Wednesday, September 9, 2009

Venous Insufficiency and MS

This a copy of press release on a meeting convened this week about the dramatic improvement in MS patients treated for venous sufficiency. The results suggest that venous blockages occur prior to the onset of symptoms and the severity of the blockages are strongly associated with the severity of the MS symptoms and rate of decline.
I knew you would want to know about this exciting news.

Venous blockages and MS

This is long - but it is a copy of the press release from a scientific meeting convened to discuss venous blockages in the setting of MS.

The bottom line is that maybe having procedures to evaluate for the presence of blockages in the blood vessels and repairing those blockages will someday soon replace taking immune modulating drugs like Tysabri. I still think nutrition will be very important. Although we may be born with the predisposition to develop blockages -- our diets, and our mother's diet coupled with the toxins in our environment may play a strong role in turning on the genes that cause blood vessels to be twisty and at risk of blockages. This is breaking news. Yet - genetics take hundreds of thousands of years to shift how our bodies are made. Shifts in diet and toxins can shift which genes are on and how our bodies are made in one generation. As dramatic as this news is, it does not change the critical role of feeding one's mitochondria and our brain cells with all the nutrients they need.

Bologna, Tuesday Sept. 8, 2009
Venous Function And Multiple Sclerosis
International Coterie
Four main points concerning the relationship between CCSVI and
MULTIPLE SCLEROSIS were covered by several experts at a Meeting in
Bologna. All the investigations that gave an answer to these 4
fundamental points were coordinated by Prof Paolo Zamboni who discovered CCSVI and its association with Multiple Sclerosis; in some other cases, research was carried out in cooperation between Prof Zamboni and major foreign Universities.
1) What is the origin of the extracranial cerebral vein stenoses which
characterize CCSVI?
2) Are there advanced diagnostic systems capable of identifying which
changes are caused by CCSVI in the central nervous system?
3) Can CCSVI be treated and how?
4) Can CCSVI therapy improve the clinical outcomes of MS and affect its
Venous Function And Multiple Sclerosis is an international coterie of
experts who met in Bologna on September 8 to discuss these issues from the
perspective of neurologists – who have developed the scientific body of
knowledge on MS – and the vascular and neurological surgeons who have
further investigated these topics following the discovery of CCSVI. All
investigations were coordinated by Professor Paolo Zamboni who discovered CCSVI and its association with multiple sclerosis.
This first study was conducted by an Italian research team composed of the
vascular surgeons’ group headed by Professor Paolo Zamboni from the
University of Ferrara and the neurologists’ group from the Department of
Neurosciences of the Bellaria Hospital in Bologna headed by Dr. Fabrizio
Fondazione Hilarescere is a foundation specially set up to provide adequate
means and resources for research into medical and scientific insights aimed at
fully understanding and curing diseases which are still partly unknown.
Fondazione HILARESCERE, chaired by Professor Fabio Roversi-Monaco, was
set up on an initiative of Fondazione Cassa di Risparmio in Bologna.
endovascular therapy has led to a decrease in the number of disease
relapses, a marked reduction in the number of active brain and spinal
lesions and also a clear-cut improvement in the patients’ quality of life.
Prof. Paolo Zamboni headed a study where, together with Dr. Fabrizio Salvi,
he was able to show that in patients with the clinical form of Relapsing-
Remitting MS – which is the most common – there is a drop in the number of
active lesions which persists up to 18 months after surgery. The percentage of
active lesions falls from 50% to 12%, thus showing that the additional
treatment of CCSVI reduces the aggressiveness of the disease. This finding is
further confirmed by the number of patients who showed no relapses after
endovascular surgery. In the 2 years before surgery, acute multiple sclerosis
attacks were found in 50% of the recruited patients, while in the 2 years
following surgery 73% of the patients had no more attacks, with a change in
the clinical course of the disease. In all these patients also cognitive and motor
