This Is MS Multiple Sclerosis Community: Knowledge & Support

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One of the newer, more interesting hypotheses about the pathology of MS is that the damage seen in MS stems from blockages (narrowing or twisting) in veins draining blood from the central nervous system. These blockages result in poor drainage and even reversal of blood flow direction, which could lead to inflammation, increased iron deposition, and eventually blood-brain barrier damage and lesions. A proponent of this hypothesis, Dr. Paolo Zamboni, has previously published results using Doppler sonogram technology showing that this reflux is prevalent in people with MS and specific to MS. Since then, he has taken the next step of performing surgical procedures in 75 people with RRMS, SPMS, or PPMS. These procedures included either balloon angioplasty (inflating up a tiny balloon inside the vein to open it back up) or stenting (inserting a tiny tube inside the vein to hold it open). In the year following the procedure, relapse rates and clinical test scores in the group overall were improved compared with those from before the procedure. Those subjects who had relapses following the procedure were also found to have had renarrowing of their treated veins. No follow-up MRIs were performed to evaluate whether this procedure reduced the formation of new or enlarging lesions, however.

These are preliminary results only so it's too soon to say exactly how CCVSI (chronic cerebrospinal venous insufficiency) is involved in MS and how/whether these types of treatments should be used in MS. An international meeting will be held in Italy next week to discuss this topic further, including a presentation by a doctor at Stanford (Michael Dake) who has recently treated some MS patients using these procedures. It is interesting to think that opening narrowed veins could lead to significant improvements for people with MS. It also raises the question of why cerebral veins are narrowed in people with MS in the first place and whether that could also be addressed.

Looks like my MRV results fit the usual pattern seen at Stanford so far. Left and right IJVs both essentially fade away to nothing at about mid-ear.
--Tracy