Chronic Cerebrospinal Venous Insufficiency (CCSVI) Research News

Canadian health minister rejects MS therapy trial

Thu, 02 Sep 2010 04:58:00 EDT

The Canadian government will not fund a clinical trial of the so-called liberation therapy for multiple sclerosis at this time, Health Minister Leona Aglukkaq says.

Aglukkaq spoke to reporters in Ottawa on Wednesday, a day after a panel of North American experts announced they unanimously recommended against supporting a clinical trial of the treatment in Canada as yet.

Aglukkaq commissioned the expert panel's report from the Canadian Institutes of Health Research, which funds medical research, and the MS Society of Canada.

"I feel the most prudent course of action at this time is to accept the recommendation of the country's leading researchers," Aglukkaq told a news conference.... [Read More]

Canadian experts &MS Society dismiss experimental MS therapy

Tue, 31 Aug 2010 11:54:00 EDT

A group of leading Canadian medical experts is advising the federal government against funding clinical trials for a controversial new multiple sclerosis therapy.

The Canadian Institutes for Health Research and the MS Society of Canada held a joint meeting on research priorities for the progressive and debilitating disease last week and provided recommendations to federal Health Minister Leona Aglukkaq.

They concluded there is not enough evidence at this time to support beginning mass clinical trials for an experimental treatment – the so-called “liberation procedure” – that opens up veins transporting blood from the brain to the heart in MS patients.... [Read More]

Chronic cerebrospinal venous insufficiency (CCSVI) found in 97.1% of patients

Tue, 31 Aug 2010 03:11:00 EDT

Correlation of localization and severity of extracranial venous lesions with clinical status of multiple sclerosis

Background. Chronic cerebrospinal venous insufficiency is suspected to play a role in pathogenesis of multiple sclerosis.

Objective. Assessment of the correlations between patterns of venous lesions and clinical characteristics of multiple sclerosis.... [Read More]

Launch CCSVI MS clinical trials immediately, researcher urges

Sat, 28 Aug 2010 04:26:00 EDT

Clinical trials of the controversial liberation treatment for multiple sclerosis should happen immediately, says a former University of Saskatchewan researcher who proposed an eerily similar theory more than a decade ago.

Bernhard Juurlink published a hypothesis in 1998 that MS is related to decreased blood flow in the brain and spinal cord.

"It was very difficult to get anyone interested in this idea — the idea was easily testable by, for example, looking for blood flow in white matter in MS patients," Juurlink said in an interview this week. "I tried to first interest clinical colleagues to image brains of MS and non-MS patients, to look at blood flow, with no success."... [Read More]

Dr Sclafani's view on the recent German and Swedish studies on CCSVI

Thu, 12 Aug 2010 04:17:00 EDT

It is regretful that Drs. Doepp and co-authors' attempt to reproduce Professor Zamboni's discovery of a link between multiple sclerosis and disturbance of the outflow veins of the brain and spine has been unsuccessful.

It is particularly unfortunate that the authors' misunderstanding of Dr. Zamboni's publications about this subject have led to their conclusions that "No cerebrocervical venous congestion in patients with multiple sclerosis" exists.�

The authors mis-state several of the criteria for a positive ultrasound examination. They state that reflux must be present in both internal jugular veins or both vertebral veins. This is not accurate. Reflux in any one of these veins was considered a positive criteria by Zamboni.... [Read More]

Science may prove angioplasty technique helpful in treating MS

Mon, 09 Aug 2010 09:47:00 EDT

Multiple sclerosis occupies a particularly terrifying niche among chronic, disabling diseases. While all serious threats to health are to one degree or another fearsome, those we understand least, and that leave us feeling most vulnerable and defenseless, are the most feared.

Variable in its course and at times indolent for years, MS can, when extreme, progress rapidly and culminate in total disability and premature death. Characterized by most as an auto-immune disease, MS is still poorly understood. We don’t really know exactly why some people get it; we don’t know how to prevent it; and there is treatment, but no cure.... [Read More]

Joint CCSVI MS study to begin within weeks

Thu, 05 Aug 2010 11:39:00 EDT

St. Joseph's Healthcare will start testing whether multiple sclerosis is a vascular disease within two weeks despite European studies questioning the controversial theory.

The highly-anticipated study funded by more than $250,000 in private donations is being tweaked after a test run involving 10 patients and 10 similar healthy people and is expected to be ready to go by the end of next week.... [Read More]

Two studies cast doubt on new MS theory

Mon, 02 Aug 2010 04:08:00 EDT

Research has emerged casting doubt on a popular new theory that multiple sclerosis is caused or worsened by blockages in the jugular veins.

In separate studies from Germany and Sweden, to be published Monday in the Annals of Neurology, researchers report they found no such trend of blockages in patients' jugular veins, which carry blood away from the brain back to the heart.

The theory, championed by an Italian vascular surgeon and some doctors in the U.S., has inspired thousands of MS patients to get tested and, in some cases, to get treatment such as the insertion of metal stents in jugular veins to keep them open.... [Read More]

Visualizing iron deposition in Multiple Sclerosis cadaver brains

Fri, 30 Jul 2010 02:19:00 EDT

Abstract

Aim: To visualize and validate iron deposition in two cases of multiple sclerosis using rapid scanning X-Ray Fluorescence (RS-XRF) and Susceptibility Weighted Imaging (SWI).

Material and Methods: Two (2) coronal cadaver brain slices from patients clinically diagnosed with multiple sclerosis underwent magnetic resonance imaging (MRI), specifically SWI to image iron content. To confirm the presence of iron deposits and the absence of zinc-rich myelin in lesions, iron and zinc were mapped using RS-XRF. ... [Read More]

CCSVI - A new paradigm and therapy for multiple sclerosis

Fri, 23 Jul 2010 17:35:00 EDT

By Salvatore J.A. Sclafani, MD,
Commentary by Michael D. Dake, MD,
and Barry T. Katzen, MD

Chronic cerebrospinal venous insufficiency (CCSVI) is a hemodynamic condition in which cerebrospinal venous drainage is altered and inhibited.

Outflow obstructions of the internal jugular veins (IJVs), vertebral veins, and/or azygos vein (AZV) and their tributaries result in stasis or reflux of these outflow veins and redirection of flow through vicarious circuits.... [Read More]

County surgeon to pursue Multiple Sclerosis trials

Fri, 23 Jul 2010 03:37:00 EDT

With health officials clamouring for more scientific research before green-lighting the new liberation treatment for multiple sclerosis (MS), local supporter and cardiovascular-thoracic surgeon Sandy McDonald is stepping up to provide it.

“I’m working with colleagues to design a double-blinded study for assessing CCSVI and its treatment,” he said, anticipating a more extensive test group than the preliminary trials first published by pioneering Italian vascular surgeon Paolo Zamboni.
“We have two neurologists, three vascular surgeons and interventional radiologists interested in being involved.”

In the process of gaining Institutional Review Board approval, McDonald said the trial is moving forward as quickly as possible, but “we have a lot of hurdles to get past before we get there.”... [Read More]

