CCSVI Study by the Traboulsee Knox Team - National Multiple Sclerosis Society

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CCSVI Study by the Traboulsee Knox Team

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Study on CCSVI in MS at University of British Columbia Hospital MS Clinic, UBC Faculty of Medicine and Saskatoon MS Clinic, University of Saskatchewan

In June 2010, the National MS Society (USA) and the MS Society of Canada committed over $2.4 million to support seven new research projects on the role of CCSVI (chronic cerebrospinal venous insufficiency) in MS, an abnormality of blood drainage from the brain and spinal cord in MS originally reported by Dr. Paolo Zamboni. The new projects take a comprehensive look at the structure and function of veins draining the brain and spinal cord in people representing a spectrum of MS types, severities and durations, and compare them to structure and function of veins in people with other diseases and healthy volunteers. The studies incorporate high standards of experimental blinding and controls designed to provide unbiased results.

Title: Investigation into Venous Insufficiency in Multiple Sclerosis

Anthony Traboulsee, MD
Medical Director, MS Clinic at UBC Hospital, Vancouver Coastal Health and University of BC
Vancouver, BC

Katherine Knox, MD
Saskatoon MS Clinic, University of Saskatchewan
Saskatoon, Saskatchewan

Timing: 7/1/10/-6/30/12
Amount: C$200,000 over two years
  • The team studied the prevalence of CCSVI in 200 people including those with MS and controls without MS, using catheter venography, ultrasound, and magnetic resonance venography.
  • Unique to this study is the inclusion of family members, such as identical twins of MS patients who have not developed MS, in control groups.
  • The team hopes to verify the usefulness of non-invasive techniques that would make it easier to screen for CCSVI, which would be needed if results from this and other research confirm that future therapeutic trials are warranted.
  • The research aimed to determine the reliability and accuracy of different imaging techniques for screening for CCSVI. This information will be needed if results from this and other research confirms that future therapeutic trials are warranted.

About the Investigators: Dr. Anthony Traboulsee is an experienced MS clinician and researcher who plays many roles at the UBC Hospital including Medical Director of the MS Clinic, Director of the MS Clinical Trials Research Group, and Assistant Director of the MS/MRI Research Group. He is also Assistant Professor of Medicine/Neurology at UBC Faculty of Medicine. He began his career earning a BS in biology from McGill University, then went to Dalhousie University for his MD degree. He was a neurology resident at UBC Hospital, part of Vancouver Coastal Health Authority, then got further training there as a postdoctoral fellow in multiple sclerosis. He also received training in MS and neurology and was a visiting research assistant at the Institute of Neurology in the UK. He returned to UBC Hospital in 2001 and became head of the MS clinic there in 2009. He has broad experience in MS clinical trials, and has authored numerous research papers. Dr. Traboulsee will lead the research team at the BC site.

Dr. Katherine Knox is the Director of the Saskatoon MS Clinic and Assistant Professor with the College of Medicine, University of Saskatchewan. She is a primary investigator with the Cameco MS Neuroscience Research Centre at Saskatoon City Hospital. She completed her specialty training in Physical Medicine and Rehabilitation at the University of Saskatchewan and her MD at McMaster University. At the University of Saskatchewan she is involved in teaching medical students and residents, multidisciplinary rehabilitation and research focusing on physical activity in MS. Dr. Knox will lead the research team at the Saskatchewan site.

Together the SK and BC sites assembled an excellent team from Vancouver Coastal Health (VCH) /University of British Columbia (UBC) and Saskatoon City Hospital/University of Saskatchewan that includes highly experienced MS neurologists, radiologists, interventional radiologists, physicists and a neuroethicist.

Project Details: This team took a comprehensive approach to study the prevalence of venous insufficiency in 200 people with MS and controls without MS, using catheter venography, Doppler ultrasound such as what was originally used to identify CCSVI, and magnetic resonance studies of the veins (MR venography). A unique aspect of this program is that they included family members – including identical twins of MS patients who have not developed MS -- as control groups to gain further insight into CCSVI. The team hoped to verify the usefulness of non-invasive techniques that would make it easier to detect venous insufficiency, should this and other research suggest that future therapeutic trials are warranted.

Recruitment: A total of 200 participants including eligible persons with MS and their family members who are registered with the Canadian Collaborative Project on Genetic Susceptibility to MS (CCPGSMS). 

Additional Personnel:
  • Dr. David K.B. Li, UBC Hospital, VCH/UBC
  • Dr. Lindsay Machan, UBC Hospital, VCH/UBC
  • Dr. Alexander Rauscher, MRI Research Centre, VCH/UBC
  • Dr. Alex MacKay, MRI Research Centre, VCH/
  • Prof. Judy Illes, Brain Research Centre, VCH/UBC
  • Dr. Christopher Voll, Faculty of Medicine, University of Saskatchewan
  • Dr. Sheldon Wiebe, Department of Medical Imaging, University of Saskatchewan
  • Dr. Peter Szkup, Royal University Hospital, University of Saskatchewan
  • Dr. Michael Kelly, Royal University Hospital, University of Saskatchewan

Progress updates

October 2013: Researchers publish findings in the medical journal The Lancet. Read a summary.

September 2012: Researchers continue with their progress in the seven Society-funded CCSVI studies in MS. Read about the most recent progress.

January 2012: This team is conducting their study at two centers (UBC Hospital, Vancouver, BC and Saskatoon City Hospital, Saskatoon, Sask.) and the goal is to recruit up to 200 subjects. Imaging protocols have been both developed and tested and the group is very satisfied with the quality of their results. Their ultrasound technologists were trained by Dr. Zamboni to perform the ultrasound testing in a similar way. There is no previous standardized venography protocol for looking at neck veins.

Recruitment is now closed at the University of British Columbia site, and will be closing soon at the Saskatoon site. All investigations are expected to be completed in March 2012. The team plans to do the preliminary analysis by April 2012. Analysis will occur in stages, starting with the catheter venography and ultrasound data, then the MR venography results will be reviewed.

The team reported that the level of interest and response rate remained high throughout recruitment. The UBC site recruited 110. At the Saskatoon site, 70 subjects have been recruited and are at various stages of the protocol. All investigators remain blinded to the status of the subjects and do not have any preliminary results to report at this time.

Quotes

  • Dr. Anthony Traboulsee: “The strength of our study is that it employs a comprehensive imaging protocol and a unique comparison group of individuals with an increased risk to develop MS. Our study will determine if CCSVI is strongly and uniquely associated with MS.”
  • Dr. Katherine Knox: “The unique inclusion of a family member control group in this study may allow us to gain further insight into the possible role of CCSVI in the mechanisms leading to MS.”

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