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CCSVI UpdateA clear understanding of Multiple sclerosis has proved elusive for generations of doctors and scientists.
The first suggestion that there could be a vascular component to the disease dates back 180 years to Sir Robert Carswell from Glasgow. He was drawing an image of a post mortem sample of brain tissue from an MS patient and commented that "there appears to be vascular lesions here".
Dr Franz Schelling from Austria has been a lone voice for many years in promoting this theory and I spent an intriguing half hour with Franz as he drew the various venous sinuses on napkins at the CCSVI conference in Poland this year. It was Franz who convinced Paulo Zamboni to explore this field and the results of that collaboration has changed the world of medicine. The recent discovery of the importance of CCSVI has filled in many of the gaps in our understanding of the disease.
At the International Society of Neurovascular Diseasemeeting in Bologna in March this year, Dr David Hubbard, a consultant neurologist from San Diego, gave the clearest description of MS that I have ever heard. He described how leakage of blood products across the blood brain barrier caused the initial damage in the brain tissue. The immune system became aware of this damage and was triggered to respond as a secondary event. I sought him out later to congratulate him on his presentation and particularly the clarity of his description of how the vascular and immune parts of the disease interact. This made sense on many levels and explained why most current treatments are only partially effective as they are aimed at the secondary and not the primary driver of the disease. This new paradigm does not exclude the immune system and immune modulating drugs as part of a treatment regime but this new understanding gives new possibilities for treatment with the possibility of improved outcomes.
Treating venous pressure by means of angioplasty could be a relatively safe and easy way of improving outcomes in MS if this theory is proven to be correct. A recent study by Ivo Petrov from Bulgaria, presented a series of over 461 CCSVI procedures carried out in Sofia, showed no major complications which confirmed the safety of angioplasty in MS (1).
A new paper published in the Journal 'Brain' in June 2011 appears to support this new paradigm (2). A research team from Vienna examined post mortem samples of 30 MS patients and 25 controls who died of other causes. For the first time, they have shown that the most recent MS lesions were associated with oxidative stress damage consistent with leakage across the blood brain barrier. Older lesions showed the T lymphocyte infiltration typical of an immune response.
A good demonstration of the damage that blood products can produce is in cellulitis in legs associated with varicose veins. As the veins enlarge, the increased pressure in the vessel causes the junction between endothelial cells lining the vein to widen allowing blood products to leak into the leg tissues. This causes inflammation in the tissues with the classic inflammatory signs of redness, heat, swelling and pain as seen in this image.
The brain has the relative protection of the blood brain barrier but this is simply a tighter connection between endothelial cells, thirty proteins joining the cells as opposed to the usual ten. Increased venous pressure in the deep veins of the brain will eventually loosen even these tight junctions and when the blood products leak into brain tissue the damage will be similar to that seen in leg cellulitis. The secondary immune response is triggered to try in an attempt to limit this damage but in itself, this response can increase inflammation.
After seven years of successfully using LDN in the management of MS, I knew that the immune system was an important factor in all types of the disease. Paulo Zamboni, Franz Schnelling, David Hubbard and others are helping us to understand the complex interplay between the immune system and the venous system in MS. A combined approach to the management of the disease is a logical way forward.
Like any new paradigm, this will take some time to be accepted by all of those involved in treating and raising the awareness of this condition but as the research stacks up, it will become clear that a major step towards understanding and successfully treating MS has taken place.
There is still much to learn and many unanswered questions but CCSVI has taken us a long way towards better understanding and treatment of this complex condition.