Study raises new questions about vascular theory for MS

Mon, 05 Jul 2010 03:54:00 EDT

A new study from Germany has found that multiple sclerosis (MS) patients showed no evidence of chronic cerebrospinal venous insufficiency (CCSVI) -- striking a blow against the theory that obstructed blood flow in veins exiting the brain may be a cause of MS. Ultrasound exams of jugular and vertebral veins in 56 MS patients and 20 controls yielded normal findings in nearly all of them, reported Florian Doepp, MD, of Humboldt University in Berlin, and colleagues online in Annals of Neurology. The findings directly contradict results reported last year and in 2007 by Paolo Zamboni, MD, of the University of Ferrara in Italy, and colleagues from a 300-participant ultrasound study, in which nearly all the MS patients but few controls had CCSVI. MS is thought to be an autoimmune disease caused by the destruction of the fatty myelin coating that surrounds and protects nerve cells, hampering or interrupting nerve impulses traveling to and from the brain and spinal cord, leading to a variety of symptoms and disabilities. The disease is thought to affect 2.5 million people worldwide and around 400,000 patients in the U.S., according to the National Multiple Sclerosis Society (NMSS). The hypothesis behind CCSVI is that obstructed blood flow due to stenosis of veins exiting the brain causes blood to back up, leading to inflammation. In the new German study, blood flow direction in both jugular and vertebral veins was found to be normal in 55 of the patients and all of the controls, and no evidence of internal jugular stenosis was seen in any participant, the researchers reported. Zamboni had listed five criteria for a diagnosis of CCSVI. However, "none of the subjects investigated in this study fulfilled more than one" of those criteria, Doepp and colleagues wrote. The report by German researchers is the second study in recent months to cast doubt on the prevalence of CCSVI among MS patients. Interim findings from a large, ongoing trial led by researchers at the State University of New York at Buffalo, reported in April at the American Academy of Neurology annual meeting, found middling percentages of MS patients, as well as a large minority of controls, met criteria for CCSVI. At the AAN meeting, Robert Zivadinov, MD, PhD, presented data from the first 500 participants in the projected 1,700-subject study. He reported that 56% of MS patients, 43% of those with other neurologic illnesses, and 22% of healthy volunteers met at least two of the CCSVI criteria, which include venous reflux, stenosis, missing flow, and abnormal blood flow in the jugular or vertebral veins following postural changes. In the study by Doepp and colleagues, there were some differences in venous flow responses to postural changes between patients and controls, but they fell short of confirming CCSVI, the researchers indicated. They found a decrease of total jugular blood volume flow when patients sat upright that was less pronounced in patients. The decrease was about half the magnitude seen in controls, Doepp and colleagues reported, such that blood flow volume in the sitting position was nearly three times as great in MS patients relative to controls. There were no differences between patients and controls in intracranial venous flow, or in jugular flow when the Valsalva maneuver was performed. "Against this backdrop we discourage interventional procedures as more work is being done to investigate 'CCSVI' and its possible role in MS," Doepp and colleagues wrote. Robert J. Fox, MD, a neurologist at the Cleveland Clinic, said the findings from the German and Buffalo studies suggested "caution before we jump up and embrace [the CCSVI theory] fully." Fox spoke this week during a live webcast sponsored by the NMSS, which recently awarded $2.4 million in grants for seven research projects -- including one led by Fox -- evaluating the CCSVI hypothesis in detail. He noted that the Buffalo data found a substantially lower prevalence of CCSVI among the MS patients and a greater prevalence in the healthy controls than in the Italian studies. Moreover, Fox said, the finding that nearly half the non-MS patients with other neurological conditions met CCSVI criteria might argue against a causative role in MS specifically. "This raises the question of, maybe the venous findings are not directly related to MS, but are related to some injury of the brain -- maybe a downstream but maybe an upstream effect of injury," he said. Patricia O'Looney, PhD, vice president for biomedical research at the NMSS, echoed the cautions about CCSVI, particularly as it relates to treatment. Zamboni and colleagues have reported successful reversal of symptoms in MS patients following venoplasty, with stenting performed in some patients. But there was no blinding or control group, raising the question of a placebo effect or, as Fox suggested, a natural regression in MS symptoms often seen in patients. Nevertheless, neurologists have reported that patients are now asking about such treatments and even traveling overseas to receive them. Indeed, during the NMSS webcast, questions from patients focused on the advisability and availability of ultrasound evaluations and venoplasty treatment. "The society shares in the public urgency to advance the understanding of CCSVI as quickly as possible," O'Looney said during the webcast. But she noted the "conflicting results in the current reported studies" and said the society's research grants were intended to "quickly and comprehensively determine the significance of CCSVI." In the meantime, she said, the U.S. and Canadian MS societies agree that data supporting treatment based on the CCSVI theory "are not yet available," and hence it would be premature to recommend them to patients. Fox said he tells patients not to seek venous ultrasonography precisely because any treatments based on the findings remain scientifically untested. "As with any therapy, it comes down to the cost-benefit ratio," he said. "What are the risks of treatment, and what are the benefits? Without a controlled trial and further study, I think we really don't know the answer to either part of that tradeoff." The study by Doepp and colleagues was funded by the German Research Foundation. One author reported speaking fees from Sanofi-aventis, Novartis, and Merck Serono. O'Looney reported no potential conflicts. Fox has had relationships with Biogen Idec, Teva, and Genentech. Primary source: Annals of Neurology Source reference: Doepp F, et al "No cerebro-cervical venous congestion in patients with multiple sclerosis" Ann Neurol 2010; DOI: 10.1002/ana.22085. Source: Medpage Today � 2004-2010 MedPage Today, LLC. (05/07/10)

Clinical trial testing new Multiple Sclerosis treatment to launch in Buffalo

Mon, 28 Jun 2010 19:48:00 EDT

Researchers at the University at Buffalo, led by the Department of Neurosurgery, will embark on a landmark prospective randomized double-blinded study to test the safety and efficacy of interventional endovascular therapy�dubbed �liberation treatment��on MS symptoms and progression. Recently, chronic cerebrospinal venous insufficiency CCSVI) has been strongly associated with multiple sclerosis (MS). In a series of original studies, Dr. Paolo Zamboni of the University of Ferrara, Italy demonstrated blockage of major venous outflow from the brain and spinal cord in patients with MS. Researchers from many institutions, including the University at Buffalo, have confirmed the association. It is hypothesized that the narrowing in the large veins in the neck and chest might cause improper drainage of blood from the brain, resulting in eventual injury to brain tissue. It is thought that angioplasty�a treatment commonly used by cardiologists and other endovascular surgeons to treat atherosclerosis�may remedy the blockages. Dr. Zamboni has further conducted preliminary studies suggesting the efficacy of venous angioplasty (�liberation procedure�) in the amelioration of MS symptoms. Now, researchers at the University of Buffalo will launch PREMiSe (Prospective Randomized Endovascular therapy in Multiple Sclerosis) to determine if endovascular intervention via balloon angioplasty to correct the blockages improves MS symptoms or progression. PREMiSe is believed to be the first IRB-approved prospective randomized double-blinded study of balloon angioplasty for MS being performed in a rigorous fashion in the US with significant safeguards in place to ensure careful determination of risks and benefits. The study is being led by principal investigator Dr. Adnan Siddiqui along with co-principal investigators Dr. Elad Levy and Dr. L.N. Hopkins of the University at Buffalo Department of Neurosurgery. Additional independent researchers from University at Buffalo will participate in the evaluation and follow-up of study patients. An independent Data Safety Monitoring Board (DSMB) will ensure the safety and effectiveness of the study on an ongoing basis. In the first phase of the study, ten MS patients from the United States and Canada exhibiting venous insufficiency will undergo minimally invasive venous angioplasties to determine if the procedure can be performed safely. The procedures, scheduled for June 29 and 30, 2010, will be performed by Drs. Siddiqui and Levy at Kaleida Health�s Millard Fillmore Gates Hospital in Buffalo, New York. The second phase of the study will randomize 20 MS patients to undergo either venous angioplasty or a �sham angioplasty� (i.e. a catheter will be inserted but there will be no inflation of the balloon). The treatment will be blinded in such a way that neither the patient undergoing the procedure nor the clinicians evaluating the patient will be aware which procedure was performed. If results suggest an appropriate safety profile and preliminary effectiveness, then researchers will approach the University at Buffalo Institutional Review Board (IRB) for an extension of the protocol to study a larger number of patients in order to convincingly prove or disprove a causal relationship between CCSVI and MS. Multiple sclerosis is estimated to affect more than 400,000 people in the United States and over 2 million people worldwide. It is typically a disease of young adults characterized by either a relapsing or progressing decline in neurologic function with resultant significant disability. It is an inflammatory neurological disease widely considered to be autoimmune in nature, though its exact origins remain elusive. If angioplasty is proven effective at improving MS symptoms, the resultant implications for the future of MS treatment could be monumental. The physicians conducting PREMiSe are cautious but optimistic that initial findings will be promising. Source: PR Web � Copyright 1997-2010, Vocus PRW Holdings, LLC. (29/06/10)

Canadian agency aims to fund research into angioplasty for MS

Wed, 16 Jun 2010 05:56:00 EDT

The Canadian Institute for Health Research wants scientists to submit grant proposals to study whether treating vein abnormalities in multiple sclerosis patients helps relieve their symptoms. CIHR President Dr. Alain Beaudet told the parliamentary Subcommittee on Neurological Disease in Ottawa Tuesday that his agency, which is the major federal agency responsible for funding health research in Canada, wants scientists to submit proposals for such research. "What I'm asking is for Canadian researchers to propose a protocol for a proper randomized, blinded clinical trial on the effect of this therapeutic approach," he said. The study would look at whether balloon angioplasty to open up blocked neck and chest veins relieves MS symptoms any better than patients given a sham treatment or no treatment. "I urge researchers interested in better understanding the linkages between MS and CCSVI to apply to CIHR," Beaudet said, noting the deadline for grant proposals is August. "Research into clinical treatment of MS has to be accelerated." The U.S. and Canadian MS Societies announced last week the awarding of $2.4 million in research grants to study a vein condition dubbed CCSVI, or chronic cerebrospinal venous insufficiency. Those studies will focus on the prevalence of CCSVI in MS patients, not on treatment. Four Canadian universities and three American centres will begin that research later this year. Beaudet also told the subcommittee that a special committee of experts has been formed, in collaboration with the MS Society of Canada, to analyze the data available on the theory that venous problems may be linked to some MS symptoms. "We are asking the committee of experts to analyze what is out there... (including) contradictions in the literature (and tell us) what is needed in further studies," he said. He noted as well a meeting of top international researchers in the field will be held in August to focus on accelerating research into MS, including research on CCSVI. The subcommittee also heard video testimony Tuesday from Dr. Marian Simka from Poland. Simka said he had diagnosed and treated some 347 MS patients for CCSVI, all of whom paid for their diagnosis with ultrasound and MRV and treatment at his hospital in Katowice. He reported the procedure "was safe and well tolerated" with "few complications, no deaths, no hemorrhages, no cerebral strokes, no stent migration" in the patients he is tracking. Simka has been using metal stents in some patients to keep veins open. The practice is controversial. One case in the U.S saw the stent fall into the patient's heart, prompting open heart surgery to remove it. Simka also reported that 80 to 90 per cent of patients treated -- including those with progressive MS for whom there are no drug treatments -- reported improvements in one to two-month follow-up studies. He expects to publish data on his work this fall. Also testifying before the committee was Dr. Paolo Zamboni, the Italian doctor pioneering the treatment for CCSVI. He told MPs the procedure has so far shown promising results. The developments come on the heels of a recent study in the Annals of Neurology which found no cases of blood flow problems in the veins of patients with MS tested with ultrasound. Source: CTV Winnepeg � 2010 CTVGlobeMedia (16/06/10)

