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CCSVI (Chronic cerebro-spinal venous insufficiency)
Chronic cerebro-spinal venous insufficiency (CCSVI) is a theory on the cause of multiple
sclerosis symptoms and possibly of MS itself that was first published in April 2009.
The theory was developed by Paolo Zamboni, a vascular surgeon at the University of
Ferrara in Italy. His theory is that stenosis (an abnormal narrowing or obstruction)
in blood vessels that take blood from the brain causes a build up of iron. This is
then able to cross the blood-brain barrier and cause inflammation and damage to cells
in the central nervous system.
Venous related problems and MS theories are not recent, they have been considered since 1863. History
Research
A small study was published in April 2009 this found that CCSVI occurred in more than 90% of the 65 people with different types of MS, but not within the control group of both healthy people and others with other neurological conditions.
Preliminary results from a study at the University of Buffalo were made available
in February 2010. The first phase of this study scanned 500 people - 280 people with
MS, plus people with clinically isolated syndrome (CIS) and other neurological diseases,
and 161 healthy controls. The Buffalo study reported that the level of CCSVI amongst
people with MS was 56.4% but also 22.4% in the healthy control."
A further phase involving another 500 people is planned and the full results from the first phase will be reported at the American Academy of Neurology meeting in April. Dr Robert Zivadinov, the principal investigator on the study, said, "The data show that narrowing of the extracranial veins, at the very least, is an important association in multiple sclerosis." He also noted that the finding that 22.4 percent of healthy controls also met two CCSVI criteria requires continuing investigation.
Treatment
Prof Zamboni has proposed that the blockage in blood vessels can be removed with surgery, sometimes called the 'liberation procedure'. A paper published by him in December 2009 reports that amongst 35 people with relapsing remitting MS, 50% had no relapses in the year following surgery, compared to 27% in the period before undergoing the procedure.
Note - Participants remained on disease modifying treatments during this period.
Results from 30 people with progressive forms of MS showed no significant change in assessments of cognitive and motor function using the Multiple Sclerosis Functional Composite scale. In February 2010, the journal Annals of Neurology reported that treatment at Stanford Medical Centre had been suspended after two people who had undergone stenting of the jugular veins developed serious complications.
Further studies
At a meeting in Canada in February 2010, Prof Zamboni reiterated that he doesn't suggest that blockages are the only cause of multiple sclerosis and he called for more rigorous testing of his work. Further studies of CCSVI and MS are planned. Reports from some of the people who have had the procedure suggest that it may not permanently cure the blockage and that the condition can reoccur.
Zamboni P, et al. Chronic cerebrospinal venous insufficiency in patients with multiple
sclerosis. Journal of Neurology, Neurosurgery & Psychiatry 2009;80(4):392-399. Abstract
(Pub Med)
First blinded study of venous insufficiency prevalence in MS shows promising results.
University of Buffalo press release - 10 February 2010.
UB News Centre
Zamboni et al. A prospective open-label study of endovascular treatment of chronic
cerebrospinal venous insufficiency. journal of Vascular Surgery 2009;50:1348-1358.
Abstract (Pub Med)
Chronic Cerebrospinal Venous Insufficiency - (CCSVI)
A chronic (ongoing) problem where blood from the brain and spine has trouble getting back to the heart. It’s caused by stenosis (a narrowing) in the veins that drain the spine and brain. Blood takes longer to get back to the heart, and it can reflux back into the brain and spine or cause oedema and leakage of red blood cells and fluids into the delicate tissue of the brain and spine.
Blood that stays in the brain too long creates ‘slowed perfusion’ -
The hypothesis of the relation between Chronic cerebrospinal venous insufficiency
(CCSVI) and multiple sclerosis (MS). The pattern of CCSVI was described by Prof.
Zamboni. csvi-
CCSVI is a condition called "Chronic Cerebrospinal Venous Insufficiency" and was discovered by Dr. Paolo Zamboni, a vascular surgeon at the University of Ferrara in Italy. It refers to a narrowing or blockage of the primary veins draining blood from the brain to the heart. These include the jugular veins, veins along the spinal column and the azygos vein in the upper chest.
This narrowing restricts the normal outflow of blood from the brain. As a result, the blood often ‘refluxes’ that is: it flows backwards into the brain. Some think the resulting flow and building pressure pushes blood into the tissue around vessels in the brain, resulting in toxic iron deposits that some believe may trigger inflammation, injury to brain tissue and cell death.
Dr. Zamboni has used doppler ultrasound to scan the heads and necks of over 500 MS patients and found the blocked, narrowed and sometimes missing veins of CCSVI in almost 100 per cent of them.
What role does iron play in MS?
Iron is dangerous to the brain because it produces free radicals which kill brain cells.
Prof. Mark Haacke, the director of the Magnetic Resonance Imaging Institute for Biomedical Research at Wayne State University in Detroit, is also conducting his own study. He's a physicist who also works at McMaster University in Hamilton, who has invented a novel tool used to analyze MRI scans of the brain called SWI, "susceptibility weighted imaging system." SWI is highly sensitive to the presence of substances such as iron and is considered one of the most sophisticated and advanced system for the diagnosis of MS.
Prof. Haacke is a physicist; his interest is confirming Dr. Zamboni's theory. He does not treat patients. Haacke's team can be contacted at info.mrimaging@gmail.com
Dr. Zamboni's team at the University of Ferrara and the Santa Anna Hospital in Ferrara can be contacted at centroilbene@gmail.com
.
Dr. Paolo Zamboni Papers
- Iron-
dependent inflammation in venous disease and proposed parallels in multiple sclerosis - jrsm.rsmjournals.com - Intracranial Venous Haemodynamics in Multiple Sclerosis -
bentham.org/pdf - Doppler Haemodynamics of Cerebral Venous Return -
bentham.org/pdf - The value of cerebral Doppler venous haemodynamics in the assessment of multiple
sclerosis -
sciencedirect.com - Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis -
jnnp.bmj.com - "Rationale and preliminary results of endovascular treatment of multiple sclerosis,
the liberation procedure", 2009
in "1978-2009 - 31 years- Vascular and Endovascular Controversies Update" 31° International Symposium - CX Charing Cross, pp. 71- 79 www.fondazionehilarescere.org/PDF - Endovascular treatment for multiple sclerosis -
www.cxvascular.com - Venous Collateral Circulation of the Extracranial Cerebrospinal Outflow Routes -
www.ingentaconnect.com - Anomalous venous blood flow and iron deposition in multiple sclerosis -
www.naturMS Society of Canada announces request for research operating grants related to CCSVI and MS
- Stenting -
an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease- induced, localised flow constriction - Angioplasty -
the technique of mechanically widening a narrowed or obstructed blood vessel. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure opening up the blood vessel to improved flow, the balloon is then collapsed and withdrawn.
MS Group
Healthy Group
56.4 % CCSVI
22.4 % CCSVI