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Alyoop

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Although the controversy surrounding CCSVI is associated with MS, people with ALS have discussed the possibility of having the treatment to ? Improve their ALS. This is the only reason that I think this discussion is important.

Yesterday at the ECTRIMS conference that I am attending in Goteburg, the Charcot foundation chose this as the topic for the symposium.

Approx. 5000 neurologists attended. I am presenting to you a very brief synopsis of what was discussed.

Dr Zamboni and his team presented his research findings. For those that are not aware of his findings, he found that 100% of MS subjects that he studied, had the ccsvi abnormality. Since the initial study, his team has been unable to come up with the same findings.

The world was extremely interested in the possibility, therefore many countries have copied The original protocol. Dr Doepp from Berlin presented that he could not come up with any evidence of ccsvi in his study. Other study teams have the same findings.

It was found that the Doppler scanning technique was plagued with false positives and was a very poor radiological investigation for ccsvi. Subjects that appear to have ccsvi after Doppler were found to have totally normal venous flow when tested with angiography.

Dr Kahn from USA did a very good talk about the fact that ccsvi would cause venous problems within the brain e.g venous hypertension, optic nerve oedema amoung other things. None of which MS patients have.

He was concerned about the people rushing to have invasive treatment eg implantation of venous stents, with no evidence of ccsvi, or evidence that it will improve any neurological symptoms. It is invasive and dangerous. Stents placed in the venous system have the risk of coming lose and traveling to the heart with fatal consequences .

He said that one of the biggest problems is the unproven hope that it has given many MS sufferers. Much money making has been had from the radiographers etc. He described it as "amputation of hope"

Dr Zamboni emphasized during his talk, that no one should be under going invasive procedures unless they are involved in a clinical trial.

It was agreed that in the interest of patient safety, interventional radiologists should continue their studies to determine the safety and efficacy of this form of treatment.

The chairman congratulated him for this comment at the end and asked him to repeat it.

MS has many disease modifying treatments that are proving effective. It is widely agreed that MS is an autoimmune disease (?cause) therefore disease targeting treatments are improving constantly, with many oral preparations about to come on the market.

For anyone with ALS wanting this unproven treatment, you must research the risks, be aware that no science supports the intervention or the theory at this moment. If you have a Doppler scan telling you you have ccsvi, then it is most probably incorrect and you would need an angiogram to confirm it. If you find a dr willing to do the stent, you need to ask yourself why, as it is not evidence based medicine.

Aly
 
Thanks very much for this Aly. It certainly throws doubt on the procedure. I am confused now as to why so many anecdotal reports are coming from MS patients who have had the procedure done and report dramatic improvements. Is it all attributable to the placebo effect?
 
I was wondering the same. The placebo effect is very strong. It causes all sorts of problems in clinical trials. About 60% of patients will get significantly better on the placebo group, thatscwhy a clinical trial needs a placebo arm to be "gold " standard.

I went to a very good talk today from 2 psychologists about cognitive changes and depression in MS. They talked a lot about how stress increases disability. Charcot back in the 1800's found this as well. You would not have thought that stress can actually cause disability to increase? It is however a very real phenomenon. Therefore it stands to reason that, if the participant really believed that the procedure works, then stress would lessen and disability would maybe decrease. Combine that with the placebo effect and I can now understand. If people tell me I am getting worse, I always walk worse, after a few days I can get on top and improve again, so I really believe our thoughts have a lot to do with disability in thecearly stages of both ALS and MS.
One of my patients recently finished a 2 year study od a new drug for MS. She went on the extension study and found to her horror that she had spent 2 years relapse free convinced shecwas on this great new medication. It just happen
Last week with another patient as well.


I meant to add to my conference summary that some researches found ccsvi in a few old MS patients that had had MS for many years. Itv
was thought that the ccsvi in these few cases was ? Caused by the chronic inflammation in ms.

Hope I haven't bored you. I slept in and missed the talk about cannabis. It would have been great but was at 7.30!

Aly
 
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