The Chinese and MS

August 27, 2011 at 2:45pm

Looking at the Chinese as a population has been very useful when studying chronic diseases.

According to Multiple Sclerosis International, the prevalence of MS in China is between one and 50 for every 100,000 people. The situation, however, changes when looking at immigrants who have come to Canada from countries where the exposure to the sun is different.

Canadians of Chinese origin were 10 times more likely to have MS than people in China, Savoie said. "Some of them have more severe MS than Canadian counterparts of Caucasian origin and that may tell us something about the fact that when you move across the globe, you're reacting, in fact, to these changes in the environment, including changes in exposure to vitamin D."

http://news.xinhuanet.com/english2010/health/2011-08/26/c_131077336.htm 

Vitamin D is obviously a very important component in this discussion, as most of Canada is at a northern latitude compared to China.  But the Chinese are also have problems with vitamin D deficiencies in their own country.

Subclinical vitamin D deficiency was widespread among Beijing adolescent girls in winter. Low plasma 25-hydroxyvitamin D concentrations in summer, low calcium intake, and low plasma calcium concentrations in winter were the main risk factors for vitamin D deficiency in winter.

http://www.ajcn.org/content/74/4/494.short

What else changes for Chinese people who move to Canada?  What other factors are new to them?

The western diet.  

This has been studied in relationship to the endothelium and heart disease by Dr. T. Colin Campbell.

BNAC review: Venous stasis and EBV, viruses and bacteria

August 24, 2011 at 9:19pm

It is quite possible that venous stasis, or slowed cerebral drainage, could be responsible for the number of viruses (such as EBV and HHV) and bacteria (such as Cpn and Lyme) that have been associated with MS-by allowing these infectious agents to pass through the blood brain barrier.  Here is the Buffalo review on this topic:

The association between EBV infection and CCSVI has not yet been explored; however, it could be hypothesized that venous stasis in the superior saggital sinus due to extracranial outflow impairment could affect the drainage of bridging veins that pass through the subarachnoid space (near the meninges and EBV-infected B-cell follicles) and contribute to EBV activation. The venous stasis hypothesis in the SSS may contribute to understanding why so many different viruses and bacteria [3,111] have been linked to increased MS susceptibility risk over the last 50 years.

http://www.expert-reviews.com/doi/abs/10.1586/ern.11.117

The blood brain barrier is supposed to keep viruses and bacteria out of the central nervous system.  Venous stasis, or slowed blood flow, would explain why so many infectious cells are passing into the brain and spine in MS.  It just makes sense!   More studies ahead.

Joan

 Dr. Zamboni-his frustration with the neurological journals using opinion pieces, not science

August 12, 2011 at 3:22pm

In a recent article in MedScape discussing the OPINION of Dr. Compston that new genes found in MS implicate the immune system only, and preclude a vascular connection,  Medscape asks Dr. Zamboni for his opinion on this new research and the recently published negative review by Dr. Bagert (both negative pieces were all over the corporate owned press.)

Asked to comment on the review by Dr. Bagert and colleagues, Dr. Zamboni expressed some exasperation that the review again does not represent actual new evidence, but is a review, including opinion pieces.

"Until a few years ago, the Archives of Neurology had a section of great interest [called] Controversies, where the reader had the opportunity to consider different visions," said Dr. Zamboni, who is director of the Vascular Diseases Center at the University of Ferrara, Italy.

"Nowadays, countless editorials and opinion articles about CCSVI have been invited in journals of clinical neurology with no chance to reply. This habit, certainly not academic, helps to make me a defendant in science, just to get reported in 30 peer-review articles an underdeveloped aspect of MS research," he told Medscape Medical News.

In their review article, Dr. Bagert and colleagues refer to the Bradford Hill Criteria that are used to assess scientific evidence of causation in biological systems and suggest that in this case, "there is very little validated scientific evidence to support the theory that CCSVI is the cause of MS, especially among the criteria of biological plausibility, coherence, and analogy."

