(綜合報導)一項最新研究的初步結果顯示，相當一部分多發性硬化症(multiple sclerosis，MS)病人頸部靜脈狹窄，這可能是這一神經疾病的風險因素之一。意大利血管疾病專家桑伯尼醫生(Dr. Paulo Zamboni)假設，慢性腦脊髓靜脈機能不全(CCSVI)是多發性硬化症的原因。血流限制可以損壞大腦組織，可能是多發性硬化症的原因之一。在實驗性 手術中，他採用血管再造技術為65名病人清除了靜脈阻塞。醫學界長期認為，多發性硬化症屬於自身免疫性疾病，免疫細胞攻擊圍繞在神經細胞周圍的髓鞘。本研 究負責人，水牛城大學的澤瓦迪諾醫生(Dr. Robert Zivadinov)表示，對研究的初步結果謹慎樂觀，並感到興奮。其研究採用多普勒超聲波影像技術，觀測了500人的情況，科學家發現，被診斷為多發性 硬化症的病人中，大約55%顯示顱外靜脈狹窄，相比之下，健康對照組中僅22%出現這類情況。若研究員將情況屬於邊緣性質的10%排除之外，多發性硬化症 病人中靜脈異常的比例升至62.5%，而健康對照組中僅26%靜脈異常。桑伯尼周三在水牛城接受採訪時表示：「在這兩組人中，存在重大的統計學上差異，前者靜脈異常的比例高近3倍。」水牛城全科醫院神經影像分析中心負責人桑伯尼表示，將進一步展開研究，探討是否隨著多發性硬化症病情的進展，靜脈機能不足情況更加嚴重。他說，將在4月份於多倫多舉行的美國神經學會年會上提交本次研究。
並附上原文如下:
First Blinded Study of Venous Insufficiency Prevalence in Multiple Sclerosis Shows Promising Results
ScienceDaily (Feb. 14, 2010) — More than 55 percent of multiple sclerosis patients participating in the initial phase of the first randomized clinical study to determine if persons with MS exhibit narrowing of the extracranial veins, causing restriction of normal outflow of blood from the brain, were found to have the abnormality.The results were reported February 10 by neurology researchers at the University at Buffalo.
When the 10.2% of subjects in which results were border line were excluded, the percentage of affected MS patients rose to 62.5%, preliminary results show, compared to 25.9% of healthy controls.
These preliminary results are based on the first 500 participants in the Combined Transcranial and Extracranial Venous Doppler Evaluation (CTEVD) study, which began at UB in April 2009. Investigators are planning to examine 500 additional subjects, who will be assessed in the second phase of the study with more advanced diagnostic tools. Complete data on the first 500 will be presented at the American Academy of Neurology meeting in April.
Robert Zivadinov, MD, PhD, UB associate professor of neurology and principal investigator on the study, says he is "cautiously optimistic and excited" about the preliminary data. Zivadinov directs the Buffalo Neuroimaging Analysis Center (BNAC), located in Kaleida Health's Buffalo General Hospital, where the study is being conducted.
"The data encourage us to continue on the same course," he says. "They show that narrowing of the extracranial veins, at the very least, is an important association in multiple sclerosis. We will know more when the MRI and other data collected in the CTEVD study are available." The analyses are being conducted by an independent statistician.
The investigation is the first step in determining if a condition called chronic cerebrospinal venous insufficiency (CCSVI) is a major risk factor for MS. CCSVI is a complex vascular condition discovered and described by Paolo Zamboni, MD, from Italy's University of Ferrara. Zamboni's original investigation in a group of 65 patients and 235 controls showed CCSVI to be associated strongly with MS, increasing the risk of having MS by 43 fold.
Zamboni and Zivadinov hypothesize that this narrowing restricts the normal outflow of blood from the brain, resulting in alterations in the blood flow patterns within the brain that eventually cause injury to brain tissue and degeneration of neurons.
The first 500 patients, both adults and children, were grouped based on their diagnosis: MS, clinically isolated syndrome (CIS) and "other neurologic diseases" (OND), in addition to healthy controls.
All participants in the first phase underwent ultrasound (Doppler) scans of the head and neck in different body postures to view the direction of venous blood flow. MS subjects also underwent MRI scans of the brain to measure iron deposits in lesions and surrounding areas of the brain, using a method called susceptibility-weighted imaging. Iron findings on these images will be related to subjects' disability and neuropsychological symptoms.
Of the total participants, 97.2 % were adults, with the 280 MS patients comprising the largest disease cohort examined in the study to date. The majority of MS subjects were diagnosed with the relapsing-remitting form of MS. There were 161 healthy controls. Doppler scan results were reported on five specific criteria that affect venous blood flow. Patients who met at least two of the criteria were considered to have CCSVI. More detailed analysis of specific Doppler criteria and their association to disease status is underway.
When the 10.2 % borderline subjects were included in the "normal" category (no venous insufficiency), the CCSVI prevalence was 56.4% in MS subjects and 22.4% in healthy controls.
