CSSVI and Multiple Sclerosis

A recent spate of intense media coverage has sparked both interest and anxiety concerning an Italian researcher, Dr. Paolo Zamboni who, following an observation that he has made regarding the presence of unique venous anomalies in the great veins of patients with MS, started treating MS patients using venoplasty and stenting to correct the venous alterations. The theory he termed chronic cerebrospinal venous insufficiency or CCSVI and the procedure he claims has "liberated" patients with all subtypes of MS from their disease.

Not surprisingly, our patients, who respect the word of our national newspaper and TV network, now believe that this "liberation treatment", as it is referred to, is a quick cure for MS and they are demanding to be investigated and treated for their perceived venous anomalies.

The CNMSC neurologists are very interested in any claim of treatment that may benefit our patients. The questions that this CCSVI theory conjures up are endless and there is so much that needs to be explained and justified through properly designed research studies. If the observations can be reproduced and the rationale properly developed to demonstrate why these venous anomalies could possibly lead to the pathology of MS, only then should we be considering properly controlled clinical trials to see if correcting the anomalies truly impacts on the disease.

The MS Society of Canada has helped to spark such research by a call for research proposals. Until the observations concerning MS-specific venous anomalies have been corroborated and a robust rationale developed to indicate that correction of the anomalies has a very good chance of altering the disease course, the CNMSC strongly recommends that patients NOT be randomly investigated or treated. Procedures on veins such as angio(veno)plasty or stenting are not without potential side effects such as venous puncture or rupture, clotting, bleeding, infection or catheter tip embolism and experience involving the manipulation of the jugular or azygous veins is generally quite limited. Most importantly, scientific and medical justification for such procedures is lacking.

As research studies in this area are initiated, we would encourage interested and qualified patients to participate, but NOT to abandon their current therapy or management plan.