Just a little preface here before presenting the writing of Doctor Nitin Sethi. We have been talking a lot this week about something called Chronic cerebrospinal venous insufficiency (that sure is a hard phrase to spell!) and the latest research of a Dr. Zamboni who claims that MS may really be a vascular disease instead of an autoimmune one. If you haven't already read about this, here is my introductory post about this topic and how some MS patients have actually had surgery to clear blockages in their veins in the hopes that this procedure will actually cure their MS symptoms.
In addition to interviews with two MS patients who have gotten this surgery I have also invited Doctor Sethi, neurologist and blogger, to give his perspective of this radical new theory. I hope that he will bring a balance to our discussion through his questions and healthy skepticism.
Remember that you call the shots as to your treatment. Always research for yourself what things you may hear. It is good to ask questions and to be cautious. Ask for second and even third opinions. Do what is right for you... is the bottom line.
I now present to you...Doctor Sethi!
Nitin K. Sethi, MD
Assistant Professor of Neurology
New York-Presbyterian Hospital
Weill Cornell Medical Center
New York, NY 10065
Chronic cerebrospinal venous insufficiency in multiple sclerosis: Is it a cause effect relationship? What we now and what we don't know
Merely me recently wrote to me asking me for my opinion on the presence of chronic cerebrospinal venous insufficiency (CCSVI) in patients with multiple sclerosis (MS). She said that CCSVI and its association with MS was a "hot" topic of debate on MS related websites and blogs. Most of the buzz has been generated by an article which first appeared in the online edition of the Journal of Neurology Neurosurgery and Psychiatry (JNNP) dated December 2008. This article by Zamboni et al and the accompanying editorial by Claude Franceschi seems to have generated more excitement in the online MS community as compared to physicians and researchers involved in this field 1, 2.
So what did Zamboni et al. exactly say that has created all this excitement? Well put simply they found significant obstacles in the main extracranial (meaning outside the brain) cerebrospinal veins (namely the jugular and azygous system of venous drainage) in their group of 65 MS patients as compared to controls (the controls were patients who were either healthy subjects matched for age and gender with MS patients, others were patients affected by other neurological diseases such as Parkinson's disease and amyotrophic lateral sclerosis and yet others were patients not affected by neurological diseases but scheduled for venography for some other pathology).
They further found different patterns of CCSVI (meaning different patterns of stenosis) in their MS patient group. Patients who had relapsing remitting and secondary progressive course of MS disease had different patterns of CCSVI as compared to patients with primary progressive MS. So what was Zamboni et al. final conclusion? Simple they said and I quote "that MS is strongly associated with CCSVI and that the location of the venous obstructions plays a key role in determining the clinical course of the disease".