In this large MS cohort, the presence of CCSVI did suggest an association with disease progression, a finding that was not shown in Zamboni's smaller cohort, Zivadinov notes.
The finding that 22.4% of healthy controls also met two CCSVI criteria requires continuing investigation, he says.
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這真的是一個好消息啊~~
回覆刪除真希望台灣神經內科的醫師能與會
讓我們可以得到最新治療的消息
在AAN預定要發表的應該就是下列內容及日期吧~~
Wednesday, April 14
Multiple Sclerosis Imaging
2:00–6:00 p.m.
Emerging Treatments in Neuromuscular Disease
2:00–6:00 p.m.
9898
Jimmy你不是有去照?結果呢?
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3月初會回診看結果囉
回覆刪除这里是加拿大的一篇评论：
回覆刪除意大利医生的报告发现MS病人的静脉狭窄是正常人的9倍，但是美国buffalo的报告发现MS病人的静脉狭窄是正常人的2-3倍.显然二者差别太大。。。。在科学上，仍然认为意大利医生的理论值得欢迎和深入研究。美国的报告也很重要，支持MS与静脉狭窄之间的联系，但是显然没有那么明显。。。。。意大利医生的研究结合使用了超声与静脉造影，而美国在研究初期只是使用了超声，但是静脉造影检查显然比超声更加敏感。这可能是一个原因。。。。。另外，从意大利医生的初步结果来看，目前还没有强大证据证明扩展静脉是治疗任何MS的有效手段。要真正证明这一点，至少需要3-5年时间来回答。也许，对MS患者来说目前最好是等待临床证明手术是安全有效的。。。。。
what did Dr. Freedman think of Zivadinov’s new findings? Commenting in Blackwell’s latest NP story on the Buffalo data showing that abnormal veins were between 2 and 3 times more common in MS patients as compared to the nine-to-one ratio reported by Dr. Zamboni, he stated, “The whole notion of cause and effect is out the window.”
Now, this is a free country where Mark Freedman, Tom Blackwell and Terence Corcoran, are entitled to their opinions. But, should not everyone, especially physicians and scientists, maintain an open mind to new and provocative information? As I noted in a previous posting, history provides us with some very sad examples attendant on the reflexive rejection of new ideas without any thought or inquiry as to their validity. Should we not learn from the past? And if we do not, how will progress be made, especially in science and the treatment of disease?
Before giving you my personal thoughts on where we currently stand with CCSVI, it is important to remember that I am an oncologist, not a neurologist, and certainly not an MS expert like Dr. Freedman. However, especially when judging the merit of new theories, sometimes outsiders to a specialty can see the “big picture” with more clarity (and perhaps less bias) than those who are “up close and personal”. And as one who, for over 35 years, has been heavily involved in laboratory and clinical research, I believe I know a thing or two about science and (sadly) the politics of science.
回覆刪除First, I continue to believe that the CCSVI theory of MS proposed by Dr. Zamboni is scientifically plausible and deserving of serious and intensive investigation. Those health professionals, and others who, for whatever reason, remain in denial should get over it and commit to finding the answer rather than obstructing progress.
Second, I believe that the preliminary findings of Dr. Zivadinov and his colleagues in Buffalo are significant and support a link between MS and CCSVI. However, their early data are not as robust as Dr. Zamboni’s and their study raises many new questions. For example, what is the true incidence of vein abnormalities in MS patients and normal controls? Does MS only occur or progress in people with more severe types of venous obstruction?
While we do not yet know, it is important to understand that Dr. Zamboni used both ultrasound and the direct injection of dye into veins (called venography) to obtain his results. The first phase of the Buffalo study employed only ultrasound. Of the two tests, venography is more sensitive and definitive in demonstrating anatomical abnormalities and blockage in veins, akin to angiograms being the “gold standard” in diagnosing coronary artery disease in the heart. In acknowledging this important difference, Dr. Zivadinov has stated that more “advanced diagnostic tools” (including, I suspect, venography) will be used to test the next 500 subjects in his study.
Finally, taking into account Dr. Zamboni’s preliminary results, there is no “level 1” evidence that unblocking veins is an effective treatment for any type of MS. As Paolo Zamboni himself has stated, the answer to that most important question will require further independent assessment and will take time, probably 3 to 5 years at a minimum, to answer. Until then, I strongly advise that patients wishing to have their veins tested, and an unblocking procedure performed, should do so only in approved clinical trials that are properly designed to insure their safety and provide an accurate assessment of efficacy.
英文的继续：In this respect, Canadian MS patients are especially fortunate that centres at McMaster and UBC already have teams of neurologists, radiologists and vascular surgeons who are committed to carrying out these complex studies. While they have our thanks and best wishes for success, they also desperately need our donations. Please be generous and help if you can.
同样是美国的研究，美国斯坦福大学的报告几乎与意大利医生结果完全一致，斯坦福大学发现MS病人静脉狭窄高达90%，但是正常人几乎没有静脉狭窄。如此来看，意大利医生的理论得到新的，强大的支持。
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