CCSVI and fMRI

May 20, 2011 at 9:41am

Dr. Giedrius Buracas is a Functional MRI (fMRI) researcher at University of California, San Diego. He presented new research the Hubbard Foundation is conducting into the MS brain before and after angioplasty.  The study utilizes functional magnetic resonance imaging to study how the brain is activated when doing specific tasks.

fMRI  is a type of specialized MRI scan used to measure the hemodynamic response (change in blood flow) related to neural activity in the brain. It is one of the most recently developed forms of neuroimaging. Since the early 1990s, fMRI has come to dominate the brain mapping field due to its relatively low invasiveness, absence of radiation exposure, and relatively wide availability.

In the Hubbard study, there were many differences in how normal vs. MS brains responded to tasks.  The MS brains showed an "undershoot"---or less bloodflow and neural activity.

There were changes in the subcortical gray matter response from before venoplasty and after.  PwMS were able to complete tasks in a more "normal" manner, and their brains showed improved blood flow and activation after treatment for CCSVI.

Here is Dr. Buracas' presentation at the Hubbard conference

http://www.youtube.com/user/HubbFound#p/u/17/K3pw7IWzEiM

"The most surprising outcome of this angioplasty intervention is that it eleviates some symptoms of MS which presumably has to do with structural damage.  The structural damage stays there, but people feel better---so, it looks like one of the contributors to the neural basis of eleviated symptoms is recovery of default mode network suppression."

Certainly, impeded blood flow into the cortical areas of the brain, as shown on these fMRI studies, could be part of the reason for slowed responses.  And repairing this flow, by getting rid of extracranial blockage, could very well be the reason for improved bloodflow  and a more normal response of the brain after angioplasty.  The brain needs normal cerebral perfusion---delivering O2 and glucose--in order to function.   Thanks again to the Hubbard Foundation for this important work.

Joan 

The Healing Power of Music

Most, but maybe not all, of you know that I'm a professional singer by trade.  I studied classical voice at the Eastman School of Music, where I also met my husband Jeff.  I've sung with the New York Philharmonic, the San Francisco Opera Company, the Los Angeles Master Chorale, but the majority of my career has been as a studio singer in LA.  I've sung on a lot of film and TV scores, albums, commercials.  Heck, you may have even heard me, and not realized it.   link to credits

Music continues to be my passion.  But my interest in music has changed over the years.  Especially as I watched how music affected Jeff.  After his diagnosis with MS, it was listening to music which would ease his neuropathic pain and calm his anxieties.   When he recommitted himself to his craft of composition, conducting and performing, I watched him heal.  Music was part of his new lifestyle.  One which incorporated a new way of eating, exercising, meditating, living.  His venoplasty procedure at Stanford allowed him even more energy to pursue his passion.  We watched his brain heal on subsequent MRIs.   Link to Jeff talking about music, CCSVI and MS

Music is universal. The images I've linked below are from a recent study.  They show six different human brains listening to music, while scanned with fMRI. The brains on the left listened to J. S.  Bach's first invention-- a gorgeous classical work which is a 2 voice fugue, originally composed as an exercise for Bach's sons.  Here is the great Glenn Gould.  link to Bach's 1st Invention

The people whose brains were scanned were not musicians, or at all familiar with the piece. However, there is activation across most brain regions, as shown by the orange color of activity on the scans. Notice how the images all look almost exactly the same, no matter the age, socio-economic status or health of the participant. Bach touched their brains in the same way.  Bach made their brains become alert, energized, activated. 

Orange= Activation

Blue= Oxygenation

On the right are the same peoples' brains listening to self-selected music-- which they chose because they loved how it made them feel. Notice how now the brain is activated in different regions, but the effect is one of calming and oxygenation--as shown by the color blue. This is the power of the music we love on our brains---it calms and soothes us, releases our emotions, heals us.

