Chronic Cerebrospinal Venous Insufficiency (CCSVI) and MS
This Research Update would not be complete without mentioning the possible connection between chronic cerebrospinal venous insufficiency (CCSVI) and multiple sclerosis (MS). CCSVI is a complex condition involving changes in blood flow, which some researchers theorize could possibly lead to the activation of the immune system, excess iron deposits, loss of myelin, and other nervous system damage. With CCSVI, the veins located on the outside of the brain - those designed to transport blood from the brain back to the heart - collapse and/or become blocked, a condition known as stenosis.
Paolo Zamboni, MD from the University of Ferrara in Milan, Italy conducted some of the first studies with MS patients and CCSVI. He tested both healthy controls as well as 65 MS patients, and in April 2009, reported that all of the individuals with MS had CCSVI, versus none of the controls. More recent studies conducted by other researchers have not duplicated these results, but different diagnostic procedures could potentially affect the outcome. Zamboni also studied the effects of using an angioplasty type of procedure on these 65 individuals with MS, in an attempt to correct the CCSVI. For those whose veins did not close back up (restenosis), the results - in terms of reduced brain lesions and reduced relapses - were favorable.
On June 30, 2010, the University at Buffalo announced the PREMiSe (Prospective Randomized Endovascular therapy in Multiple Sclerosis) study to evaluate balloon angioplasty with CCSVI and its effects on MS. For more information, readers may visit www.buffalo.edu and search for CCSVI. Although the PREMiSe study is no longer recruiting participants, two other studies in Albany, New York may still be recruiting. For more information, visit www.clinicaltrials.gov and search for CCSVI.
While many CCSVI research proposals are presently under consideration, a number of individuals with MS have decided not to wait. Unfortunately, having the procedure performed outside of a clinical trial does pose risks and some adverse events have occurred. Larger and more rigorous studies are needed to confirm: (1) if CCSVI is involved with MS; (2) if the procedure to open these blood vessels is safe; (3) how to best perform the procedure; and (4) if the procedure will have a positive effect on MS-disease activity.
The opinion of many neurologists - including Dr. Zamboni - is that individuals with MS are strongly advised to either participate in a trial or wait until such studies are complete and the results are published before having the procedure performed. This will ensure greater safety and enable patients to make a more informed decision prior to undergoing this invasive treatment.
|Last Updated on Monday, 25 March 2013 12:31|