New Study Results Cast Doubt on Theory that CCSVI Causes MS

[Guest guest]

This was recently posted and I haven't seen it discussed on MScured. It

shows that CCSVI MAY BE A RESULT OF MS but not cause MS..In my own

situation, I also have several congenital blood clotting disorders and am on

blood thinners (heparin injections 2x daily) for 15 months and get IVIG

infusions every 3 weeks for the past 16 months. Since that time, I have

finally had no recurrent relapses since Jan 2010 and no new lesions based on

3 separate brain MRIs in 2010 and 2011. I also have significantly less

symptoms in many areas. My MRV showed a congenital defect in the circle of

Willis but it was not a Hubbard Foundation approved MRV; and Venous Doppler

evaluation in Jan of 2010.

Source " http://www.msfocus.org/news-details.aspx?newsID=93

New Study Results Cast Doubt on Theory that CCSVI Causes MS

4/13/2011

A just-released study on the relationship between MS and chronic cerebral

venous insufficiency (CCSVI) found that CCSVI may be a result of MS, not a

cause, according to researchers.

A narrowing of the extracranial veins that restricts the normal outflow of

blood from the brain, CCSVI has been a much-discussed topic in the MS

community and among healthcare providers since it was first publicly

described as a possible cause of the disease in October 2009.

The study, conducted by University at Buffalo (UB) researchers, appears in

the current issue of Neurology, the journal of the American Academy of

Neurology. Zivadinov, M.D., PhD, associate professor of neurology in

the UB School of Medicine and Biomedical Sciences and president of the

International Society for Neurovascular Disease, is first author on the

paper.

" Our results indicate that only 56.1 percent of MS patients and 38.1 percent

of patients with a condition known as clinically isolated syndrome (CIS), an

individual's first neurological episode, had CCSVI.

" While this may suggest an association between the MS and CCSVI, association

does not imply causality. In fact, 42.3 percent of participants classified

as having other neurological diseases (OND), as well as 22.7 percent of

healthy controls involved in the study, also presented with CCSVI.

" These findings indicate that CCSVI does not have a primary role in causing

MS, " says Zivadinov. " Our findings are consistent with increased prevalence

of CCSVI in MS, but substantially lower than the sensitivity and specificity

rates in MS reported originally by the Italian investigators. "

CCSVI is a complex vascular condition discovered and described by Paolo

Zamboni, MD, from Italy's University of Ferrara. It is characterized by

narrowing of vessels draining blood from the cranium. Zamboni hypothesized

that this narrowing restricts the normal outflow of blood from the brain,

resulting in alterations in the blood flow patterns within the brain that

eventually cause injury to brain tissue and degeneration of neurons, leading

to MS.

Zamboni's original investigation in a group of 65 patients and 235 controls

showed that CCSVI appeared to be strongly associated with MS, increasing the

risk of having MS by 43 fold.

The results of the UB study are based on 499 participants in the Combined

Transcranial and Extracranial Venous Doppler Evaluation (CTEVD) study, which

began at the university in April 2009.

The study group consisted of 289 persons with MS, 163 healthy controls, 26

with OND and 21 with CIS.

MS participants also were defined by disease type: relapsing-remitting (RR),

secondary progressive (SP), primary-progressive (PP), progressive-relapsing

(PR) and MS with neuromyelitis optical (NMO) - a type of MS that affects the

optic nerves and spinal cord exclusively.

All participants underwent transcranial and extracranial echo-Doppler scans

of the head and neck. Persons were considered " CCSVI-positive " if they met

two or more of five venous hemodynamic (VH) criteria.

Prevalence rates were calculated in three groupings: only subjects with

positive and negative CCSVI diagnoses; only borderline cases included in the

negative group; and subjects who fulfilled any of the five criteria.

When only positive and negative CCSVI cases were considered, results showed

a CCSVI prevalence of 62.5 percent in MS patients, 45.8 percent in those

with OND, 42.1 percent in CIS, and 25.5 percent in healthy controls.

When borderline cases were included as negative for CCSVI, prevalence

figures were 56.1 percent in MS patients, 42.3 percent in those with OND,

38.1 percent with CIS and 22.7 percent in healthy controls.

When all cases that met at least one of the five VH criteria were included

in the analysis, CCSVI prevalence was 81.3 percent in MS cases, 76.2 percent

in CIS patients, 65.4 percent in OND cases and 55.2 percent in healthy

controls.

The highest prevalence was seen in relapsing primary-progressive MS (89.4

percent), followed by non-relapsing secondary-progressive MS (67.2 percent),

NMO (66.6 percent), primary-progressive MS (54.5 percent) and

relapsing-remitting MS (49.2 percent). CCSVI prevalence was substantially

higher in progressive MS than in non-progressive MS patients. In addition,

patients with a progressive MS disease subtype had higher CCSVI prevalence

than those with non-progressive MS.

" The higher prevalence of CCSVI in progressive MS patients suggests that

CCSVI may be a consequence, rather than a cause, of MS, " says Bianca

Weinstock-Guttman, M.D., co-principal investigator of the study and UB

professor of neurology. Therefore, the possibility that CCSVI may be a

consequence of MS progression cannot be excluded and should be further

investigated.

" Several studies have reported that patients with progressive MS show

decreased blood flow through the brain's neuronal tissue, indicating that

CCSVI may be secondary to reduced perfusion, " says Weinstock-Guttman. " In

addition, we recently showed an association between the severity of CCSVI

and reduced cerebral blood flow in brain parenchyma of MS patients in an

published pilot study. "

E. Ann Yeh, MD, UB assistant professor of neurology and a major collaborator

on the study, noted that of the 10 pediatric MS patients who participated in

the study, five presented with CCSVI (50 percent), yielding prevalence

similar to that in adult MS patients.

" Although the sample size was too small to draw any firm conclusions, these

results suggest that CCSVI is also present in children and is not the result

of aging, " she says.

Concludes Zivadinov: " The differences between our study, the original

Italian CCSVI study and other recently published studies also emphasize the

need for a multimodal approach for the assessment of CCSVI. In addition to

Doppler sonography, use of selective venography, magnetic resonance

venography and intraluminal Doppler methods can provide more evidence for

the true prevalence of CCSVI in MS. "

The study was supported by the Buffalo Neuroimaging Analysis Center, Baird

MS Center and the s Neurological Institute, all from UB, as well as the

Direct MS Foundation, the Jacquemin Family Foundation and more than 500

individual donors.

http://www.msfocus.org/news-details.aspx?newsID=93