Why is this important? Physicians are now using self-selected music in psychiatric hospital settings to calm and "medicate" patients, and give them hope and healing. Music therapists are using different playlists to work with stroke patients, to help them regain balance, brain function, and health. Music is being employed as medicine.  link

I saw this in action last year, in a ground-breaking hospital, where a classically trained composer and fellow Eastman alumnus,  J. Todd Frazier,  has created a program which is changing music therapy.   New imaging modality is showing us what happens to the human brain on music.  He believes we were created to be music makers, listeners, participants. Music is essential to humanity.  link to more info on J. Todd Frazier

Here is the abstract for the published paper the fMRI image is taken from.  Todd was one of the authors on this study.  While in Houston, I also met with Dr. Karmonik,  the world renowned MRI imaging expert behind these studies---and he is not a musician, but he has become a believer in the brain altering power of music.  https://www.ncbi.nlm.nih.gov/pubmed/27464741

 "The researchers found distinct brain activation patterns for the different music pieces. The self-selected pieces, which Frazier says were quite diverse, brought about significant activity in the emotion and memory centers of the brain, while unfamiliar music activated attention and memory areas. Karmonik notes that, despite such different self-selected musical pieces, the patterns of brain activity were remarkably similar.

“We showed a similar connectivity pattern in the brains of these individuals in the self-selected music,” he says. “This is important because it shows it’s the music. That music really drives all of these brain processes even if you are of a different age, gender, or background. That familiar music really seems to do something for everybody.”

Having spent time with J. Todd Frazier, in meetings and in the hospital he has changed,  I've become a believer.  Todd's original desire was to prove the importance of music education---he was frustrated by the perception that music was not essential in schools, that music was merely entertainment.  As the son of a physician, he knew better, and set out to change this perception.  But now his mission is even greater.  He wants to use music to heal.

Since meeting Todd, I've wanted to bring this program to other hospitals, to more patients, to future music therapists and researchers.  And that is why I became more involved as a trustee at the University of Rochester.  Thankfully, other trustees and administrators agreed with Todd.  The Eastman School of Music and University of Rochester Medical Center will now begin a collaborative music and medicine program, to further understand and utilize the healing power of music.  

So, what can you do, today, to incorporate this science?  I would recommend putting together a 30 minute playlist of your very favorite music.  This should include music you are very familiar with, music which makes you feel something beautiful.  Every day, when you need to relax --go to a quiet place and listen to your familiar music playlist with headphones.  Breathe deeply and let the music wash over you.  You are oxygenating your brain. 

You should also explore new music in styles that you enjoy, but are not as familiar with.   When you are feeling terrific and energized already, try listening to this new music.  Let it further activate and stimulate your brain.  Try dancing or moving to the music in any way you can.  You are increasing neuronal pathways.

I hope this science gives you some hope and encouragement.  We can do so many things to heal our own brains--by adding music to nutrition, exercise, sunshine, meditation, sleep.  Our complete solution to chronic illness will never be found in one pill or infusion.  Healing means living in a new way.

Be well,

Joan 

Study on Brain Changes in MS and Depression

July 3, 2010 at 11:43am

There's an article and podcast in Scientific American this week regarding a new study completed at UCLA. It looks at physical brain changes in people with MS who have depression. The researchers found on MRI that the hippocampus is smaller in pwMS, and that the HPA axis (the neuroendocrine system which regulates stress and other functions) is hyperactive.  The hippocampus is the area of the brain which controls memory and mood---and a hyperactive HPA axis is related to increased cortisol release and stress.  Both of these brain changes are real, measurable, and related.

If you have chronic hypoxic insult (meaning an ongoing lack of adequate oxygen) to your brain, you'll have a smaller hippocampus and a hyperactive HPA axis.   And you'll most likely suffer from depression. 

Here's the link and podcast

http://www.scientificamerican.com/podcast/episode.cfm?id=the-connection-between-multiple-scl-10-07-03

Those with hypoxic injury show atrophy of the hippocampus and hyperactive HPA axis. JUST LIKE people with MS, and people who have suffered a brain injury due to drug use, carbon monoxide poisoning, and sleep apnea.  There is a decrease in brain tissue due to neuronal loss.  And this is linked to lowered oxygen levels.

