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June 14, 2010 11:42  by Dr. Lorne Brandes
In a late-day joint announcement on Friday, June 11, the U.S and Canadian Multiple Sclerosis Societies awarded seven grants to study the relationship between CCSVI (chronic cerebrospinal venous insufficiency) and MS; a total of $699,329 went to four Canadian university teams (UBC/Saskatchewan; Calgary; Ottawa; Toronto) while $1,739,480 went to three U.S. institutions (U. of Wisconsin; Cleveland Clinic; U. of Texas).

As expected, funding is only for the investigation of the relative prevalence of vein anomalies among MS patients, close relatives, normal controls and patients with other neurological disorders such as Alzheimer’s disease, and not for treatment.

Notably rejected were funding requests from McMaster and the U. of Buffalo. Given the critical involvement of Hamilton’s Dr. Mark Haacke and Buffalo’s Dr. Robert Zivadinov in the early CCSVI clinical studies, could politics have played a role here?

Perhaps, but a good argument can be made that the MSS-appointed international review panel of experts purposely decided to fund other teams of investigators in the hope of obtaining new, unambiguous data that, at the end of the day, should provide a comprehensive answer to the relationship between blocked veins and MS.

 Funding of a study at Toronto’s Hospital for Sick Children to examine neck and chest vein anatomy in children and adolescents with MS, and in age-matched healthy controls, is especially welcome; if a strong association between blocked veins and MS is found early in life, this will undoubtedly galvanize support for Dr. Zamboni’s hypothesis.

Less understandable is why the American researchers received, on average, 2.5 times as much money as their Canadian counterparts to carry out roughly the same types and sizes of studies. Could the difference be explained by significantly higher costs to perform ultrasound and MRI studies in the U.S.? Possibly, but the optics are not good on that score. Nonetheless, I believe that, without exception, the grants were awarded to excellent investigators on both sides of the border.

That said, I continue to find a statement in the Canadian MSS May 5 request for $10 million from the federal government to be, at best, disingenuous:

“The Government of Canada can play a leadership role in addressing the needs of Canadians living with MS by funding research, including clinical trials in CCSVI and MS. Doing so will both advance research and provide safeguards to those seeking treatment.” [The italics are mine.]

I don’t know about you, but it seems to me that the MSS is talking out of both sides of its mouth. At the same time as it is limiting the scope of its own funded studies to determine whether there is an association between CCSVI and multiple sclerosis, it is lobbying government to pick up the tab for treatment studies of the same condition about whose relevance the organization is seeking answers!

As I pointed out in a previous blog post, many MS patients who have undergone venoplasty show a marked improvement in longstanding symptoms such as severe fatigue, “brain fog”, headache, and cold extremities. For that reason, I suggested that MS be taken out of the equation and that provincial health care plans pay for this relatively cheap and safe treatment, since it appears to effectively relieve these chronic, life-altering symptoms. Thus far, there have been no takers.

So let me try another approach by asking this question: what organ or tissue does not suffer serious consequences when veins that drain blood from it become blocked?

The answer?  There are no exceptions. Here are three well documented examples: cirrhosis and liver failure secondary to hepatic vein obstruction (Budd-Chiari syndrome); loss of vision secondary to retinal vein occlusion; and severe shortness of breath and pulmonary (lung) hypertension secondary to pulmonary vein stenosis.

On that basis, are we to believe that our most vital and, in many ways, most delicate organ, the brain, stands alone in being impervious to impaired venous drainage? Hard to imagine.

Indeed, a recently-published case report that included a literature review, summarizes what has been observed when one or both jugular veins in the neck are suddenly blocked off by a clot. They include increased intracranial (brain) pressure; headache; altered consciousness; lethargy; double vision; visual loss; and eye muscle (6th cranial nerve) weakness.

Do the symptoms sound familiar? They do to many patients with MS. Is it just coincidental that sudden jugular vein occlusion mimics many of the findings in MS? I truly doubt it.

One fallout of a jugular vein clot, increased intracranial pressure (ICP), deserves special mention. Ask most neurologists and they will tell you that increased ICP is not a feature of MS. Yet the literature contains numerous reports of high ICP in both adult and pediatric patients with active MS. Taking all of this into account, it would not be a stretch to suggest that any patient with active MS and high ICP is almost certain to have severe jugular vein stenosis.

So, back to the question posed in the title. Do we already know whether MS and CCSVI are associated? Based on the results of the majority of published studies to date, I believe we do, and the answer is yes. Do we have all the answers regarding this association? No, and hopefully the MSS-funded research will help provide them.

But clinical studies aside, an even more important question is what to do right now for symptomatic people with proven neck or chest vein blockage, irrespective of whether they have, or have not, been diagnosed with MS. Based on what we already know about how impaired venous drainage damages other vital organs, as well as the consequences to the central nervous system of sudden jugular vein blockage, should they not be offered immediate treatment under the Canada Health Act?

If you agree with me that they absolutely should, consider emailing your comments (or this blog post) to your provincial and federal health ministers and MPs. Let’s keep up the pressure on our health authorities to do what is right, both morally and scientifically.

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