MULTIPLE SCLEROSIS AND  CCSVI

AT EXCEL MEDICAL CENTER IN TIJUANA, MEXICO

Multiple sclerosis (MS) is a neurodegenerative disorder that affects approximately 350,000 people in the United States with an estimated 2 to 2.5 million people worldwide, making it the most common non-traumatic cause of disability among young and middle-aged people in the developed world (Koch-Henriksen and Sorensen, 2010). The etiology of this disease is  complex with theories that implicate it’s genesis from auto-immune to inflammatory and somewhere in the middle lies a possible viral infection. Most recently Prof. Zamboni from Ferrara, Italy, has brought forth compelling reports proposing a LINK, between a recently defined entity named Chronic Cerebral Spinal Venous Insufficiency or CCSVI as the premier etiology of Multiple Sclerosis. Nonetheless, a unifying hypothesis has yet to be identified.

The concept behind CCSVI, stems from the extraordinary frequency of obstruction or narrowing to the distal segments of the veins draining the cerebral cortex as well as the veins that drain the spinal cord in some patients.

In order to understand the treatment concept of CCSVI, we’ll like to give a small summary of the anatomy involved in this disease:

The cerebro-spinal venous system is a large interconnected network of venous drainage that spans the length of the neuro-axis. The primary intracranial venous drainage can be simplistically divided into deep and superficial systems, while additional drainage occurs through emissary veins. The cortex or brain matter, drains through a series of veins that ultimately form a sort of a dam, called sinus, which in turn drains  into a lower level sinus that eventually drains into the Transverse Sinuses in both sides of the head.

From these sinuses, two outflow systems provide the majority of venous drainage out of the head; the Internal Jugular Veins ( IJV ) anteriorly right and left, and the vertebral venous system posteriorly (San Millan Ruiz et al., 2002). Each of the paired IJVs receives venous outflow from the transverse sinus,  terminating at the brachio-cephalic vein which is formed by the junction of the bilateral IJV and the Subclavian Vein ( which drain blood flow coming from the arms) on each side of the upper chest.

The other system is the posterior vertebral venous system which includes the internal and external vertebral venous plexuses. This system too, eventually drains as well into the brachio-cephallic system in the upper chest. Finally, there is communication between the vertebral venous system and the Azygous vein via the intercostal veins and other collaterals.

Now, the Azigous vein is a large conduit that is formed by the junction of the spinal veins in both sides of the lumbar spine. In it’s course receives the blood from most of the intercostal veins, which in turn, receive the blood from the spinal system, and this system,  drains the

spinal medulla. We like to point out that the Azigous system lies in the most posterior aspect of the thorax  and joins the Superior Vena cava immediately above the right side of the heart.

It is being said ( P. Zamboni 2009), that patients with obstruction of the Azigous vein are the ones that present Primary Progressive M S more frequently, apparently because the blood draining the spinal medulla is stagnant and consequently patients with this obstruction, develop more severe symptoms. 

So, after this narrative, we can understand what happens to patients that develop obstruction to the distal segments of the veins draining their brain. If the two major veins

anteriorly, the jugular veins are obstructed, then the blood flow from the anterior territory of the brain will become stagnant and will lead to congestion of the brain tissue, with  consequent elevation in the pressure inside these veins. This in turn, will force the draining blood in this system to look for other venous channels available, leading to reflux of blood into the posterior system or any other available channel;  so that ultimately this blood can end its voyage and return back to the heart where everything started to begin with. 

Now, once the brain becomes congested, the elevated pressure inside the small veins will transmit or contaminate this high pressure to the brain capillaries, breaking down the blood brain barrier that protects the brain tissue and separates the circulating blood from the brain cells, allowing blood products such as red blood cells and others, to leave the vascular space and come in contact with the brain tissue that lies around the small venules within the brain.

We must remember that the red cells have hemoglobin, and this is a combination of a protein and a molecule of Iron. So, once the red cell leaves the vascular space and comes in contact with the brain cells, its membrane looses it’s integrity and eventually degenerates. Once this takes place, it’s iron content concentrates around these venous capillaries and initiate an inflammatory process that leads to  plaque formation with a high content of iron, characteristic of M S, which has been found in the latest studies using MRI to be the possible culprit in the etiology of this disease( Iron and Neuro-degeneration, Michael Khalil, 2011).

This appears to be the mechanism that ultimately leads to degeneration of the myelin on the axons that communicate one cell to an other ( cell talk ) fragmenting the message between the brain center and the periphery, leading to the clinical expression of Multiple Sclerosis.

