Did you know, in 1937 it was first proposed that MS might be caused by venous obstruction?
Canadian neurosurgeon Bryce Weir, MD, recently wrote a review of the recent news surrounding chronic cerebrospinal venous insufficiency syndrome in the CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES, concluding " the possibility that venous reflux, reversal of flow, and venous hypertensionare the primary inciting causes of at least some forms of MS is currently a defensible hypothesis”.
Dr. Weir isa prestigious retired neurovascular surgeon who has been the head in Calgary (now Professor Emeritus at the University of Alberta) and at The University of Chicago (now Professor Emeritus at University of Calgary) where he has been the Chief of Neurosurgery and Director of the Brain Research Institute of the Pritzker School of Medicine. He retired from University of Calgary after being Vice-President of Medical Affairs.
Dr. Weir writes "From the earliest pathological studies the perivenular localization of the demyelination in multiple sclerosis (MS) has been observed. It has recently been suggested that obstructions to venous flow or inadequate venous valves in the great veins in the neck, thorax and abdomen can cause damaging backflow into the cerebral and spinal cord circulations. Paolo Zamboni and colleagues have demonstrated abnormal venous circulation in some multiple sclerosis patients using non-invasive sonography and invasive venography.
Furthermore, they have obtained apparent clinical improvement or stabilization by endovascular ballooning of points of obstruction in the great veins in some, at least temporarily.
If non-invasive observations by others validate their initial observations of a significantly increased prevalence of venous obstructions in MS then trials of angioplasty/stenting would be justified in selected cases in view of the biological plausibility of the concept.”
Blogger/columnist Dr. Flanagan, who calls himself “The Upright Doctor” has also posed potential connections between MS and Parkinson’s and Alzheimer’s in his latest post.
Upright doc points out that Chronic Cerebrospinal Venous Insufficiency (or CCSVI, as coined by vascular surgeon Dr. Paulo Zamboni of the University of Ferrara, Italy) nearly perfectly describes the thesis of a book he wrote based on twenty years of research.
As Flanagan notes, while the term CCSVI is new, the role of extra cranial venous drainage in contributing to neurodegenerative diseases is a topic he has been writing about for nearly 20 years; he illustrates this point quite literally, featuring an illustration of the brain’s venous drainage system on the cover of his most recent book. Flanagan’s research began more than twenty years ago with anthropological studies focused on Alzheimer’s.
Flanagan believes that the venous drainage problem lies not in the jugular veins (as Zamboni theorizes with his CCSVI in MS theory), but within the vertebral veins as they pass through the upper cervical spine and base of the skull, positing that the deformation and compression of the vertebral venous outlets is far more likely to cause CCSVI than venous stenosis in jugular routes.
These opinions are in sharp contrast to that of Dr. Freedman, publishingthe Paper Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosisinthe Annals of Neurology, expressing much more caution and skepticism, concluding that “ at present, invasive and potentially dangerous endovascular procedures as therapy for patients with MS should be discouraged until such studies have been completed, analyzed, and debated in the scientific arena. ”
Freedman notes that there is the possibility that the development of venous flow abnormalities may be secondary to other disease processes in MS, questioning that the correlation of CCSVI with the well-established clinical, immunologic, histopathologic, and imaging features of MS needs to be further investigated – a caution the MS patient community has expressed impatience with, given the large body of clinical and anecdotal evidence available.
The treament of CCSVI through interventional venoplasty wil llikely continue even as the neurosurgeons make their arguments. As more patients seekt he treatment, more providers are stepping forward to provide the diagnostic imaging testing for diagnosis.
The treamtent, cautions Dr. Jorge Luna, Stanford trained interventional cardiologist at Hospital Angeles, should always be performed in a full-service hospital with an on-site, up-to-date cath lab, and in the presence of a multidisciplinary team inclulding an interventional neurologist and a interventional readiologist trained in the protocol.
http://www.wellsphere.com/multiple-sclerosis-ms-article/ccsvi-a-canadian-neurosurgeon-weighs-in/1298478