Multiple Sclerosis Experts Question Vein Disorder Theory

British medical experts are questioning a new theory put forward by Italian vascular surgeon Dr. Paolo Zamboni that multiple sclerosis (MS) was caused by blocked veins in the neck or chest.

Dr. Zamboni’s theory centres around the repeated references in research text books to deposits of iron in the blood vessels and a link to MS.

Excess deposits of the heavy metal have been proven to lead to inflammation and cell death in the laboratory. These are both characteristics of MS.

Using ultrasound to examine the vessels leading in and out of the brain, he said he had tested his theory in people and found that in a majority, including his spouse who he also experimented upon, the veins draining blood from the brain were malformed or blocked. In people without MS, they were not.

He further suggested that iron was damaging the blood vessels and allowing the heavy metal, along with other unwelcome cells, to cross the crucial brain-blood barrier, a process termed Chronic Cerebrospinal Venous Insufficiency (CCSVI).

He said he had devised an experimental procedure that involved removing the blockage in the veins that carry blood to and from the brain.

So far, he has performed the angioplasty-like surgery, known as "la liberation" in Italian, on 120 MS patients, including his wife, whose multiple sclerosis provoked his interest in tackling the disease.

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His findings were published in the Journal of Vascular Surgery and scientists at the University of Buffalo in New York announced they would test his theory by recruiting for a large study.

However, British experts sound skeptical. Research Communications Officer at the MS Society, Dr Susan Kohlhaas, said: "Several medical advisers to the MS Society have read through the papers published by Dr Zamboni, and have heard him lecture on the subject.

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"They are not convinced by the evidence that blockages to draining veins from the brain are specific to people with MS, or that this explains the cause of MS at any stage of the condition."

Dr Zamboni's most recently published work examined CCSVI in 65 people and suggested that 50 per cent of people with relapsing remitting MS were relapse-free for 18 months.

Among the control group of MS patients who did not undergo the procedure, Zamboni found that only 27 per cent went 18 months without a relapse. There was no published benefit for people with progressive forms of the condition.

Participants with relapsing remitting MS, however, were allowed to continue receiving their usual form of treatment, so it is inconclusive whether any reduction in relapse rate was due to the CCSVI procedure.

Importantly, the result of the procedure was measured using different MRI scanning machines and at different times, meaning the data is inconsistent and not a useful measure.

Professor Alastair Compston, Head of the Department of Clinical Neurosciences at the University of Cambridge, is one of the six medical advisors of the MS Society, UK.

He said: "The treatment for CCSVI is not available for patients with multiple sclerosis in the United Kingdom because there is no convincing evidence to suggest that it is safe or beneficial to people with MS.

"People with MS are unlikely to benefit from treatments that dilate blood vessels."

Dr Susan Kohlhaas stressed, “The MS Society supports evidence-based information concerning MS and welcomes new avenues of research into the causes and possible treatments.

“More research is needed to pin down any relationship between CCSVI and MS and in that respect we welcome the trial currently recruiting in New York.”



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