires, AR; Vrhnika, SI)

Objectives: Venous vessel pathology in patients with multiple sclerosis (MS) has increased a great interest in the scientific community. The new vascular entity named chronic cerebrospinal venous insufficiency (CCSVI) is characterised by multiple stenoses of the extracranial veins – jugular and azygous veins. A four patterns of venous stenosis was described. Pathohistological studies desribed perivenous distribution of demyelinating lesions, and by high resolution MR venography a central vein in the long axis of MS lesions was highlighted. The role of an iron accumulation in the brain tissue is discussed.The aim of our study was to elucidate the occurence of the venous vessel pathology in patients with an advanced progressive course of MS.

Methods: The MS patients who fulfilled 2 or more of the 5 proposed criteria obtained by Doppler sonography required for the CCSVI, underwent selective venography. Disability status was assessed by the Expanded Disability Status Scale (EDSS). Fatigue was evaluated using Fatigue Severity Scale (FSS). Selective venography by placing a coronary catheter in the right femoral vein was performed. Informed consent by participating subjects and agreement of the National ethical committee was obtained.

Results: In this study we enrolled 30 consecutive MS patients (aged 27-73 years) with progressive course of disease – 17 patients with secondary progressive and 13 with primary progressive MS with mean EDSS 5.53 (range 2.0-7.5). The mean narrowing of the jugular and azygous veins was 75% (range 50-95%). After 95 transluminal dilatations the improvement of the venous outflow was achived. Endovascular treatment did not produced any serious side effects. The significant improvement of EDSS score (less than 1.0 point) was not noticed, but significant amelioration of the fatigue assessed by FSS (p < 0.001).

Conclusion: In all MS patients with the progressive course of disease venous vessel pathology was discovered. Selective venography is a very important and sensitive method in detecting stenosis of the extracranial venous pathway. By advanced pyramidal involvement an improvement of disability score is not expected. The amelioration of fatigue plays an important role in defeating daily obstacles in MS patients. Even in advanced disability, quality of life could be well preserved. It seems that the endovascular treatment in more disabled MS patients is promising.

[1eye]

link

Multiple sclerosis: clinical aspects

Sunday, May 29, 2011, 12:00 - 13:00
Extracranial venous vessel pathology in multiple sclerosis

M. Denislic, Z. Milosevic, M. Zorc, O. Mendiz, M. Leskosek, D. Ravnik (Ljubljana, SI; Buenos Aires, AR; Vrhnika, SI)

Objectives: Venous vessel pathology in patients with multiple sclerosis (MS) has increased a great interest in the scientific community. The new vascular entity named chronic cerebrospinal venous insufficiency (CCSVI) is characterised by multiple stenoses of the extracranial veins – jugular and azygous veins. A four patterns of venous stenosis was described. Pathohistological studies desribed perivenous distribution of demyelinating lesions, and by high resolution MR venography a central vein in the long axis of MS lesions was highlighted. The role of an iron accumulation in the brain tissue is discussed.The aim of our study was to elucidate the occurence of the venous vessel pathology in patients with an advanced progressive course of MS.

Methods: The MS patients who fulfilled 2 or more of the 5 proposed criteria obtained by Doppler sonography required for the CCSVI, underwent selective venography. Disability status was assessed by the Expanded Disability Status Scale (EDSS). Fatigue was evaluated using Fatigue Severity Scale (FSS). Selective venography by placing a coronary catheter in the right femoral vein was performed. Informed consent by participating subjects and agreement of the National ethical committee was obtained.

Results: In this study we enrolled 30 consecutive MS patients (aged 27-73 years) with progressive course of disease – 17 patients with secondary progressive and 13 with primary progressive MS with mean EDSS 5.53 (range 2.0-7.5). The mean narrowing of the jugular and azygous veins was 75% (range 50-95%). After 95 transluminal dilatations the improvement of the venous outflow was achived. Endovascular treatment did not produced any serious side effects. The significant improvement of EDSS score (less than 1.0 point) was not noticed, but significant amelioration of the fatigue assessed by FSS (p < 0.001).

