Neurologists at the University of Buffalo conducted a 500-participant (adults and children) Combined Transcranial and Extracranial Venous Doppler Evaluation (CTEVD) study, reporting that more than 55 percent of multiple sclerosis patients had the CCSVI abnormality.
CCSVI is characterized by a narrowing of the extracranial veins, causing restriction of normal outflow of blood from the brain. When borderline subjects were excluded, the percentage of affected MS patients rose to 62.5 percent as compared to 25.9 percent of healthy controls, a statistically significant outcome.
The investigation was the first step in determining if a condition called chronic cerebrospinal venous insufficiency (CCSVI) is a major risk factor for MS. Results of the study strongly indicate the narrowing of the extracranial veins is an important association in multiple sclerosis.
CCSVI is a complex vascular condition first discovered and described by Paolo Zamboni, MD, of the University of Ferrara, Italy. Dr. Zamboni’s investigation of a group of 65 patients and 235 controls showed CCSVI to be associated strongly with MS – i.e. CCSVI sufferers were more than 40 times more likely to have MS than those without CCSVI.
Zamboni hypothesized that the observed 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.
To identify CCSVI, Doppler scans of the head and neck are used to view the direction of venous blood flow. Patients also undergo MRI scans of the brain to measure iron deposits in lesions and surrounding areas of the brain using a method called. Iron findings on these images will be related to subjects' disability and neuropsychological symptoms.
The study advanced Zamboni’s learning, with findings indicating that the presence of CCSVI suggest an association with disease progression.
At present the Canadian network of MS clinics is abiding by a consensus agreement to forego testing or treating patients for CCSVI, until further research has been conducted into Dr. Zamboni’s findings. This conservative approach has led to many Canadians seeking diagnostic testing of/treatment for CCSVI abroad in Poland, Belgium, India and Mexico.
“It cannot be disregarded that CCSVI is a newly recognized condition,” agrees Dr. Jorge Luna, a Stanford-trained interventional cardiologist on staff at Hospital Angeles Tijuana. “Two different points of view of the same problem will always yield more information.”
The CCSVI hypothesis has generated sufficient heat and light to lead the MS Society of Canada to take the unprecedented step of issuing a request for research operating grants to study the relationship between CCSVI and MS., stating that “By funding research into MS and CCSVI, the MS Society hopes to clarify the relationship between CCSVI and MS and to identify what treatment potential it may offer to people living with MS.”
Thus far, over $2.4 million has been committed to support operating grants to explore the relationship between CCSVI and MS. These studies will take a comprehensive look at the structure and function of the veins draining the brain and spinal cord in a spectrum of MS types, severities and durations, compared to controls of people with other diseases and healthy volunteers.
Classical experimental design – the highest standard of experimentation, featuring double blinding and control conditions, will yield objective, quantifiable, statistically valid and reliable results. Doppler ultrasound imaging technology (used by Dr. Zamboni) will be among the many imaging technologies included.
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