Study questions vein blockages hypothesis in people with MS

Mon, 14 Jun 2010 06:16:00 EDT

A study published online today, led by scientists from Barts and The London School of Medicine and Dentistry, part of Queen Mary, University of London, and University Hospital Charit�, Humboldt University in Berlin, found no evidence supporting previous claims that blockages in veins play a significant role in MS. The 2009 proposal, that people with MS have chronically blocked veins, which lead to a backflow of blood into their brains, was reported by a group of Italian researchers, who coined the term chronic cerebro-spinal venous sufficiency ( CCSVI). The research triggered international media interest and caused many people with MS to believe their veins need to be scanned and widened, or �liberated� in the words of the leading author. Treatment attempts based on the theory of CCSVI resulted in two serious adverse events, one of which was fatal. Dr Klaus Schmierer, a clinical senior lecturer in neuroimmunology at the Blizard Institute for Cell and Molecular Science at Barts and The London, and co-author of the paper published today, said his research with the University Hospital Charit� in Berlin brought CCSVI into question. �We used virtually identical ultrasound techniques to try and reproduce the results by Dr Zamboni and his co-researchers but we had quite different outcomes. In the 76 subjects used in our research, the blood flow in the head and neck veins was normal in everyone except for one person with MS,� Dr Schmierer said. �Although some people have tried interventional procedures to �unblock veins� we would strongly advise against this until further investigations into CCSVI and its possible role in MS are conducted.� Dr Schmierer�s fellow researchers, Florian Doepp, Jose Valdueza and Stephan Schreiber, performed an extracranial and transcranial venous ultrasound analysis of 76 subjects; 56 people with MS and 20 healthy people. None of the subjects fulfilled more than one criterion for CCSVI. �Although we didn�t find any evidence to support the theory of CCSVI, the discrepancies between the studies may be due to the inclusion in our study of blood flow analysis. We believe the comprehensive venous blood flow assessment performed in our study provides a strong basis to diagnose obstructions in the veins,� Dr Schmierer said. "Further studies to evaluate this theory are underway. Preliminary results from a large study at the University of Buffalo have so far been inconclusive." Link to study: http://www3.interscience.wiley.com/journal/123513536/abstract?CRETRY=1&SRETRY=0 (14/06/10)

North American MS societies to fund seven CCSVI research projects

Sun, 13 Jun 2010 04:21:00 EDT

MS societies in Canada and the United States have announced they are releasing funds to study the effectiveness of a new, unproven treatment for multiple sclerosis. The treatment is based on research by an Italian physician named Paolo Zamboni, who found abnormalities in the veins that drain blood from the brain and spine in people who suffer from MS. He dubbed the condition CCSVI, or chronic cerebrospinal venous insufficiency, and set about alleviating the blockages. Zamboni's work was featured in reports on CTV's W5 this year, prompting wider interest in the controversial theory. Under pressure from patients eager to receive the new treatment, the MS Society of Canada said Friday it is committing $700,000 to study the link between CCSVI and MS. South of the border, the National MS Society said it will spend $1.7 million for the same purpose. Together, the two organizations say they will fund seven research projects on CCSVI. "The MS Society of Canada is committed to funding strong science, backed by research goals that move us forward in our pursuit to end MS," Yves Savoie, president and CEO of the MS Society of Canada said in a statement. "I am very pleased that grantees, their collaborators and their host institutions will help us play a part in better understanding CCSVI and its relationship to MS." One of the studies awarded funds is being conducted by a team of researchers from the University of British Columbia, Vancouver Coastal Health Research Institute and the University of Saskatchewan. They plan to recruit 100 participants with MS as well as 100 people in a control group who don't have the disease. "Our goal is to verify the condition itself, and the usefulness of non-invasive techniques that would make it easier to screen for CCSVI," the study's lead researcher, Dr. Anthony Traboulsee at the University of British Columbia, said in a statement. Another of the funded studies will be conducted by Dr. Brenda Banwell at the Toronto Hospital for Sick Children's pediatric MS clinic, in the hopes of determining whether vein blockages also occur in young MS patients. "We do feel that the kids have the ability to teach us something really important here," Banwell said. "I think if it's absent in children, that will add a lot of weight to the concern that this finding is an observation perhaps in selected MS patients, but it's not a fundamental part of MS," she said. But if the study finds that CCSVI is more frequent in children with MS, "then I think it adds an enormous weight in the �this is important' aspect," she said. Two other studies led by Dr. Carlos Torres at the University of Ottawa and Dr. Fiona Costello at the University of Calgary have also earned funding to explore CCSVI. The seven new research studies are to pick up on Zamboni's findings, examining whether CCSVI causes MS, hoping to reconcile "conflicting data" from previous studies and possibly paving the way for medical trials to determine whether treating CCSVI improves or changes the condition of MS patients. But some say the funding is far less than expected. "For context, over the last two years the MS Society has granted $21.1 million in research grants," said Kate Bahen of Charity Intelligence a group that analyzes charitable organizations. Bahen says the CCSVI research accounts for 3 per cent of research spending. "This research isn't expected to produce results until June 2012 and will only involve 430 people with MS in the initial scans," Bahen said. "The other estimated 54,500 people with MS will have to wait at least two years." Most Canadian research teams interested in CCSVI suggest that funding in the range of $500,000 to $600,000 is needed to properly conduct a trial. "CCSVI is a serious legitimate medical theory that requires rigorous research. I am worried that this isn't enough funding to adequately do this work, preferably in a timely manner," Bahen said. Surprisingly, the research team from McMaster University and St. Joseph's Hospital in Hamilton, which had applied for funding, and are preparing for a study, were not given any funding from the MS Society. Nor was the research team at University of Buffalo, where Dr. Robert Zivadinov has been conducting pioneering research on CCSVI. Others say that the research projects ignore evidence being collected at clinics in Poland, Europe and the U.S. "I would note this research, when it is all done and published, will not bring us any notable understanding that we don't already have today," said Ashton Embry, the father of a patient with MS and Member of an MS support group based in Alberta called Direct MS. "This is classic stall research which will delay any real research which will test the efficacy of CCSVI treatment." Source: CTV � 2010 CTVGlobeMedia (13/06/10)

Vascular comorbidity is associated with more rapid disability progression in MS

Mon, 17 May 2010 02:13:00 EDT

ABSTRACT Background: Vascular comorbidity adversely influences health outcomes in several chronic conditions. Vascular comorbidities are common in multiple sclerosis (MS), but their impact on disease severity is unknown. Vascular comorbidities may contribute to the poorly understood heterogeneity in MS disease severity. Treatment of vascular comorbidities may represent an avenue for treating MS. Methods: A total of 8,983 patients with MS enrolled in the North American Research Committee on Multiple Sclerosis Registry participated in this cohort study. Time from symptom onset or diagnosis until ambulatory disability was compared for patients with or without vascular comorbidities to determine their impact on MS severity. Multivariable proportional hazards models were adjusted for sex, race, age at symptom onset, year of symptom onset, socioeconomic status, and region of residence. Results: Participants reporting one or more vascular comorbidities at diagnosis had an increased risk of ambulatory disability, and risk increased with the number of vascular conditions reported (hazard ratio [HR]/condition for early gait disability 1.51; 95% confidence interval [CI] 1.41�1.61). Vascular comorbidity at any time during the disease course also increased the risk of ambulatory disability (adjusted HR for unilateral walking assistance 1.54; 95% CI 1.44�1.65). The median time between diagnosis and need for ambulatory assistance was 18.8 years in patients without and 12.8 years in patients with vascular comorbidities. Conclusions: Vascular comorbidity, whether present at symptom onset, diagnosis, or later in the disease course, is associated with a substantially increased risk of disability progression in multiple sclerosis. The impact of treating vascular comorbidities on disease progression deserves investigation. R.A. Marrie, R. Rudick, R. Horwitz, G. Cutter, T. Tyry, D. Campagnolo and T. Vollmer Source: Neurology� 2010;74:1041�1047 (17/05/10)

Canadian trials to examine 'liberation procedure' for multiple sclerosis

Wed, 05 May 2010 07:03:00 EDT

Duncan Thornton is still getting used to enjoying the small things that most Canadians take for granted. �I do laundry spontaneously,� says the 47-year-old resident of Winnipeg, Manitoba. Diagnosed with multiple sclerosis in August 2009, Thornton figures he�s had the disease for at least two decades. �Fatigue was always the most disabling aspect of my illness. � For the last 20 years, anytime I stood for more than five minutes I began looking for a chair.� Duncan and his brother, 49-year-old Evan of Ottawa, Ontario, who also has MS, made headlines in March after travelling to a clinic in Poland for surgery nicknamed the �liberation procedure.� The operation is based on research by Paolo Zamboni, a professor of medicine at the University of Ferrara in Italy. He suspects multiple sclerosis is not, as is widely believed, an auto-immune disease, but rather, a vascular condition he dubbed chronic cerebrospinal venous insufficiency, or CCSVI. Zamboni discovered that in about 90% of people with multiple sclerosis, the veins draining blood from the brain are blocked or malformed, causing a build-up of iron in the brain. Zamboni believes that build-up causes the neurological symptoms of multiple sclerosis. It is not a new hypothesis, according to Dr. Ian Rodger, vice-president of research at St. Joseph�s Healthcare Hamilton, in Ontario. But it remains clinically untested, Rodger says. �The idea that blood vessels are involved in MS goes back over 100 years. But it rises to the surface and fades away. For the last 50 years, at least, the auto-immune theory has been somewhat dominant.� Researchers at St. Joseph�s Healthcare will test Zamboni�s proposition. �I have no doubt that there is an auto-immune component to MS. But what Zamboni has done is he has raised the awareness again that the vascular component could be real,� Rodger says. �So it could be auto-immune with a vascular component. And who knows what else? We don�t know.� Rodger says his team is looking to establish the prevalence of CCSVI by comparing subjects who have multiple sclerosis and with age- and gender-matched healthy people. Those 100 people will be put in four categories: primary progressive, secondary progressive, relapsing-remitting, and benign. �Specifically, we are going to measure by ultrasound and try to mimic almost exactly, if not exactly, what Zamboni has done. We�re also going to use MR [magnetic resonance] imaging to look at the architecture of the veins,� Rodger says. �We�re trying to see whether MR is superior to ultrasound. It�s obviously a lot more expensive. But you see different things with MR than you see with ultrasound. So really, we�re going to do a comparison.� The University of British Columbia and Vancouver Coastal Health has partnered with the University of Saskatchewan to undertake a similar research project. �A lot of people are anxious to have a test done and surgery without having the validation done first,� says Dr. Anthony Traboulsee, the medical director of UBC�s MS clinic. �Our feeling is that the validation of Zamboni�s original findings needs to be done first before people run off to have surgery.� �So far, that hasn�t been replicated and we think that is the most important first step before going on to treatment trials,� Traboulsee adds. The UBC-led team will compare the use of catheter venography with ultrasound and magnetic resonance venography as methods of validating the presence or absence of venous abnormalities in people with multiple sclerosis, compared with those who do not. �We�re also looking to see if it�s real,� Traboulsee says. �That�s what the whole community is waiting for. Is this real or is this fantasy? If results have only come out of one group, then that is interesting but not proof in itself. So a completely independent research group needs to reproduce what somebody else did to prove it�s a valid abnormality.� �The first step is to reproduce Zamboni�s findings,� he adds. �The second step is to find what test is good enough to find the abnormality, so we�re doing both of those in one study. Then the third step would be to show if treatment is beneficial. Unless we do the proper studies, a lot of people are going to be exposed to surgery for this potential abnormality and may get a risk from the surgery without getting a clear sustainable benefit.� Source CMAJ Copyright 1995-2010, Canadian Medical Association (05/05/10)

