Dignan recently posted the link to Dr. Paolo Zamboni's abstract on Chronic Cerebrospinal Venous Insufficiency (CCSVI). I asked him to post in the general, but he suggested I go ahead and break it down, since the vascular connection to MS has become my holy grail... Dr. Zamboni is a vascular doctor at the University of Ferrara in Italy. In his studies, he came upon a unique situation to MS patients, a reflux of their brain/spinal blood. His team initiated a new study, based on his previous observations, just published December online Dec. 5th by JNNP.
The breakdown: 65 clinically defined MS patients and 235 controls (including healthy patients and those with other neurological disorders), blindly underwent a combined transcranial and extracranial Color-Doppler high-resolution examination (TCCS-ECD) aimed at detecting at least two of five parameters of anomalous venous outflow, blood flowing up and down the same vessel. (venous insufficiency seen by the eye are varicose veins on the legs.)
Subsequently, venography demonstrated in CDMS, and not in controls, the presence of multiple severe extracranial stenosis, affecting the principal cerebrospinal venous segments; it configures a picture of chronic cerebrospinal venous insufficiency (CCSVI)
Zamboni's team found that in 100% of the patients with MS, and in 0% of the controls, something was blocking the blood vessels near the brain and/or spine (the jugular vein and the azygous vein), creating a reflux situation. They could see this in color on the doppler. Reflux is when blood cannot pass by an obstruction. This distends blood vessels, and allows for leakage. This reflux happened in MS patients, not the controls, no matter what position they were on the tilt board.
We also found a highly significant difference in the distribution of the clinical courses among the CCSVI patterns (p<0.0001, chi-squared test) (Table III). Particularly, the location of venous obstruction seems to be a key element influencing the clinical course of the disease.
Zamboni's team found that the majority people with RRMS had blockage in the extra and intracranial area, and that those with PPMS had blockage in veins along the spinal column.
In this study we described the association between MS and the altered modality of venous return determined by extracranial multiple venous strictures. In our controls, venography quite resembled the normal imaging of extracranial cerebrospinal veins. 25 The hampered cerebrospinal venous drainage in patients with MS determines a complex haemodynamic picture defined as CCSVI.
CCSVI, Chronic Cerebrospinal Venous Insufficiency, appeared only in patients with MS. None of the other neurologically diseased patients had this pattern.
Regarding the causative role of CCSVI in MS, our review of the literature revealed descriptions of associations between the extracranial venous obstructive malformations herein described and disabling clinical pictures defined as myelopathies, without a precise neurological diagnosis to date.27-28
In our study the reflux occurred in any body position without the need to elicit it by a forced movement, suggesting that it is not an expression of valvular incompetence but rather of a stenosing lesion that cannot be crossed with postural or respiratory mechanisms, thereby becoming a long-lasting reverse flow.
Zamboni does not define these blockages, or posit what these "venous obstructions" are, but they are in the blood vessels, and they are hampering the correct flow of blood in people with MS.
The following observation was a revelation....
However, if vessel abnormalities were due to an inflammatory-autoimmune disease, they would be less frequent in patients treated with
immunomodulating/immunosuppressant agents. On the contrary, our analysis in the RR-SP group did not demonstrate an increased number of extracranial venous stenosing lesions in untreated as compared to treated patients.
Immune modulating therapy did nothing to change vessel lesions or reflux bloodflow. huh.
I'm not going to editorialize. I'd like to ask other people to read the abstract, look at the pics, and read his other studies.
Zamboni and his team have stumbled upon something, and it appears a new light is shining on MS research.
This has brought me renewed hope, and I thank Dignan for digging it up and sharing it with us.