CCSVI as Epiphenomenon

The journal Radiology is the premier publication for Radiologists world wide. “Brain Hemodynamic Changes Associated with Chronic Cerebrospinal Venous Insufficiency Are Not Specific to Multiple Sclerosis and Do Not Increase Its Severity” is published in the October 2012 issue of Radiology (http://radiology.rsna.org/content/265/1/233.abstract). Marziali et al conclude that patients meeting diagnostic criteria for CCSVI had decreased cerebral blood flow (CBF) when compared to patients not meeting the criteria for CCSVI. This lends support to the observations of Zamboni and others that the observed jugular vein abnormalities are real and result in flow disturbances. The authors also concluded that the identified hemodynamic changes had no bearing on the presence of multiple sclerosis.

What does this mean? In the conclusion the authors used epiphenomenon to describe CCSVI. An epiphenomenon is a secondary phenomenon. It occurs along with a primary phenomenon. In other words, the venous abnormalities seen in CCSVI are real but are secondary to what is causing MS. Balloon dilation treats the epiphenomenon vein blockages. Could it also treat the cause of MS?

Research is needed to answer that question. Unfortunately the climate for CCSVI research is rather inhospitable. Be it neurologists, pharmaceutical industry and governmental agencies supporters of further scientific inquiry are hard to find. Studies finding no link between venous obstruction and MS lend credence for those saying CCSVI is a hoax. Patient experiences are however compelling and hard to summarily dismiss.

At Synergy we are of the opinion that the CCSVI procedure treats the autonomic dysfunction. Neurologists know and accept that autonomic symptoms are a major contributor to the suffering experienced by those with MS. To date, no known treatment exists for autonomic dysfunction. Objective review of what symptoms respond in those seeking CCSVI care can only lead to the conclusion that if there is a benefit, it is an autonomic one. If we accept the jugular obstructions as epiphenomenon and the illness as autonomic dysfunction, which has no known treatment, then the only impediment to progress would be procedure safety.

Multiple studies have been published demonstrating the safety of the “CCSVI procedure”, yet many opponents of CSSVI treatment still cast it in a negative light by perpetuating the fear that “safety” should be a concern for patients. But it is clear that the procedure is safe if done by a skilled physician. Erroneously labeling the CCSVI procedure (or any procedure) as unsafe, when the medical literature serves notice that it is safe is not only incorrect, but conceals the truth from those in need. All treatments are determined to be safe (or not) by way of scientific medical research. Opponents of CCSVI treatment have a responsibility to voice their opinions, but the logical next step should be to conduct further research in order to reach a consensus.

Regardless of our affiliations, each one of us has a responsibility to do the right thing by advancing the research on CCSVI treatment. Including the ongoing research we’re doing at Synergy Health, a handful of other medical groups are working hard on this. In our opinion study should not be fixated on veins or multiple sclerosis. Rather autonomic dysfunction should be the focus of further scientific inquiry. Eventually the truth will be known, but most likely when we look at the problem in a different light.

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Dr. Arata is an accomplished physician internationally respected for his work in Interventional Medicine. He specializes in treating chronic venous obstruction and venous occlusive disease. His experience in this area spans for more than a decade, long before the discovery of CCSVI. He has performed thousands of central venograms and angioplasties for blocked veins for a variety of different diseases.