Here are some studies to back this up:

Several reports suggest that the activity of the hypothalamo-pituitary-adrenal axis (HPA-axis) is increased following hypoxia/ischaemia and that this might be associated with increased neuronal vulnerability-

http://www.ncbi.nlm.nih.gov/pubmed/7496805

Hypoxia damages multiple organ systems especially those with high oxygen utilization such as the central nervous system. The purpose of this study was to compare the neuropathological and neuropsychological effects of hypoxia in patients with either carbon monoxide poisoning or obstructive sleep apnea. Neuroimaging revealed evidence of hippocampal atrophy in both groups.

http://journals.cambridge.org/action/displayAbstract;jsessionid=5D1BB4D8DC4AFE6AF2B8C57D4D9F32BB.tomcat1?fromPage=online&aid=195135

I talked about this at length with Dr. Haacke last year. I know that he and Dr. Hubbard are looking at oxygenation levels in pwMS before and after angioplasty using fMRI BOLD technology, and they are finding that patients indeed have lower oxygen levels in their brains before, and better oxygenation after.

The pieces fit together when we look at MS as a disease of chronic venous insufficiency.  Slowed blood flow to and from the brain is related to reduced oxygenation of tissue.

If ordinary people like you and I can see this...isn't it time for the medical profession to see it, too?

There are things that can be done to help alleviate depression.  
Exercise, UV ray therapy, whole foods full of phytonutrients can all be helpful.  
So can therapy and drug treatment.
Don't suffer in silence.  If depression is part of your MS---you are not alone.
Please get help,

Joan

A Body in Motion

More research coming in on the importance of execise for people with MS.  This newest study looked at how aerobic exercise can INCREASE the size of the brain, and improve memory.

The hippocampus (literally "sea monster") got its name because of its shape--it resembles a sea horse.  It is the part of the forebrain responsible for memory forming,  mood, organizing and storing.

The hippocampus is much smaller in people who have MS, Alzheimer's, depression and in those who have had some sort of hypoxic, or low oxygen injury to the brain.  And yes, this ties in with Dr. Zamboni's discovery of restricted cerebral outflow and CCSVI.  The hippocampus needs adequate oxygen and blood flow to remain healthy.
http://ccsviinms.blogspot.com/2010/07/study-on-brain-changes-in-ms-and.html

Hippocampal atrophy seen in MS is linked to the memory deficits that affect approximately 50% of individuals with MS. Despite the prevalence of this disabling symptom, there are no effective pharmacological or behavioral treatments. 

"Aerobic exercise may be the first effective treatment for MS patients with memory problems," noted Dr. Leavitt, research scientist in Neuropsychology & Neuroscience Research at Kessler Foundation. "Moreover, aerobic exercise has the advantages of being readily available, low cost, self-administered, and lacking in side effects." 

The study's participants were two MS patients with memory deficits who were randomized to non-aerobic (stretching) and aerobic (stationary cycling) conditions. Baseline and follow-up measurements were recorded before and after the treatment protocol of 30-minute exercise sessions 3 times per week for 3 months. Data were collected by high-resolution MRI (neuroanatomical volumes), fMRI (functional connectivity), and memory assessment. Aerobic exercise resulted in a 16.5% increase in hippocampal volume, a 53.7% increase in memory, and increased hippocampal resting-state functional connectivity. Non-aerobic exercise resulted in minimal change in hippocampal volume and no changes in memory or functional connectivity.

http://www.sciencedaily.com/releases/2013/11/131101125506.htm

Please note that the researchers make some great points.  There are NO MS drugs that can increase your brain size or help with memory.  Exercise, with the consult of your physician, has no side effects, doesn't cost much and you can do it on your own schedule.

Now, here comes the cheerleading part.

Aerobic exercise simply means "with oxygen."  When we engage in aerobic exercise, we get our heart pumping!  Our blood vessels widen, our heart pumps faster and stronger, to deliver oxygen rich blood throughout our body.  This strong flow of blood creates a wonderful effect on the endothelium, called "shear stress."  The forceful flow of blood throughout vessels releases healing and vasodilating nitric oxide.  

