Apollo Hospitals
in India
Liberation Treatment - CCSVI
Introduction
The compromised and inefficient blood in the cervical and thoracic veins flowing from the central nervous system (CNS) to the heart denotes Chronic cerebro-spinal venous insufficiency (CCSVI). This is a syndrome that is a result of insufficient venous blood and ultimately results to multiple sclerosis abns various other types of brain dysfunction.
During the syndrome, the blood flow comprises of reduced and erratically reversed flow velocities. It also involves altercation in changed brain dynamics, related to stenosis of the jugular and azygos veins. The particular scenario was vividly described by Paolo Zamboni in the year 2008. He was the one who also mentioned the association of CCSVI with multiple sclerosis (MS). This hypothesis was received with a lot of optimism from the patients’ point of view. It also helped in more treatment options for multiple sclerosis. However, the hypothesis also faced cynicism in the medical community along with supportive researches by some institutions.
History
Paolo Zamboni was one main defenders of the syndrome’s relationship with multiple sclerosis. Described by Paolo Zamboni in 2008, the CCSVI reflects high sensitivity and specificity that actually distinguishes healthy individuals from those suffering from multiple sclerosis. The description was followed by small open-label study. This study helped in reflecting the good effects of angioplasty in treating MS patients with CCSVI. Bologna in Italy played host to the first ever international symposium in 2009. The International Union of Phlebology concluded Venous stenosis due to developmental abnormalities as the main cause of CCSVI. However, during 2010, relationships between MS and CCSVI revealed conflicting results as the relationship was evaluated.
Symptoms and consequences
There are various symptoms and consequences of this syndrome. Delayed perfusion, hypoxia, iron deposits around the cerebral veins and reduced drainage of the catabolites and increased transmural pressure are some of the possible consequences of the syndrome.
Pathophysiology
Catheterization of the azygous and IJV veins of the When MS patients diagnosed with CCSVI in Zamboni’s studies reveled further facts. According to the author, it revealed that in most of the cases the veins were stenosed. However, lack of proper evidence did not allow the study to gain reliability.
Zamboni and colleagues further revealed that the malformed blood vessels were actually resulting to increased deposition of iron in the brain. That was ultimately igniting autoimmunity and degeneration of the nerve’s myelin sheath. Though iron deposition is a common case in various types of neuro logical disorders like Alzheimer’s disease or Parkinson’s disease but CCSVI not in the control group in neurological problems.
After the diagnosis, CCSVI was initially found to combine extracranial and transcranial doppler sonography. Moreover, there are five parameters of venous drainage denoted as the features of the syndrome. However, only two of them prove to be enough. Five parameters are as follows:
- Reverted postural control of the main cerebral venous outflow pathways.
- Reflux in the internal jugular and vertebral veins
- High-resolution B-mode evidence of stenosis of the internal jugular
- Reflux in the deep cerebral veins
- Flow in the internal jugular or vertebral veins that could not be detected with Doppler
There is also the Magnetic resonance venography which can be used for the diagnosis of CCSVI in MS patients but it has limited value. Moreover, as proposed it can only be used in combination with the other techniques. There have been a lot of differences in the initial article on CCSVI and the later one. According to the first article, healthy people don’t have abnormal venous function parameters. The Zamboni report raised suspicions as none of the healthy people met the parameters for a diagnosis of CCSVI while all patients did. It actually raised the suspicion of whether the diagnostic test carried efficient clinical conditions. It was the second study that revealed the original results in contrary to the other studies that revealed CCSVI to occur in 20% of MS patients.
Treatment
There was also a small pilot study which revealed an alternate way to treat MS patients. It revealed a way which makes use balloon angioplasty to treat MS patients, diagnosed of CCSVI and had their cerebral veins stenosed. The study also revealed a clinical benefit for the patient relapsing-remitting subtype. During the follow-up of the patients a very high rate of re-stenosis was revealed. However, the study failed to reach proper interpretation as there was lack of proper control group. Evaluators’ blindness also aggravated the problem. Other flaws were the small treated sample, and use of approved therapies for the disease among patients.
The authors of the pilot study also proposed use of stents might be a more feasible treatment as a result of high re-stenosing rates. By using stents, rare but serious adverse events have been reported. This has resulted to a number of US hospitals banning the surgical procedure except clinical trials.
Research directions
To reveal further relationships between CCSVI and MS, there is a larger study going at Buffalo Neuroimaging Analysis Center. It has also given press release that claims preliminary results supporting the link.
Further experiments are also on the cards as the Multiple Sclerosis Society of Canada has promised to provide further funds for experimental trials on the hypothesis. However, they have also made it clear to the patients not to make use of these until a conclusion is drawn.
Reception
The hypothesis is well received by great optimism from patients’ side on one side but also resulted to disbelief in some sections. The disbelief is a result of the limited data to support claims like the existence of syndrome efficacy of vascular treatments for the syndrome in preventing incidence of multiple sclerosis.
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