Conclusion: In all MS patients with the progressive course of disease venous vessel pathology was discovered. Selective venography is a very important and sensitive method in detecting stenosis of the extracranial venous pathway. By advanced pyramidal involvement an improvement of disability score is not expected. The amelioration of fatigue plays an important role in defeating daily obstacles in MS patients. Even in advanced disability, quality of life could be well preserved. It seems that the endovascular treatment in more disabled MS patients is promising.

I'm an agnostic kind of guy but if I wasn't I'd be on my knees. Please whatever powers natural or supernatural there are, let this be the thing that saves all those dying people.

[PCakes]

I'm an agnostic kind of guy but if I wasn't I'd be on my knees. Please whatever powers natural or supernatural there are, let this be the thing that saves all those dying people.

Amen!

[fernando]

Oscar Mendiz (O.Mendiz) is a top IR and Cardiologist here in Argentina.

[cheerleader]

this is an interesting study, because it is headed up by neurologist/cardiologist teams and is a collaboration between Slovakia and Argentina. And it was presented at a neurological conference. Sadly, Dr. Zivadinov did not present his angioplasty study at ANA in Hawaii....where 10 pwMS all had venous malformations.

In this study,every single person with MS had some sort of venous abnormality upon angioplasty. Having spoken with most of the doctors involved in angioplasty, this is what they are finding...90-100% of pwMS have venous malformations slowing drainage.
I'll say an extra prayer for you, one eye

cheer

[Cece]

If they have an easier time finding CCSVI in advanced progressive MS, then they could research this group specifically. (And it's a group where there aren't other treatment alternatives, since the DMDs are useless.)

Great piece of research. Does research from outside of the US get discounted???

[ErikaSlovakia]

this is an interesting study, because it is headed up by neurologist/cardiologist teams and is a collaboration between Slovakia and Argentina.
...
cheer

Just a little correction.
It is Slovenia, not Slovakia.
Erika

[cheerleader]

this is an interesting study, because it is headed up by neurologist/cardiologist teams and is a collaboration between Slovakia and Argentina.
...
cheer

Just a little correction.
It is Slovenia, not Slovakia.
Erika

thanks, Erika. For those, like me, who don't know the difference between 2 very different countries on opposite sides of Hungary and Austria...here's a good link. Always learning something new on this site
http://www.slovensko.com/slovakia/slo.htm
cheer

[fogdweller]

link

By advanced pyramidal involvement an improvement of disability score is not expected. The amelioration of fatigue plays an important role in defeating daily obstacles in MS patients. Even in advanced disability, quality of life could be well preserved. It seems that the endovascular treatment in more disabled MS patients is promising. [/b]

As someone with primary progressive, 35 years post diagnosis, this is encouraging. So far the info has been that angioplasty for CCSVI is most useful for early PPMS patients. Dr. Sclafani once said that it would be helpful with the autonomic system ... with that and fatigue, there is real reason to perform angioplasty on PPMS paients!

[1eye]

I thought I would post this here. If it is seen at all in this country, I think this study has a direct bearing on why we need to stop messing around and approve saving lives using taxpayer dollars. I want Mr. Farrel and people who knew Bill Peart and the people who depend on emergency follow-up care in St. Catherines, Ontario and elsewhere to know how hard their Ministers are working for them:

Thank you for your e-mail and attachments regarding the treatment of Multiple Sclerosis
(MS). I know how difficult it can be for those fighting MS and their families - indeed, my
own grandfather had MS.

It’s important that access to effective new treatments be made available to the people of
Ontario as quickly as possible, especially when people are fighting serious diseases. l
recognize the great hope that Dr. Paolo Zamboni’s new theory is offering MS patients.
Like you, l want to do all that we can to move as quickly as we can to determine if it is
effective and safe for treating MS.