I have spoken with Dr. Cooke and Dr. Dake from Stanford about those who have remained stenosis free in the four years since treatment for CCSVI, they have commented that the patients that remained the most aerobically active have done the best.  

If there is any way for you to take 30 minutes, 3x a week, to get your heart pumping, find it!  Suggestions on how to do this include stationary biking, elliptical machines, swimming, jogging, biking, hiking, treadmills, dancing, zumba, jazzercise, boxing, an aerobics or cardio class.   Please consult with a physician or physical therapist to learn which activity might be best suited to your activity abilities.  It may be simply impossible for you to move enough to get your heart pumping, and that's the terrible tragedy of MS progression.  But if there is any way---please try it.  

Jeff started slowly, using an elliptical machine. It wasn't pretty.  He had numbness and balance issues after his MS diagnosis, and this was about all he could handle.  But he kept at it, even with pain and fatigue.  A year later, he was back on his bike, and able to walk the dog and hike a bit.  After venoplasty, his heat intolerance disappeared, and he could work up a real sweat, so he went to mountain biking, hiking and even returned to skiing.  Last week he was showing off, and jogging up the hills on our hike.  And now his brain volume looks normal on MRI.

You can do this!!

Please, share this info in your MS community, and encourage others to join you.

A body in motion, stays in motion--

As the winter approaches and hours of sunshine diminish, fight the impulse to stay in bed or on the couch.  Get up, get moving, and feel the blood moving through your vessels.  The shear stress created heals the endothelium. You are, quite literally, healing your brain.

be well, be active,

Joan

History, Hysteria and Hope

May 24, 2013

  

In the last two years, the paradigm for treating MS has changed.  Vitamin D supplementation is routinely recommended.  A healthy diet and exercise are encouraged.  Stress reduction and lifestyle changes, like smoking cessation, are encouraged.  

We are seeing a subtle shift in the understanding of MS as a purely autoimmune disease which cannot be modified, to an inflammatory disease which can be addressed with lifestyle changes encouraging cardiovascular health.

This is new.  

We also now understand that the changes which happen to the brain early in the MS disease process create pain, depression and fatigue.  These are not imagined symptoms.  They are real, and linked to atrophy of the hippocampus and thalamus.

Here is some more background about how MS has been viewed and treated throughout history.

You will see, the shift in how neurology considers MS is still evolving.

We're getting there.

The history of MS research is full of assumptions that were once held as fact by neurologists, but were later proven untrue.  It's important to review how multiple sclerosis patients have been described over the course of history, in order to understand the current mindset of neurology.  I hope this opens some eyes.   

Each of these three points were once believed to be factual.  We now know they were wrong, dead wrong. 
But the repercussions of these inaccurate beliefs linger today.

1. MS is related to the patient's psychological condition.

The very beginnings of MS research were dominated by French neurologist Charcot's fascination with hysteria and personality disorders as related to neurological disease.

Hysteria, from the ancient Greek word for uterus, was a nervous illness long associated exclusively with women. Symptoms differed from patient to patient and from one historical period to another, but they always involved both the body and the mind. Some characteristic symptoms included shortness of breath, heaviness in the abdomen, muscular spasms and fainting. Anxiety, irritability and embarrassing or unusual behaviour were also noted.

Hysteria received intense attention during the late 1800s. The French neurologist Jean-Martin Charcot proposed hysteria was an inherited nerve disease, similar to multiple sclerosis...Charcot investigated hysteria using hypnosis. In lectures he invoked characteristic symptoms in male and female hysterics by applying pressure to specific spots on the hypnotised patient’s body. Critics argued these performances testified to Charcot’s powerful influence over his patients, not the nature of hysteria.

http://www.sciencemuseum.org.uk/broughttolife/techniques/hysteria.aspx

This subtle message, which began as an understanding of MS as a disease involving the psyche,  was that MS was somehow initiated by a personality or nervous disorder which could be controlled by the neurologist.  This subtext continued on into the 20th century.  Here is research from the 1950s.

