Michael Arata, MD, Frances DeBarge-Igoe, RN, Piay DeGuzman Synergy Health Concepts, Newport Beach, CA.
BACKGROUND: Jugular venous angioplasty has been performed as a treatment for a condition described as CCSVI. The efficacy of this treatment been challenged as being attributed to a placebo effect or that objective data is lacking and reported responses to treatment thus far have been only subjective in nature. The FDA states, “there is no clear scientific evidence that the treatment of internal jugular or azygos venous stenosis is safe in MS patients, impacts the symptoms of MS, changes the overall course of MS or improves the quality of life for MS patients.” observation of patients’ presenting symptoms for CCSVI treatment has lead to the hypothesis that these symptoms are related to autonomic dysfunction rather than a new entity, CCSVI or MS. Normalization of blood pressure post jugular venous angioplasty has also been observed and supports to the hypothesis of autonomic dysfunction. Heart rate variability (HRV) testing was therefore incorporated for assessment of autonomic dysfunction in patients undergoing jugular vein angioplasty.
METHODS: Autonomic function was assessed 24 hours pre procedure and 24 hours after jugular ballooning. Hrv analysis was carried out using the ans2000, D.E. Hokanson, inc. Bellevue, WA. A total of 24 patients underwent successful testing both before and after jugular angioplasty. R-r interval variation with deep inspiration was analyzed with determination of the mean circular resultant (mcr).
RESULTS: Sixteen (66.7%) patients saw and improvement in mcr 24 hours after jugular balloon dilation. In four (16.7%) patients the improvement was such that their mcr was normalized.
CONCLUSION: HRV testing allows objective assessment of response to treatment following jugular venous angioplasty in patients with symptomatic autonomic dysfunction. Jugular venous angioplasty should be studied further as a potential treatment of autonomic dysfunction.