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The missing link for MS? Expert's perspective on chronic cerebrospinal venous insufficiency cure

15 December 2009 - Philadelphia Multiple Sclerosis Examiner

There's been much excitement in the MS community since Dr Paolo Zamboni, the Director of the Vascular Disease Center at the University of Ferrara in Milan, Italy presented his research findings on the effect of blood flow, iron storage and inflammation in people with MS at the 25th Congress of the European Committee for Treatment and Research in MS (ECTRIMS) in September, 2009.

In November, the National MS Examiner reviewed how researchers around the world were reacting positively to Dr Zamboni's surgery on 65 MS patients. Performing an experimental angioplasty procedure called Chronic Cerebrospinal Venous Insufficiency Surgery (CCSVI) (see video below), Dr Zamboni attempts to improve blood flow from the brain to the heart and, by so doing, reduce iron deposits and damage in the brain. This is significant because people with MS, as with other neurodegenerative disorders, have higher deposits of iron. Dr Zamboni believes that iron builds up in the brain and damages blood vessels that then allow iron and immune cells to cross the blood brain barrier and begin to attack mylein coverings of nerve cells and MS develops. Since Dr Zamboni views MS not as an autoimmune condition, but as a vascular disease process, he has promoted a new and creative way of possibly treating MS.

The MS community and internet have been buzzing with inquiries as to how CCSVI may help, cure or become available. In an effort to clarify all the hype and gain an informed perspective, Dr Jack Burks, Neurologist, Chief Medical Officer of the Multiple Sclerosis Association of America (MSAA),and Program Director at Holy Name Hospital's Comprehensive MS Center in Teaneck, NJ and Susan Courtney, science writer at the MSAA, published an article on the MSAA website on December 11, 2009. Dr Burks offerred the following insights to the Philadelphia MS Examiner as well on Dr Zamboni's study and findings.

"Out of the box" treatment

Dr Burks confirms that Dr Zamboni's efforts are encouraging because he attempts to 'think out of the box' and has gained some positive, though mixed, results in his pilot study. Dr Zamboni is considered to be a leader in CCSVI research. Dr Burks explains that the CCSVI experimental treatment focuses on the following concepts:

  • the primary problem in MS is blockage in veins that deliver blood from the brain to the heart
  • this causes backflow or reflux of blood back into the brain
  • then iron deposits and active immune cells enter the brain and cause damage seen in MS.

Dr Zamboni believes that by opening up blocked veins, through an angioplasty procedure, the blood will flow normally from the brain and MS damage will cease. This hypothesis challenges the widely held belief that MS is caused directly by the immune system. Dr Zamboni published his results on 65 MS patients who underwent his vein opening angioplaty procedure in The Journal of Vascular Surgery in December 2009.

A note of caution

Dr Burks reminds us that Dr Zamboni's study is "promising but highly preliminary" and that Dr Zamboni is "not encouraging patients to rush out and have this procedure". Dr Burks advises that "this procedure not be considered a treatment for MS at this time". 50% of the MS patients in the study had relapses after the surgery and about 50% of one of the large veins that were opened by the procedure collapsed again, with the highest level of re blockages occurring at 8 -9 months after the original procedure. And, as with most MS research, this study raises more questions than it answers. Dr Burks recommends that those with MS wait before considering this procedure, unless in a clinical trial, until the scientific questions are answered through more research. Currently, CCSVI with iron overload is considered to be one of many theories that may address the underlying cause and treatment for MS.

A note of hope

Dr Burks suggests that Dr Zamboni's research efforts represent a step forward and that further rigorous, clinical trials are needed to confirm his findings that utilize control groups. At this time, a larger, follow-up study is being conducted by The University of Buffalo in New York to test Dr Zamboni's findings. Another CCSVI pilot study is heavily underway as well by Dr Dake of Stanford University's School of Medicine.

Author: Philadelphia Multiple Sclerosis Examiner

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