Begründung der Berufung

Im Urteil wird gesagt:

Aufgrund [] der Tatsache, dass gegenwärtig noch keine gesicherten Erkennt­nisse über die Ursachen der Erkrankung vorliegen, gibt es grundsätzlich keine Standardthe­rapie, jedoch stehen mehrere Behandlungsformen zur Verfügung

Wir stellen fest: Es gibt keine Standardtherapie, mithin überhaupt keine Therapie. Aha!

jedoch stehen mehrere Behandlungsformen zur Verfügung

Es gibt keine Therapie, aber es stehen mehrere "Behandlungsformen" zur Verfügung?! Bitteschön, was soll mir eine "Behandlungsform", wenn diese doch keine Therapie ist! "Behandlungsformen" interessieren mich nicht, Therapie interessiert mich! Gibt es eine Therapie? Leider nicht. Ende der Durchsage.

Was sind im übrigen "Behandlungsformen"? Handauflegen dürfte doch auch eine Behandlungsform sein! Also gibt es bei allen Krankheiten und unter allen Umständen "Behandlungsformen". Irgendwie ja nicht. Also ist die Aussage mit den "Behandlungsformen" einfach hohl und darf niemals Grundlage für ein Gerichtsurteil sein!

Zum Thema "csvi" (Chronisch cerebale venöse Insuffizienz) gibt es zahlreiche Artikel und Studien. Niemand würde Artikel veröffentlichen oder sich die Arbeit einer Studie machen, wenn das Thema csvi fernliegend wäre. Daher, und weil es keine Therapie der MS gibt und weil meine MS primär chronisch progredienter Art sehr schnell fortschreitet (Pflegestufe I: 14.5.2005, Pflegestufe II: 1.7.2008, Pflegestufe III: 28.9.2011; die fundierte Vermutung (im Wohnungsprozeß (Begruendung_der_Klageerwiderung, Meine_Wohnung) lautet, daß ich in zwei bis vier Jahren bettlägerig sein werde; möchte ich weiterhin, daß die Kosten der Behandlung übernommen werden. Wenn sie nämlich übernommen werden, kann und werde ich mich mit erheblichen Hoffnungen sofort einer weiteren Behandlung unterziehen!!

Wissenschaftliche Artikel

Radak D, Tanaskovic S, Marinkovic S, Antonic Z, and Kolar J: Internal jugular vein duplication: a further truncular malformation in a patient with multiple sclerosis

Phlebology. 2011 Oct

Abstract: Different internal jugular vein (IJV) abnormalities can be found in patients with multiple sclerosis (MS): stenoses, complete occlusion, distortions and intraluminal structures, such as membranes, webs and inverted valves. IJV duplication is a very rare phenomenon. We report a case of right IJV duplication as an incidental finding during IJV morphological and haemodynamic assessment in a patient with MS. A 55-year-old female patient was admitted to our Institute for IJV and vertebral veins morphological and haemodynamic assessment. During the last seven years she had been treated for MS. Colour Doppler ultrasonography in our patient did not reveal IJV or vertebral veins stenoses or abnormal valves, but instead right IJV duplication. This finding was confirmed using multislice computed tomography angiography and by selective phlebography. In conclusion, to our knowledge, a case of IJV duplication in a patient with MS has not been described yet. This further venous malformation can be assessed by the means of Doppler ultrasounds.

Bavera P. M., Mendozzi L., Cavarretta R., Agus G. B.: Venous extracranial Duplex ultrasound and possible correlations between multiple sclerosis and CCSVI: an observational study after 560 exams

Acta Phlebologica 2011 August;12(2):109-13

Abstract: The article concerns an observational study subsequent to 560 Duplex ultrasound (DU) exams on multiple sclerosis affected patients. The aim of the study was to find out, after the so-called “Zamboni Theory”, if there may be any correlations between chronic cerebrospinal venous insufficiency (CCSVI) and Multiple Sclerosis (MS). All the patients had a certain diagnosis for MS and all exams were carried out, with a group of control in non-MS patients, by the same operator using two similar but different brand Duplex devices following the same procedure. The aim was to find any possible malformation in the extracranial venous cerebral outflow, mainly concerning the internal jugular vein and vertebral plexus system. Outflow malformations due to significantly reduced vein diameter and/or valve flaps were seeked both in horizontal and upright position. The results were interesting considering the constant presence of venous outflow problems in a significant number of patients affected by SM disease. The diagnosis percentage happened to be very similar, and significant, using either DU devices.