The above process is very reminiscent of what takes place in patients that suffer from varicose veins in the lower extremities. Take a perfectly normal pregnant woman, who during the last trimester of her pregnancy due to compression that the enlarging uterus exerts over the veins in back of the abdomen, the blood coming back from the veins in the lower extremities can not transit freely back to the heart, leading to congestion and swelling of the lower legs and the ankles. If there are repeated pregnancies and there is genetic predisposition for varicose veins, patients frequently will develop varicosities around the calves and if the stagnation of blood is sustained, a dark/bluish discoloration

around the ankles with some degree of swelling. This discoloration is caused by the iron that is deposited in the deeper layers of the skin. NO DIFFERENT THAN WHAT HAPPENS IN THE BRAIN.

PROPOSED TREATMENT FOR  CCSVI

In 2009, investigators studying M S patients ( Zamboni el al., 2009), found that a large density of patients with this disease had obstruction of the venous drainage of the brain, particularly, the distal segment of both yugular veins and in some patients the posterior circulation as well ( Azygous ). The initial studies where done with doppler and subsequently, confirmed by venous MRI. While, there has been controversy regarding these findings as being the cause of the disease, nonetheless, Dr. Zamboni’s group in Italy, initiated a program whereby once confirmed the narrowing in these vessel via angiography, decided to dilate these veins using the time honored balloon catheters or tubing’s ( angioplasty) , that have been in use for the treatment of blocked arteries, in particular the Coronary Arteries since 1977 ( Gruntzig, 1977).

As we understand it, the first patient to undergo such treatment, was Dr. Zamboni’s wife who had been afflicted with M S for years. The result was so dramatic, that from being severely disabled prior to the dilatation procedure, in the course of several days she regained all her lost faculties and as of this moment she appears to be very functional, with a reduction in the number and extent of the M S plaques on MRI.

The results of this treatment on Mrs. Zamboni was so dramatic that Dr. Zamboni coined the term Liberation Treatment ( L T ), since it liberated the patients from their neurological incarceration and since, a vast number of patients that have had this procedure, have returned to a normal life again. 

Once the news about this procedure were disseminated world wide, and in our constant effort to participate and deliver the best Medical Care available, Excel Medical Center in Tijuana, Mexico, initiated it’s program of CCSVI on June of 2010; first recruiting three top notch Interventional Cardiologist, trained in the best Universities in the USA and Certified by the American Board of Cardio-Vascular Diseases and Interventional Cardiology, with a vast experience in coronary interventions for more than 75 years combined. Additionally, these doctors practice on both sides of the border, San Diego, Cal. and Tijuana and are available 24 hrs/day.

The first procedure was done in September of 2010 and since, we have performed over 200 procedures, with zero complications and in some cases Fantastic Results. We have noted that, once we dilate one severe occlusion, patients frequently note a change in their vision, making their sight more clear and the fogginess in their heads dissipates or diminishes.

Over the ensuing days, there is a progressive reduction of the motor and sensory deficits that characterizes this disease and some patients are able to regain their lives once again.

Now, we must say that not all patients obtain the same results, since those with the most advanced disease do not fare as well, but in the vast majority of cases and the earliest the L T is done, there is a considerable improvement in their M S clinical scale and it is for this reason that we have continued working in perfecting the technique that we have developed to implement the Liberation Treatment at Excel Medical Center.

We are conscious and aware of the skepticism that exist regarding the concept of CCSVI  and it’s L T in M S, but how can we explain the remarkable improvement in the clinical condition obtained by patients with M S that undergo this procedure and that in spite of taking all the medications prescribed their disability continued. This is a powerful result offered by the L T and it is for this reason that we at Excel Medical Center, believe that the concept of CCSVI in some way is operating and disturbing the normal physiology of the venous circulation in the brain and that once relieved, the stagnation of blood that perhaps leads to brain edema and or a mild case of normal pressure hydrocephalus is decompressed with consequent improvement in brain function.

Excel Medical Center has initiated additionally, a Stem Cell Program for patients with M S in conjunction with the Liberation Treatment and even though we have only preliminary results, we are very encourage and enthusiastic , because we can see a difference and better results with the treatment as a whole.

The Doctors participating in the CCSVI program are:

Dr. Genaro Fernandez F.A.C.C., Dr. Gustavo Mondragon F.A.C.C  and Dr Ernesto L. R. Osuna, F.A.C.C.

For more inquires, please visit our Web site and contact our Senior Representative Tina, to find out about availability, type of procedure and global cost.