Is Ms related to vein congestion?

[mdj]

Is it? Because ...
http://www.jvascsurg.org/article/S0741- ... 2/fulltext
Liberation Procedure in the Treatment of Chronic Cerebro-Spinal Venous Insufficiency
- Is Chronic Cerebro-Spinal Venous Insufficiency Related To Brain Congestive Syndrome Rather Than Multiple Sclerosis

"...The evaluation of 205 ms patient’s status before the PTA procedure, 6 and 12 months after the procedure was performed using: EDSS, MSFC, PASAT and SDMT tests...
...On the check-up 6 and 12 months after the procedure the EDSS did not show any statistical significant difference between the pre and post procedural values..."

What that's means - No benefits with angioplasty on 205 MS patients?!

Best regards, Mdj.

[mdj]

Conclusions

The results obtained in this study suggest that CCSVI is related to Brain Congestive Syndrome rather than MS indicating that “Liberation” procedure may improve clinical signs in patients with MS because of brain decongestion.

Brain Congestive Syndrome - is this something new? How they prove that?

Best regards, Mdj.

[Cece]

The outcome of the procedure was also analyzed using: PRO-patient related outcomes, SF-36 questionnaire,EQ-5D (EuroQol) and Functional Assessment of Multiple Sclerosis (FAMS) quality of life. In order to determine the effects of the procedure blood sample from jugular vein was analyzed 24h before the procedure and 24h, 72h and 7 days after the procedure (pH and bicarbonate, BE, pCO2 and pO2, K+, Na+, CRP).

However, initial benefit of the procedure was seen in almost 70% of treated patients. This benefit was impossible to quantify due to the fact that neurological tools measures quality of changes in different systems but not the quantity. During the one year follow-up period over 40% of treated patients developed almost all symptoms that were present before the procedure. It is interesting that initial benefit was associated with the improvement in the biochemical parameters from the blood sample analysis. This brain decongestions after “Liberation” procedure is probably the reason for relatively fast improvement in clinical signs that we see in some group of treated patients

I think "brain congestion syndrome" is a new term. It is good to distinguish between MS and CCSVI.

They saw no EDSS improvements. They saw improvements in 70% of treated patients but found those improvements difficult to quantify. Over the following year, 40% lost those improvements, which would mean 60% retained their unquantified improvements. (I think of my own brighter colors and reduced cogfog, and how do you quantify that easily?)

But what is new about this study is that they took a blood sample from the jugulars before the procedure, another sample a day after the procedure, and at three days, and at one week. The initial improvement was associated with improvement in the biochemical parameters in those blood samples. These changes in the blood sample are probably due to a relief of brain congestion.

As Dr. Sclafani has said, he is not treating MS, he is treating CCSVI. Treating CCSVI relieves brain congestion, and this can be measured through blood samples from the jugulars. I did not know that.

[NHE]

Is it? Because ...
http://www.jvascsurg.org/article/S0741- ... 2/fulltext
Liberation Procedure in the Treatment of Chronic Cerebro-Spinal Venous Insufficiency
- Is Chronic Cerebro-Spinal Venous Insufficiency Related To Brain Congestive Syndrome Rather Than Multiple Sclerosis

"...The evaluation of 205 ms patient’s status before the PTA procedure, 6 and 12 months after the procedure was performed using: EDSS, MSFC, PASAT and SDMT tests...
...On the check-up 6 and 12 months after the procedure the EDSS did not show any statistical significant difference between the pre and post procedural values..."

What that's means - No benefits with angioplasty on 205 MS patients?!.

So, the paitents didn't get worse. The pharmas selling DMDs would call this success.

NHE

[cheerleader]

I find this paper extremely encouraging....thanks for posting, mdj! I think your title is mistaken, however...it should be "Is MS related to BRAIN congestion?"
Cece, thanks for pointing out the serum testing. I dug further, and found what they tested before and after venoplasty:

In order to determine the effects of the procedure blood sample from jugular vein was analyzed 24h before the procedure and 24h, 72h and 7 days after the procedure (pH and bicarbonate, BE, pCO2 and pO2, K, Na, CRP).

Jeff's relief of cog fog, heat intolerence, and spasms are not reflected in his EDSS numbers. These are difficult to quantify.

But if we look at venoplasty to relieve diffuse cerebral hypoxia....those serum numbers will give us more concrete, scientific information, and are more important biomarkers than an EDSS score. Also, relief of c reactive protein in the serum (CRP) would reflect a lessening of inflammation.
cheer

[DougL]

I find this paper extremely encouraging....thanks for posting, mdj!

yes thanks for posting this mdj.