Tucker TW: A physics link between venous stenosis and multiple sclerosis

Med Hypotheses: 2011 Dec;77(6):1074-8. Epub 2011 Sep 29

Abstract: This paper hypothesizes that a stenosis or obstruction at a lower extremity of an internal jugular vein (IJV) would, in accordance with the physics of fluid dynamics, cause a standing pressure wave within the vein. This pressure wave would possess regions of large pressure fluctuations and other regions of relatively little fluctuation which also have substantially lower peak pressure values. If the wavelength of the hypothesized pressure wave is comparable to the distance from the obstruction to the venule end of the capillary bed, then a region of high pressure fluctuation would exist at the venules. Depending on the degree of obstruction, the pressure fluctuations at the venules of the capillary bed would be substantially greater than those that would exist in a healthy unobstructed vein. This increase in blood pressure fluctuation located at the venule end of the capillary bed, which would be equivalent to local hypertension, is predicted to reduce the pressure drop across the bed which, in turn, would reduce blood flow through the bed in accordance with Darcy's Law. Such a reduction in blood flow through the bed would be accompanied by a reduction in the transfer of oxygen, glucose and other nutrients into the brain tissue in accordance with Fick's Principle. The reduction in oxygen levels in the brain tissue (i.e. hypoxia), would, in turn, be associated with increased fatigue and decreased mental acuity in the subject patient. Also the deprivation of oxygen in the brain tissue may result in the death of oligodendrocyte cells, which, in turn would result in the deterioration of the myelin surrounding the brain's neural axons. In addition, the paper also predicts that, in cases of extreme obstruction, the predicted localized hypertension at the venule end of the capillary bed may be sufficiently high to cause a localized disruption in the blood-brain barrier. Such a disruption of the blood-brain barrier could then allow the migration of leukocytes (auto-immune attack cells), from the blood into the brain tissue, enabling them to attack myelin, which has degenerated or deteriorated from the reduction in repair function normally provided by oligodendrocyte cells. Such leukocyte attack on myelin has long been associated with multiple sclerosis.

Radak D, Kolar J, Tanaskovic S, Sagic D, Antonic Z, Mitrasinovic A, Babic S, Nenezic D, and Ilijevski N: Morphological and haemodynamic abnormalities in the jugular veins of patients with multiple sclerosis

Phlebology. 2011 Sep

Abstract: OBJECTIVES: Multiple areas of stenosis and different levels of obstruction of internal jugular and azygous veins (a condition known as cronic cerebrospinal venous insufficiency) recently emerged as an additional theory to the well-known autoimmune concept, explaining etiology of multiple sclerosis (MS). The aim of our study was to evaluate internal jugular vein (IJV) morphology and haemodynamic characteristics in patients with MS and compare it with well-matched healthy individuals and to evaluate the prevalence of venous flow abnormalities in both groups. METHODS: Sixty-four patients with clinically proven MS and 37 healthy individuals were included in our study. In all patients, IJV morphology and haemodynamic characteristics were evaluated by colour Doppler sonography as well as venous flow disorder. The patients were classified into four groups according to MS clinical form presentation. The prevalence of morphological and haemodynamic abnormalities in the IJV were assessed. RESULTS: The presence of stenosing lesion, mostly intraluminal defects like abnormal IJV valves, were observed in 28 patients (43%) in the MS group, and in 17 patients (45.9%) in the control group (P = NS). By adding haemodynamic Doppler information in the IJV venous outflow was significantly different in 42% of MS patients showing flow abnormalities (27/64), as compared with 8.1% of the controls (3/37), P < 0.001. CONCLUSION: In our group of patients, patients suffering from MS had significantly more IJV morphological changes and haemodynamic abnormalities when compared with healthy individuals not suffering from MS. These findings can be well demonstrated by non-invasive and cost-effective Doppler ultrasound.

Insgesamt können 144 (!) Publikationen aus dem Zeitraum 2006 bis Dezember 2011 nachgewiesen werden.