Custom CGH array profiling of copy number variations (CNVs) on chromosome 6p21.32 (HLA locus) in patients with venous malformations associated with multiple sclerosis

Thu, 29 Apr 2010 06:15:00 EDT

Abstract (provisional) Background Multiple sclerosis (MS) is a complex disorder thought to result from an interaction between environmental and genetic predisposing factors which have not yet been characterised, although it is known to be associated with the HLA region on 6p21.32. Recently, a picture of chronic cerebrospinal venous insufficiency (CCSVI), consequent to stenosing venous malformation of the main extra-cranial outflow routes (VM), has been described in patients affected with MS, introducing an additional phenotype with possible pathogenic significance. Methods In order to explore the presence of copy number variations (CNVs) within the HLA locus, a custom CGH array was designed to cover 7 Mb of the HLA locus region (6,899,999bp; chr6:29,900,001-36,800,000). Genomic DNA of the 15 patients with CCSVI/VM and MS was hybridised in duplicate. Results In total, 322 CNVs, of which 225 were extragenic and 97 intragenic, were identified in 15 patients. 234 known polymorphic CNVs were detected, the majority of these being situated in non-coding or extragenic regions. The overall number of CNVs (both extra- and intragenic) showed a robust and significant correlation with the number of stenosing VMs (Spearman: r=0.6590, p=0.0104; linear regression analysis r=0.6577, p=0.0106). The region we analysed contains 211 known genes. By using pathway analysis focused on angiogenesis and venous development, MS, and immunity, we tentatively highlight several genes as possible susceptibility factor candidates involved in this peculiar phenotype. Conclusions The CNVs contained in the HLA locus region in patients with the novel phenotype of CCSVI/VM and MS were mapped in detail, demonstrating a significant correlation between the number of known CNVs found in the HLA region and the number of CCSVI-VMs identified in patients. Pathway analysis revealed common routes of interaction of several of the genes involved in angiogenesis and immunity contained within this region. Despite the small sample size in this pilot study, it does suggest that the number of multiple polymorphic CNVs in the HLA locus deserves further study, owing to their possible involvement in susceptibility to this novel MS/VM plus phenotype, and perhaps even other types of the disease. Alessandra Ferlini , Matteo Bovolenta , Marcella Neri , Francesca Gualandi , Alessandra Balboni , Anton Yuryev , Fabrizio Salvi , Donato Gemmati , Alberto Liboni and Paolo Zamboni BMC Medical Genetics 2010, 11:64doi:10.1186/1471-2350-11-64 � 1999-2010 BioMed Central Ltd (29/04/10)

Multiple Sclerosis patients at Georgetown screened for blood flow abnormality called CCSVI

Tue, 27 Apr 2010 04:32:00 EDT

Georgetown University Hospital has begun screening some Multiple Sclerosis (MS)patients for a condition that causes abnormal blood drainage from the brain that some research is suggesting might exacerbate their MS symptoms. �We are proceeding very cautiously and slowly with this. It might work or it might be a dead end, but we need to see where the science takes us without risking patient safety,� said Carlo Tornatore, MD neurologist and head of Georgetown�s Multiple Sclerosis Clinic. With 2,000 patients, Georgetown�s MS clinic is the largest in the DC area. The test is a screening diagnostic ultrasound performed in the Non-invasive Vascular Laboratory that evaluates the central venous circulation for abnormal flow patterns that may indicate chronic cerebrospinal venous insufficiency (CCSVI), essentially a blockage that can cause a backup of blood into the brain. The screening is an ultrasound of the veins in the neck and carries no risk to the patient. It may or may not be covered by insurance. �The theory is that when the blood backs up into the brain or the spinal cord, the blood vessels break open a little bit and iron deposits from the blood get into the brain. In response, white blood cells attack the myelin sheath of the nerves and cause a breakdown of the myelin sheath that we see in patients with MS,� said Dr. Tornatore. Multiple sclerosis is a chronic, often disabling disease that attacks the central nervous system, which is made up of the brain, spinal cord, and optic nerves. MS symptoms can be mild like numbness in the limbs, or they can be severe, including loss of vision, paralysis and difficulty breathing. The progression and severity of symptoms vary from person to person. The National Multiple Sclerosis Society reports an estimated 400,000 people in the United States have MS, with 200 more people diagnosed each week. Around the world, MS is estimated to affect more than 2.1 million people and more women than men. If the patient�s ultrasound finds certain abnormal flow patterns, then they are referred on for a venogram to be performed by Richard Neville, MD, chief of Vascular Surgery at Georgetown. �The venogram confirms and assesses the extent of the blockage or abnormal flow. The procedure involves placing a catheter into the veins and obtaining pictures of the blood flow in the veins. If we find a blockage, then we can then perform an angioplasty, by inflating a balloon inside the vein to open the blockage. Venous angioplasty is a procedure we perform often in other situations and we believe is a fairly safe option. We are not using stents to prop open the veins.� Dr. Neville and Tornatore have applied for a clinical trial under IRB protocol which will allow the supervised collection and analysis of data from the diagnostic and therapeutic procedures. �We are hoping to evaluate this new modality in a thoughtful and scientific way,� said Dr. Neville. Dr. Tornatore will be following up with his MS patients who receive angioplasty. �After the procedure, I will be following the patients with a battery of tests, including follow-up ultrasounds to determine whether the veins have re-stenosed, or re-clogged.� So far, GUH has screened 40 MS patients for the condition and half have been found to have it. Those approximately 20 patients will go on to have a venogram and angioplasty, if indicated. To date, five MS patients have had venograms with angioplasty. �I�ll be shocked if this is the total answer to MS; it�s a very complicated disease,� said Dr. Tornatore. �But the whole concept of the veins being too narrow is interesting and something we feel we can�t ignore. We owe it to our patients to explore this.� Source Georgetown University Hospital � Georgetown University Hospital (27/04/10)

Chronic cerebrospinal venous insufficiency (CCSVI) in Multiple Sclerosis patients - Kuwait study initial results

