CCSVI RESEARCH here

[MSUK]

New MRI research shows that changes in brain blood flow associated with vein abnormalities are not specific for multiple sclerosis and do not contribute to its severity, despite what some researchers have speculated. Results of the study were published online, August 21, by the Radiological Society of North America in the journal Radiology.

New magnetic resonance imaging (MRI) research shows that changes in brain blood flow associated with vein abnormalities are not specific for multiple sclerosis (MS) and do not contribute to its severity, despite what some researchers have speculated. Results of the research are published online in the journal Radiology.

“MRI allowed an accurate evaluation of cerebral blood flow that was crucial for our results,” said Simone Marziali, M.D., from the Department of Diagnostic Imaging at the University of Rome Tor Vergata in Rome.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/2944

[cheerleader]

Clinical Improvement after Extracranial Venoplasty in Multiple Sclerosis

David Hubbard, MD, Donald Ponec, MD, Justin Gooding, MD, Richard Saxon, MD, Heidi Sauder, PhD, Mark Haacke, PhD

Purpose
This study proposed to prospectively evaluate safety and clinical changes in outpatient endovascular treatment in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI).

Materials and Methods
Two hundred fifty-nine patients with MS were followed with the Multiple Sclerosis Impact Scale (MSIS-29) before and for 1and 6 months after treatment of extracranial internal jugular vein and azygos vein stenoses and occlusions using venous angioplasty, as well as stent placement in 2.5% of patients. Before treatment, the patients were tested with magnetic resonance (MR) venography and flow quantification.

Results
We found statistically significant improvements in the MSIS-29 scores (P < .01) at both 1 and 6 months. At 1 and 6 months, 67.9% and 53.6% were improved on the physical scale, respectively, and 53.0% and 44.4% were improved on the psychological scale, respectively. Women showed greater improvement than did men on the physical scale at 6 months (P = .01). Patients with primary progressive MS (PPMS) showed less improvement than did those with relapsing-remitting MS (RRMS) on the psychological scale at 1 month, and venoplasty treatment of more vein sites versus fewer vein sites showed greater improvement on the physical scale at both 1 and 6 months. Fifteen patients (6.3%) reported recurrent symptoms after clinical improvement and were treated again. There was one serious adverse event, a deep venous thrombosis at the catheter insertion site, which resolved with treatment.

Conclusions
Endovascular treatment of CCSVI in patients with MS appears to be a safe procedure resulting in significant clinical improvement.

http://www.jvir.org/article/S1051-0443( ... 7/abstract

[frodo]

Quantitative flow measurements in the internal jugular veins of multiple sclerosis patients using magnetic resonance imaging

PURPOSE:

To study the blood flow through the internal jugular veins (IJVs) of the MS population.

MATERIALS AND METHODS:

Two hundred MS patients and 14 normal volunteers were evaluated with magnetic resonance imaging (MRI) at 3T. Contrast-enhanced time-resolved 3D MR angiography and 2D time-of-flight imaging were performed to assess abnormalities in the extracranial vascular anatomy. Based on this assessment, the MS population was divided into subgroups of non-stenotic (NST), cervical 1 stenotic only (C1ST) and cervical 6 stenotic (C6ST) subjects. In this study, 2D phase contrast MR imaging was used to quantify blood flow through major veins and arteries in the neck and flow differences among the groups were analyzed.

RESULTS:

Of the 200 MS patients, 87 (43.5%) belonged to the NST group, 50 (25%) belonged to the C1ST group and 63 (31.5%) belonged to the C6ST group. The total IJV flow normalized to the total arterial flow of the NST group was 75.12 ± 12.22 %. This was significantly higher than that of the C1ST group, 63.93 ± 16.08 % (p < 0.0001), which in turn was significantly higher than that of the C6ST group, 52.13 ± 20.71 % (p = 0.001). Seventy-nine percent of the stenotic groups had a normalized subdominant IJV flow of less than 20%, a combined IJV flow of less than 5o% and/or a sub-dominant IJV flow vs. dominant IJV flow ratio of less than 1/3. Only 2% of the NST group had a combined IJV flow of less than 50%, compared to 35% of the stenotic groups.

CONCLUSION:

Blood flow through the IJVs was reduced in the MS population with stenoses compared to those without.

