Lancet Neurology: Two new reviews on vascular connection

[cheerleader]

Lancet Neurology has posted two very interesting reviews outlining the vascular connection to MS. The three main focuses are hypoperfusion, increased incidence of ischemic stroke, and the ischemic injury of the MS brain in white matter lesions and gray matter atrophy. CCSVI is also discussed as a possible mechanism of this vascular injury.

I've purchased both papers and written reviews of the research on Facebook.
https://www.facebook.com/note.php?note_ ... 0489747211
https://www.facebook.com/note.php?note_ ... 0373787211

For those not on Facebook and interested in purchasing the reviews for themselves...link below.
http://www.thelancet.com/journals/laneu ... 7/fulltext

The most interesting development is the change of heart for MS researcher Massimo Filippi, co-author of the first negative review of Dr. Zamboni published in the Annals of Neurology in Feb 2010.
http://onlinelibrary.wiley.com/doi/10.1 ... 1/abstract

Filippi now writes about the vascular aspects of MS, how the ischemic injury to brain tissue appears to be primary , and need for more research and clinical trials for CCSVI.

For instance, in a combined perfusion and diffusion MRI study, there was an association between decreased perfusion and decreased mean diffusivity—a measure of tissue integrity—in the corpus callosum of patients with relapsing-remitting MS.7 This finding seems to be more consistent with what would be expected in primary ischaemia rather than as a result of secondary hypoperfusion associated with Wallerian degeneration.

Interesting times,
cheer

[Cece]

Oh that is very interesting!! I got an earful from my neurologist about the hypoperfusion being due to the MS, not the other way around.

It is very, very good to see these articles in the Neurology journals.

Thank you for writing up the notes on these and all the work that you do!!

[Cece]

A number of recent vascular studies do not support the CCSVI theory, but some elements of CCSVI might be explained by slower cerebral venous blood flow secondary to the reduced cerebral perfusion in patients with MS compared with healthy individuals.

The way it's phrased makes it sound as if all studies are coming in negative. This is not true. A number of recent studies do not support it and a number of recent studies support it.

[cheerleader]

yes, Cece---that sentence comes from the abstract for the first review. There are many words like "might", "may", "seems", "some" and other such quantifiers. The actual paper has more concrete sentences, which come from the actual research. And they include the positive studies showing CCSVI. Which is why I bought the papers....as we've learned, the abstracts are often worded to be PC so that they might be printed in neurological journals
cheer

Abstract:
Vascular aspects of multiple sclerosis
Miguel D’haeseleer, Melissa Cambron, Ludo Vanopdenbosch, Jacques De Keyser
Three types of vascular dysfunction have been described in multiple sclerosis (MS). First, findings from epidemiological studies suggest that patients with MS have a higher risk for ischaemic stroke than people who do not have MS. The underlying mechanism is unknown, but might involve endothelial dysfunction secondary to inflammatory disease activity and increased plasma homocysteine concentrations. Second, patients with MS have global cerebral hypoperfusion, which might predispose them to the development of ischaemic stroke. The widespread decrease in perfusion in normal-appearing white matter and grey matter in MS seems not to be secondary to axonal degeneration, but might be a result of reduced axonal activity, reduced astrocyte energy metabolism, and perhaps increased blood concentrations of endothelin-1. Data suggest that a subtype of focal MS lesions might have an ischaemic origin, and there seems to be a link between reduced white matter perfusion and cognitive dysfunction in MS. Third, the pathology of MS might be the consequence of a chronic state of impaired venous drainage from the CNS, for which the term chronic cerebrospinal venous insufficiency (CCSVI) has been coined. A number of recent vascular studies do not support the CCSVI theory, but some elements of CCSVI might be explained by slower cerebral venous blood flow secondary to the reduced cerebral perfusion in patients with MS compared with healthy individuals.

[Cece]

It's very interesting to read Dr. D'haeseleer's 2011 research in light of the new research showing that bosentan can restore cerebral blood flow to normal levels in pwMS.
2011 research on vascular apsects of MS: http://www.ncbi.nlm.nih.gov/pubmed/21683931
new research on bosentan: http://www.ncbi.nlm.nih.gov/pubmed/23509249

other research by Dr. D'haeseleer: http://www.ncbi.nlm.nih.gov/pubmed?term ... d=23509249

I wish this one had had positive results: http://www.ncbi.nlm.nih.gov/pubmed/23428956
He was looking at reduced cerebral blood flow and impairment of axonal mitochondrial metabolism and astrocytic phosphocreatine (PCr) metabolism but found no relationship. If there had been a relationship, that would've given support to the need to treat the reduced cerebral perfusion to get it to normal levels.

[MrSuccess]

I believe that - Dr. Filippi - has in the past ...... written papers on the association and connection of MS to TRAUMA.

This is NOT a chicken-or-the-egg argument . The Trauma came FIRST.


MrSuccess