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Chronic Cerebrospinal Venous Insufficiency (CCSVI): A Possible Cause of Multiple Sclerosis (MS)

Updated on February 14, 2012
  • Intracranial hypoxia is a condition when brain tissues don't get adequate oxygen supply in order to function properly.
  • Delayed perfusion stands for a process of nutrient delivery to cells by passing through arterial capillaries slower than normal standard physiological conditions.
  • Increased transmural pressure is the difference between pressure inside and outside a walled structure (eg, blood vessels).
  • Reduced drainage of catabolites is a conditon in which complex molecules are broken down into simpler ones with the purpose of energy production, however this process is reduced thus causing insufficient cell nutrition.
  • Deposition of iron in cerebral veins provokes macrophage infiltration causing an autoimmune reaction on the myelin sheat leading to gradual degradation of the tissue.

Multiple Sclerosis is an autoimmune disease affecting the myelin sheats located around the axons of the brain, thus causing a gradual scarring, in strict terms a demyelination process that disturbs the normal conduction of the impulses along the axons generating a vast number of symptoms. It has been speculated that development of MS, being a non-hereditary disease, involves multiple factors like specific genetic alterations, infections and environmental issues as well. However, these theories haven't been yet proven, and the attempt of creating a synthetic overview is still an utopistical concept.

Are there alternative causes which may play a crucial role?

In 2008, an Italian vascular surgeon called Paolo Zamboni attempted to derail from the mainstream by placing focus on vascular causes.

Zamboni and his team hypothesized that a malformation consisting in stenosis of the internal jugular vein and azygos veins generates compromised blood flow in the venous tracts draining the central nervous system. This condition may play a role in the degenerative process of MS, hence this, the following consequences may happen:

  • Intracranial hypoxia
  • Delayed perfusion
  • Increased transmural pressure
  • Reduced drainage of catabolites
  • Deposition of iron in cerebral veins

Zamboni named this condition Chronic Cerebrospinal Venous Insufficiency (CCSVI or CCVI).


Click thumbnail to view full-size
Picture showing blood (arrows) encircling the wall of a vein (V). Iron-laden phagocyte is also present (M).MRI scan showing plaques (white spots).
Picture showing blood (arrows) encircling the wall of a vein (V). Iron-laden phagocyte is also present (M).
Picture showing blood (arrows) encircling the wall of a vein (V). Iron-laden phagocyte is also present (M).
MRI scan showing plaques (white spots).
MRI scan showing plaques (white spots).

CCSVI and Iron deposits

While testing CCSVI, Zamboni suspected an indirect connection between MS plaques and blood reflux in the brain. He thought that MS plaques are caused by CCSV itself, causing a deposition of heme iron in myelin tissue. However iron metabolism is more complex and harder to understand. This simple phenomenon doesn't prove a link between the two conditions as a study showed normal ferritin levels in the cerebrospinal fluid.

Another opposing finding demonstrated the presence of iron in other neurodegenerative diseases too, like Alzheimer's disease and Parkinson's disease that are not associated with CCSVI.

  • Phagocyte is the white blood cell responsible for protecting the body from harmful foreign particles, bacteria, dead or dying cells by ingesting them.

  • Ferritin is a protein containing and distributing iron in a controlled measure.
  • Heme is a special group inside Hemoglobin mainly responsible for transportation of oxygen.

Picture showing the balloon used to dilate the narrowed vein.
Picture showing the balloon used to dilate the narrowed vein.

Around 90% of patients affected by MS have CCSVI showing a stenosis, or a valve deficit of the internal jugular vein.

Also Dr. Zamboni's wife was affected by MS who underwent angioplasty. Two years after the experimental intervention, no neurological signs of the disease were present.

Liberation therapy

In order to examine the hypothesis, Dr. Zamboni chosed to perform an angioplasty by inserting a balloon catheter in the affected vein after an intracranial and extracranial doppler sonographic investigation and a diagnosis of CCSVI was made. The balloon's role was to dilate the narrowed tract. The intervention was later called by himself "liberation therapy".

How can these veins be described?

The affected veins have a truncal malformation, other characteristcs include a stenotic, in poorer terms a narrowing in a specific tract of the vein. Aneurysms, jugular valve defects are also reported.

Is there any controversy in the connection between CCSVI and MS?

Despite the evidence of sudden improvement in brain circulation, a strong connection between CCSVI and MS have not yet been found. Epidemiological findings show that other factors contributing to MS can be as follows:

  • Epstein-Barr virus infection
  • Parental ancestry
  • Date of birth
  • Geographic location

Reactions from scientific community

After the liberation procedure, patients were constantly improving on neurological examinations, symptoms like tremor, hand and leg stiffness, equilibrium impairments slowly started to wear off. In the first month a possible placebo effect due to enthusiasm could be present, this generated skepticism among neurological community, however, considering the severity of the disease varying from subject to subject, in nearly all the patients improvement was evident.

Skepticism has become to raise when in other studies two deaths were reported, and few patients, despite the treatment, did not show signs of improvement.
In 2009, the Multiple Sclerosis Society of Canada committed to fund CCSVI research, however the process was halted by Canadian Istitutes of Health Research because of lacking scientific evidence on the safety and efficacy of the procedure, and the linkage between CCSVI and MS.

Further studies

In order to re-examine Zamboni's theory, US and Canadian MS societies have launched seven studies with the purpose of clarification of this condition. An ongoing study conducted in Buffalo pointed out that not only MS patients have CCSVI, in their findings beside 62% of MS-CCSVI cases, CCSVI has been found in 26% of healthy controls and 45% of individuals with other neurological disorders.

(on the right) Dr. Zamboni and his team
(on the right) Dr. Zamboni and his team

Intervention testimonials

The good news was showing up when almost the majority of patients started to feel a warmness in their hand soon after the operation. Surprisingly, after months of rehabilitation nearly every patient who underwent the treatment, reported increased movement coordination, increased equilibrium. Above all, basic movements that otherwise patients wouldn't be able to perform because of MS, became normal tasks. The ability to jump, run and stable walk meant the greatest gift in their life.

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    • overcrok profile image
      Author

      overcrok 6 years ago

      Hi Polly, bee sting therapy has a very interesting mechanism, basically it modifies the immune response, as I know, it keeps abnormal autoimmune processes away from the affected areas, thus promoting symptomatic relief, however its effectiveness hasn't been proven yet, and aside from this, it takes on average more than six weeks to feel the benefits. Anyway, thanks for your info, I see it as a good tip for writing a hub on this topic.

    • Pollyannalana profile image

      Pollyannalana 6 years ago from US

      What about all the people who claim bee sting therapy helps drastically? I had a best friend die from MS and I would have had her try that if I had gotten to her in time.

      Polly

    • overcrok profile image
      Author

      overcrok 6 years ago

      Hello Jen, thank you for your comment. Indeed, It's worth a try, since the results are miraculous, Dr. Zamboni merits a lot of support.

    • Jen's Solitude profile image

      Jen's Solitude 6 years ago from Delaware

      Thank you for providing such good information. People with MS are still waiting for more results to be issued and many of us would be happy to give this a try.

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