[MSUK]

Australian researcher, A/Prof Brian Chambers of the Austin Hospital, Melbourne, has published the results of his MSRA-funded study into the prevalence of chronic cerebrospinal venous insufficiency (CCSVI) in early MS (view the abstract here).

is a condition where drainage of blood from the brain and spinal cord is impeded. It is thought CCSVI may contribute to the development or symptoms of MS and was originally described by Dr Zamboni of Italy in 2009. In his sample, all people with MS had CCSVI whereas healthy individuals showed no evidence of CCSVI. Subsequent studies have been unable to replicate this marked difference in CCSVI prevalence. Some studies have found an increased prevalence of CCSVI in MS, but have also shown that it is present in healthy individuals and in people with other neurological diseases (OND). For earlier round-ups of CCSVI news, please type ‘CCSVI’ into the search box of this website.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/3538

[MSUK]

Patient trial of proposed MS treatment announced by Canadian government



A long-awaited national trial of a controversial experimental treatment for multiple sclerosis has been given the go-ahead and will soon begin recruiting patients, federal Health Minister Leona Aglukkaq announced Friday.

Aglukkaq, in Halifax for a meeting with provincial and territorial health ministers, said about 100 MS patients will be enrolled in the Phase I and II trial to assess the safety of the procedure to unblock narrowed neck veins and its efficacy in improving MS symptoms.

The condition — dubbed chronic cerebrospinal venous insufficiency, or CCSVI — has been proposed as a possible cause of MS by Italian vascular surgeon Paolo Zamboni.

More than three years ago, Zamboni hypothesized that narrowed and twisted veins in the neck and chest create a backup of blood in the brain, resulting in iron deposits that could cause the brain lesions typical of MS.

The disease causes the destruction of myelin, the protective sheath around nerves throughout the body, leading to progressive physical and cognitive disability. An estimated 55,000 to 75,000 Canadians have MS, and the country has one of the highest rates of the incurable disease in the world.

"We've always said that we needed the science behind the actual procedure," Aglukkaq told reporters. "This area of MS clinical trials is very important to many of our constituents and today is huge progress."... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/3538

[MSUK]

A Canadian study that tracked 80 multiple sclerosis patients who underwent the controversial “liberation treatment” outside of the country suggests that about half of them saw their symptoms improve after the procedure.

Researchers in British Columbia surveyed 80 people over the phone one year after they received the controversial treatment, which involves opening up blocked veins to improve blood flow from the brain.

“The picture that seems to be coming out is that about half of the patients feel some improvements in MS symptoms. The degree of improvements ranges from mild to significant,” Dr. Anthony Traboulsee, medical director of the UBC Hospital MS Clinic, told CTV News.

“And about half the patients feel exactly the same as before the procedure or worse.”... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/3538

[MSUK]

The largest study to date testing the venous-obstruction theory of multiple sclerosis failed to support it, leading the Italian Multiple Sclerosis Society to declare the theory dead.

Reported here by leaders of the group, known by its Italian abbreviation AISM, the study of nearly 2,000 individuals with blinded central imaging analysis found the condition in only about 3% of MS patients and in only slightly fewer healthy controls or patients with other neurological conditions.

Key data were released at a press briefing by principal investigator Giancarlo Comi, MD, of the University of Milan, and other study leaders in advance of Comi's formal presentation, scheduled for Saturday at the annual meeting of the European Committee for Treatment and Research in Multiple Sclerosis.

They characterized the study as the largest yet conducted on the so-called chronic cerebrospinal venous insufficiency theory (CCSVI), advanced in 2009 by Paolo Zamboni, MD, of the University of Ferrara in Italy.

The CCSVI theory quickly took the MS community by storm, leading many patients to seek venous angioplasty and stenting procedures in hope of obtaining relief or even a cure, as Zamboni and some other vascular surgeons claimed was possible.

But the theory also drew substantial criticism, especially after numerous other researchers were unable to reproduce Zamboni's original findings of 100% presence of CCSVI in MS patients and 0% in non-MS controls. Some groups were unable to detect CCSVI in more than a small fraction of patients, while others found that it was relatively common but without specificity for MS.

In the new study, sponsored by AISM and called CoSMo, ultrasound analyses were performed on 1,874 individuals at 35 clinics throughout Italy. A total of 107 were subsequently excluded because of technical problems with the images or because participants were found not to meet the specified inclusion criteria (such as age or disease duration).... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/3538

[MSUK]

Percutaneous transluminal angioplasty for treatment of CCSVI in MS patients



The more popularly known 'Liberation procedure' for treatment of venous stenoses (CCSVI) in the brain of MS sufferers

Multiple sclerosis (MS) is an inflammatory disease of the nervous system and the most frequent cause of neurological disability in young adults. Myelin, the material that wraps around and protects the nerves becomes damaged and this results in scarring and the formation of scar-like plaques.
MS is considered to be an immune-mediated disease in which the person's own immune system attacks the nervous system and most of the current drug therapies are based on this hypothesis.

