意大利醫生桑柏尼(Paolo Zamboni)最初查看65名患者和235個控制對象，認為中樞神經 靜脈循環異常和多發性硬化症有強烈關係。
水牛城研究的主要研究者齊瓦迪諾夫醫生(Robert Zivadinov)說，研究結果顯示，慢性腦脊椎靜脈機能不全，在導致多發性硬化症沒有主要角色。 報告週三發表於網上版的《神經學》(Neurology)期刊。 不過他也說，多發性硬化症程度嚴重的患者中，慢性腦脊椎靜脈機能不全更為多見。本文來自家園網
他說：「這明顯是要考慮的重要因素。我們需要了解，是慢性腦脊椎靜脈機能不全導致多發性硬化症惡化，還是相反的因果關係。」
This "suggests that CCSVI may be a consequence rather than a cause of MS," Dr. Bianca Weinstock Guttman, a co-author of the study, said in a University of Buffalo news release.
水牛城醫學中心表示: 由我們的研究報告看來, CCSVI可能是MS引發的結果.
"An increase prevalence in progressives as compared to relapsing disease leaves open the possibility that CCSVI may be playing a contributory role in or be a consequence of the disease or may be age related," wrote authors Dr. Robert Fox and Dr. Alex Rae Grant in an accompanying editorial.
水牛城醫學中心表示: 由我們的研究報告中也指出在較為嚴重的MS病型態(逐漸退化型)當中, CCSVI扮演了很關鍵的角色, 它CCSVI會加速病程的進展以及身體機能的退化,
"I think there are two key messages of the study," said Dr. Robert Zivadinov, a professor of neurology at the University of Buffalo and the study's lead researcher.
Robert Zivadinov:這個研究有兩個很重要的訊息.
"One is certainly that CCSVI is associated with MS,"
一個是 CCSVI的確和MS有關連
"On the other hand, the fact that almost one in four (subjects) has CCSVI and has no MS, and the fact that almost 45 per cent of our subjects who had other neurologic diseases had CCSVI, clearly puts a question whether CCSVI is the cause of this disease," he said.
另一個是 CCSVI可能是MS引發的結果
-------------------------------------------閱讀原文:
Details: The funded investigators, which include an integration of both MS and vascular experts, report progress in establishing their teams, putting their protocols in place, recruiting participants and beginning their studies, as summarized below.
該7個研究團隊前6個月的研究進度如下:
• Dr. Brenda Banwell, The Hospital for Sick Children, Toronto, Ontario: Her team received Research Ethics Board approval in the fall and has begun enrolling participants and studying vein abnormalities in children and teenagers who have MS, and healthy controls of the same age, using non-invasive MRI measures of vein anatomy and novel measures of venous flow, as well as ultrasound. The team’s ultrasound experts have received training in Dr. Zamboni’s original techniques.
Read details of Dr. Banwell’s plans.
• Dr. Fiona Costello, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta: Her team received Research Ethics Board approval in the fall to begin recruiting a cross-section of people with MS compared to other neurological diseases and healthy volunteers. They also recruited two ultrasonography experts who have begun ultrasound scanning as originally used by Dr. Zamboni. Dr. Costello’s team slowed recruitment briefly to upgrade to a new 3T MRI machine (twice as strong as standard clinical MRI) that will be used to perform MR venography scans to compare against the ultrasound tests.
Read details of this team’s plans.
• Dr. Aaron Field, University of Wisconsin School of Medicine and Public Health, Madison: His team will be using MR venography and ultrasound techniques originally used by Dr. Zamboni to investigate CCSVI in people with early and later MS, controls with other conditions and healthy volunteers. A study coordinator is developing a recruitment list and an ultrasound expert has been hired and is slated to receive training in the Zamboni techniques. Dr. Field has been negotiating with the Institutional Review Board on issues related to study details and informed consent, and hopes to have these issues resolved to obtain IRB approval in the coming weeks so that scanning can begin.
Read details of this team’s plans.
• Dr. Robert Fox, Cleveland Clinic, Cleveland: His team has received Institutional Review Board approval for using MR venography, ultrasound, MRI and clinical measures in people with MS or who are at risk for MS (CIS) and comparison groups, and recruitment is ongoing. Two ultrasound researchers underwent training in the technique originally used by Dr. Zamboni, and the team has obtained a new ultrasound machine previously used in other CCSVI studies. The ultrasound team found several aspects of the published methodology ambiguous, and they have standardized the protocol and analysis to achieve consistent results. To share ideas and solutions to these methodological challenges, Dr. Fox’s team has submitted an abstract for consideration for presentation at the American Academy of Neurology’s annual meeting in April.
