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Kuwait to offer controversial MS treatment
Updated: Fri Apr. 09 2010 10:59:30
By Avis Favaro, CTV News
Kuwait has become the first country in the world to offer a controversial treatment to all its patients with multiple sclerosis who have blocked veins in their necks.
CTV News has confirmed that Kuwait's minister of health has given interventional radiologists in the country the go-ahead to use the state-financed medical system to begin treating patients who have blocked veins and abnormal blood flow in their necks.
According to a theory proposed by University of Ferrara's Dr. Paolo Zamboni in Italy, and first broadcast on CTV's W5 last November, many patients with MS have blocked or narrowed veins in their necks and chests. He calls the condition CCSVI, or chronic cerebrospinal venous insufficiency.
He theorizes that the blockage prevents blood from draining properly, sending it back to their brain, a problem that could contribute to the immune response that marks MS.
The theory has generated a lot of interest in Kuwait, which has high rates of MS, particularly among women.
In a telephone interview with CTV, Dr. Tariq Sinan, an interventional radiologist and an associate professor at the Department of Radiology in the Faculty of Medicine at Kuwait University says the health ministry will allow radiologists to begin treating MS patients who have CCSVI, starting next week, as part of an ongoing study.
The Kuwait News Agency KUNA also reported the development, quoting the chairman of the standing committee for co-ordination of medical research at the ministry, Dr. Youssof Al-Nesf, as saying: "The presentation meets the legal, moral and scientific criterions specified by concerned organizations, including the World Health Organization."
The decision is based on research by a team headed by Sinan who studied 12 MS patients in March. All of them had CCSVI and were offered what Zamboni has dubbed the Liberation Treatment. The treatment is a vein version of angioplasty, in which a small balloon is inserted into a blocked vein to force it open.
(No stents were used in the procedures, a practice some doctors around the world have tried and one that Dr. Zamboni does not endorse.)
Sinan says all of the patients saw improvements in their MS symptoms, with some noticing "dramatic" results.
"On one day, on March 3, we did three patients. Two had dramatic improvements on the table and started crying because they couldn't believe what they were feeling," Sinan reported.
He says patients with more severe MS reported fewer improvements, but did notice feeling less stiffness and more energy. Those with less severe disease, reported up to 90 per cent improvements in their fatigue and numbness in their hands and leg.
"In one case, the patient couldn't see from one eye and started to be able to see," Sinan reported.
Sinan said he's confident the results he saw were not the result of the "placebo effect," a phenomenon in which patients fool themselves into feeling better by an otherwise ineffective treatment.
"If this is a placebo effect and I have MS, I would want this placebo effect," Sinan said.
"It is amazing the kind of improvements the patients say they have. It cannot all be attributed to placebo. Not being able to see and then being able to see, better bladder control, end of foot drop -- that cannot be placebo."
Last week, Dr. Sinan says a group of neurologists petitioned the country's ministry of health to stop the treatments. Their concerns – shared by other MS specialists around the world -- is that the link between blocked veins and MS has not been proven, and that the treatment could be dangerous. They have called for more studies.
But after review, and submissions from physicians and patients, the decision was to allow the treatments, which will be covered by the state-financed medical system.
The procedure will not be performed to treat MS per se but to treat only "improper blood flow" in the veins.
"So we say this is a vascular problem in the neck. Patients, when you dilate the veins, they feel better. We don't have to talk about MS or the link to MS," said Sinan.
Patients will be warned that the procedure is experimental, and the potential risks of venoplasty will be detailed in consent forms. Patients who agree to treatment will be part of an ongoing study that will be done in cooperation with a Kuwait neurologist.
The team will use ultrasounds and magnetic resonance venograms to scan the neck veins, as well as MRIs to track changes in the brain, including the appearance of MS-related lesions.
Doctors hope to treat 10 Kuwaiti patients a week, beginning next week.