No link between narrowed veins and MS: Canadian-led study

A Canadian study found that narrowing of the veins leading from the brain is just as prevalent in patients with Multiple Sclerosis as in people without the disease.

A study published in the British medical journal The Lancet finds that narrowing of the veins leading from the brain -- a condition called CCSVI -- is just as prevalent in patients with Multiple Sclerosis as in people without the disease.

The study, funded by the MS Society of Canada and led by Dr. Anthony Traboulsee of the University of British Columbia, calls into question the controversial theory that MS is caused by or associated with CCSVI, or chronic cerebrospinal venous insufficiency.

Four years ago, Italian doctor Paolo Zamboni proposed that MS was linked to constricted veins in the head and neck. He provided research that showed that opening the veins with tiny balloons – a procedure he dubbed the liberation treatment -- could improve symptoms in patients and reduce the number of attacks. Since then, hundreds of patients have sought the procedure and dozens of studies have been presented -- all with conflicting results.

The Lancet study used ultrasound to examine the veins of 79 people with MS, as well as a procedure called catheter venography. They also looked at the veins of 55 people who were siblingsof the patients, as well as 43 unrelated healthy volunteers.

Traboulsee, an associate professor of Neurology at UBC and director of the MS Clinic at UBC Hospital, says that catheter venography is considered the most accurate, "gold standard" technology for revealing the size and shape of veins. The procedure involves injecting a dye into a vein and then examining the vein through an X-ray.

The research team compared the width of veins between the brain and the heart with a normal reference point taken from below the jaw.

They say they found that at least two-thirds of the 79 MS patients and the two groups of healthy volunteers had veins that narrowed by at least 50 per cent. The differences in rates of venous narrowing between the groups were not statistically significant.

In all, vein narrowing was present in:

“It’s certainly clear now that the CCSVI or these narrowings are not the cause of Multiple Sclerosis. They’re just too common to be the cause of Multiple Sclerosis,” Traboulsee said during a news conference Tuesday.

He said the study also showed that the ultrasound criteria usually used to diagnose CCSVI are unreliable. Ultrasound found vein narrowing in fewer than half the cases that were detected by catheter venography.

“We think this is going to be very important information for patients and families, to say look at all the different studies out there when trying to make decisions about their care,” he said.

But MS patient Steve Garvie says the study raises some important questions in his mind – namely, why does he feel so much better after getting the liberation treatment for himself?

“This does work, and it does give people their lives back,” Garvie told CTV News. “I think that every single person should have blood flowing in their body properly, whether they have MS or not.”

Garvie says he worries the study will stop other MS patients from undergoing liberation treatment. “They will dwell in pain and suffer let MS run its course, unfortunately.”

Dr. Sandy McDonald, a vascular surgeon based in Barrie, Ont., said the new study hasn’t added any clarity to an important question: Does CCSVI provide any benefit to those with MS?

“We don’t know if the quality of life is better; that trial is yet to be done.”

Still, two MS experts who reviewed The Lancet study, Dr. Friedemann Paul of Germany and Dr. Mike Wattjes of the Netherlands, write in an accompanying commentary that the results sound a "death knell" for the CCSVI hypothesis.

"If chronic cerebrospinal venous insufficiency actually existed, the ultrasound findings of this study and previous studies would suggest that up to half of the general and otherwise healthy population should be judged to be seriously ill because of venous insufficiency of the cervical veins," they write.

For his part, Traboulsee is still working on a study on the effectiveness of the so-called “liberation therapy."

His team is providing angioplasty to MS patients with narrowed neck veins as well as sham (placebo) treatments. Each group will then "cross over" to the other treatment after a year, so that all patients will receive the angioplasty at some point. Results from that study are expected in late 2015.

Traboulsee says many MS patients want to know if the liberation procedure is beneficial.

"We are committed to evaluating this treatment with robust methods and utilizing patient-focused outcomes," he says.

With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip