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The Canadian Journal of Neurological Sciences
Issue: Volume 37, Number 6 / November 2010
Pages: 745 - 756
URL: Linking Options

Multiple Sclerosis - A Vascular Etiology?


Bryce Weir A1

A1 Department of Surgery, University of Chicago, Illinois, USA


Abstract:

From the earliest pathological studies the perivenular localization of the demyelination in multiple sclerosis (MS) has been observed. It has recently been suggested that obstructions to venous flow or inadequate venous valves in the great veins in the neck, thorax and abdomen can cause damaging backflow into the cerebral and spinal cord circulations. Paolo Zamboni and colleagues have demonstrated abnormal venous circulation in some multiple sclerosis patients using non-invasive sonography and invasive venography. Furthermore, they have obtained apparent clinical improvement or stabilization by endovascular ballooning of points of obstruction in the great veins in some, at least temporarily. If non-invasive observations by others validate their initial observations of a significantly increased prevalence of venous obstructions in MS then trials of angioplasty/stenting would be justified in selected cases in view of the biological plausibility of the concept.


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The Canadian Journal of Neurological Sciences
Issue: Volume 37, Number 6 / November 2010
Pages: 716 - 716
URL: Linking Options

CCSVI: Hope, Hype or Snake Oil?


Joel Oger A1 and Mona Alkhajawah A1

A1 University of British Columbia, Vancouver, British Columbia, Canada


This article does not have an abstract.

Even the Buffalo numbers qualify as significantly increased as does the recent one with 92% (?) prevalence of CCSVI in advanced cases of MS.

late MS (LMS): RRMS of more than 10 years duration.

The possibility that venous reflux, reversal of flow, andvenous hypertension are the primary inciting causes of at least some forms of MS is currently a defensible hypothesis. In varying forms this is not a new idea having some rationale from pathological studies. It remains to be seen if independent investigators, using larger numbers of patients, will replicate the strength of the association between MS and initially,sonographic abnormalities and if positive, subsequently,pathology on venography. Assuming this occurs and is also supportive, finally, interventional procedures in selected patients, enrolled in organized trials with randomization,appropriate controls, blinded assessment techniques, with indicated monitoring and sufficient follow-up time, would be appropriate. Will the operative relief of sites of flow obstruction provide durable remission? Will the procedures prove safe? Until what point in the course of the disease is it reasonable to anticipate a cessation of progression even if the theory is true? The huge community of sufferers, perhaps millions world-wide, for better or worse, already has had its hopes raised by a blizzardof one-sided reporting in the popular press and the internet on the “Liberation Procedure” so there is some urgency.