New Study: Inadequate cerebral blood flow in MS

[cheerleader]

The study out of NYU looks at cerebrovascular reactivity, or CVR. CVR is how the brain reacts or responds with blood flow when there is vasodilation. This function is extremely important, as neurons need adequate blood flow to provide glucose and oxygenation. Without this response of adequate cerebral bloodflow (CBF), the brain will not function properly, and neurons can potentially die.
http://archneur.jamanetwork.com/article ... id=1893478

Patients with MS had a significant decrease of cerebrovascular reactivity compared with controls. This decrease in CRV correlated to gray matter atrophy, but did not correlate with white matter lesions.

Their conclusion was that there is an impairment in the cerebrovascular pathophysiology in pwMS, and that inadequate blood flow to neurons may indeed be the cause of neurodegeneration in MS. And that this was a vascular problem, NOT a problem initiated by white matter lesions.

We know that impaired CVR is related to arterial stenosis and occlusion of the blood vessels in the neck. http://www.hindawi.com/journals/rrp/2012/268483/

More info on what the researchers found and how it relates to CCSVI and endothelial dysfunction:
http://ccsviinms.blogspot.com/2014/08/i ... ty-in.html

[Cece]

Yulin Ge is on the list of authors for this study.

Cerebrovascular reactivity (CVR) is an inherent indicator of the dilatory capacity of cerebral arterioles for a vasomotor stimulus for maintaining a spontaneous and instant increase of cerebral blood flow (CBF) in response to neural activation.

Ok, so this is measuring how the brain is able to increase cerebral blood flow as needed. It's a sympathetic nervous system impairment to not be able to do that.

Someone with CCSVI might still have enough cerebrovascular reactivity to compensate somewhat for the effects of CCSVI. Someone else might lack that cerebrovascular reactivity (or might lose that function as MS goes on) and, in the same internal environment of CCSVI, can have far worse consequences than the person with functioning normal cerebrovascular reactivity.

There was a significant negative correlation between gray matter CVR and lesion volume (R = 0.6, P = .004) and a significant positive correlation between global gray matter CVR and gray matter atrophy index (R = 0.5, P = .03).

MS lesions and gray matter atrophy are correlated and potentially causing the impairment in cerebrovascular reactivity, which would then worsen the MS by creating a not-good environment for the neurons. When the neurons are activated, they don't get the increase in blood flow that's needed.

Traumatic brain injury often causes disturbances in cerebrovascular reactivity http://europepmc.org/abstract/MED/1588625 (shout-out to MrSuccess and Donnchadh and anyone who sees a connection between trauma and MS onset).

Cerebrovascular reactivity is abnormal in diabetes: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1606446/ (shout-out to Lindacarol and anyone who has linked diabetes and sugar and MS worsening)

Cerebrovascular reactivity remains the same in men as they age but decreases dramatically in women: https://stroke.ahajournals.org/content/29/7/1311.full (shout-out to the increased prevalence of MS in women)

What I'm looking for in googlescholar are ways to improve cerebrovascular reactivity, not all these correlations between it and different diseases! In the last study, when it mentions a big drop-off in CVR in women between their 4th and 5th decades, it stated that HRT therapy in post-menopausal women appears to enhance CVR.

[Cece]

One more study on the subject of cerebrovascular reactivity and "normal" white matter lesions due to age:
http://stroke.ahajournals.org/content/33/4/972.short

Cerebral Perfusion and Cerebrovascular Reactivity Are Reduced in White Matter Hyperintensities
J.R. Marstrand, MD; E. Garde, MD, PhD; E. Rostrup, MD, MSc; P. Ring, MSc; S. Rosenbaum, MD, PhD; E.L. Mortensen, PhD; H.B.W. Larsson, MD, PhD
+ Author Affiliations

From the Danish Research Centre for Magnetic Resonance (J.R.M., E.G., E.R., P.R., S.R.), Hvidovre Hospital, Hvidovre, and Department of Health Psychology (E.L.M.), Institute of Public Health, University of Copenhagen, Copenhagen, Denmark; and MR-Centre, University Hospital Trondheim (H.B.W.L.), Trondheim, Norway.