However, a new theory has been recently proposed with a suggestion that impaired blood flow in the veins draining the central nervous system, so called chronic cerebrospinal venous insufficiency (CCSVI), may play a role in the cause of MS. CCSVI is thought to be congenital and it may result in iron deposits which in turn trigger the immune system to attack the central nervous system thus damaging the myelin. The proposed treatment for CCSVI is balloon angioplasty which entails the widening of narrowed (stenosed) veins, the commonly named 'liberation procedure'. This theory has gained a lot of attention via the Internet, mainly among the patients' community, and the increased interest by the media has further enhanced the expectations of people suffering with MS. We searched the relevant literature but found no studies that matched the criteria of methodological quality necessary for their inclusion in this review.... Read More - http://www.msrc.co.uk/index.cfm/fuseact ... ageid/3538

[eric593]

Endovascular treatment of CCSVI unhelpful in MS according to Dr. Alroughani et al:

http://www.ncbi.nlm.nih.gov/m/pubmed/23301864/

[Cece]

http://www.ncbi.nlm.nih.gov/m/pubmed/23301864/

35.6% of patients stopped their DMTs. There was no difference among the patients who stopped their DMTs with respect to relapses, EDSS score or new MRI activity

The conclusion from this would be that DMTs don't work.

[erinc14]

[eric593]

MS activity and damage appeared to worsen post-treatment. Perhaps PTA exacerbates MS and neurological worsening and not even DMD's can ameliorate or impact the negative effect?

[Anonymoose]

MS activity and damage appeared to worsen post-treatment. Perhaps PTA exacerbates MS and neurological worsening and not even DMD's can ameliorate or impact the negative effect?

This study, and probably most group studies of PTA msers, can't really provide any conclusive evidence about the effectiveness of PTA. Each situation is unique and each PTA procedure likely produces unique results depending upon the pre-PTA conditions and the PTA technique.

I think the variability of results (assuming complete treatment and no restenosis) suggests something other than improved perfusion is the cause for post-PTA improvement.

[eric593]

IMO, a blinded trial with a larger # of participants and an experienced IR over a couple years will be able to at least give us some idea of whether there is any benefit to PTA or not and what, if any, impact it has on our neurological status or progression.

If there is a distinct group that benefits, then it may be possible to look at their particular factors to determine if they have anything in common pathologically. If not, it may simply be placebo effect.

But I think a good trial should tell us something. BNAC may be too small to give us much useful data though unless there is overwhelming evidence that PTA resulted in improved, persisting health outcomes.

[Cece]

Endovascular Treatment of Chronic Cerebro-Spinal Venous Insufficiency in Multiple Sclerosis: A retrospective study.

AuthorsAlroughani R, et al. Show all Journal
Int J Neurosci. 2013 Jan 9. [Epub ahead of print]

Affiliation
1Division of Neurology, Department of Medicine , Amiri Hospital , Kuwait.

Abstract
Abstract Background: Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) has been proposed to be associated with Multiple Sclerosis (MS). Zamboni et al reported significant improvement in neurological outcomes in MS patients who underwent Percutaneous Transluminal Angioplasty (PTA). Objectives: To retrospectively evaluate the neurological outcomes in MS patients who underwent PTA. Method: Relapsing remitting MS patients who underwent PTA and completed at least one year post PTA were assessed. Patients with clinically isolated syndrome or progressive forms of MS were excluded. Primary endpoint was the proportion of relapse-free patients at one year. Secondary endpoints were change in mean EDSS score and proportion of patients with new MRI activity (defined as either Gadolinium-enhancing or new T2 lesions) at one year. Results: 45 patients satisfied the inclusion criteria. Females constituted 71.1%. The mean age and mean disease duration were 33.76 and 7.16 years respectively. At one-year post-PTA, the proportion of relapse-free patients decreased from 84.44% to 66.67% (p = 0.085) whereas the mean EDSS score increased (p = 0.017). The proportion of patients with new MRI activity increased significantly from 17.78% to 44.44% (p = 0.012). 35.6% of patients stopped their DMTs. There was no difference among the patients who stopped their DMTs with respect to relapses, EDSS score or new MRI activity. Conclusion: The study revealed that PTA in relapsing remitting MS patients was not associated with any neurological improvement. However, there was an increase in disease activity irrespective of the adherence to DMTs. Further evidence of the association between CCSVI and MS is required.

The data is of patients 1 year post-PTA but we don't know if their veins remained open at 1 year. The techniques of Dr. Sinan involved very large balloons and very large pressures. Other IRs copying his techniques discontinued doing so after seeing occlusions of the veins. I would want to see the data crunched both ways: including all patients and including only the patients whose veins were known to still be open at 1 year. Another failing of the study is that there is no matched control group who did not undergo angioplasty. MS gets worse over time.