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It has been six years since Dr. Paolo Zamboni first began publishing his research on the connection of multiple sclerosis and the extracranial venous system.
The very first international conference for CCSVI research was held in Bologna, Italy during September 2009. The International Society for Neurovascular Disease (ISNVD) grew from that conference--with founding board members who were all present in the beginning.
This year, Dr. Zamboni will be making a presentation on a new method of diagnosing CCSVI, cervical plethysmography.
This method uses a neck collar to monitor blood flow, as the patient is quickly tipped from supine to upright position. Plethysmography (from the Greek, meaning: to measure the increase in mass or volume--in this case, blood flow) is less dependent on the operator's technique. As we saw with doppler technology, different protocols lead to a variety of results--and very few researchers utilized the full Zamboni protocol, creating much confusion.
Here is a recent paper on the results of this technique from Dr. Zamboni:
http://www.ncbi.nlm.nih.gov/pubmed/22521804
Abstract
BACKGROUND:
Magnetic resonance imaging and echo color Doppler (ECD) scan techniques do not accurately assess the cerebral venous return. This generated considerable scientific controversy linked with the diagnosis of a vascular syndrome known as chronic cerebrospinal venous insufficiency (CCSVI) characterized by restricted venous outflow from the brain. The purpose of this study was to assess the cerebral venous return in relation to the change in position by means of a novel cervical plethysmography method.
METHODS:
This was a single-center, cross-sectional, blinded case-control study conducted at the Vascular Diseases Center, University of Ferrara, Italy. The study involved 40 healthy controls (HCs; 18 women and 22 men) with a mean age of 41.5 ± 14.4 years, and 44 patients with multiple sclerosis (MS; 25 women and 19 men) with a mean age of 41.0 ± 12.1 years. All participants were previously scanned using ECD sonography, and further subset in HC (CCSVI negative at ECD) and CCSVI groups.
Subjects blindly underwent cervical plethysmography, tipping them from the upright (90°) to supine position (0°) in a chair. Once the blood volume stabilized, they were returned to the upright position, allowing blood to drain from the neck. We measured venous volume (VV), filling time (FT), filling gradient (FG) required to achieve 90% of VV, residual volume (RV), emptying time (ET), and emptying gradient (EG) required to achieve 90% of emptying volume (EV) where EV = VV - RV, also analyzing the considered parameters by receiver operating characteristic (ROC) curves and principal component mathematical analysis.
RESULTS:
The rate at which venous blood discharged in the vertical position (EG) was significantly faster in the controls (2.73 mL/second ± 1.63) compared with the patients with CCSVI (1.73 mL/second ± 0.94; P = .001). In addition, respectively, in controls and in patients with CCSVI, the following parameters were highly significantly different: FT 5.81 ± 1.99 seconds vs 4.45 ± 2.16 seconds (P = .003); FG 0.92 ± 0.45 mL/second vs 1.50 ± 0.85 mL/second (P < .001); RV 0.54 ± 1.31 mL vs 1.37 ± 1.34 mL (P = .005); ET 1.84 ± 0.54 seconds vs 2.66 ± 0.95 seconds (P < .001). Mathematical analysis demonstrated a higher variability of the dynamic process of cerebral venous return in CCSVI. Finally, ROC analysis demonstrated a good sensitivity of the proposed test with a percent concordant 83.8, discordant 16.0, tied 0.2 (C = 0.839).
CONCLUSIONS:
Cerebral venous return characteristics of the patients with CCSVI were markedly different from those of the controls. In addition, our results suggest that cervical plethysmography has great potential as an inexpensive screening device and as a postoperative monitoring tool.
It will interesting to hear Dr. Zamboni discuss this research with the other researchers present. How does this slowed cerebral drainage affect the brain? What is happening to brain tissue with each heartbeat in pwMS? And is there a marked difference in return after venoplasty for CCSVI?
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