Abstract

Background and Purpose— There is growing evidence that white matter hyperintensities (WMH) should not be considered as benign age-dependent changes on MR images but indicate pathological changes with clinical consequences. Previous studies comparing subjects with WMH to normal controls have reported global reductions in cerebral blood flow (CBF) and cerebral vascular reactivity. In this study, we examined localized hemodynamic status to compare WMH to normal appearing white matter (NAWM).

Methods— A group of 21 normal 85-year-old subjects were studied using dynamic contrast-enhanced MRI together with administration of acetazolamide. From a combination of anatomic images with different signal weighting, regions of interest were generated corresponding to gray and white matter and WMH. Localized measurements of CBF and cerebral blood volume (CBV) and mean transit time were obtained directly within WMH and NAWM.

Results— When comparing WMH to NAWM, measurements showed significantly lower CBF (P=0.004) and longer mean transit time (P< 0.001) in WMH but no significant difference in CBV (P=0.846). The increases in CBF and CBV induced by acetazolamide were significantly smaller in WMH than in NAWM (P=0.026, P<0.001).

Conclusion— These results show that a change in the hemodynamic status is present within the WMH, making these areas more likely to be exposed to transient ischemia inducing myelin rarefaction. In the future, MRI may be used to examine the effect of therapeutic strategies designed to prevent or normalize vascular changes.

"In the future, MRI may be used to examine the effect of therapeutic strategies designed to prevent or normalize vascular changes." This is from 2001, it's now 2014, where are those therapeutic strategies?

[cheerleader]

Great studies, Cece...they show the direct connection to CBF, hemodynamics, ischemia and the vasculature.

"In the future, MRI may be used to examine the effect of therapeutic strategies designed to prevent or normalize vascular changes." This is from 2001, it's now 2014, where are those therapeutic strategies?

I'm afraid to say that there will be no "therapeutic strategies" until pharmaceutical companies can figure out how to monetize treatments for reperfusion injury and ischemia. They've got a hold on the mechanical treatments, at least as long as the brain is the organ suffering from hemodynamic changes. Pharma is STILL fighting carotid artery stenting even though vascular docs are showing how this improves cognition. And endothelial health, which can be improved today with exercise, lifestyle changes and nutrition, will only be discussed as a "therapy" once there is a pill to prescribe.

http://ccsviinms.blogspot.com/2014/04/s ... nosis.html

cheer

[MrSuccess]

thanks for the shout out .... I have been wanting to bring some research info , that I have regarding the MS > Trauma connection . Absolutley no doubt about it. Proven.

I have been very busy this summer , but still read TIMS CCSVI posts. Hang in there ... I'll
find the time soon to post.

MrSuccess ......... when I walk in a room .... no one knows who I am .....

[Cece]

It seems that impaired cerebral reactivity is not specific to MS as it's seen in a number of disorders
It could be a contributing factor to the development of MS or a result of the MS
Definitely neurovascular

thanks for the shout out ....

I'm impressed you found the shout-out buried within text. Good to see you here.

[MrSuccess]

I still find all the information you and ringleader provide , to be credible and informative. Job well done. I can only wish to be able to contribute on such a scale.

I have some interesting information regarding MS > Trauma to share with everyone here at TIMS. I really don't like doing anything half-a***d .... so I need some time to get it right before posting.

Always one to be slow to take leaps of faith .... Dr.Zamboni's CCSVI theory is as strong as ever in my book. I have read nothing to cause me to waver in supporting Dr.Zamboni.

An organ .... ANY organ must not have reduced or blocked bloodflow. [ CCSVI ]

It's as simple as that.

Mr.Success [ thanks M ]