MS Surgery

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Now remember I’m not a surgeon, neurologist, or multiple sclerosis specialist of any sort. I’m just a pharmacist who thinks MS and its treatment is interesting. But I have to tell you about a possible MS treatment that has been getting a lot of buzz lately.

For me it started with a documentary on CTV’s W5. They were interviewing an Italian vascular surgeon named Paolo Zamboni. They told a compelling tale. You could see from his hands that Dr. Zamboni could no longer perform operations. He had developed a neurological condition that wouldn’t allow him to hold a scalpel. He continued to work as a doctor and professor and then his wife developed MS. So, Dr. Zamboni started doing lots of reading about Mutiple Sclerosis.

During his research, Dr. Zamboni read about iron deposits in the brains of MS patients. Others had noted them before, but no one had attributed much significance to them. Have you heard the saying, “To a carpenter, the whole world looks like a nail”? Well that’s what I thought of when Dr. Zamboni explained what he thought when he read about these iron deposits. Dr. Zamboni, the former vascular surgeon, thought the iron deposits were due to improper drainage of blood from the brain. So took some ultra sound images of the necks of some MS patients and found many of them had strictures or narrowing of the veins that drain the brain.

Dr. Zamboni’s team then went the next step and used little balloons to open the narrow veins and let the blood drain properly from MS patient’s brains. Low and behold, many had improvement in their MS symptoms! Dr. Zamboni calls the condition of narrow veins draining the brain CCSVI or Chronic Cerebrospinal Venous Insufficiency.

At the moment Dr. Zamboni and colleagues in the US are testing more MS patients to see how many have CCSVI. They will be doing more opening of the veins with balloons to see how many people’s symptoms improve. Even the Canadian Multiple Sclerosis Society is now offering research money to the best candidates to research CCSVI. It is very exciting.

Now I am going to be a wet blanket. The odds are CCSVI and its treatment is not a cure for MS. I’d love to be wrong, but that is not usually how these things turn out. Five years from now, probably the best we can hope for is CCSVI diagnosis and treatment is one more tool in the toolbox for MS treatment. The worst case is that when we look back five years from now we will see that some people were hurt or worse from a surgery that was eventually proven to have more risks than benefits.

Two MS treatments from the past that come to mind are substance P and massive chemotherapy. Several years ago a Canadian researcher was convinced a dysfunction in a brain chemical called substance P was involved in MS. Substance P is usually involved in pain transmission. Since in MS there is a problem with nerve transmission, this theory seemed plausible. However, I haven’t heard any more about substance P and MS in the last few years. I don’t know if it was disproven or just fell out of favor, but substance P is no longer the next big thing in MS treatment. A more troubling treatment involved massive chemotherapy. Despite Dr. Zamboni’s work, the current belief is that in MS the body’s own immune system attacks the myelin sheaths around nerve fibres. This makes nerve transmission not work as well. A fascinating presentation I went to a few years ago talked about a trial in which they destroyed the immune systems of some severely ill MS patients. They used chemotherapy drugs to kill off the bone marrow which produces immune cells that fight disease. Then they regrew “normal” bone marrow in these patients to give them “normal” immune systems. They did have some success. Some of these MS patients no longer had attacks. That is wonderful, but a few of the test subjects died from the massive chemotherapy. In my mind the risk of that treatment surely out weighed the benefit.

So has Dr. Zamboni found a cure for MS? No one really knows. I’ll definitely be watching for his papers to be published as he tests more and more people. It is great that he is bringing a whole new type of thinking to the problem of MS. If I had MS would I run out and get the surgery? Not yet. I would wait and see what happens with the ongoing trials. But if you haven’t seen it yet, go to the W5 website and watch the documentary. I found it fascinating.

http://www.ctv.ca/w5 CTV's W%

As always if you have any questions or concerns about these products, ask your pharmacist.