Here are part of the one year results from the BNAC CCSVI study, as to be presented at the ECTRIMS meeting in France.

link to abstract

This particular study looked at pwMS and CCSVI who were treated with venoplasty.  

There were two groups studied--ALL were given venoplasty.

One group was treated immediately,  or the "immediate treatment group" of 8 --ITG

the second group was treated six months later, or the "delayed treatment group" of 7--DTG

I will include the abstract below in italics, and then explain each section.

Please note that this study is not looking at how venoplasty affects MS symptoms, or MS progression.  It is simply looking at what happens to cerebrospinal fluid velocity in the brain.  This is a very important area of study, because it is a tangible, measurable change in brain perfusion.  We are now learning how CSF movement is essential for brain health, and how detrimental CSF stasis, or lack of movement, can harm the brain.

Here is a recent note on the importance of cerebrospinal fluid, and how this may be a missing element in current CCSVI research.  

link

Here is a study from Dr. Zamboni from the beginnings of his research, where he noted that the severity of CCSVI was related to alterations in cerebrospinal fluid dynamics.  

link

Chronic cerebro-spinal venous insufficiency (CCVI)

Thursday, October 11, 2012, 15:30 - 17:00

Cine cerebrospinal fluid imaging changes in patients with multiple sclerosis after venous angioplasty. A 1-year follow-up study

R. Zivadinov, C. Magnano, R. Galeotti, C. Schirda, B. Weinstock-Guttman, E. Menegatti, J. Hagemeier, A.M. Malagoni, D. Hojnacki, C. Kennedy, I. Bartolomei, C. Beggs, F. Salvi, P. Zamboni (Buffalo, US; Ferrara, IT; Bologna, IT; Bradford, UK)

Background: Chronic cerebrospinal venous insufficiency (CCSVI) is associated with multiple sclerosis (MS). Percutaneous transluminal angioplasty (PTA) of duplex-detected lesions (in the internal jugular and/or azygos veins) was previously applied in a pilot study of 15 MS patients to preliminarily assess whether PTA reduced MS disease activity, when used in addition to standard medical treatment. The higher percent brain volume change decrease over the first 6 months (-1.27%) in the immediate treatment group (ITG) suggested a more pronounced pseudoatrophy effect compared with the delayed treatment group (DTG) (-0.57%), possibly because of a potential anti-inflammatory effect of PTA or alternatively, due to a decrease in brain volume or improvement in cerebrospinal fluid (CSF) flow because of better venous drainage following angioplasty.

--This is an important thing BNAC noted.  The immediate affect of venoplasty in the ITG group was to cause a small and temporary brain volume decrease--they call it "pseudoatrophy" because it isn't real brain tissue loss, it's just that the brain temporarily appears smaller due to increased cerebrospinal fluid flow and better venous drainage.  (Jeff and I know about this from his firsthand experience.  He had some nasty headaches after venoplasty at Stanford, which could be relieved when he lay down.  These positional headaches were no doubt due to the change of fluid levels in his brain.  As Dr. Dake said to him, it's as though his brain became a wrung out sponge---the fluid levels were being altered, and he was getting CSF headaches. Eventually, the headaches became less regular, and then disappeared. And he has no signs of any brain atrophy.)

Objectives: To investigate changes in cine cerebrospinal fluid (CSF) pulsatile flow and velocity measures in patients with relapsing-remitting (RR) MS who underwent venous angioplasty. Methods: This was a prospective cohort study, that included 15 patients with RRMS and duplex-detected CCSVI. Eight patients had PTA in addition to medical therapy (ITG) immediately following baseline assessments, while 7 had delayed treatment with PTA after 6 months of medical therapy alone (DTG).

CSF pulsatile flow and velocity measures were quantified over 32 phases of the cardiac cycle, using a semi-automated method. These outcomes were compared between ITG and DTG at baseline, 6 and 12 months of the study.

This explains the objective, or reason for the study.  BNAC wanted to look at how cerebrospinal fluid flowed throught the brain during the cardiac cycle.  They measured this on MRI during the phases of one complete filling and then emptying of the heart with blood.

Results: At baseline, there were no significant differences between ITG and DTG in CSF pulsatile flow (p=0.474) or velocity (p=0.714) measures. However at month 6, significant improvement in CSF pulsatile flow and velocity was detected in the ITG compared to DTG. 

When they started, before treatment at baseline measurements, all of the 15 patients showed similar rates of CSF pulsatile flow.  But at 6 months after the first group was treated, there became a significant difference in flow velocity when they compared the treated group to the non-treated group.  And this difference continued....when the delayed group was treated at 6 months, the group that had been treated 12 months ago still showed a bit better flow.  And the newly treated group showed increases in CSF velocity and flow.

No significant within-group changes were found for velocity in both treatment arms. Conclusions: This study shows that in MS patients with CCSVI, PTA treatment has a beneficial effect on CSF flow and velocity measures. This improvement could be due to better venous drainage following angioplasty. 

This is interesting, because it appears that EVERYONE who was treated with venoplasty had this improvement in cerebrospinal fluid flow.  BNAC posits that this is due to better venous drainage.

So, here we have a measurable improvement following venoplasty for CCSVI----better cerebrospinal fluid flow.  

Better cleansing of the delicate brain tissues, better transport of nutrients, better cerebral pressure regulation.  

That sounds like something people with a neurodegenerative disease might find beneficial, don't you think?

Thanks to BNAC for moving CCSVI research forward at ECTRIMS,

Joan