No link between MS, narrow blood vessels: study

NEW YORK Mon Aug 8, 2011 5:19pm EDT

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NEW YORK (Reuters Health) - A new study provides more evidence that multiple sclerosis (MS) is not caused by a blood vessel condition, as some research has suggested.

The new findings follow a study last month in which Dr. Ellen Marder from the Dallas Veterans Affairs Medical Center and her colleagues reviewed the current literature on the condition, called chronic cerebrospinal venous insufficiency, or CCSVI. They couldn't find any convincing data to suggest that narrowing blood vessels in CCSVI are behind MS.

Based on those findings, Marder's group said MS patients should not undergo surgery to open up those blood vessels (see Reuters Health report of July 14, 2011).

Now they've reported on another study, in which they found that people with MS are no more likely to have signs of CCSVI on ultrasound tests than people without MS.

The researchers say the results -- and recent reports from other investigators -- "call into question" whether CCSVI actually does play a role in causing MS, and whether there's really any point in trying to treat the blood vessel condition.

In Archives of Neurology, they summarize the history of the suggested link between MS and CCSVI. In 2009, Italian researchers first suggested that people with MS were more likely to have narrowing of the veins that run from the brain and spine to the heart -- which could cause some blood to leak back into the brain.

Doctors then proposed that correcting the situation through surgery might ease MS symptoms, such as movement and balance problems.

But more recent studies haven't shown clearly whether people with MS are more likely than others to have CCSVI, or whether an invasive vessel-opening surgery could have any benefit.

In their current study, Marder's team took ultrasound images inside and outside the brains of 18 people with MS -- all U.S. veterans -- and another 11 people of the same age and gender without MS. On those scans, they looked for the proposed signs of CCSVI, including a lack of blood flow -- or backward blood flow -- in veins in the head and neck, as well as narrowing of those veins.

Four MS patients had one of those signs show up on their ultrasounds -- but so did four people in the comparison group.

"We don't think (CCSVI) is the cause of multiple sclerosis," Marder recently told Reuters Health. "We would not advise our patients to be tested for this or act on any recommendations based on this sort of testing."

Still, some researchers have continued pushing for a link between MS and CCSVI, and a few doctors have started offering procedures to MS patients to open their veins -- surgeries typically given to people at risk of heart attack that carry bleeding and infection risks.

Timothy Coetzee, chief research officer at the National Multiple Sclerosis Society, said there are still conflicting opinions about what role CCSVI might play in the disease -- and that while this study adds evidence to that debate, it doesn't shut the door on it.

"In my mind the jury's still somewhat out on what it means for MS," he told Reuters Health.

His organization has handed out over $2 million to fund research on CCSVI, and Coetzee said he hopes those studies will help "draw some conclusions" on what the condition might mean for MS care. "We need to be sure that ideas are tested and validated because of the impact that has on people" with MS, he said.

In the end, he added, what matters most is that people with MS talk with their own doctors about the best treatment for their condition.

SOURCE: Archives of Neurology, online August 8, 2011.

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Comments (4)
CCSVI_Society wrote:
We are still in the early stages of research on vascular issues with the veins of the chest and neck. While the connection to MS is an intriguing one, there is no need to establish at this point that CCSVI causes MS or even if CCSVI is found in all cases of MS. What we do know is treatment of CCSVI relieves some symptoms previously attributed to MS (and other neurological conditions). If this treatment turns out to be just another therapy that needs repeating during the course of a person’s lifetime and nothing more, it will still be one of the biggest medical discoveries of our time.

As a founding Board member of the National CCSVI Society, I invite all researchers to turn their attention to possible new discoveries based on information coming from their CCSVI colleagues. In the meantime, we must not delay in treating those with symptoms most likely to benefit (headache, fatigue, pain, spasms) to see if treatment offers much needed relief.

Sandra Birrell

Aug 08, 2011 6:45pm EDT  --  Report as abuse
ComnSents wrote:
18 patients and 11 controls does not a definitive research comment make. I remain as skeptical as many others. But a high-powered research study will be necessary to even begin to attempt to convince people that CCSVI and MS may not be linked.

And to offer a different perspective from Ms Birrell: It is not ideal to “treat” ailments without knowing the cause. Treatments, particularly angioplasty and stent placement, carry side effects, complications and unintended consequences. Once angioplasty has been performed, the treated vein, in this discussion, undergoes a healing response to the injury of the balloon inflation. Such injury is intended and is called “controlled dissection.” It is the reason why we must know that we are treating a significant ailment, not just speculating on what might happen. After such angioplasty, therefore, progressive narrowing of the treated vein may occur, prompting the lifelong repeat treatments that Ms Birrell noted may be necessary. I wouldn’t suggest such course of action until or unless there is demonstrated a significant benefit by rigorous, controlled research studies. Until such time, it is irresponsible of practitioners to provide such care. (I treat veins and arteries for a living as an interventional radiologist.)

Aug 09, 2011 9:01am EDT  --  Report as abuse
hsvkitty wrote:
WOW! Being there are different types of MS and the 4 people in the supposed “control” group all from the military (where stress may have been the trigger ) perhaps they are missing the all important info… that MS seems to strike pockets of areas and and families, yet no known cause has been found…

In other words, in Italy Zamboni has found it helped alleviate symptoms enough to become famous. It also worked on many who went for help, but not all. So it may still be a weakness in the area that has exacerbated MS symptoms, being many are now walking who were unable, therefore not a cause, but perhaps a trigger of symptoms for some.

I am glad they delved further but wish it were on a larger group of people with more diverse jobs and background and for LONGER term. Perhaps looking at the flow of blood in the brain and the quality of blood in the brain.

(I hope I do not offend people with MS, but this next statement is true) Diet, exercise and blood flow are intrinsically conjoined and I know 2 very ill people who have progressed quickly. Neither have changed their diet and both are addicted to Coke and other sweet drinks (drank no water only coke) one wouldn’t even take vitamins I bought her (chelated with minerals and added omega 3) or change her diet, or get sunshine or exercise. They are the ones who might be studied for lack of blood flow.

Aug 09, 2011 11:45am EDT  --  Report as abuse
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