CCSVI and MS

The possibility of a connection between chronic cerebrospinal venous insufficiency and multiple sclerosis (CCSVI and MS) has sparked great interest among patients and healthcare providers alike. And it’s easy to see why—since the first description of MS in 1868 by a professor of neurology at the University of Paris, Jean-Martin Charcot, there remain more questions than answers about the underlying causes and proposed treatments for this disease. MS has long been poorly understood: In the 1940s, it was thought to be related to reduced circulation in the brain; in the 1960s, it was believed to be caused by unknown allergic reactions; and since the 1990s, MS has been described as an autoimmune disease, in which the body’s defense mechanisms (T cells) are inadvertently activated to attack the myelin sheath that surrounds and insulates nerves in the central nervous system.

Over the past 2 decades, much work has been done to try to answer questions regarding the possible viral infectious agents that could start this autoimmune process, the effect of target proteins within the myelin sheaths, and malfunctions in the blood-brain barrier that might allow substances from blood to escape into the brain and initiate the insult that possibly leads to MS. Recently, an Italian vascular surgeon, Paolo Zamboni, has tried to “connect the dots” in this elusive disease and has put forward the concept of CCSVI that might partly contribute to the development and progression of MS. Similar work was reported in 1970 that suggested central venous compression, thrombosis, and hypertension are associated with central nervous system myelopathies; unfortunately, that research went unnoticed.

Now, in 2010, MS affects more than 1 million patients worldwide, usually in the prime of their lives, and the associated healthcare burden is enormous. The difference between today and the MS evolution over the past several decades is that today’s advances in medicine are intimately connected to technological advancements and occur at a pace never witnessed before. Various medical specialists have the ability to exchange information and work productively, and our diagnostic and therapeutic abilities using duplex ultrasound, magnetic resonance angiography, and angiography are much simpler. There is a sense of urgency for patients that are suffering, and preliminary data point toward the validity of CCSVI’s role in MS.

So, where do we go from here? There is no cure for MS, and most therapy today is focused on immunosuppressive agents that blunt the immune system and have significant potential side effects. Preliminary reports on minimally invasive surgery using angioplasty of narrowed central internal jugular and azygous veins, as described by Dr. Zamboni, are encouraging.

All good research leads to more questions than answers, and for physicians and patients to evolve our understanding of the implications of CCSVI, in the near future, prospective and blinded randomized controlled trials will be vital in proving the efficacy of treating CCSVI in MS patients. This truly will be the beginning of a host of technologically advanced therapies that would target CCSVI in ways that we can only imagine today.

About the following videos:

Our own Dr. Manish Mehta presenting an overview of MS-CCSVI at the Albany Vascular Roundtable sponsored by the Center for Vascular Awareness on November 10, 2010.

Manish Mehta, MD, MPH - pt1

Manish Mehta, MD, MPH - pt2