Fri, 23 Apr 2010 04:23:00 EDT

Chronic cerebrospinal venous insufficiency (CCSVI) in Multiple Sclerosis patients - Kuwait study Introduction - http://www.ccsvikuwait.com/uploads/Introduction.pdf AIM & OBJECTIVE: In Kuwait the MS patient is increasing and it is estimated about 3000 � 6000 patients. This program started in March. 2010, it is multidisciplinary approach, vascular diagnostic lab. doctor, vascular surgeon, and vascular intervention radiology, radiologist and neurologist. Our objective to diagnose MS patient with Chronic cerebrospinal venous insufficiency (CCSVI) and to evaluate them with Duplex scanning and magnetic resonance venography and to evaluate clinical and or radiological improvement of these cases after treating them with angioplasty with or without stent of the diseased affected part of the internal jugular vein, This method is a new application of a standard procedure that may be helpful in relieving some of the symptoms of MS patients with CCSVI and it was advocated in Italy, Poland and USA. In Kuwait we would like as usual to lead the way in the Gulf state and Arabian countries to study and assess the feasibility of such a new method of possible clinical improvement of some or all of the symptoms of MS patients which may help improve quality and functions of the patients and whether or not reach and meet our expectation, therefore we will do a pilot study of 100 patients and evaluate clinical improvement by a neurologist at 1, 3, 6, and 12 months. Colour Duplex scan at 1, 3, 6, 9, and 12 months intervals. MRV at 6 and 12 months intervals. MRI brain at 3, 6, and 12 months intervals. If the initial results of the study fulfilling our objectives then we will do more cases and continue the study for 1 year to include total 500 cases at least. SAMPLE SIZE: 100 - 500 MS patients from all hospital. INCLUSION CRITIERA: Patient: with proven MS with positive Doppler and MRV (> 50% stenosis) Age: 18 and above Sex: both males and females Nationality: Kuwaiti Venue: Mubarak Al Kabeer Hospital (other public hospitals will refer to Mubarak Hospital) EXCLUSION CRITIERA: Patient with sever co-morbid conditions (i.e. heart or lung disease or terminal of the disease MS) Patients younger than 18 years Pregnant females Patient with contrast allergies Patient with abnormal mental status Patient with normal Doppler and MRV testing(< 50% stenosis) Patients in whom the diagnosis of MS is not confirmed THE TESTS: Doppler ultrasound studies (VASCULAR Lab.) MRV (Magnetic Resonance Venography) THE PROCEDURE: The angioplasty done by an Interventional Radiologist with assistance from a vascular surgeon. The patient is awake but is given mild anesthesia (50-100 % fentanyle). The procedure can be painful and the recovery can take a couple of months as the brain becomes acclimated to the new pressures of the new blood flows. The Accessory Nerve shares the same sheath as the jugular vein; therefore, there have been some instances where the Accessory Nerve (shoulder movement) has been damaged--time will tell if the damage is temporary or permanent. THE RESULTS: The angiography may stop MS progression, BUT it cannot fix all symptoms, especially if axons have already been lost. However, some symptom improvements (anecdotally reported) are immediate, such as increased visual acuity and decreased (or eliminated) brain fog, tinnitus, and fatigue. MULTIDISCIPLINARY TEAM: Vascular Surgery Unit Vascular Intervention Radiology Vascular Diagnostic laboratory MR Radiologist Anesthetist Neurologist NEUROLOGIST TASK: Referral of MS patients Document of severity of MS symptoms before the procedure with EDSS-FSS- and MSIS. Document of MS symptoms immediately after the procedure with EDSS-FSS- and MSIS. Follow up of patient symptoms at 3, 6 and 12 months SEQUENCE OF EVENTS: 1.Neurology OPD (pre and post procedure) 2.Vascular OPD (patient Data) 3.Duplex 4.MRV 5.Admission & Venogram 6.OPD follow up program ◦Duplex ◦MRI ◦Neurology report ◦Treatment of possible stenosis MANAGEMENT OF COMPLICATIONS : �Stroke � ICU and neurologist management �Bleeding or thrombosis � ICU and medical or surgical intervention �Dissection or contrast extravasations � Re- ballooning and rarely use of stent Management: �In the clinic check RFT, Coagulation profile, RFT, CBC, Vit D deficiency and cross match I unit of blood �Admission as a day case (for 4-8 hours) �Patient Consent �Investigations (Duplex and MRV) � Plavix (2 tablets) & ASA before the procedure �Angioplasty depend on the findings �If angioplasty done then � LMWH (Clexane) start 3hours after procedure for three days � Plavix for 10 days post procedure on day 4 � ASA for one year post procedure on day one � Remove compression bandgae in the groin next day � Patient informed in case of groin bleeding or headache or flushed face to report to us urgently ( for emergency Dr. Hussein Safar- tel 66789333) � Followed up in the vascular clinic after 3 days, 1 week, 1, 3,6, 9, 12 months. � Follow up with neurologist at 1, 3. 6. 12 months Follow up: Out patient Clinic - Checking clinical improvement (neurologist and vascular) Duplex scanning initially after 1st months then every three months for one year- all date of Duplex testing is given to the patient (Dr. Abdul-Aziz Al Muzaini) MRI for MS at 3, 6, and 12 months then as required (for white spots), (Radiologist and neurologist) At 6 months and one year MRV (vascular) Follow up with neurologist report (neurologist) Possible complications Possible restenosis Possible re-intervention with balloon angioplasty Initial Results April 2010

Funding trials of CCSVI: Can the MS Society do better?

Sat, 17 Apr 2010 02:03:00 EDT

by Dr. Lorne Brandes The good news emanating from this week�s American Academy of Neurology (AAN) meeting in Toronto was that, although skepticism abounded, Dr. Paulo Zamboni and CCSVI were not ignored by �the establishment�. Far from it, judging by the conference�s special session devoted to debating and discussing his controversial new theory that MS is primarily a disease caused by blocked neck or chest veins. In addition to Dr. Zamboni, a panel of MS experts, a large crowd of neurologists, and more than 4,000 patients from around the world attended the event on line... surely a first for any medical meeting, and indicative of the pivotal role that the Internet has played in galvanizing an MS community enthralled with the Zamboni hypothesis and unhappy with currently-available immunosuppressive therapies. Now the bad news: despite a willingness of investigators to move forward, there appears to be a major stumbling block in obtaining the monies required to fund the human clinical trials needed to learn whether blocked neck and chest veins cause MS, and whether unblocking them will truly benefit patients with the disease. For example, in the absence of public funding, Dr. Robert Zivadinov, head of the largest CCSVI study at the University of Buffalo, requires patients to pay several thousand dollars to be tested. In Canada, ambitious clinical trials planned at UBC, McMaster and the University of Saskatchewan have been delayed for lack of funds. They remain on hold pending the results, expected in June, of a special MS Society-sponsored grant competition. But, as reiterated in a report on CTV�s W5, successful applicants will receive a maximum grant of only $200,000 over two years. "I am quite convinced as a result of the excitement, the mobilization, the media attention, the process of discovery is going to be much accelerated," Yves Savoie, the president of the Canadian MS Society, told W5. Much accelerated? By awarding each needy centre (how many, we do not yet know) a total of $200,000 to carry out these sophisticated, expensive and highly important studies? Is he kidding? As one involved in laboratory and clinical cancer research for over 35 years, I must tell you that, given the costs required for any type of human investigation, especially one as complex as a study of the potential relationship between CCSVI and MS, this is a paltry sum, by any standard. A strategy that spreads small amounts of money among many investigators will accomplish very little at the end of the day. Can�t the MSS do a lot better than this? Indeed, how much of the money they raise each year actually goes to funding research? To answer this question, I obtained a copy of the Society�s most recent financial statement, audited by Price, Waterhouse, Coopers, LLP. Here is the bottom line: for the year ended August 31, 2009, the Canadian MSS took in revenue of $33,677,000. Of that amount, $28,503,000 came from donations (including $1,197,000 from the United Way) and fundraising events. The amount spent on research? Twenty-two cents out of every dollar collected, for a total of $7,324,000. As for how the rest was allocated: $10,495,000 was spent on services to patients $889,000 to help fund MS clinics $2,806,000 for chapter and volunteer support and development $4,086,000 for public awareness and education $1,570,000 to cover �government and community relations�. So here is my question to the Canadian MSS: could you not spend less money educating people about a disease of which they are already well aware, and stop spending over $1.5 million on government and community relations (whatever form that may take)? By making those specific budget cuts, you might easily free up several million dollars to help Canadian centres move ahead with their CCSVI trials without jeopardizing patient care, or taking away from other funded research projects. Given the importance of this issue, I hope you will give serious thought to this suggestion. Source: CTV � Copyright 2010 CTVglobemedia Publishing Inc (17/04/10) MSRC CCSVI Research Page - http://www.msrc.co.uk/index.cfm/fuseaction/show/pageid/2994

Hemodynamic patterns of chronic cerebrospinal venous insufficiency in multiple sclerosis. Correlation with symptoms at onset and clinical course

Tue, 06 Apr 2010 03:46:00 EDT

AIM: Chronic Cerebrospinal Venous Insufficiency (CCSVI) is associated with multiple sclerosis (MS). CCSVI is detected by transcranial and extracranial color-Doppler high-resolution examination (TCCS-ECD) and venography that permit to identify five types of venous malformations and four major (A-D) hemodynamic patterns of anomalous extracranial-extravertebral venous outflow. We investigated possible correlation between such hemodynamic patterns and both the symptoms at onset and clinical course in patients with MS and CCSVI. METHODS: TCCS-ECD, selective venography and clinical records of 65 patients affected by definite MS and CCSVI were reviewed. RESULTS: The four hemodynamic patterns of CCSVI were unevenly (P<0.0001) distributed with respect to the types of clinical presentation and course. In particular the Type A or B patterns were common in patients with onset of optic neuritis, but rare in patients presenting with spinal cord symptoms who typically showed a type D pattern. As well, the type A or type B hemodynamic were more common in patients with relapsing-remitting course than in patients with secondary progressive course and rare in patients with primary progressive course. The C hemodynamic pattern was not observed in patients with primary progressive course who showed a remarkable prevalence of the type D pattern. CONCLUSION: The distribution of venous malformations and the resulting hemodynamic pattern show correlation with symptoms at onset and clinical course in patients with MS and CCSVI. Bartolomei I, Salvi F, Galeotti R, Salviato E, Alcanterini M, Menegatti E, Mascalchi M, Zamboni P. Center for Rare and Neuroimmunitary Diseases, Department of Neurological Science, Bellaria Hospital, Bologna, Italy Source: Pubmed PMID: 20351674 (06/04/10) - MSRC CCSVI Research Page http://www.msrc.co.uk/index.cfm/fuseaction/show/pageid/2944

Chronic cerebro-spinal venous insufficiency: report of transcranial magnetic stimulation follow-up study in a patient with multiple sclerosis