activities – assessed by means of an outcome measure called MSFC - are
significantly and persistently improved while the same is not true for patients
with the progressive forms of the disease. In the latter, however, progression
was stopped and the patients’ quality of life improved.
The experts discussed, provided data and gave an answer to all 4
fundamental questions:
1) What is the origin of the extracranial cerebral vein stenoses which
characterize CCSVI?
3 scientists answered this question from different perspectives: Professor
Byung B. Lee, Georgetown University School of Medicine di Washington DC,
showed that the malformations found in CCSVI are congenital truncular
malformations which therefore certainly precede the development of Multiple
Sclerosis. For this reason they cannot be regarded as a consequence of
Multiple Sclerosis. Prof. Lee showed in which phases of the venous system
development the malformations observed in CCSVI may appear. Byung B. Lee
is the Chairman of the World Consensus Conference which gathers vascular
experts from 47 countries and recently approved a scientific update on venous
malformations in Montecarlo. (1)Professor Giulio Gabbiani, Centre Médical Universitaire di Ginevra,demonstrated that there are no auto-immune phenomena in diseased veins thus excluding that the malformations found in CCSVI result from Multiple Sclerosis. He showed the results of a study which provides a histologic
comparison between the walls of the veins affected by CCSVI-MS and those of
normal subjects. Furthermore, at molecular level, CCSVI veins are structurally
different from those of the control subjects, thus confirming the approach of the
Montecarlo Consensus Conference. Prof. Gabbiani is one of the most important
world experts in microscopic vessel wall morphology. (2)
The third presentation was about whether – genetically speaking – these
malformations have any correlation with the findings so far obtained from the
genetic study of MS. Prof. Alessandra Ferlini, Director of the Institute of
Genetics at the University of Ferrara, discussed this point by presenting the
promising results of a pilot study. (3)2) Are there advanced diagnostic systems capable of identifying which changes are caused by CCSVI in the central nervous system? This is the second question addressed at the Meeting. Professor Mark Haacke,
Director of the MRI Istitute for Biomedical Research in Detroit (4,5,6) and
Professor Bianca Weinstock-Guttman, Neurologist at the Jacobs Neurological
Institute (7) showed new magnetic resonance (MRI) parameters linked to CCSVI which might in the future bring about a true revolution in the way of diagnosing MS. These new parameters include: quantification of iron deposits and volume assessment of intracranial veins and CSF. 3) The third question that was answered at the Meeting was: Can CCSVI be treated and how? Innovative minimally-invasive endovascular repair
techniques were discussed on account of the findings obtained by Dr. Roberto
Galeotti (8), Head of the Interventional Radiology Section at the University
Hospital of Ferrara who was the first in the world to perform this type of surgery,
and Dr. Michael Dake, Chief of Cardiovascular and Interventional Radiology at
Stanford University School of Medicine (California), who was the first to treat
CCSVI outside Italy. The most important finding is safety. At 2-year follow-up no major complications were observed. All surgical procedures were performed on a day hospital basis. Statistically, this treatment decreases pressure in the cerebral veins in a highly significant way, thus showing its enormous anti-inflammatory potential.(8)The risk of re-stenosis is 16 times higher in the jugular veins than in the azygos vein, thus pointing to the need for more sophisticated and efficient tools
to approach the former. Research will make such tools available during 2010.
4) The fourth and fundamental point is whether CCSVI therapy can improve
the clinical conditions of MS and affect its prognosis.
Dr. Fabrizio Salvi from the Bellaria Hospital in Bologna was the first
Neurologist who studied the clinical correlations of CCSVI treatment in
MS patients together with Prof. Paolo Zamboni. The patients enrolled in this
study were 120 from all clinical classes, but only the results of the 65 subjects
who are over 18 months from surgery will be reported in order to describe the
outcome with the greatest possible accuracy. Generally speaking, patients
treated with endovascular therapy showed a decrease in the number of