To this point, Dr. Zamboni responds that he would like to see the authors apply the Bradford Hill Criteria, citing exclusively original articles and not editorials and opinions. If his own work is scientifically inaccurate by these criteria, then so is much of the epidemiologic data in other aspects of MS, he says, where studies are equally inconsistent in sample sizes and methods of data collection.

Of the studies published to date on CCSVI, despite the high variability, MS is associated with CCSVI in an average of 80% of cases vs 10% of the healthy population, Dr. Zamboni asserts.

"Furthermore, with respect to the biological plausibility and the coherence of Bradford Hill Criteria, the autoimmune theory cannot in turn explain several vascular aspects well detailed in the MS literature," he toldMedscape Medical News.

From Dr. Zamboni on new published research

August 12, 2011 at 1:22pm

An important message from Dr. Zamboni regarding the newly published study placed online today.  This is the 2nd  CCSVI endovascular treatment study undertaken in Ferrara, Italy.  The patients were Italian and American, in cooperation with BNAC.   There were two groups, an immediate treatment group, and a delayed treatment group,  The MRI technicians were blinded as to who was in which group.  All patients were on disease modifying drugs before, during and after, for consistancy in treatment.   This is very important to understand.  Angioplasty for CCSVI reduced lesions, improved MS symtoms and reduced relapses, when compared to those in the delayed group on the drugs alone.  Here's the note from Dr. Zamboni-

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Here attached for you, from the site of the European Journal of Vascular Endovascular Surgery, the second treatment study.  This study is also known as MS-EVT treatment of American and Italian patients who have traveled from across the Atlantic to be treated.
http://www.ejves.com/article/S1078-5884%2811%2900201-2/abstract

The study design is unique in the history of medicine. The patients were operated on in Ferrara, but the results were audited in Buffalo. Patients were divided into two mixed groups of Italians and Americans. The first ITG  (immediate treatment group) was operated on immediately, while the second group DTG (delayed treatment group) was treated six months later, allowing us to compare the ITG with DTG. Finally, we compared patients in the second six months, when both groups were operated on.  Then, all patients were compared with their original state during the previous year, prior to PTA.

The study is small (we had no money to do more), however, is very strong, certainly stronger than that of 2009 JVS, as it eliminates many of the criticisms of the latter. Particularly--

1. There is a control group for comparison, in practice it as a randomized as possible for use in surgery

2. MRI measures are rigorous, high-standard 3-tesla, comparable and indisputable as completely blind

3. Patients were evaluated by neurologists and neuroradiologists of two centers

4. Statistical analysis was done by an independent statisticians and blinded.

What does it prove

1. Both groups after the PTA had a significant improvement in the MSFC score compared to previous year, with substantial maintenance of EDSS (no disease progression)

2. In the ITG during the first 6 months there were fewer relapses. The percentage has been on an annual basis of 0.16 against 0.66 of the DTG. In fact the DTG in the first six months received only drugs. After surgery, the DTG no longer had more relapses than the ITG, confirming the protective effect of PTA on relapses.

3. ITG  T2 lesion load decreased while the DTG increased. After the PTA in the DTG lesion load stabilized during the second six months.

4. Complications were zero, zero thrombosis

5. 27% restenosis

6. ITG had one patient- despite the PTA, who had a recurrence and worsening on the MRI, confirming that the MS-CCSVI can not be handled alone by only interventionist. This article suggests the causes of deterioration after PTA on which new studies are needed.

More results

1. Ahead Zivadinov and all 17 consecutive patients had venography confirmed CCSVI

2. the ITG had an effect more pronounced in brain volume reduction than that of the DTG, a likely anti-edema and anti-inflammatory effect of the PTA.

Key messages

* CCSVI is associated with MS --as the first treatment of the condition changes the clinical parameters of the second

* The modification of parameters in a blinded MRI is totally immune from the placebo effect, then measured the improvements are real

* The treatment is safe in safe hands and can be beneficial

* To say after these two pilot studies, positive treatment studies, epidemiological studies have to wait is not sustainable

Paolo Zamboni, MD

Director, Vascular Diseases Center

University of Ferrara