Thu, 01 Apr 2010 07:05:00 EDT

The pyramidal pathway is frequently affected early on in multiple sclerosis (MS) and impaired motor performance is a major cause of disability. Pyramidal tract function can be assessed using transcranial magnetic stimulation (TMS). TMS supports the diagnosis of MS, detecting corticospinal tract involvement and monitoring its course with or without treatment. It has been never investigated whether any relationship exists between the TMS outcome measure and minimally invasive treatment of multiple severe extracranial stenosis, affecting the principal ce rebrospinal venous segments in MS patients. We report the clinical and transcranial magnetic stimulation follow-up of a patient during a relapse in relapsing-remitting MS. She underwent percutaneous balloon angioplasty of the associated chronic cerebrospinal venous insufficiency (CCSVI), due to membranous obstruction of the proximal azygous vein, with severe stenosis of the left internal jugular vein. Treatment of the associated CCSVI made a parallel improvement in both clinical and neurophysiological parameters, allowing us to avoid high dose steroid therapy. The relationship between the clinical and neurophysiological course on the one hand, and haemodynamic correction of the associated CCSVI on the other, calls for further exploration on a wider number of patients. The impact of CCSVI on the different neuro-physiological parameters has not been fully estimated, but the intriguing case here reported suggests that it may be greater than previously assumed. The demonstration of a modification of the cerebrovenous function with both clinical manifestation and via TMS suggests that the hampered cerebral venous return may contribute to the clinical course of MS. Plasmati R, Pastorelli F, Fini N, Salvi F, Galeotti R, Zamboni P. Department of Neurology, Bellaria Hospital, Bologna, Italy2 Vascular Diseases Centre, University of Ferrara, Italy Source: Pubmed PMID: 20351675 (01/04/10) MSRC CCSVI Research Page - http://www.msrc.co.uk/index.cfm?fuseaction=show&pageid=2944

Is chronic fatigue the symptom of venous insufficiency associated with multiple sclerosis? A longitudinal pilot study

Thu, 01 Apr 2010 06:58:00 EDT

AIM: Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular phenomenon recently described in multiple sclerosis (MS) that is characterized by stenoses affecting the main extracranial venous outflow pathways and by a high rate of cerebral venous reflux that may lead to increased iron deposition in the brain. Aim of this study was to investigate the relationship between CCSVI and iron deposition in the brain of MS patients by correlating venous hemodynamic (VH) parameters and iron concentration in deep-gray matter structures and lesions, as measured by susceptibility-weighted imaging (SWI), and to preliminarily define the relationship between iron measures and clinical and other magnetic resonance imaging (MRI) outcomes. METHODS: Sixteen (16) consecutive relapsing-remitting MS patients and 8 age- and sex-matched healthy controls (HC) were scanned on a GE 3T scanner, using SWI. RESULTS: All 16 MS patients fulfilled the diagnosis of CCSVI (median VH=4), compared to none of the HC. In MS patients, the higher iron concentration in the pulvinar nucleus of the thalamus, thalamus, globus pallidus, and hippocampus was related to a higher number of VH criteria (P<0.05). There was also a significant association between a higher number of VH criteria and higher iron concentration of overlapping T2 (r=-0.64, P=0.007) and T1 (r=-0.56, P=0.023) phase lesions. Iron concentration measures were related to longer disease duration and increased disability as measured by EDSS and MSFC, and to increased MRI lesion burden and decreased brain volume. CONCLUSION: The findings from this pilot study suggest that CCSVI may be an important mechanism related to iron deposition in the brain parenchyma of MS patients. In turn, iron deposition, as measured by SWI, is a modest-to-strong predictor of disability progression, lesion volume accumulation and atrophy development in patients with MS. Zivadinov R, Schirda C, Dwyer MG, Haacke ME, Weinstock-Guttman B, Menegatti E, Heininen-Brown M, Magnano C, Malagoni AM, Wack DS, Hojnacki D, Kennedy C, Carl E, Bergsland N, Hussein S, Poloni G, Bartolomei I, Salvi F, Zamboni P. Buffalo Neuroimaging Analysis Center, University at Buffalo, Buffalo, NY, USA Source: Pubmed PMID: 20351672 (01/04/10) MSRC CCSVI Research Page - http://www.msrc.co.uk/index.cfm?fuseaction=show&pageid=2944

Chronic cerebrospinal venous insufficiency and iron deposition on susceptibility-weighted imaging in patients with multiple sclerosis: a pilot case-control study

Thu, 01 Apr 2010 06:49:00 EDT

Iron stores and cerebral veins in MS studied by susceptibility weighted imaging

Thu, 01 Apr 2010 06:40:00 EDT

AIM: In this paper, we seek to determine whether the iron deposition as seen by susceptibility weighted imaging (SWI) in the basal ganglia and thalamus of patients with multiple sclerosis is greater than the iron content measured in normal subjects (individuals unaffected by multiple sclerosis). As increased iron content may result from increased venous pressure, such information would add credence to the concept of Zamboni et al (1) that MS is caused by chronic cerebrospinal venous insufficiency. METHODS: Fourteen MS patients were recruited for this study with a mean age of 38 years ranging from 19 to 66 year-old. A velocity compensated 3D gradient echo sequence was used to generate SW images with a high sensitivity to iron content. We evaluated iron in the following structures: substantia nigra, red nucleus, globus pallidus, putamen, caudate nucleus, thalamus and pulvinar thalamus. Each structure was broken into two parts, a high iron content region and a low iron content region. The measured values were compared to previously established baseline iron content in these structures as a function of age. RESULTS: Twelve of fourteen patients had an increase in iron above normal levels and with a particular pattern of iron deposition in the medial venous drainage system that was associated with the confluence of the veins draining that structure. CONCLUSION: Iron may serve as a biomarker of venous vascular damage in multiple sclerosis. The backward iron accumulation pattern seen in the basal ganglia and thalamus of most MS patients is consistent with the hypothesis of venous hypertension. Haacke EM, Garbern J, Miao Y, Habib C, Liu M. Department of Radiology, Wayne State University, Detroit, MI, USA2 Department of Radiology, the First Affiliated Hospital, Dalian Medical University, Dalian, China Source: Pubmed PMID: 20351671 (01/04/10) MSRC CCSVI Research Page - http://www.msrc.co.uk/index.cfm?fuseaction=show&pageid=2944

CSF dynamics and brain volume in multiple sclerosis are associated with extracranial venous flow anomalies: a pilot study

Thu, 01 Apr 2010 06:41:00 EDT

AIM: We previously reported unexpectedly robust associations between vascular haemodynamic (VH) anomalies in the principal extracranial cerebral veins, causing chronic cerebrospinal venous insufficiency (CCSVI), and multiple sclerosis (MS). Aim of this study was to investigate the relationship between the VH changes and MRI measures of MS disease severity in a cross sectional survey. METHODS: The number of anomalous VH criteria were measured using an echo-color Doppler, whereas CSF flow, atrophy and lesion measures were obtained from quantitative magnetic resonance imaging (MRI) analysis in sixteen consecutive relapsing-remitting MS patients, (mean age: 36.1+/-SD 7.3 years, disease duration: 7.5+/-1.9 years and median EDSS: 2.5) and in 8 healthy controls (HC) with similar age and sex distributions. RESULTS: All 16 MS patients investigated and none of the HCs met the VH criteria for CCSVI (P<0.0001). MS patients showed significantly lower net CSF flow compared to the HC (P=0.038) that was associated with number of anomalous VH criteria present (r=0.79, P<0.001). Moreover, increases in the number of anomalous VH criteria present were negatively associated with lower whole brain volume (Spearman R=-0.5, P=0.05). CONCLUSION: VH changes occur more frequently in MS patients than controls. Altered VH is associated with abnormal CSF flow dynamics and decreased brain volume. Zamboni P, Menegatti E, Weinstock-Guttman B, Schirda C, Cox JL, Malagoni AM, Hojnacki D, Kennedy C, Carl E, Dwyer MG, Bergsland N, Galeotti R, Hussein S, Bartolomei I, Salvi F, Ramanathan M, Zivadinov R. Vascular Diseases Center, University of Ferrara-Bellaria Neurosciences, Ferrara and Bologna, Italy Source: Pubmed PMID: 20351670 (01/04/10) MSRC CCSVI Research Page - http://www.msrc.co.uk/index.cfm?fuseaction=show&pageid=2944

Use of neck magnetic resonance venography, Doppler sonography and selective venography for diagnosis of chronic cerebrospinal venous insufficiency: a pilot study in multiple sclerosis patients and healthy controls

Thu, 01 Apr 2010 06:41:00 EDT

AIM: Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of primary veins outside the skull that restrict normal outflow of blood from the brain. CCSVI was recently described as highly prevalent in patients with multiple sclerosis (MS), and can be non-invasively diagnosed by Doppler sonography (DS) and invasively by selective venography (SV). The aim of this paper was to investigate the value of neck magnetic resonance venography (MRV) for the diagnosis of CCSVI compared to DS and SV in patients with MS and in healthy controls (HC). METHODS: Ten MS patients and 7 HC underwent DS, 2D-Time-Of-Flight venography (TOF) and 3D-Time Resolved Imaging of Contrast Kinetics angiography (TRICKS). MS patients also underwent SV. The internal jugular veins (IJVs) and the vertebral veins (VVs) were assessed by both MRV sequences, and the findings were validated against SV and DS. SV has been considered the diagnostic gold standard for MS patients. RESULTS: All MS patients and none of the HC presented CCSVI, according to the DS criteria. This was confirmed by SV. For CCSVI diagnosis, DS showed sensitivity, specificity, accuracy, PPV and NPV of 100%, whereas the figures were 40%, 85%, 58%, 80% and 50% for 3D-TRICKS, and 30%, 85%, 52%, 75% and 46% for 2D-TOF in the IJVs. In MS patients, compared to SV, DS showed sensitivity, specificity, accuracy, PPV and NPV of 100%, 75%, 95%, 94% and 100%, whereas the figures were 31%, 100%, 45%, 100% and 26% for 3D-TRICKS and 25%, 100%, 40%, 100% and 25% for 2D-TOF in the IJVs. CONCLUSION: The use of MRV for diagnosis of CCSVI in MS patients has limited value, and the findings should be interpreted with caution and confirmed by other imaging techniques such as DS and SV. Hojnacki D, Zamboni P, Lopez-Soriano A, Galleotti R, Menegatti E, Weinstock-Guttman B, Schirda C, Magnano C, Malagoni AM, Kennedy C, Bartolomei I, Salvi F, Zivadinov R. The Jacobs Neurological Institute, State University of New York, Buffalo, NY, USA Source: Pubmed PMID: 20351669 (01/04/10) MSRC CCSVI Research Page - http://www.msrc.co.uk/index.cfm?fuseaction=show&pageid=2944

