Chronic Cerebrospinal Venous Insufficiency (CCSVI) and MS

Chronic Cerebrospinal Venous Insufficiency (CCSVI) describes a hypothetical disruption of blood-flow in which the venous system is not able to efficiently remove blood from the central nervous system resulting in increased pressure in the veins of the brain and spinal cord which in turn results in damage to these areas. Recent reports have revived the idea of an association between inadequate venous drainage and multiple sclerosis.

The MS Society of Canada is aware of recent reports on the subject of CCSVI that may open up new avenues of research including new therapies for MS. While the early data shows promise, it is important to acknowledge that the concepts surrounding CCSVI and multiple sclerosis are still relatively new and requires replication and validation in much larger, well-designed scientific studies before they can be accepted as established.

• Why the sudden interest in CCSVI and MS?

Media attention and a few recent reports have revived speculation about a possible dysfunction of brain blood-flow and/or drainage in MS. In particular, one study involving 65 people with different types of MS compared with 235 people who were healthy or who had other neurological disorders, a robust relationship was found between having MS and signs of venous insufficiency – suggesting that blood drainage by veins may be impaired, contributing damage to nerve tissue. This study, by Paolo Zamboni MD, R Galeotti, E Menegatti, (University of Ferrara, Italy) and colleagues, was published in 2009. (J Neurology Neurosurgery Psychiatry. 2009 Apr; 80 (4): 392-9. Epub. 2008 Dec 5.) Read the abstract here.

Zamboni’s theory is that MS is marked by a process called chronic cerebrospinal venous insufficiency, in which blood-flow between the heart and brain is disrupted. He contends that results in increased pressure in the veins of the brain and spinal cord and narrowing or twisting of the small venous structures in the neck, chest and spine, causing nerve tissue damage. The investigators called this venous obstruction "chronic cerebrospinal venous insufficiency" (CCSVI). Patients undergoing treatment for MS did not appear to influence whether or not they showed signs of CCSVI. It is speculated that the abnormal venous drainage of blood returning back from the brain and spine might set-off the inflammation and immune-mediated damage characteristic of MS.

• Do these reports mean that MS is caused by venous insufficiency?

Not necessarily. Based on what has been published, we can only say that MS may occur in association with impaired venous drainage of the central nervous system. This impairment, if present, could cause MS but it is possible that it is incidental to the disease. More study is needed.

• How has CCSVI been treated?

Researchers into CCSVI have used "balloons" to open up narrowed veins or inserted stents into veins to keep them open. This work is at a very early stage and has been performed on only a very small number of patients. It requires passing a catheter (wire) through the veins to the area of venous narrowing so that it can be widened and is not without risk including the chance of bleeding or the formation of blood clots.

• Will the treatment of CCSVI be useful for the various forms of MS?

Whether this type of treatment will be useful in all the main forms of MS is unknown as research on this question is at a very early stage and much more work is needed.

• What is the MS Society’s position on CCSVI?

The MS Society believes that this topic opens up new avenues of research in MS including the possibility of new treatments. Although the early data are of great interest, it is important to acknowledge that the concept of CCSVI as a cause of MS and the use of stents or balloons to widen veins as treatments, are ideas that are far from being accepted by most researchers in the field. The early results need to be replicated and validated in much larger well-designed studies.

As you may have already read in "My Genetic Heritage", in 1993 while in the National Hospital, London undergoing clinical assessment of a previous diagnosis of MS, it was discovered that I had a heart-murmur. I was referred to Royal Brompton Hospital and diagnosed with hypertrophic obstructive cardiomyopathy (HoCM). This obstruction of the outflow of blood through the mitral valve makes me breathless. I believe this venous insufficiency contributed to my MS.