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Q
New Approach to Multiple Sclerosis?

What do you think of the new treatment for multiple sclerosis (MS) that involves expanding narrow veins in the neck and chest? Is it a worthwhile alternative?

A
Answer (Published 7/29/2010)

You're referring to a theory and treatment being advanced by a vascular surgeon in Italy, Dr. Paolo Zamboni, who has suggested that multiple sclerosis (MS) may be due to narrowed veins in the neck and chest that block drainage of blood from the brain. He believes that expanding these narrowed areas in blood vessels can relieve symptoms of the disease.

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I have read a New York Times report about Dr. Zamboni's work and about how word of his treatment has sped around the world on the Internet, generating demand for it. Understandably, many MS patients are frustrated by a disease for which there's no cure and no reliable treatment. MS is one of the most baffling of all afflictions - we know very little about what triggers it and what factors influence its progression and outcome.

MS begins with localized inflammatory changes of the myelin sheaths surrounding nerve fibers as a result of an attack by the immune system. The resulting damage interferes with nerve impulses and can lead to symptoms such as muscle weakness, loss of vision, and a variety of other neurological impairments. Although considered an autoimmune disease, it is not clear what prompts the immune system to attack nerve sheaths as it does in MS.

Pressure from patients has led to a number of studies aimed at determining whether or not Dr. Zamboni is onto something. He has reported finding narrowings in the chest and neck veins of MS patients but not of healthy individuals. He has tried opening the narrowed blood vessels with balloons and found that some patients with relapsing remitting MS recover fully (including his wife, according to what he told the Times) but that some aren't helped. In a study published in December 2009 in the Journal of Vascular Surgery, Dr. Zamboni reported that his treatment lessened fatigue in patients with the progressive form of the disease but resulted in no changes in mobility.

The only way to determine for sure whether this unconventional treatment works is with clinical trials that compare treated patients to controls who get a sham procedure (neither patient nor doctors knowing who gets the real thing). Studies have just begun, so it will be a while before we get results. The Times reported that even in the absence of proof, patients have been seeking out doctors worldwide who are willing to perform Dr. Zamboni's "liberation" technique, but it is a procedure I cannot recommend yet.

I like to work with MS patients because of the disease's variability and potential to go into remission, as well as its responsiveness to an integrative approach including stress reduction, mind/body therapies and changes in diet and lifestyle. Here is more information on the measures I recommend for multiple sclerosis.

Andrew Weil, M.D.

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