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Monday, October 29, 2012

CCSVI and Multiple Sclerosis


By 
WebMD Feature
Reviewed by Louise Chang, MD

People with a lifelong condition like multiple sclerosis (MS) are always on the lookout for a new treatment that might improve, or even cure, their disease. In the last few years, there's been a lot of buzz about a vein condition called CCSVI and its possible connection to MS.
However, this connection is very controversial. Some researchers say treating CCSVI can relieve MS symptoms. Others say CCSVI isn't even real. They compare it to the snake venom, bee stings, and other dubious "cures" that have been proposed to treat MS over the years.
So what is CCSVI? Could it be the next big breakthrough in MS research? Or is it just a false theory with a potentially dangerous treatment?


CCSVI Explained

CCSVI stands for chronic cerebrospinal venous insufficiency. It's a narrowing of veins in the neck and chest that carry blood away from the brain and spinal cord. The theory is that when blood flow is slowed, it backs up into the brain and spinal cord and leads to oxygen loss and iron deposits in the brain.
In 2009, Italian researcher Paolo Zamboni, MD, first introduced the idea that CCSVI might cause MS, or make its symptoms worse. When he used ultrasound to compare the blood vessels of people with and without MS, he found abnormal blood flow in 100% of the people with MS, but in 0% of people without MS.

Does CCSVI Really Exist?

Zamboni's findings sound impressive. But when other researchers have tried to copy his research, they haven't gotten the same results.
  • Some studies have found that CCSVI is more common in people with MS than in healthy people -- but not nearly as common as Zamboni found.
  • Other studies have reported CCSVI in almost exactly the same number of healthy people as in people with MS.
  • Some researchers have also found CCSVI in people with other nervous system conditions.
These differences in results raise questions about whether CCSVI is a real condition and how it relates to MS. "When something is true, it is replicated. This is how science works," says David A. Hafler, MD, chairman of the Yale School of Medicine department of neurology.
Why have researchers gotten such different results? One reason is that research teams use different criteria to evaluate CCSVI.
"The way the ultrasound is conducted is not yet standardized," says Robert Fox, MD, staff neurologist and medical director at the Cleveland Clinic Mellen Center for MS. "It's not like getting a blood count." He found that when people were examined with different types of scans, the number of CCSVI cases changed.
The difference in results could also have to do with something as basic as how much water study participants had to drink before their scans. "If you don't have a lot of volume in the veins they're going to collapse down," Fox says. When he had study participants drink Gatorade before their ultrasound, many of them no longer had signs of CCSVI. "Once you fill up the veins, you have much more blood flowing through them, and they're much more plump."
Even though researchers are still divided on whether CCSVI exists, some studies have started looking at the effects of treating it with surgery.


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