I received a great question from someone after they read the article regarding CCSVI in the New York Times Magazine. They asked:
“It first says that you said you were not treating MS just the blockage in the veins but then you sent a letter you had a change of view with an explanation. I am confused can you please explain?”
Let me see if I can clarify. My initial experience with CCSVI was based on the assumption that it was for MS. It wasn’t exactly clear how but in some manner dilating the jugular veins had an impact on MS. As I gained more experience it became evident that the procedure helped patients with neurologic diseases other than MS, such as Parkinson’s. Logically it follows that CCSVI could not then be a treatment for MS. The degree of venous obstruction did not seem to have any bearing on the impact of the procedure. This observation lead to treating less obstructed jugulars and noting no difference. Ultimately non obstructed jugulars were dilated and the typical CCSVI response ensued. Clearly something else had to be going on.
Fortunately we followed all our patients symptoms. A trend became evident after hundreds of patients. Despite the myriad presentations of MS, the same constellation of symptoms were present in our patients. This consistent group of symptoms were those of autonomic dysfunction. Autonomic dysfunction as the underlying entity satisfied some of the discontinuities we encountered. For example, autonomic dysfunction is associated with all neurodegenerative diseases not just MS. This explained how a patient with Parkinson’s could benefit from CCSVI. The vagus nerve is the conduit for autonomic signals and it travels alongside the jugular vein. Renal denervation therapy has shown us that autonomic fibers can be manipulated via a transvascular approach. If the balloon mechanically stimulated the vagus nerve and it was what lead to the response to treatment it would solve the mystery of how a patient with a normal jugular vein could respond to jugular ballooning.
The implications were so compelling that we changed our protocol and now focus on autonomic dysfunction. Treatment rests on definitive testing for it with HRV analysis rather than venous studies. Interestingly enough we are now able to objectively document response to therapy. Conjecture of a placebo effect has been nullified. I firmly believe that jugular ballooning treats autonomic dysfunction. Any impact on MS is mediated by alteration of the autonomic system not by changes in blood flow. Future investigations need to include a means of measuring autonomic function for patient screening and assessment of treatment response.
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