The reproducibility of colour Doppler in chronic cerebrospinal venous insufficiency associated with multiple sclerosis

Thu, 01 Apr 2010 06:42:00 EDT

AIM: Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome described in multiple sclerosis (MS) patients, characterized by stenosis of the main extracranial veins with hampered cerebral venous outflow. In the original description echo-colour Doppler demonstrated to be an ideal non invasive tool for screening CCSVI patients, but the reproducibility was not assessed. Aim of this study is to assess the variability coefficient between trained and in not trained echo-colour Doppler operators. METHODS: Thirty-six (36) subjects, matched for age and gender, were subset in 3 groups (group A, 12 healthy controls, HC; group B, 12 multiple sclerosis patients, MS; group C, 12 patients with other neurological disease, OND) underwent echo-colour Doppler screening for CCSVI according to an original protocol previously described. The inter observer variability rate was assessed by comparing respectively trained vs not trained operators, and trained vs trained operators, by using the same echo-colour Doppler equipment. In addition, by scanning 15 subjects after one month from the first session, intra observer coefficient was also assessed in trained operator. RESULTS: The inter observer variability rate between trained and not trained echo-colour Doppler operators, were not completely satisfactory (K coefficient 0.47 95% CI 0.27-0.68). To the contrary the inter observer agreement between trained operators was much more reliable (K coefficient 0.80 95% CI 0.59-1.01). Finally, the intra observer variability rate in trained operators was 0.93, (95% CI 0.80-1.06) confirming a highly satisfactory agreement. CONCLUSION: Echo-colour Doppler is a powerful, non-invasive and reproducible tool for screening CCSVI-MS but it needs special training. Menegatti E, Genova V, Tessari M, Malagoni AM, Bartolomei I, Zuolo M, Galeotti R, Salvi F, Zamboni P. Vascular Diseases Centre, University of Ferrara, Italy Source: Pubmed PMID: 20351668 (01/04/10) MSRC CCSVI Research Page - http://www.msrc.co.uk/index.cfm?fuseaction=show&pageid=2944

Internal jugular vein morphology and hemodynamics in patients with multiple sclerosis

Thu, 01 Apr 2010 06:02:00 EDT

AIM: The aim of this study is to compare the hemodynamics and the morphology of the internal jugular veins using Colour-Doppler and B-mode sonongraphy in multiple sclerosis patients (MS) and in controls. METHODS: The internal jugular veins of 25 MS patients and 25 controls were examined using colour Doppler and B-mode ultrasound in sitting and supine positions, recording the changes in hemodynamics and the presence or absence of morphological changes. The presence of at least two of the extracranial Zamboni criteria in the same individual was considered positive for evidence of chronic cerebrospinal venous insufficiency (CCSVI). RESULTS: According to the described criteria, 92% of the MS patients showed abnormal findings and 84% of them showed evidence of CCSVI, however; only 24% of controls showed abnormal findings, but none of them showed evidence of CCSVI (OR=7.25, 95% CI 2.92-18.01, P<0.0001). CONCLUSION: Hemodynamic abnormalities and morphological changes involving the internal jugular vein are strongly associated with MS. These findings can be demonstrated by a non-invasive, cost effective Doppler ultrasound criteria. Al-Omari MH, Rousan LA. Radiology Department, King Abdullah University Hospital, Jordan University of Science and Technology, Jordan. Source: Pubmed PMID: 20351667 (01/04/10)

Extracranial Doppler sonographic criteria of chronic cerebrospinal venous insufficiency in the patients with multiple sclerosis.

Thu, 01 Apr 2010 05:47:00 EDT

AIM: The aim of this open-label study was to assess extracranial Doppler criteria of chronic cerebrospinal venous insufficiency in multiple sclerosis patients. METHODS: Seventy patients were assessed: 49 with relapsing-remitting, 5 with primary progressive and 16 with secondary progressive multiple sclerosis. The patients were aged 15-58 years and they suffered from multiple sclerosis for 0.5-40 years. Sonographic signs of abnormal venous outflow were detected in 64 patients (91.4%). RESULTS: We found at least two of four extracranial criteria in 63 patients (90.0%), confirming that multiple sclerosis is strongly associated with chronic cerebrospinal venous insufficiency. Additional transcranial investigations may increase the rate of patients found positive in our survey. Reflux in internal jugular and/or vertebral veins was present in 31 cases (42.8%), stenosis of internal jugular veins in 61 cases (87.1%), not detectable flow in internal jugular and/or vertebral veins in 37 cases (52.9%) and negative difference in cross-sectional area of the internal jugular vein assessed in the supine vs. sitting position in 28 cases (40.0%). Flow abnormalities in the vertebral veins were found in 8 patients (11.4%). Pathologic structures (membranaceous or netlike septa, or inverted valves) in the junction of internal jugular vein with brachiocephalic vein were found in 41 patients (58.6%), in 15 patients (21.4%) on one side only and in 26 patients (37.1%) bilaterally. CONCLUSION: Multiple sclerosis is highly correlated with chronic cerebrospinal venous insufficiency. These abnormalities in the extracranial veins draining the central nervous system can exist in various combinations. The most common pathology in our patients was the presence of an inverted valve or another pathologic structure (like membranaceous or netlike septum) in the area of junction of the IJV with the brachiocephalic vein. Simka M, Kostecki J, Zaniewski M, Majewski E, Hartel M. Department of Angiology, Private Healthcare Institution SANA, Pszczyna, Poland Source: Pubmed PMID: 20351666 (01/04/10) MSRC CCSVI Research Page - http://www.msrc.co.uk/index.cfm?fuseaction=show&pageid=2944

Saskatoon researchers to test MS/CCSVI findings of Italian doctor

Wed, 31 Mar 2010 03:28:00 EDT

In light of work done by an Italian researcher into the cause of multiple sclerosis, Dr. Katherine Knox and her team of researchers announced they will put a controversial hypothesis to the test. Knox, director of the MS Clinic, located at City Hospital, and members of her research team outlined their plans during an educational session on Tuesday. They also fielded questions from patients and health officials from around Saskatchewan. Dr. Paolo Zamboni, of the University of Ferrara in Italy, has hypothesized there's a connection between MS and Chronic Cerebrospinal Venous Insufficiency (CCSVI) -- impaired blood drainage through the veins from the brain. Knox said Zamboni hypothesized that CCSVI occurs when the veins that drain the spinal cord as well as the brain are blocked and obstruct the normal flow of blood. She said Zamboni's theory assumes the obstruction causes back pressure and a leakage of red blood cells from the vessels. Iron is released from the red blood cells, which stimulates an inflammation in the brain or spinal cord. Zamboni and his colleagues have published a study that proposes CCSVI might be corrected by endovascular surgery. Symptoms of MS disappeared in most patients when he cleared blockages and got the blood flowing again. Zamboni's hypothesis helped Knox and her team identify specific areas of research and allowed them to set out their goals. "We would like to know how common (CCSVI) is or is not in MS," Knox said. "We would like to know if it's a risk factor in MS and how to look for it." Knox said they are launching a pilot project that will test 35 subjects with MS symptoms and a separate study that will test people who are at a high risk for MS. Knox and her team studied the work of Zamboni, including tests he ran on 65 people with MS and 235 people without the disease. "He concluded that obstructions may be causative of MS rather than a coincidental finding," Knox said. "He said the hypothesis of venous malformations of congenital development origin associated with MS seems to be plausible, but that additional longitudinal studies are necessary to confirm this hypothesis." Knox pointed out several problems with both the research conducted by Zamboni and his final hypothesis. "We can say that maybe it's not clear what we should call normal and abnormal," she said. "We don't know exactly how those criteria were developed and what we should label as normal and abnormal." Knox said there were problems with the tests done on the group without MS as well as the logical error of assuming abnormalities in blood flow is a cause of MS. She said she will avoid these problems when conducting her own studies. Knox and her team are just as anxious as MS patients are in testing Zamboni's hypothesis. However, she said they are not at the stage where they can safely and effectively treat someone with MS. "Unproven treatments are associated with high cost, high risk and unknown benefit and a public funded system on its own cannot support the right to unproven treatment," Knox said. Source: The StarPhoenix � The StarPhoenix (31/03/10)

100 MS patients will get special CCSVI investigation in new study

Sun, 28 Mar 2010 02:19:00 EDT

St. Joseph�s is holding the equivalent of a big-jackpot lottery for area multiple sclerosis patients when it randomly selects 100 of them to take part in its study of a radical new theory that the disease is vascular. More than 22,000 MS patients from all over the world have vied for one of the spots in the Hamilton research testing the theory of Italian Dr. Paolo Zamboni that is expected to start this summer. But in the end, only area patients will take part. Researchers Dr. Ian Rodger and Dr. Mark Haacke will randomly choose from 1,200 patients who have been treated by Hamilton�s MS Clinic located at McMaster University Medical Centre. They will do ultrasounds and MRI scans to determine if there is any difference in the veins draining blood from the head in MS patients compared to 100 similar healthy people. Zamboni believes the veins draining blood from the brain are blocked and leaking in MS patients. This allows iron to leak into brain tissue and he thinks the buildup causes many symptoms of MS. Zamboni found those veins blocked or malformed in more than 90 per cent of MS patients he studied -- including his wife. It�s a radical departure from current thinking that MS is an autoimmune disease with few treatments. St. Joseph�s is one of only two centres in Canada studying the theory. The other is in British Columbia. Rodger and his staff are hoping to personally contact each of the more than 22,000 patients who have asked to be part of the study. �We feel an obligation to get back to these people,� said Rodger. �A lot of patients would love to be part of the study, but from the standpoint of scientific rigor you have to do the selection randomly otherwise bias can come into the data you may generate.� Source: thespec.com Copyright Metroland 2010 (28/03/10)

