The theory that there is association between narrowing of arteries draining blood from the brain was discussed during the recent ECTRIMS
meeting in Sweden. ECTRIMS (European Committee for Treatment and

Research in Multiple Sclerosis) is the largest annual international

conference devoted to basic and clinical research in multiple sclerosis.

A symposium on CCSVI attracted delegates from around the world,

including Paolo Zamboni who proposed the theory, and represented a wide

range of views.

The range of the discussion demonstrated the range of opinions on this subject held by researchers and also the difficulties in addressing
a new area of research. The scientific debate covered fundamental

issues such as the definition and detection of CCSVI, disagreements in

the interpretation of research results and the nature of the association

between CCSVI and MS.

Dr Robert Zivadinov of the University of Buffalo reported on research that showed a higher prevalence of CCSVI amongst people with secondary
progressive as opposed to relapsing remitting MS. He said, "Our

findings point against CCSVI having a primary causative role in the

development of MS. We are showing that CCSVI is connected to the

progression of disease, but whether it is a cause of the progression or a

consequence, we don't know at this time."

The symposium also discussed surgery to correct CCSVI. With some
dissenters, the general feeling was that with the current level of

understanding, surgery should only be conducted within the scope of

legitimate clinical studies. Speaking to Medscape Medical News, Dr

Zamboni expressed concerns about treatment being offered outside

research, saying he wants, "a rigorous randomized controlled trial in

order to rapidly understand the value of the angioplasty in MS

treatment, rather [than] perform treatments on patients out of any

scientific and ethical control... It is unethical to charge for an

experimental procedure."

These concerns reflect stories in the Canadian press of people experiencing complications from one form of treatment involving the
insertion of stents (small, mesh tubes) to keep affected veins open.

Although generally considered safe, there have been reports of blood

clots forming around the stent and in October one man died in a Costa

Rican clinic following attempts to dissolve the clot.

Discussing the sometimes heated disagreements on the internet and in the popular press about the theory and access to treatment, Dr Zamboni
said "I'm really determined to root this in science, or at least do my

best."

The National Multiple Sclerosis Society in America and the Canadian MS Society have made grants available for research looking into
prevalence and detection of CCSVI and the University of Buffalo is

conducting a trial of vascular surgery.

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