Chronic cerebrospinal venous insufficiency or shortened CCSVI is the medical term which describes problems with the blood flow in the central nervous system veins. As the result of this problem, patients may experience: reduced catabolite drainage, increased transmural pressure, delayed perfusion, iron deposits around the veins in the brain and intracranial hypoxia. Some scientists suggest that multiple sclerosis (MS) might also be caused by CCSVI.
Link between CCSVI and Multiple Sclerosis
There are several things Zamboni and his colleagues claimed to connect chronic cerebrospinal venous insufficiency and MS. According to their opinion, pathophysiology of MS includes stenosis of the azygous and IJV veins in about 90% of MS patients. Further theory explains that these deformed blood vessels can cause accumulation of iron in the brain and consequently lead to autoimmune reaction of the body. As the result of this autoimmune response, there is degeneration of the myelin sheath of the nerves and that’s what is causing multiple sclerosis.
There are problems with this hypothesis, because there are also some healthy people experiencing CCSVI. Additionally, CCSVI can’t explain all epidemiological facts associated with MS, such as: inheritance, Epstein-Barr infection, geographical location or the day of birth. Another problem is that venous diseases are more common in men, but women are more likely to suffer from MS. Venous problems also frequently affect older people (over 50 years of age) and these patients experience hypertension, edema, infarcts or transient ischemia. However, MS is usually diagnosed in younger individuals and these patients don’t experience consequences associated with venous problems. Also, the accumulation of iron in the brain is usually seen in patients suffering from Parkinson’s or Alzheimer’s diseases, and these are in no way associated with CCSVI.
For above mentioned reasons, studies can’t completely support this theory and there is a need for more epidemiological studies about the relationship between MS and CCSVI.
Zamboni Treatment for MS
Paolo Zamboni is the scientist who started the theory about CCSVI and MS and the following treatments. He claims that certain endovascular intervention can help people suffering from MS. However, there are many reasons why this procedure is not recommended as standard or safe to be used in MS patients.
Balloon dilation of stenosed jugular veins in patients suffering from multiple sclerosis is the procedure suggested as the treatment for CCSVI, but neither neurological community or various MS organizations worldwide advise this procedure to their patients or members.
The procedure is not proven to be efficient in controlled randomized studies. There are also some serious complications that may arise in patients having this surgery, including lethal consequences. Patients may experience intracranial bleeding, jugular vein thrombosis or migration of the stent into the heart after angioplasty and stenting procedures recommended by Zambini. Because of these problems, the procedure is banned is some American hospitals and in Canada. The only way a patient may have this procedure is when he or she is involved in some clinical trials. In Kuwait the situation is dramatically different and patients are allowed to have this procedure and it is also paid by their health care system. Some other countries also allow this type of procedure for MS patients.