Medizinische Studien

Siddiqui A, Levy E and Hopkins LN: Prospective Randomized Endovascular therapy in Multiple Sclerosis (PREMiSe)

University at Buffalo Neurosurgery (UBNS). Source: UB, prweb.com, CTV

Italian MS Foundation (FISM): Epidemiological study to confirm and extend Dr. Zamboni’s findings by evaluating the prevalence of CCSVI in healthy controls, MS and other neurodegenerative diseases

Source: msif.org, Italian MS Foundation (FISM)

Zivadinov R: Controlled Randomized EndovaScular Therapy (CRET) study for CCSVI

Sources: mastersofms.com, BNAC newsletter.

Buffalo Neuroimaging Analysis Center (BNAC), University of Buffalo, The State University of New York

Canadian Institute for Health Research (CIHR): Randomized, blinded clinical trial on the effect of this therapeutic approach (CCSVI)

CTV Winnipeg, Canadian Institute for Health Research (CIHR)

Wolinsky J: CCSVI and its relationship to MS

University of Texas Health Science Center at Houston, USA.

Traboulsee A, Knox K, Li DKB, Machan L, Rauscher A, MacKay A, Illes J, Voll C, Wiebe S, Szkup P, Kelly M: Investigation into Venous Insufficiency in Multiple Sclerosis

MS clinic in Saskatoon, Saskatchewan, Canada.

Torres C, Cameron IG, Hogan MJ, Schweitzer ME, Lum C, Bussière ME, Chakraborty S, Freedman MS: Chronic Cerebrospinal Venous Insufficiency in relation to Multiple Sclerosis

The Ottawa Hospital, University of Ottawa, Ontario, Canada.

Fox RJ: A Multi-Modal Assessment of Chronic Cerebrospinal Venous Insufficiency

Dr. Robert Fox Cleveland Clinic, Cleveland, USA.

Field A: Study of CCSVI in MS using quantitative time-resolved 3D MRV

University of Wisconsin School of Medicine and Public Health, Madison, USA.

Costello F, Goyal M, Frayne R, Mah JK, Davenport J, Scott J: Determining the relationship between chronic cerebrospinal venous insufficiency (CCSVI) and multiple sclerosis (MS)

Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.

Banwell B, Macgowan c, Laughlin S, Shroff M, Sled J, Yeung R, Benseler S, Traubici J, Moharir M, Arnold D, Narayanan S, Bar-Or A,Marrie RA: Cerebral Venous Hemodynamics in Pediatric Multiple Sclerosis

The Hospital for Sick Children, Toronto, Ontario, Canada.

Zamboni P: Randomised controlled CCSVI treatment trial

(medpage interview at 2:15), Italy

Dake M: CCSVI Study

Stanford University.

Tornatore C, Neville R: CCSVI treatment study

Georgetown University Hospital.

Sinan T, Al Khashan S, Safar H, Almuzaini AA, Bin naki AM, Al bader M, Bahzad M: CCSVI study Kuwait

ccsvikuwait.com. Study description, Introduction; Mubarak Hospital and other Hospitals of Kuwait

Hubbard D: The fMRI BOLD Response in MS, Support for the CCSVI Hypothesis

Hubbard Foundation for fMRI Research.

Mehta M: Liberation Study - 500 person

clinicaltrials.gov: NCT01089686. Study to evaluate treating chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis patients. v-aware Vol. 2, Issue 1, March 2010, p18: Announcement. The Vascular Group, PLLC, Albany NY, USA.

Rodger I, Haacke EM: St. Joe's MS study - 100 person and 100 controls

St. Joseph's Healthcare, Canada.

Zamboni P, Galeotti R, Weinstock-Guttman B, Cutter G, Menegatti E, Malagoni AM, Bartolomei I, Cox JL, Salvi F, and Zivadinov R: Endovascular Treatment for Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis: A Longitudinal, Magnetic Resonance Imaging, Blinded Pilot Study. - 16 person

J Vasc Surg. 2010 Mar;51(3):794. doi:10.1016/j.jvs.2009.11.022.

University of Ferrara, Ferrara, Italy; NY State University in Buffalo, Buffalo, NY

Buffalo Neuroimaging Analysis Center (BNAC), New York State University (SUNY), Buffalo: Combined Transcranial and Extracranial Venous Doppler evaluation in multiple sclerosis and related diseases (CTEVD study). - 1700 person

CTEVD press release, TV news, WBFO Public Radio, Buffalo News, CTEVD Study Enrollment, Newsletter Vol 1 Issue 1, 4 Feb 2010 (PDF), Press release Feb 9, 2010