(Abst.) CCSVI: Case-control neurosonography results

 
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PostPosted: Wed Feb 27, 2013 5:26 pm    Post subject: (Abst.) CCSVI: Case-control neurosonography results Reply with quote

From PubMed, February 19, 2013:

Quote:



Ann Neurol
. 2012 Dec 13.

Chronic cerebrospinal venous insufficiency: Case-control neurosonography results

Barreto AD, Brod SA, Bui TT, Jemelka J, Kramer L, Ton K, Cohen A, Lindsey JW, Nelson F, Narayana PA, Wolinsky JS.

Department of Neurology, University of Texas Health Science Center at Houston. andrew.d.barreto@uth.tmc.edu.

OBJECTIVE:

Chronic cerebrospinal venous insufficiency (CCSVI), has been implicated in the pathophysiology of multiple sclerosis (MS). We sought to determine if neurosonography (NS) provides reliable information on cerebral venous outflow patterns specific to MS.

METHODS:

Single center, prospective case-control study of volunteer MS and non-MS participants. A neurosonologist, blind to the subject's diagnosis, used high resolution B-mode imaging with color and spectral Doppler to systematically investigate, capture and record extracranial and intracranial venous drainage. These neuroimaging results were evaluated and scored by an expert blinded to subject's information and with no interactions with the participants.

RESULTS:

Altogether 276 subjects were studied: 206 with MS and 70 non-MS. MS patients were older than non-MS subjects (48.3±9.9 vs 44.3±11.8 years, p<0.007), with durations from first symptoms and diagnosis of 13.7±10 and 9.9±7.8 years, and EDSS 2.6±2.0. Overall, 82 subjects (29.7%) fulfilled one of five NS criteria proposed for CCSVI; 13 (4.7%) fulfilled two criteria required for diagnosis, none fulfilled >2 criteria. The distribution of subjects with 0, 1 or 2 criteria did not differ significantly across all diagnostic groupings, between MS and non-MS subjects, or within MS subgroups. CCSVI was present in 7.14% of non-MS and 3.88% of MS patients (p=0.266). No significant differences emerged between MS and non-MS subjects for extracranial or intracranial venous flow rates.

INTERPRETATION:

NS findings described as CCSVI are much less prevalent than initially reported, and do not distinguish MS from other subjects. Our findings do not support the hypothesis that CCSVI is causally associated with MS.

PMID:23418024


The abstract can be seen here.
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PostPosted: Tue Mar 12, 2013 6:47 pm    Post subject: More on this in Medical News Today Reply with quote

From Medical News Today,March 11, 2013:

Quote:
Low Incidence Of Venous Insufficiency In MS

Results of a study using several imaging methods showed that CCSVI (chronic cerebrospinal venous insufficiency) occurs at a low rate in both people with multiple sclerosis (MS) and non-MS volunteers, contrary to some previous studies. The research by an interdisciplinary team at The University of Texas Health Science Center at Houston (UTHealth) was published in a recent early online edition of the Annals of Neurology.

"Our results in this phase of the study suggest that findings in the major veins that drain the brain consistent with CCSVI are uncommon in individuals with MS and quite similar to those found in our non-MS volunteers," said Jerry Wolinsky, M.D., principal investigator and the Bartels Family and Opal C. Rankin Professor of Neurology at The UTHealth Medical School. "This makes it very unlikely that CCSVI could be the cause of MS, or contribute in an important manner to how the disease can worsen over time." Wolinsky is also a member of the faculty of The University of Texas Graduate School of Biomedical Sciences at Houston and director of the UTHealth MS Research Group.

CCSVI has been described by Italian neurosurgeon Paolo Zamboni, M.D., as a new disorder in which veins draining the central nervous system are abnormal. Zamboni's published research linked CCSVI to MS. Not all researchers have been able to duplicate his results.

UTHealth was one of three institutions in the United States to receive an initial grant to study CCSVI in multiple sclerosis (MS). The grant was part of a $2.3 million joint commitment from the National MS Society and the MS Society of Canada.

The UTHealth team tested several imaging methods including ultrasound, magnetic resonance imaging with an intravenous contrast agent, and direct radiologic investigation of the major veins by direct injection of veins with radio-opaque contrast. The goal was to validate a consistent, reliable diagnostic approach for CCSVI, determine whether CCSVI was specific to MS and if CCSVI contributed to disease activity.

The team was blinded to the participant's diagnosis throughout the study. Doppler ultrasound was used to investigate venous drainage in 276 people with and without MS. Using the criteria described by Zamboni for the diagnosis of CCVSI, UTHealth researchers found less prevalence of CCVSI than in some previous studies and no statistical difference between those with MS and those without MS. Detailed experience with the other imaging approaches are being readied for publication.

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system, interrupting the flow of information within the brain and from the brain to the body. It affects more than 400,000 people in the United States and 2.1 million in the world.


_______________________
References

Co-investigators from the UTHealth Medical School and Mischer Neuroscience Institute include Alan M. Cohen, M.D., professor and chief of Vascular Interventional Radiology; Andrew Barreto, M.D, assistant professor of neurology and director of the neurosonography laboratory; Larry Kramer, M.D., professor of diagnostic and interventional imaging and chief of Cardiovascular MRI; Ponnada Narayana, Ph.D., professor of diagnostic and interventional imaging and director of the MR Research Group; Staley A. Brod, M.D., professor of neurology; John W. Lindsey, professor of neurology; and Flavia Nelson, associate professor of neurology.
University of Texas Health Science Center at Houston
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