UBC researchers planning to study Multiple Sclerosis vein theory

Wed, 03 Mar 2010 03:30:00 EDT

A medical centre in British Columbia says it wants to become the first in the country to test the controversial theory that multiple sclerosis patients have blocked veins, preventing proper blood flow from the brain. "There's a large demand for us to look into this," Dr. Anthony Traboulsee told CTV News. "Patients are very excited. We are very interested ourselves, and we want to meet the demand of our patients." A group of researchers at the University of British Columbia MS Clinic, part of the Vancouver Coastal Health Authority, are planning to study the theory, using a variety of imaging techniques. If it gets approval and funding, it appears to be the most comprehensive examination of this novel theory in the world. They will be studying the findings of Italian researcher Dr. Paolo Zamboni, who believes that blocked veins in the neck and chest of MS patients lead to blood drainage problems and triggers the immune responses that mark the disease. Zamboni contends that angioplasty surgery on these blocked veins, a procedure he calls the Liberation Treatment, can then open them. A preliminary study of the treatment in 65 patients showed it improved the quality of life for many patients, and as long as the veins remained open, symptoms of MS were reduced and new attacks were halted. The BC team envisions a study that begins with MS patients being scanned for abnormalities, likely using the ultrasound test pioneered in Italy. They would also be given MRI scans, to see how the different tests detect possible problems. The prevalence of vein problems would also be assessed in MS patients and in normal healthy control patients. Data would also be blinded to minimize the risk for bias in the research. Once these non-invasive scans have been done, test patients would proceed to the angiography suite. There they would undergo a venogram. That's where a probe is inserted, from the groin, into the vein system that travels through the chest and into the neck. Doctors inject a dye and watch the blood-flow. This is also, according the University of Ferrara team, the definitive way of seeing blockages in the jugular veins in the neck and the azygos vein in the chest. And if there are blocked or narrowed veins, the UBC researchers want to open them up to see what happens. "Not only do we want to see if we can detect these abnormalities, we also want to see, if we change them, does it improve peoples' lives?" said Traboulsee. The B.C. researchers, who include radiologists, vascular specialists, and physicists working on new imaging technologies, say they had heard about the theory before CTV's W5 aired a story describing the theory, and were investigating the possibility of a study. But interest in the theory in Canada has exploded since the episode aired. A professor of neurosurgery at the University of Buffalo, Dr. Robert Zivadinov, who worked on an early study with Zamboni, says his office was contacted by 8,000 MS patients in the three weeks after the W5 episode aired. The Vancouver researchers want to determine the prevalence of the vein abnormality, which Zamboni has dubbed CCSVI -- or chronic cerebrospinal venous insufficiency. They also want to know how easily it can be detected with ultrasound and MRI testing. Joining the study will be Alex Rauscher, a physicist. He hopes to look at MRI scans of patients to search for evidence of iron deposits in the brain, since some research has suggested that iron in the brain may contribute to the inflammation and the immune system attacks that mark MS. "It is our duty to find the answers," said Rauscher. The Vancouver Coastal Health researchers say they have applied for funding from the MS Society of Canada to fund research to determine the most practical and reliable test for CCSVI. But because of the size and scope of the study -- and their desire to begin quickly -- they are also accepting funding from other agencies and private donations. Donations should be directed to: VGH and UBC Hospital Foundation - UBC Faculty of Medicine (funds can be specified for CCSVI research) The researchers note that their study is not accepting patients yet and likely won't for a few months until they acquire funding, obtain ethical approval, and develop an MRI and ultrasound testing protocol. Patients are asked to refrain from contacting the clinics until they are ready to proceed with the study. Meanwhile in Italy, one of the companies that manufactures the ultrasound machines used in the testing for CCSVI, is beginning to hold training sessions for doctors and technicians who want to learn the novel technique for scanning the neck and head. One training program is being held this week at the University of Ferrara with technicians who developed the tests, and with Zamboni. A second session is planned for March. Contact information for the course is available through: Claudio.Buffagni@esaote.com Source: CTV News � 2010 CTVGlobeMedia (03/03/10)

Blood brain barrier compromise with endothelial inflammation may lead to autoimmune loss of myelin during multiple sclerosis

Mon, 01 Mar 2010 05:24:00 EDT

Multiple sclerosis is an autoimmune disease characterized by multifocal areas of inflammation and demyelination within the central nervous system. The mechanism that triggers the disease remains elusive. However, recent findings may indicate that multiple sclerosis, at its source, could be a hemodynamic disorder. It has been found that multiple sclerosis patients exhibit significant stenoses in extracranial veins draining the central nervous system (in azygous and internal jugular veins), which are associated with significant pressure gradients measured across strictures. Such anatomic venous abnormalities were not found in the control group of healthy subjects. In this review, it is hypothesized that pathological refluxing venous flow in the cerebral and spinal veins increases the expression of adhesion molecules, particularly intercellular adhesion molecule-1 (ICAM-1), by the cerebrovascular endothelium. This, in turn, could lead to the increased permeability of the blood-brain barrier. Inflamed and activated endothelium could secrete proinflammatory cytokines, including GM-CSF and TGF-beta In these settings, monocytes could transform into antigen-presenting cells and initiate an autoimmune attack against myelin-containing cells. Consequently, a potential therapeutic option for multiple sclerosis could be pharmacotherapy with either substances that strengthen the tight-junctions barrier, or with agents that reduce the expression of adhesion molecules. In addition, surgical correction could be an option in some anatomical variants of pathologic venous outflow. We are optimistic that a hemodynamic approach to the multiple sclerosis pathogenesis can open a new chapter of investigations and treatment of this debilitating neurologic disease. Simka M. Department of Angiology, Private Healthcare Institution SANA, Pszczyna, Poland. Source: PMID: 19442163 (01/03/10)

Iron leads to memory impairment that is associated with a decrease in acetylcholinesterase pathways

Mon, 01 Mar 2010 04:26:00 EDT

Perez VP, de Lima MN, da Silva RS, Dornelles AS, Vedana G, Bogo MR, Bonan CD, Schr�der N. Neurobiology and Developmental Biology Laboratory, Faculty of Biosciences, Pontifical Catholic University, Av. Ipiranga, 6681 Pr�dio 12C, Sala 340, 90619-900 Porto Alegre, RS, Brazil. Increasing evidence indicates that excessive iron in selective regions of the brain may be involved in the etiology of neurodegenerative disorders. Accordingly, increased levels of iron have been described in brain regions of patients in Parkinson's and Alzheimer's diseases. We have characterized neonatal iron loading in rodents as a novel experimental model that mimics the brain iron accumulation observed in patients with neurodegenerative diseases and produces severe cognitive impairment in the adulthood. In the present study we have investigated the involvement of the cholinergic system on iron-induced memory impairment. The effects of a single administration of the acetylcholinesterase (AChE) inhibitor galantamine or the muscarinic receptor agonist oxotremorine on iron-induced memory deficits in rats were examined. Male Wistar rats received vehicle or iron (10.0 mg/kg) orally at postnatal days 12 to 14. At the age of 2-3 months, animals were trained in a novel object recognition task. Iron-treated rats showed long-term impairments in recognition memory. The impairing effect was reversed by systemic administration of galantamine (1 mg/kg) immediately after training. In addition, iron-treated rats that received oxotremorine (0.5 mg/kg) showed enhanced memory retention. Rats given iron showed a decreased AChE activity in the striatum when compared to controls. The results suggest that, at least in part, iron-induced cognitive deficits are related to a dysfunction of cholinergic neural transmission in the brain. These findings might have implications for the development of novel therapeutic strategies aimed at ameliorating cognitive decline associated with neurodegenerative disorders. Source: Pubmed PMID: 20158466 (01/03/10)

The severity of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis is related to altered cerebrospinal fluid dynamics

Sun, 28 Feb 2010 04:04:00 EDT

Chronic cerebrospinal venous insufficiency(CCSVI) is a vascular picture that shows a strong association with multiple sclerosis (MS). The aim of this study was to investigate the relationship between a Doppler cerebral venous hemodynamic insufficiency severity score (VHISS) and cerebrospinal fluid (CSF) flow dynamics in 16 patients presenting with CCSVI and relapsing-remitting MS (CCSVI-MS) and in eight healthy controls (HCs). The two groups (patients and controls) were evaluated using validated echo-Doppler and advanced 3T-MRI CSF flow measures. Compared with the HCs, the CCSVI-MS patients showed a significantly lower net CSF flow (p=0.027) which was highly associated with the VHISS (r=0.8280, r2=0.6855; p=0.0001). This study demonstrates that venous outflow disturbances in the form of CCSVI significantly impact on CSF pathophysiology in patients with MS. Zamboni P, Menegatti E, Weinstock-Guttman B, Schirda C, Cox JL, Malagoni AM, Hojanacki D, Kennedy C, Carl E, Dwyer MG, Bergsland N, Galeotti R, Hussein S, Bartolomei I, Salvi F, Zivadinov R. Source: Pubmed PMID: 20018140 (28/02/10)

Preliminary results of preoperative diagnostics and endovascular treatment for CCSVI

Mon, 15 Feb 2010 06:19:00 EDT

Preliminary results of preoperative diagnostics and endovascular treatment for CCSVI Marian Simka EuroMedicVascular and Endovascular Surgery Department Katowice Poland http://www.ms-mri.com/docs/Simka-hamilton%20-ccsvi-1.pdf