Multiple Sclerosis Patients Feel Better After a Controversial Procedure, but Expert Offers Warning
By Laird Harrison
WebMD Health News
Latest Neurology News
Reviewed by Louise Chang, MD
March 29, 2012 (San Francisco) -- Most patients in two new studies said that their multiple sclerosis got better after doctors cleared blockages from their veins.
Researchers reported their results earlier this week at the Society of Interventional Radiology's annual meeting.
"It's a nice experience with a large group of patients," Michael Dake, MD, tells WebMD. He was not part of either study. Dake is a surgery professor at Stanford University in California.
But another expert warns that the studies don't prove the procedure works. Lily Jung Henson, MD, tells WebMD that multiple sclerosis patients should not try the procedure yet. Henson is a neurology professor at the University of Washington. She was not part of the new studies.
MS patients have a wide range of mental and physical symptoms. They may have trouble moving and thinking. Most experts believe the patients' immune cells attack their own nerves. There is no cure. The usual treatment is drugs to weaken these attacks.
Some MS patients also have blockages in veins in their necks or chests. It's still not clear whether the blockages cause symptoms of multiple sclerosis. But the two new studies aimed to find out if MS symptoms could be improved by clearing the blockages.
The procedure is called balloon angioplasty. It is often used for patients who have clogged arteries. Surgeons use ultrasound and other methods to look in the patients' veins.
If they spot a blockage, they thread tiny balloons through the patients' veins. They inflate the balloons to widen the places where the veins are blocked. They then take out the balloons.
If the balloons are not enough, the doctors insert stents. These tiny tubes hold the veins open.
Researchers at Rush University in Chicago surveyed 89 patients who had this procedure. Forty-eight said their MS symptoms clearly got better. The others had unclear or no improvement. Patients with the "relapsing-remitting" form of MS improved the most.
A few patients had problems related to the procedure. Three had blood clots in the targeted veins. Three had bleeding where the balloons were inserted. One died four months after the procedure for unknown reasons.
Another study was done at Albany Medical Center in Albany, N.Y. Researchers surveyed 213 patients. The study had similar results as the Rush study. Patients at Albany were more likely to benefit if they had had MS for less than five years.
Hector Ferral, MD, led the Rush study. He tells WebMD that the next step is to learn more about what is blocking the patients' veins. "We think there are valves in the jugular vein that are either too thick or are not closing properly," he says.
After that, researchers can design a study in which some patients get a fake treatment and others get the real procedure. Researchers will track both groups to see who is healthier.
The treatment should already be available to patients like the ones in the studies, Ferral says. "We have a good enough justification to do this procedure."
Henson disagrees. "This is not ready for prime time," she says. The symptoms of relapsing-remitting MS patients often get better on their own, so it's hard to know if they felt better because of the procedure. Researchers should study the procedure in animals before doing it in humans, Henson says.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
SOURCES: Society for Interventional Radiology's 37th Annual Scientific Meeting, Chicago, March 24-29, 2012. Hector Ferral, MD, professor of radiology, Northshore University Health System, Chicago. Michael Dake, MD, professor of cardiothoracic surgery, Stanford University, Stanford, Calif. Lily Jung Henson, MD, neurology professor, University of Washington.
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