The following material is an interpretation of current developments in medical research. If the reader is an authority in their field and finds any incorrect factual information we would be more than happy to make appropriate corrections. In such a case please send an email to adolfo . gianni @ gmail . com. Please note that at this point in time what is now called "MS" may be a disease which is initiated in a multiple of ways as indicated by the results of 2009 research at the MSRA website here.

Click here for the Original Study by Prof. Paolo Zamboni published in Dec.2008  

Several news reports and medical journal articles have indicated that over the last 12 months interesting new ideas and medical procedures have been developed involving unique vascular irregularities found only in PwMS. These irregularities are described as stenosing venous malformations.

Studies have been published in eminent medical journals such as Nature and publicised in the world's media relating to the possible discovery of one cause or trigger to the Multiple Sclerosis auto-immune process.

The origin or "cause' of MS has been a conundrum in the medical world since the 19th Century when MS brains were first dissected and and the disease state first described.

Vascular surgeons overseas (Italy, Poland, Germany, Canada and the United States) have diagnosed a substantial number of PwMS and some have already been treated for a condition in which varying degrees of narrowing has been identified in certain brain and/or spinal cord veins - namely the internal jugular vains and the azygous veins. These veins collect blood draining from the brain and spinal cord.

This "Chronic Cerebro-Spinal Venous Insufficiency" or CCSVI is thought to be responsible for a chronic reversal and abnormal collateral pattern of blood flow returning to the heart from the brain and/or the spinal cord. In CCSVI, substitute circles are activated that bypass blocked veins and therefore reduce resistance to drainage, avoiding intracranial hypertension. The time of venous outflow is longer than normal, however, leading to insufficient venous drainage, as confirmed by the mean transit time measured in magnetic resonance (MR) perfusion studies, even in normally appearing white matter.

This abnormal blood flow is thought to be pathological in that reverse flow and pressure changes may  be responsible for damaging the integrity of small veins draining the brain/spinal cord resulting in micro-bleeding into the central nervous system tissue. Furthermore the breaching of this "blood-brain barrier" and the breakdown of leaked blood cells and serum in CNS tissue is known to cause the death of nerve tissue such as neurones, astrocytes and other structural support (glial) cells.

This in turn is thought to trigger the immune system to recruit lymphocytes from flowing blood and direct them to the perceived damaged area to mop-up and remove dead or dying cells. It is this inflammation process which is seen as active demyelinating plaques in MRI images of PwMS brains & spinal cords. The non-active plaques are thought to be the scar tissue left fom the inflammation process.

If narrowing in the veins draining the brain/spinal cord are identified it may possible to correct the abnormal blood flow by angioplasty, which is a commonly performed procedure where collapsed or narrowed blood vessels (usually arteries) are 'ballooned" open in a key hole surgical intervention using the femoral vein accessed via the groin under local anaesthesia.

In such a procedure if the veins appear abnormal and unlikely to stay open just by the ballooning procedure, the vascular surgeon may insert a more rigid "stent" device designed to remain in the vessel and keep it open to allow a normal blood flow. It is thought that the narrowing of blood vessels occurs slowly over the developmental years and thereby becomes chronic by the time of young adulthood.

The CCSVI condition is most likely congenital in nature and vascular surgeons are aware of other vascular deformities which develop during development i.e. before birth in utero or shortly thereafter, and become apparent as a recognised disease later in life as children or possibly later as young adults.

This MS Australia info sheet is a transcript of an interview with Prof. Anne-Loiuise Ponsonby and discusses current theories of MS triggers and may be dowloaded from here. This Hilarescere Foundation info sheet here is a transcript of a lecture by Assoc. Prof. Alessandra Ferlini discussing a newly discovered association between MS genetic markers in CCSVI patients in which the number of copy number variations correlates witht he number of venous malformations in the patients.

Major CCSVI diagnostic centres are located in the US, Canada and Europe. Locations and contact numbers may be found by visiting the This is MS forums website. The CCSVI ultrasound methodology was developed over a number of years in Italy by Prof. Paolo Zamboni a vascular surgeon and his team at St.Anna Hospital and Ferrara University in nothern Italy.

The existence of CCSVI is required to be confirmed in larger medical studies which must be published in the appropriate medical literature before the theory and practical management are to be accepted by a consensus of specialists in the Vascular Surgery and Neurology medical fields. Such studies have already started and are being conducted by 2 renowned U.S. medical research organisations at Jacobs Neurological Institute in New York state and at Stanford University Medical Center in California. Further studies are being continued at the medical organisation in Italy where CCSVI was first described by Prof. Zamboni. Other organisations in Europe, China and Japan are reported to be in the process of establishing similar studies.

Links to other websites with more information:

http://www.buffalonews.com/home/story/899766.html

http://tecnogeeks.com/msviewsandrelatednews/blog5/index.php?itemid=1502#more

http://www.facebook.com/pages/CCSVI-in-Multiple-Sclerosis/110796282297