My initial experience with CCSVI was based on the assumption that it was for MS. It wasn’t exactly clear how but in some manner dilating the jugular veins had an impact on MS. As I gained more experience it became evident that the procedure helped patients with neurologic diseases other than MS, such as Parkinson’s. Logically it follows that CCSVI could not then be a treatment for MS. The degree of venous obstruction did not seem to have any bearing on the impact of the procedure. This observation lead to treating less obstructed jugulars and noting no difference. Ultimately non obstructed jugulars were dilated and the typical CCSVI response ensued. Clearly something else had to be going on.
Am I reading this correctly? Is he saying that he dilated nonobstructed jugulars in isolation (meaning nothing else was treated at that time) and the patients had improvements such as what is seen after an obstructed CCSVI jugular is dilated?
Possibilities suggest themselves
1 - placebo effect
2 - unseen stenosis was dilated, thus leading to improvements
3 - blood thinners used during the procedure led to symptomatic improvements
4 - pwMS have abnormal collagen throughout their jugulars, as shown in Dr. Zamboni's autopsy research, and if ballooning the jugulars softens the collagen in the vein wall, then this may allow greater distensibility thus leading to improvements in flow
5 - Dr. Arata's explanation - ballooning the jugular mechanically stimulates the vagus nerve running alongside the jugular, thus leading to improvements
If the balloon mechanically stimulated the vagus nerve and it was what lead to the response to treatment it would solve the mystery of how a patient with a normal jugular vein could respond to jugular ballooning.
I think the finding that patients have improvements after ballooning of an unobstructed vein is a new finding, but what does it mean? I am not convinced by Dr. Arata's explanation, although it is plausible, as are the other four possibilities listed. It opens him to criticism that he would take the step of ballooning unobstructed veins, but if a patient is paying out-of-pocket, then is the doctor free to do whatever is in his power that he thinks will help, and his finding was that ballooning these unobstructed veins was helpful?
It's a new idea to consider: does ballooning an unobstructed jugular vein offer the same results as ballooning an obstructed jugular?
We would need data to support this idea. Replication, publication, controlled trial, etc.
How often do patients turn up for CCSVI treatment that are then seen to have no obstructions whatsoever? He's treating patients that are not MS patients, was this exclusively in those patients? Or was it in patients that had been previously treated?