Read details of this team’s plans.
• Dr. Carlos Torres, The Ottawa Hospital, University of Ottawa, Ontario: His team obtained Research Ethics Board approval in the winter and at once began the first phase of scanning using MR venography in people without MS, which will be used to compare with various scans in people with MS. Dr. Torres’s team has overcome several obstacles including negotiating with the Research Ethics Board over elements of the informed consent form used to explain the study’s procedures and potential outcomes to participants. Team members are slated to be trained using the ultrasound techniques originally used by Dr. Zamboni, and they are on track recruiting more participants for the study.
Read details of this team’s plans.
• Dr. Anthony Traboulsee, UBC Hospital MS Clinic, UBC Faculty of Medicine and Dr. Katherine Knox, Saskatoon MS Clinic, University of Saskatchewan: The teams at both sites have received Research Ethics Board approval and have begun to recruit and scan participants. Their ultrasound technologists were trained by Dr. Zamboni, and they are also using catheter venography and MR venography to investigate the prevalence of CCSVI in people with MS and controls without MS. The radiologists on the teams of Drs. Traboulsee and Knox are meeting in February 2011 to ensure the consistency of their protocols across sites. The teams are on target for accrual of recruits and completion of the study.
Read details of their plans.
• Dr. Jerry Wolinsky, University of Texas Health Science Center at Houston: His team applied in advance and obtained Institutional Review Board approval in the spring, and the team’s neurosonographer has received intensive training for intracranial and extracranial ultrasound scanning techniques. The team has already scanned a significant number of participants, which includes people with different types of MS, people with other conditions, and people with no known health problems. One obstacle Dr. Wolinsky’s team is addressing is the difficulty of recruiting non-MS control subjects who don’t have a personal interest in the purpose of the trial. The team is testing whether other imaging methods can confirm the ultrasound findings, while identifying the most reliable technique to screen for CCSVI.
Read details of this team’s plans.
Going Forward: These seven teams were chosen by an international panel of experts that included specialists drawn from all key relevant disciplines including radiology, vascular surgery and neurology. The grants were selected for having the greatest potential to quickly and comprehensively determine the significance of CCSVI in the MS disease process. (Read more) The teams are now established and scanning procedures are underway at all but one of the study sites. Researchers have demonstrated a clear willingness to share technical advice and information so that projects can move forward as smoothly as possible. At this six-month milepost they are making significant progress on plans for these two-year studies.
The next update on the work of the seven grantees will be reported in six months.
Dr.Dake博士是第一個在美國使用氣球擴張和支架撐開術來治療多發性硬化症患者的靜脈狹窄情形(CCSVI)的醫師。 1月10日，他提出了一個全面的的證據來支持 靜脈狹窄情形(CCSVI)和多發性硬化症的關係。 以下是他內容豐富的演講以及之後回答觀眾的提問的影片。
Among those conducting CCSVI research is Dr. Michael Dake, a professor of cardiothoracic surgery at Stanford University School of Medicine.
Dake followed 30 people with MS who had stents implanted to open their veins. Two months after surgery, they reported feeling 50 percent less fatigued than before surgery, Dake said. They continued to be less fatigued at the one-year mark, even improving slightly from where they were two months after surgery, he said.
在Dake博士所處理的病患當中，有30位病患在靜脈當中植入了支架。經統計後發現：手術2個月後有一半的病人比手術之前較不會疲累。持續追蹤手術一年後，仍舊維持其精神狀態，比手術之前較不會疲累，有些甚至比手術2個月還要更有精神。
People who saw the most benefit were those with the relapsing-remitting form of MS, in which periods of remission, when the person feels relatively good, are followed by MS flares, Dake said.
而且對於反覆發作型的MS病患而言術後的反應更佳。
People with more aggressive or more advanced forms of MS, including primary and secondary progressive MS, reported about a 40 percent drop in fatigue two months after the surgery, but the effect did not last at the one-year mark, Dake said.
