Friday, 10 August 2012

Research: ccsvi population


BACKGOUND: Chronic cerebrospinal venous insufficiency (CCSVI) has been associated to multiple sclerosis (MS).
 
OBJECTIVE: To evaluate the possible association between CCSVI and MS, using a population-based control design.
 
METHODS:  A random cohort of 148 incident MS patients were enrolled in the study. We have also studied 20 patients with clinically isolated syndrome (CIS), 40 patients with other neurological diseases (OND), and 172 healthy controls. Transcranial (TCC) and Echo Color Doppler (ECD) were carried out in 380 subjects. A subject was considered CCSVI positive if ≥2 venous hemodynamic criteria were fulfilled.
 
RESULTS: CCSVI was present in 28 (18.9%) of the MS patients, in 2 (10%) of CIS patients, in 11 (6.4%) of the controls, and in 2 (5%) of the OND patients. A significant association between MS and CCSVI was found with an odds ratio of 3.41 (95% confidence interval 1.63-7.13; p = 0.001). CCSVI was significantly more frequent among MS subjects with a disease duration longer than 144 months (26.1% versus 12.6% of patients with duration shorter than 144 months; p = 0.03) and among patients with secondary progressive (SP) and primary progressive (PP) forms (30.2% and 29.4, respectively) than in patients with relapsing remitting (RR) MS (14.3%). A stronger association was found considering SP and PP forms (age adjusted OR = 4.7; 95% CI 1.83-12.0, p = 0.001); the association was weaker with the RR patients (age adjusted OR = 2.58; 95%CI 1.12-5.92; p = 0.02) or not significant in CIS group (age adjusted OR = 2.04; 95%CI 0.40-10.3; p = 0.4).
 
CONCLUSIONS: A higher frequency of CCSVI has been found in MS patients; it was more evident in patients with advanced MS, suggesting that CCSVI could be related to MS disability.

The study shows that if you have MS your are 3 times more likely to have ultrasound phenotype and suggests that this is increased with disease duration and more common in progressive MSers than RRMSers which is not what Prof Zamboni claimed.

2 comments:

  1. I do not understand how at this point there are still doctors who used Doppler rather than venography. What are your thoughts about that CCSVI appear as the disease progresses? Is this logic with the autoimmune theory? A chronic inflammation can cause venous narrowing and malformations of the valves?Do you think that CCSVI may be a risk factor or an aggravating factor? thanks, alvaro

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  2. Alvaro, any vascular specialist (i.e NOT a neurologist) will tell you that the valve malformations seen in CCSVI patients (elongated, double, fused, reversed valves) are CONGENITAL. Moreover, chronic abnormal blood flow can lead to vein inflammation with subsequent endothelial damage (google Dr Scholbach). Combine the two, let the years pass and you will get a picture of causality and progression in MS.

    Dripstones are made of drops and centuries. The damaging agent in MS need not be severe, but constant.

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