[Cece]

pH and bicarbonate - would measure the acidity of the blood
BE - ?
pCO2 - ? carbon dioxide but why is there a 'p' - partial pressure carbon dioxide
pO2 - ? oxygen but why is there a 'p' - partial pressure oxygen
K - potassium
Na - sodium
CRP - is a measurement of inflammation

If the severity of congestion is a factor in how much potential there is for immediate improvements, then this might be a way to predict going into the procedure how high one's hopes should be. Plethysmography should be better than either MRV or doppler ultrasound at quantifying venous congestion in the neck (which would approximate venous congestion of the brain).

I am really curious if treatment 'normalized' the pwMS in these serum measurements, if indeed the pre-treatment measurements were abnormal? And just what was the difference between the responders and the nonresponders, and which factors seemed most significant? What can the pO2 and pCO2 measurements tell us about hypoxia in untreated CCSVI?

[Cece]

http://www.expert-reviews.com/doi/pdf/10.1586/erc.12.73

Chronic cerebrospinal venous insufficiency Molic et al. (Clinical Centre Nis, Nis, Serbia) discussed the Liberation procedure in the treatment of chronic cerebrospinal venous insufficiency – whether chronic cerebrospinal venous insufficiency related to brain congestive syndrome is rather than multiple sclerosis, highlighted chronic cerebrospinal venous insufficiency (CCSVI), which occurs due to compromised blood flow in the veins draining the central nervous system. This condition has been hypothesized to have a causal role in multiple sclerosis (MS). Currently, balloon angioplasty or stenting ‘liberation procedure’ has been the proposed treatment option for CCSVI in MS patients. Molic evaluated this procedure in patients with varying forms of MS with CCSVI. Patients were examined before the liberation procedure and at both 6 and 12 months postprocedure. Approximately 70% of treated patients showed an initial benefit, but more than 40% of the treated patients regained almost all of the preprocedural symptoms after 12 months. The author concluded that because blood biochemical parameters improved postprocedure, the liberation procedure had its greatest effects on relieving brain decongestion.

This study suggests that CCSVI is related to brain congestive syndrome rather than MS.

A summary of the article under discussion.

I don't get much when I search for brain congestive syndrome. Cold water on the head and hot mustard bath on the feet will help, according to The Complete Herbalist. http://chestofbooks.com/health/herbs/O- ... Brain.html

If you search for congestive syndrome, then google brings many, many articles on pelvic congestive syndrome. If pelvic veins can be congested, so can cerebral veins and neck veins.

[frodo]

Brain Congestive Syndrome - is this something new? How they prove that?
Best regards, Mdj.

I would say that they try to define Brain Congestive Syndrome as a new condition consisting of having abnormal levels of pH and bicarbonate, BE, pCO2 and pO2, K+, Na+, CRP in blood.

It is great that they have done that because now it can be said that CCSVI is related to a measurable abnormal condition, and it can be treated on its own right.

[cheerleader]

Cece--I think it's just a bad translation...
cerebral congestion is considered an archaic diagnosis:

• The concept of "cerebral congestion" as a cause of apoplexy was first proposed by Morgagni in 1761, and had a profound influence in the treatment of stroke during the next 150 years. It accounted not only for cerebral hemorrhage, but also for lacunes (Dechambre, 1838), état criblé (Durand-Fardel, 1842), depression, maniac outbursts, headaches, coma, and seizures. According to Hammond (1871, 1878), cerebral congestion was "more common... than any other affection of the nervous system." This notion fell into oblivion when an accurate method for bedside determination of blood pressure became available (Riva-Rocci, 1896; Korotkov, 1905) allowing for better understanding of the neurologic complications of arterial hypertension.

however cerebral venous congestion due to thrombosis
http://www.ncbi.nlm.nih.gov/pubmed/17573553
or intracranial venous congestion due to arteriovenous fistula
http://stroke.ahajournals.org/content/32/12/2945.full
or cerebral venous circulatory disturbances (CVCD) due to stroke
http://www.sciencedirect.com/science/ar ... 9306026710
might be considered corrolates for what the researchers are calling brain congestion. I think something was lost in their translation.

The changes in serum numbers after treatment could be from a return of shear stress and healing of the endothelium after treatment. And it's terrific that they have numbers to show the changes to blood.
cheer