Could MS be caused by narrowing of veins that drain blood from the brain and spinal cord? This novel but unproven idea has gained much attention over the past two years via news reports and multiple website postings. The blood vessel abnormalities are reported to lead to a condition called chronic cerebrospinal venous insufficiency or CCSVI. It has also been suggested that MS could be treated by correcting the blood vessel narrowing by dilating the veins and inserting small, expandable tubes called stents to keep them open. This proposed treatment has been referred to as the “liberation treatment.”
Is CCSVI a Real Breakthrough and Should People with MS Be Undergoing the “Liberation Treatment”?
The excitement about CCSVI has largely arisen by reports coming from Dr. Paulo Zamboni and colleagues at the University of Ferrara in Italy. Using sound waves (doppler ultrasound) to assess blood flow through veins, Dr. Zamboni studied 65 people with MS and compared them with 235 people who did not have MS. They found that 100% of the people with MS had blood vessel flow abnormalities while none of the people without MS had this pattern of abnormalities.
Dr. Zamboni dilated the blood vessels of the 65 people with MS using angioplasty, a procedure that opens blocked or narrowed blood vessels. Some of the people seemed to improve while others did not. Subsequently, Dr. Robert Zivadinov and colleagues at the University of Buffalo have claimed in news releases to have replicated Dr. Zamboni’s findings, although they report only 50% of people with MS have abnormalities compared with 25% of people without MS. Other physicians have begun treating people with MS with dilatation of blood vessels.
While there is understandable excitement about CCSVI, much more research needs to be done.First, Dr. Zamboni’s observations need to be repeated by other researchers. If CCSVI is associated with MS, then other researchers should be able to find the same abnormalities. Second, if there are blood vessel abnormalities associated with MS, this does not prove that they cause MS. It could be the other way around. The inflammation seen in the brain and spinal cord of people with MS could be causing the blood vessel abnormalities. If so, treating the blood vessels may have no effect on MS. Third, the “liberation treatment” carries significant risks; there has already been one person with MS who underwent blood vessel dilatation who died as a complication of the procedure. No one should be treating people with MS with this procedure outside the setting of an approved research study.
This is an exciting, intriguing notion that has not yet gone through the usual steps that a pharmaceutical agent does before being implemented in practice. There are legitimate concerns that people could be harmed undergoing testing and procedures while we wait for answers. The United States and Canadian MS Societies will start funding research on CCSVI this year. Several research groups are trying to repeat the findings of Dr. Zamboni. We will know within a couple of years whether CCSVI is really a breakthrough. Until then, unless enrolled in an approved research study, people with MS should not be undergoing the “liberation treatment.”
Dennis Bourdette, MD - Portland VAMC