CCSVI: New Hope for MS?

An Overview of CCSVI Research

By Yves Savoie, President and Chief Executive Officer, Multiple Sclerosis Society of Canada

In late 2009, people with MS, researchers, volunteers and staff of the Multiple Sclerosis Society of Canada learned about a promising study of 65 people with MS, conducted by Italian researcher Dr. Paolo Zamboni. The MS Society is hopeful about the potential of this research into chronic cerebrospinal venous insufficiency (CCSVI). We are privileged to play a role in better understanding CCSVI and look forward to seeing research results, as quickly as possible, in order to best help those living with MS.

In this article, the Multiple Sclerosis Society of Canada’s president and CEO, Yves Savoie, answers questions about the research and explains what the MS Society is doing to advance knowledge about CCSVI:

What is CCSVI?
CCSVI is a term used to describe a condition in which the venous system is not able to efficiently remove blood from the central nervous system. The term suggests that this is related to narrowing of small venous structures (veins) in the neck and chest, resulting in blood leaking into the adjacent tissue, depositing iron which, in turn, triggers an immune response.

Why is there a sudden interest in CCSVI and MS?
Interest stems from the findings of cardiovascular research and three recent studies. In late 2009, Dr. Paolo Zamboni and colleagues published two studies. They compared 65 people with different types of MS with 235 people who were healthy or who had other neurological disorders. An association between having MS and narrowing of specific veins was found in all 65 people.

The second study involved treatment to relieve the venous narrowing. People with relapsing MS showed improvement in some study measures 18 months after treatment, but there was no improvement for those with progressive MS.

The third study is the work of Dr. Robert Zivadinov and colleagues at the University of Buffalo. They released interim findings in February 2010. Using a sophisticated ultrasound technique to screen 500 study participants, Dr. Zivadinov observed evidence of CCSVI in 56.4 per cent of people with MS, but also in 22.4 per cent of healthy controls.

What is the MS Society’s position on CCSVI?
The MS Society of Canada believes that this topic opens up a new avenue of research for the possibility of a treatment for people living with MS. The concept of CCSVI as a cause of MS, and the use of stents or balloons to widen veins as treatments, are ideas that need to be replicated and validated in much larger, well-designed studies. The MS Society moved immediately to establish a research competition targeted at CCSVI. In fact, we were the first MS organization in the world to do this.

What are some of the research questions that need to be answered?
First, there must be a consensus about how to image narrowed veins—this will take research. There also has to be a clearer understanding of the relationship between narrowed veins and MS. If there is a relationship, research will be needed on the best way to treat narrowed veins. Some of this research can be accomplished in a relatively short time, but as with any MS therapy, measuring the real impact requires long-term observation.

Why does the process take so long?
There are many important questions relating to CCSVI and MS, and the research must be done properly so we will have answers that can guide people with MS, their physicians, the MS Society and governments in making reliable decisions about treatment options.

Can CCSVI be tested/treated now?
The CCSVI concept is not a proven therapy for MS. Also, specialized equipment and training are needed to test for the condition. For these reasons, CCSVI is not widely tested or treated at this time in Canada.

While testing and treatment is available in several other countries, in an interview on CTV’s current affairs program, W5, Dr. Zamboni recommended that people not be treated until more research is completed. If the treatment of CCSVI is proven to be a valid therapeutic treatment option for MS, then the MS Society will advocate to make it widely accessible.

What is the MS Society of Canada doing to bring pressure on the Government of Canada and provincial governments to make CCSVI screening and treatment available?
The responsibility for health services is with provincial governments. Over the past 15 years, the MS Society has led advocacy efforts for inclusion of scientifically proven drug therapies on provincial drug-funding plans, once Health Canada approval has been secured. If the treatment of CCSVI proves to be a valid therapeutic treatment option, the MS Society will advocate to make it widely accessible.