However, decisions about care in our publicly-funded health care system must rely on
the best available clinical evidence. Dr. Zamboni’s new treatment for Chronic
Cerebrospinal Venous Insufficiency (CCSVI) is currently considered experimental, and
experimental services are not covered under OHIP. In fact, Dr. Zamboni himself has
stated publicly that patients demanding access to this treatment should wait until it has
been thoroughly tested.

Currently, angioplasty is an insured service under OHIP for people who have a
recognized clinical condition that would benefit from the procedure. CCSVI is not yet
one of those recognized clinical conditions and requires focused research to determine
if it should become an insured service through OHIP. Please note that angioplasty for
CCSVI has never been an insured service under OHIP.

Please be assured that our government is watching the developments related to CCSVI
with enormous interest. Last spring, l requested that the Ontario Health Technology
Advisory Committee (OHTAC) review available evidence on the CCSVI procedure.
OHTAC advised that it cannot make a recommendation at this time due to a lack of
evidence. lt also committed to following international and national research results as
they become available and will continue to review the latest research and literature on
this subject.

More recently, as you know, the Canadian Institutes for Health Research (CIHR), the
federal agency responsible for funding health research in Canada, and the MS Society
of Canada met with leading North American scientists and experts to discuss the CCSVI
procedure and to identify research priorities for Canada in this area. On August 31,
2010, Dr. Alain Beaudet, President of CIHR, reported that the scientific experts agreed
that there is an overwhelming lack of scientific evidence related to the link between
blocked veins and MS.

In response to Dr. Beaudet’s report and recommendations, the federal government is
establishing a scientific expert working group made up of the principal investigators from
the seven MS Society of Canada and US National MS Society-sponsored studies (four
in Canada and three in the US). The expert working group will include scientists from
ClHR and the MS Societies, as well as representatives from the provinces and
territories, to monitor and analyze preliminary and final results from these studies, and
related studies from around the world. Information on the ClHR report and its findings,
and the MS Society research is available at
http://www.cihr-irsc.gc.ca and http://mssociety.ca/en/releases/nr_20100611.htm.

ln addition, my federal, provincial and territorial colleagues and I committed at our
September 2010 meeting to speed up the development of a protocol for a Pan-
Canadian clinical trial if and when the research supports it. Please be assured of our
resolve to work together, as well as our commitment to do everything we can to
accelerate the work in this area once the results of the national and international studies
are known.

l want to assure you that we’re committed to ensuring that Ontario's health care system
is supported by the best research so we can provide the best care possible - treatment
that is safe and supported by best practices and clinical evidence. Research supported
by the MS Society is under way in the province to augment the initial work by Dr.
Zamboni. Of the four MS Society-sponsored studies in Canada, two are taking place in
Ontario -- one at The Ottawa Hospital and the other at The Hospital for Sick Children in
Toronto. l am advised that both studies will investigate the correlation between CCSVI
and MS.

As l mentioned earlier, angioplasty is an insured service under OHIP for people who
have a recognized clinical condition that would benefit from the procedure. That's why
it’s so important for the research community to proceed with their studies to see if
CCSVI is a condition that causes or aggravates MS.

ln the meantime, as you also know, my ministry has set up an expert advisory group to
provide advice on follow-up care and treatment for people with multiple sclerosis (MS)
who return to Ontario after undergoing the experimental CCSVI procedure outside of
Canada. A copy of my announcement on the expert advisory group is attached. The
MS Expert Advisory Group is free to consult with clinicians who have direct experience
with the CCSVI procedure. It has the mandate to consult with other organizations,
associations, experts, as well as solicit input and feedback from general practitioners
and other health care providers who may interact with MS patients.

In addition, our government will support the federal government if it moves to create a
national multiple sclerosis registry for patients living with MS.

Our government shares your desire to take advantage of medical breakthroughs as
Soon as the clinical evidence shows that it is safe and effective to provide the treatment.

I’m hopeful that that happens soon for the sake of those fighting diseases like MS and
their families, and l ask for your patience while the international and national studies are
completed.

Thank you again for writing.

Sincerely,

Deb Matthews
Minister