但是對於主要退化型以及次要退化型的MS病患而言，手術2個月後有40%的病人比手術之前較不會疲累。但是情況卻無法持續一年。
Dake was scheduled to present his findings this week at the International Symposium on Endovascular Therapy in Miami Beach。
此一檢查為一無侵入性的檢查, 類似做腹部超音波掃描般, 為求謹慎, 整個過程 約莫1個小時至1.5小時, 主要針對頸部兩側, 以及頸部前後做靜脈的掃描, 必要時需配合呼氣和吸氣, 以觀察靜脈血液流動的情形, 為一動態的檢測, 也可以觀察出血液是否回流腦部.
An Italian doctor has been getting dramatic results with a new type of treatment for Multiple Sclerosis, or MS, which affects up to 2.5 million people worldwide. In an initial study, Dr. Paolo Zamboni took 65 patients with relapsing-remitting MS, performed a simple operation to unblock restricted bloodflow out of the brain - and two years after the surgery, 73% of the patients had no symptoms. Dr. Zamboni's thinking could turn the current understanding of MS on its head, and offer many sufferers a complete cure.
Multiple sclerosis, or MS, has long been regarded as a life sentence of debilitating nerve degeneration. More common in females, the disease affects an estimated 2.5 million people around the world, causing physical and mental disabilities that can gradually destroy a patient's quality of life.
MS目前全球有約250萬病人
It's generally accepted that there's no cure for MS, only treatments that mitigate the symptoms - but a new way of looking at the disease has opened the door to a simple treatment that is causing radical improvements in a small sample of sufferers.
Italian Dr. Paolo Zamboni has put forward the idea that many types of MS are actually caused by a blockage of the pathways that remove excess iron from the brain - and by simply clearing out a couple of major veins to reopen the blood flow, the root cause of the disease can be eliminated.
Dr. Zamboni's revelations came as part of a very personal mission - to cure his wife as she began a downward spiral after diagnosis. Reading everything he could on the subject, Dr. Zamboni found a number of century-old sources citing excess iron as a possible cause of MS. It happened to dovetail with some research he had been doing previously on how a buildup of iron can damage blood vessels in the legs - could it be that a buildup of iron was somehow damaging blood vessels in the brain?
He immediately took to the ultrasound machine to see if the idea had any merit - and made a staggering discovery. More than 90% of people with MS have some sort of malformation or blockage in the veins that drain blood from the brain. Including, as it turned out, his wife.
MS病患中有90%以上的人發現有靜脈血管窄化的現象He formed a hypothesis on how this could lead to MS: iron builds up in the brain, blocking and damaging these crucial blood vessels. As the vessels rupture, they allow both the iron itself, and immune cells from the bloodstream, to cross the blood-brain barrier into the cerebro-spinal fluid. Once the immune cells have direct access to the immune system, they begin to attack the myelin sheathing of the cerebral nerves - Multiple Sclerosis develops.
He named the problem Chronic Cerebro-Spinal Venous Insufficiency, or CCSVI.
Zamboni immediately scheduled his wife for a simple operation to unblock the veins - a catheter was threaded up through blood vessels in the groin area, all the way up to the effected area, and then a small balloon was inflated to clear out the blockage. It's a standard and relatively risk-free operation - and the results were immediate. In the three years since the surgery, Dr. Zamboni's wife has not had an attack.
Widening out his study, Dr. Zamboni then tried the same operation on a group of 65 MS-sufferers, identifying blood drainage blockages in the brain and unblocking them - and more than 73% of the patients are completely free of the symptoms of MS, two years after the operation.
65位Ms病患在確認靜脈血管窄化的情性後進行手術, 手術後2年 超過73%的病患沒有復發..
In some cases, a balloon is not enough to fully open the vein channel, which collapses either as soon as the balloon is removed, or sometime later. In these cases, a metal stent can easily be used, which remains in place holding the vein open permanently.
Dr. Zamboni's lucky find is yet to be accepted by the medical community, which is traditionally slow to accept revolutionary ideas. Still, most agree that while further study needs to be undertaken before this is looked upon as a cure for MS, the results thus far have been very positive.
Naturally, support groups for MS sufferers are buzzing with the news that a simple operation could free patients from what they have always been told would be a lifelong affliction, and further studies are being undertaken by researchers around the world hoping to confirm the link between CCSVI and MS, and open the door for the treatment to become available for sufferers worldwide.
It's certainly a very exciting find for MS sufferers, as it represents a possible complete cure, as opposed to an ongoing treatment of symptoms. We wish Dr. Zamboni and the various teams looking further into this issue the best of luck.
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