disease relapses, a marked reduction in the number of active brain and
spinal lesions and also a clear-cut improvement in the patients’ quality of
life. The findings of this investigations will soon be published in detail on the
Journal of Vascular Surgery (8).
Finally, Dr. Robert Zivadinov, Jacobs Neurogical Institute di Buffalo, discussed
the results of a revolutionary pilot study performed last year where both
American and Italian patients were blindly assessed in the USA by means of
advanced MRI technology, then submitted to vascular surgery in Italy and
followed up during the following year (9). This study was defined by the patients
who volunteered to participate as the study of the 50,000 miles for treatment,
because of the many trips they had to take overseas. This study was sponsored
by Fondazione Hilarescere.
(1) World Consensus Conference on Venous Malformations, Montecarlo
September 4th 2009. This document was approved by experts from 47 different
countries and will be published on all most important vascular surgery journals.
(2) G. Gabbiani, M. Coen, F. Mascoli, P. Zamboni. Manuscript in
(3) A. Ferlini, M. Bovolenta, M. Neri, F. Gualandi, A.Yuryev, F. Salvi, A.
Liboni and P. Zamboni. Manuscript in preparation.
(4) Haacke EM, Makki M, Ge Y, Maheshwari M, Sehgal V, Hu J, Selvan M,
Wu Z, Latif Z, Xuan Y, Khan O, Garbern J, Grossman RI. Characterizing iron
deposition in multiple sclerosis lesions using susceptibility weighted imaging. J
Magn Reson Imaging. 2009;29:537-44.
(5) A. V. Singh and P. Zamboni Anomalous venous blood flow and iron
deposition in multiple sclerosis. J Cereb Blood Flow Metab. 2009 Sep 2. [Epub
ahead of print]
(6) P. Zamboni, E. Menegatti, B. Weinstock-Guttman, C. Schirda, J. L. Cox,
A. M. Malagoni, D. Hojnacki, C. Kennedy, E. Carl, M. G. Dwyer, N. Bergsland,
R. Galeotti, Sara Hussein, I. Bartolomei, F. Salvi, R. Zivadinov. The severity of
altered venous haemodynamics is related to CSF dynamics in chronic
cerebrospinal venous insufficiency Submitted To Current Neurovascular
(7) P. Zamboni, E. Menegatti, B. Weinstock-Guttman, C. Schirda, J. L. Cox,
A. M Malagoni, D. Hojnacki, C. Kennedy, M. G. Dwyer, N. Bergsland, R.
Galeotti, I. Bartolomei, F. Salvi, M. Ramanathan, R. Zivadinov. Csf flow and
brain volume in multiple sclerosis are associated with altered cerebral venous
doppler haemodynamics. Study presented at the European Multiple Sclerosis
Congress ECTRIMS Düsseldorf, 9-12 September 2009
(8) P. Zamboni, R. Galeotti; E. Menegatti; A. M. Malagoni, S. Gianesini, I.
Bartolomei, F. Mascoli, F. Salvi Endovascular treatment of chronic
cerebrospinal venous insufficency. A prospective opern-label study. Journal of
Vascular Surgery, 2009, in press.
(9) P. Zamboni, R. Galeotti, B. Weinstock-Guttman, G. Cutter, E. Menegatti,
A. M. Malagoni, D. Hojnacki, J. L. Cox, C. Kennedy, I. Bartolomei, F. Salvi, R.
Zivadinov Endovascular Treatment for Chronic Cerebrospinal Venous
Insufficiency in Multiple Sclerosis . A longitudinal pilot study. Study presented at
the European Multiple Sclerosis Congress ECTRIMS Düsseldorf, 9-12
September 2009
Bologna, 8 September 2009
Press Office: Laboratorio delle idee – Francesca Rossini –

Although this is dramatic news, there are also press releases that indicate foods from the cabbage family influence how our blood vessels are shaped. That tells me that our nutrients influence how likely we are to develop chronic blockages which may lead to more aggressive MS. Once again, I think it is very important to have 3 cups of greens, cabbage family and onion family vegetables each day. To learn more about nutrition for mitochondria and brain check out my web site.


Fernando said...

Notes taken by an assistant to the conference:

Terry, many thanks for your excellent work.


Anonymous said...

Appreciate your work. As the woman who brought the Italian research to the states and attended the conference, I have to say it appears that the venous malformations found in the jugular and azygos veins are congenital. Of course, a healthy diet, exercise and supplements promote endothelial health, but the only way to overcome the stenosis is thru endovascular surgery. These are major malformations of the veins which create damaging reflux in the brain and spine-

EvanDouglas said...

A calf vein is the common site for DVT. A thigh vein is less commonly affected. Rarely, other deep veins in the body can be blocked by blood clots.


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