Multiple Sclerosis

Multiple sclerosis (MS) is a condition affecting the central nervous system. Many people believe it to be caused by an immune system attack on the body’s myelin (the insulating cover over the nerves). When areas of myelin are damaged, the delicate nerve fibers are exposed. Like a frayed electrical cord, the nerves in the affected area can “short-circuit,” disrupting the flow of nerve signals to/from the brain. In some cases, thick scar tissue can build along the damaged sections of myelin.

Symptoms of MS vary greatly from one person to another. Some of the most common signs include: fatigue, vision problems, dizziness, numbness/tingling, weakness, tremor, pain, memory problems, slurred speech and bladder/bowel dysfunction.

The Multiple Sclerosis Association of America estimates 400,000 Americans have been diagnosed with MS and 10,000 new cases are diagnosed each year. Women are affected three times more often than men.

MS Types

There are four main types of MS. The most common form is relapsing-remitting MS, accounting for 80 to 85 percent of new cases. These patients experience flare-ups (exacerbations or relapses) of symptoms followed by complete or partial recovery (remission) and no further progression of the disease.

Secondary-progressive MS occurs in people initially diagnosed with the relapsing-remitting form. Symptoms become progressively worse and the patient may or may not have any distinct relapses. The Multiple Sclerosis Association of America estimates about 90 percent of patients with relapsing-remitting MS eventually develop secondary-progressive MS.

Primary-progressive MS is characterized by a steady, but gradual worsening of symptoms from the onset of the disease. Patients do not have any distinct periods of relapse or remission. About 10 percent of MS patients have the primary-progressive type.

Progressive-relapsing MS is the rarest form of the MS, accounting for only about 10 percent of cases. Patients have acute relapses, as well as a progressive worsening of symptoms between the relapses.

A Blood Vessel Problem?

In 2009, an Italian researcher, Paolo Zamboni, reported that some patients with MS also have a vein circulation problem, called chronic cerebrospinal venous insufficiency (CCSVI). In this condition, the veins carrying deoxygenated blood from the brain are either blocked or have collapsed. The venous blood is forced to re-route through smaller veins, which aren’t capable of handling the overflow. Venous blood flow not only slows, but backs up. Zamboni theorizes this clogging in the veins causes a build-up of iron in the surrounding tissues and may activate the immune system, leading to myelin destruction.

Three main veins have been implicated in CCSVI – the two internal jugular veins (one on each side of the neck) and the azygous vein in the chest. Investigators have theorized that if CCSVI is linked to MS, then opening these blocked veins may reduce MS symptoms.

Doctors at the University of Maryland School of Medicine in Baltimore, MD have used an interventional radiology procedure to test the CCSVI hypothesis. It’s an outpatient procedure that’s done using local anesthesia. First, patients are given MRIs and other sophisticated imaging scans to determine if a blockage really exists. If so, a thin catheter is fed through the circulatory system up to the target area of the vein. Then a balloon at the tip of the catheter is inflated. As the balloon expands, it opens the vein. When the balloon is deflated and the catheter is removed, blood flows more freely through the area. Interventional Radiologist Ziv Haskal, M.D., says if the procedure is successful, patients typically see some levels of immediate improvement in MS symptoms.

The CCSVI intervention for MS is very controversial. Most researchers believe MS to have a neurological basis. If MS is proven to be related to a circulatory problem, it takes the diagnosis and treatment down a completely different road with different kinds of specialists (interventional radiologists rather than neurologists). The surgery studies so far have been very small and the results don’t always last (because the veins can become blocked again). In addition, not all patients with MS are found to have CCSVI.

Many experts are discouraging the use of CCSVI intervention until larger studies are done to determine the ideal candidates and look at the risks and benefits of the treatment. A clinical trial is currently taking place in Albany, NY. Haskal hopes to eventually open his own clinical trial examining the benefits/risks of CCSVI intervention.

A clinical trial of chronic cerebrospinal venous insufficiency (CCSVI) treatment for multiple sclerosis is taking place in Albany, NY. For information, click here, then type the trial identification in the search box: NCT01089686.

For general information on multiple sclerosis:

Multiple Sclerosis Association of America
Multiple Sclerosis Foundation
National Institute of Neurological Disorders and Stroke
National Multiple Sclerosis Society


For information CCSVI, click here.
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