Two new studies published today call into the question the controversial theory that multiple sclerosis (MS) is caused by blockages in jugular veins, an idea that has inspired many MS patients to undergo an experimental and as-yet unproven operation.
Most neuroimmunologists maintain that MS is an auto-immune disease caused by the body attacking the myelin sheath that protects neurons. But Paolo Zamboni, a vascular surgeon at the University of Ferrara in Italy, has been advocating a radically different view. He argues that MS is a vascular disease caused by iron deposits damaging the blood vessels in the neck, which allows the heavy metal and other toxins to block the blood-brain barrier — a condition he has dubbed ‘chronic cerebrospinal venous insufficiency’, or CCVI.
To remedy the problem, Zamboni has advanced an experimental surgery similar to balloon angioplasty to unclog veins and get blood flowing normally again. Zamboni has tested the treatment on a handful of people, including his MS-afflicted wife, and says that the symptoms of the disease have vanished in many of the patients.
But not everyone agrees with Zamboni’s theory. In independent studies published today in the Annals of Neurology, researchers from Germany and Sweden tested a combined total of 77 MS patients and 40 healthy controls, and found that blood flow was normal in all but one of the participants. Notably, although the Swedish researchers used magnetic resonance imaging with phase contrast to measure parameters of anomalous venous outflow, both the German group and Zamboni’s team relied on the same technique, one called extra- and trans-cranial color-coded sonography.
Zamboni is reportedly standing by his theory, even in the face of the contradictory results. According to the Wall Street Journal, the Italian doctor questions some of the German researchers’ methodologies. What’s more, he told the Journal of his unpublished data from 500 MS patients showing that 90% of them suffer from blocked veins compared with only 2% of his 1,000-person control-group.
Zamboni’s contentious theory gained traction last November after CTVglobemedia, the Canadian media conglomerate that owns the CTV television station and the Globe & Mail newspaper, ran a primetime television documentary and a front page news story highlighting Zamboni’s work. A June 2010 story in the New York Times then further fanned the flames of the controversy. Ever since, patient advocates and MS foundations have been clamoring for more research into the CCVI hypothesis.
The amount of corroborating data has been scarce, though. Last year, a doctor at Stanford University in California treated a few dozen MS patients with a stent to hold blood cells open, but the procedures were halted after one patient died and other complications arose. Researchers at the University of Buffalo in New York and the University of British Columbia in Vancouver, Canada, are now carrying out randomized clinical trials of the experimental treatment. Last week, the premier of the Canadian province of Saskatchewan also announced plans to fund research into the controversial therapy.
Image: Histology of brain MS plaque showing streaks of blood (arrows); courtesy of Paolo Zamboni