Welcome Prof Zamboni, who is the director of the Centre for Vascular Disease at the University of Ferrara. Prof Zamboni has studied MS for many years and has discovered a causal or contributing factor with this disease. What is the story Professor Zamboni?

Well we have observed that in a significant number of MS patients, the newest numbers are at least 75% of PwMS, who have this associated vascular condition that affects the extra-cerebral veins in the neck particularly the jugulars, and these veins let's say drain rather badly and because they are the conduits on which we depend for the oxygenation of the CNS which then occurs at a lower rate therefore less effective, and therefore our view is that this contributes to the factors which cause and worsen the MS disease.

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All right, how is this surgical intervention performed?

Well we have hypothesized that a minimally invasive and as conservative as possible surgical intervention. In the first pilot study we conducted in 2007 and which we studied the results for a year, we have enlarged the restrictions in the veins with small balloons which by dilating them a few times allow the constricted sections to be enlarged.

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Here then what have you found? If you resolve the obstructions do the patients improve their condition?

Well the answer is that this depends on the degree or severity of the disease has reached... this is a disease which has a variety of scenarios. In young persons who have a relapsing remitting pathology, we have observed a great reduction in the number of attacks and also recovery of some functions and reduction of disability, because being at the beginning of the disease the person's regenerative capacity of the brain could be employed.  In patients who have had the pathology many years longer, and whose brain has suffered more damage which has caused much scarring....then the scarred areas are able to repair the damage but are not able to regain function...for example if this person has been wheelchair bound for 10-15 years we cannot expect that this person will now walk. However we have observed that there are other advantages which for this person are very important. For example one of the most difficult symptoms to treat and which has no drug treatment is Chronic Fatigue. This prevents a person from conducting most physical or social activities to the extent this leads to a worsening symptom spiral. The reduction of chronic fatigue improvements reported in such people allows them to recover their interests in social and a range of preferred activities and some people even recover some function which allows them to do some work; and therefore I think from the medical and societal points of view these results are not a miracle but symptoms are probably connected to the vascular condition that was treated and in any case very important to the QOL of patients.

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In fact you have given hope to patients but you don't promise miraculous cures.

This medical treatment is based on facts. We attempt to correct an aspect of the disease which we have observed and what we try to obtain all the improvements possible which may have been caused or worsened by the vascular condition.

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At what point is the research?

Well after the 2007 pilot group we studied the results and in 2009 offered the local regional (Emilia Romagna) medical authority to fund an increased level of evidence of this promising observation. There was a group effort for over a year to share the protocol between different professionals because it does require an interdisciplinary approach, so therefore a neurologist is included because the disease evidently has a neurological aspect where we engage with respect to vascular disease, radiology and other professionals in how to collaborate together and which measures were needed to provide evidence in order to prove that this pathology can be efficiently treated with the therapy (angioplasty) we have proposed. Now this work has finished positively because the ethics committee of the University of Ferrara as well as its hospital have given the green light. Now in order to provide transparency we have invited all Italian MS medical centres to participate in this study so  that even the smallest and furthest away could join. We have had good participation because well over 24 centres so far which are confirmed will be part of this study, and this means we be able the spread the research work not only in our region but throughout the whole country; and of these at least 15 or 16 already have the requisite capacity to start the work. Therefore so we can say we are about to start the research.

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When would you be able to provide any outcomes and conclusions?

Well what I can say is that if all goes well we can start this summer. After that it's 1 to 1.5 years of observations following treatment for all centres to provide their results, so I think within 2 years we will be able to provide results and hopefully treatment will be made available throughout the nation. The interesting thing is that by going this way, if the treatment is demonstrated as being effective, automatically the 24 centres in the study will be able to provide the treatment in the public hospital system, which is after all what we have been aiming to achieve.

http://www.youtube.com/watch?v=f4R-JK5UjHA

CCSVI AUSTRALIA Thanks for translating Adolfo. It really could not be more simply explained; the hypothesis and treatment. 2 years sounds like a long time... But at least they have a trial starting. Kerri