This Is MS Multiple Sclerosis Community: Knowledge & Support

CCSVI interdisciplinary approach (Bianca Weinstock-Guttman, USA)

Recently, a new vascular condition called chronic cerebrospinal venous insufficiency (CCSVI) was proposed to
be linked to multiple sclerosis (MS). CCSVI is characterized by impaired blood outflow from the central nervous
system to the periphery, secondary to anatomical abnormalities of the major neck and azygos veins. As of now,
the available data cannot determine whether CCSVI is a cause, consequence or mere association with MS
although the higher prevalence of CCSVI found in progressive MS patients may suggest that CCSVI may play a
contributory role on disease progression. Similarly the role of intra- and extra-cranial venous system
impairment in the pathogenesis of other various vascular inflammatory and neurodegenerative disorders
requires further evaluation. Physiological inter-individual variation of the cerebral venous anatomy and the lack
of standardized diagnostic guidelines for evaluation of the intra- and extra-cranial cerebrospinal venous system
provided contradictory findings and consequently more questions are raised than plausible answers were
given. Taking in consideration these multiple challenges only a corroborative team work that include vascular
specialists, neurologists with special interest in MS and neuroimaging will be necessary to provide the
appropriate network to understand, assess and eventual treat CCSVI. Further studies are necessary to define
the role of CCSVI in health vs. disease in general and in MS and other inflammatory conditions in special before
any open label therapeutic interventions are implemented.

Financial Disclosure: Teva Neurosciences, Biogen Idec, EMD Serono, Pfizer, Novartis, Acorda, ITN