"The personality characteristics associated with multiple sclerosis as revealed by the MMPI profiles are presented and discussed. The personality characteristics revealed are: a reaction of depression, preoccupation and concern about bodily functions, feelings of hopelessness and insecurity, as well as tendencies toward indecisiveness, narrowness of interests, and introversion. Difficulty in accepting the disease, and its progressive limitations, as well as ambivalence and insecurity concerning the future, are often reflected in relatively poor emotional control and social adjustment."

http://psycnet.apa.org/journals/ccp/15/3/253/

2. MS does not cause fatigue.  

In the 20th century it was believed that fatigue was not a symptom of MS.  It was believed that fatigue was what caused MS.

Patients were told to stop exercising and to rest in order to avoid relapses.  The underlying message, again, was that there was a personality type that developed MS--neurotic, stressful, type A personality--hysterics. The message was that if patients could just rest, take it easy, not worry;  they could avoid relapses and disease progression.  This has been proven untrue.  Many different people develop MS: from athletes to academics, from mothers to rock stars, from children to middle aged adults.   And stress and rest are not part of the equation in contracting the disease.  And fatigue is often the presenting symptom before an official MS diagnosis as we learned this week.  And those who are able to exercise do better with symptom management.

3. MS does not cause pain

 When most people think of multiple sclerosis, they think of a disease that causes symptoms of weakness and motor problems -- not pain.

"About 10 or 20 years ago, there was a saying that MS causes all kinds of trouble but doesn't cause pain, which really isn't true," says Francois Bethoux, MD, director of rehabilitation services at the Mellen Center for Multiple Sclerosis Treatment and Research at The Cleveland Clinic.

http://www.medicinenet.com/script/main/art.asp?articlekey=52405

As many with MS can tell you---they feel pain.  Their pain is real, and it is caused by their MS.  Even though patients have been describing their pain to their doctors for over a hundred years, it is only in the last 10 years that this has been taken seriously.

__________________________________________________________

I believe that the distance between the multiple sclerosis patient and the neurologist was allowed to persist through the historical characterization of the MS patient as hysteric, emotionally labile, neurotic or mentally unbalanced.  These false depictions were created by a group of doctors who were threatened by their own personal lack of understanding of the disease and inability to change its course.    It was too difficult to confront the ravages of MS and not be able to cure the disease.  It was easier to portray the patient as defective and the source of their malady.   This provided a comfortable distance between doctor and patient.

Neurology so distanced itself from the patient, that THEY DIDN'T EVEN BELIEVE THE MS PATIENT WAS IN ACTUAL PAIN.  It took over one hundred years for neurologists to admit that there might be pain, or fatigue, or depression caused by multiple sclerosis.  This is absurd.

Since the advent of MRI technology, doctors have concrete evidence of the degredation of gray matter, atrophy of the hippocampus, and demyelination in areas of the brain responsible for emotion, pain and cognition.  All of these changes to the brain are linked to depression, pain and fatigue.  
http://ccsviinms.blogspot.com/2010/07/study-on-brain-changes-in-ms-and.html

These changes to the brain occur early in MS.  Researchers can see the slowed blood flow and hypoperfusion.  They can study fMRI images. 7Tesla imaging (Ge, et al) has allowed researchers to see the microscopic vascular changes that happen to the veins in the MS brain. 
http://ccsviinms.blogspot.com/2009/12/hypoperfusion-decreased-blood-flow-in.html

The physical changes to the brain are caused by a disease process.  They are not psychological or imagined.   The disease comes first, and the brain damage follows.

If there are any young neurologists reading this, I implore you, bridge the gap between patient and doctor.

Look at your patients as family members, friends, siblings, loved ones, human beings. 

Study their MRI images, work with vascular doctors and look at their cerebral blood flow, specifically, the venous return.  Don't be afraid of collaboration between disciplines.  For this is the future of medicine.

Talk to your patients, but most importantly, listen to them.  When they tell you they are in pain, or exhausted or depressed--believe them.  Try to help them.  And try to learn WHY this is happening.

It's time to say goodbye to the era of Charcot and hysteria.  It's time for science.

Joan

Charcot demonstrating hypnosis on an "hysterical" Salpêtrière patient, "Blanche" 

A painting by Pierre Brouillet