1. Recent Progress in Brain Recovery Dr. Bill Code, MD, FRCPC Director, Medical Research National CCSVI Society www.nationalccsvisociety.org 1

2. Bill Code No financial disclosures 2

3. Veins Affected Internal jugular veins –80% have valve problems Azygos vein –70% have valve problems in azygos arch Remainder of azygos and hemiazygos may need stent 3

4. Why Treat CCSVI? All about circulation To assist recovery For symptom control 4

5. Hypoperfusion Reduced blood flow –Arterial –Venous (CCSVI) Diminished supply –Oxygen –Nutrients 5

6. What symptoms may improve? 1.Fatigue 2.Headaches 3.Brain fog 4.Autonomic Control –Temperature –Bladder –Bowel 5.Muscle Spasticity 6.Balance 7.Sleep Disturbance 6

7. Potential Causes of Hypoperfusion Anatomy Low blood pressure Stroke Thickened blood (hypercoagulation) 7

8. Treatment Options of CCSVI Anatomy Venous angioplasty Selective chiropractic treatment Dental Assessment Thrombosis prevention Anticoagulation Metabolic Intervention Diet Metals Medication 8

9. Prevention of Restenosis Anti-coagulation Anti-inflammatory supplements pre- and post Nitric oxide enhancement –Lifestyle (exercise, yoga, stop smoking.) –Special enzymes (bromelain) –Magnesium 9

10. Causes of Thickened Blood or Narrowed Veins Genetic Infection triggers –Viruses –Bacteria Heavy Metals Diet Chemicals Trauma 10

11. Diagnosis of Thick Blood Careful history Miscarriages, DVT, pulmonary embolus Rule out Hughes ie Anticardiolipin Syndrome or other disorder Lab tests ISAC (Immune System Activation of Coagulation) 11

12. Treatment of Thick Blood Dibigatron (Pradaxa) or Rivaroxaban (Xarelto) Warfarin Heparin Lumbrokinase (Boluoke) Not Clopidogrel (Plavix) 12

13. When should I go for CCSVI treatment? Sooner is better: –Prevent further brain injury and best recovery –Reduced risk of dementia –Some brain injury may not be reversible 13

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15. Anatomy Considerations: 1. C-6, venous angioplasty 2. C-1,C-2 - arteries -veins - Cerebrospinal Fluid ie CSF, flow 3. Atlas Adjustment eg NUCCA 4. Neurosurgery of artery 5. Craniosacral Therapy 6. Vitamin D 7. Diet 15

16. Evaluation of Anatomic Issues: 1.Cardiac Gated MRI, flow 2. Upright MRI 3. Heart Rate Variability 16

17. Reduced Perfusion, Ischemia and Hypoxia in MS MRI best to study perfusion. Meng Law and others shows there is reduced perfusion as a function of severity of disease. Decreased CBF and prolonged MTT in white matter near lateral ventricles in MS patients. Source: Law, M. Radiology. 2004, Jun; 231: 645-652 17

18. Omega-3s and the Brain Improves synaptic fluidity Promotes nerve growth and repair Improve cognition Limits tau entanglements Source: Gu, Y. Neurology 2012, May 2 18

19. Other Considerations 1. Birth, in womb or life traumas 2. Skull asymmetry or cosmetic interventions, including dental 3. Infections - Epstein Barr Virus - Lyme ie Borrelia burgdorferi - Chlamydia pneumoniae 4. Mast Cell Activation Syndrome 5. Dysautonomia 19

20. LDN for Neurodegenerative Disease MS ALS Parkinson’s Transverse myelitis Alzheimer’s For mechanism, refer to: 20 Brown N., Medical Hypotheses. 2009 Mar; 72(3): 333-7

21. LDN and PPMS M. Gironi, Milan Italy 40 patients Reduced spasticity Neurologic progression in only one Beta endorphins increased 21 Gironi M., Multiple Sclerosis. 2008 Sep; 14(8): 1076-83

22. LDN for Crohn’s Disease First published clinical study Dr. Jill Smith of Pennsylvania State 2/3 in remission 89% improved to some degree 22 Smith JP, American Journal of Gastroenterology 2007; 102:1-9 Smith JP, Dig. Dis & Sciences 2012 March

23. LDN and MS Bruce Cree MD at UCSF LSN and Quality of Life improved –Mental Health –Pain –Perceived Deficits 23 Cree B, Annals of Neurology 2010;

24. Recent Progress in Brain Recovery Dr. Bill Code, MD, FRCPC Director, Medical Research National CCSVI Society www.nationalccsvisociety.org 24