Experimental procedure gives MS patient mobility back

Nearly 400,000 people in the United States have been diagnosed with multiple sclerosis (MS), an autoimmune disease that affects the brain and nervous system. Now, a new experimental treatment is helping one women move again.

One year ago, 48-year-old Barbara Garcia was not able to walk across a room without the help of a walker or wheelchair. Multiple sclerosis, which causes nerve impulses to be stopped or slowed, was taking its toll physically and mentally.

"It was like, 'Why me?'," said Garcia. "I've been trapped in an old person's body forever. There's been no quality of life."

Tests showed that Garcia, who was diagnosed with the disease at age 25, had a narrowing in the jugular veins which some believe is associated with MS. When Dr. Bulent Arslan at Moffitt Cancer Center reviewed her tests, he agreed to do an experimental procedure known as venoplasty for Chronic Cerebrospinal Venous Insufficiency (CCSVI).

Dye is injected into the jugular veins to locate the narrowed area. Then, similar to an angioplasty, a balloon's inserted into the vein and inflated to improve blood flow from the brain toward the heart.

"We do that until we get enough improvement in the vein and the flow so that blood flow is not restricted," said Arslan, who is also an associate professor of radiology at the University of South Florida in Tampa. "She started showing improvement on the table, which I did not believe at the time."

When he asked Garcia to see if she could walk, she was able to get up and walk around the bed.

Garcia can now take care of her granddaughter and has even gone on vacation in Spain. However, some doctors still believe the short- and long-term benefits of balloon venoplasty are being blown out of proportion.

"We need to make sure this procedure works, make sure it's durable, find out more about it," said Dr. Bruce Zwiebel, an interventional radiologist at Tampa General Hospital.

Despite that, being free of a walker or wheelchair is all the proof Garcia needs.

Garcia's procedure was the first of 120 for Arslan.

While venoplasty is not a cure, but he reports that 70 to 80 percent of his MS patients show improvement after treatment. More than $2 million has now been committed to study the procedure in the United States and Canada.

Research Summary:
MS Controversy: Inflating Veins, Deflating Symptoms

Background: Multiple sclerosis, also referred to as MS, is an autoimmune disease that affects the brain and spinal cord. Inflammation damages the nerves, causing impulses to be stopped or slowed. The cause of MS is unknown, and there is no cure. MS is more common in individuals of northern European descent, and women are more than twice as likely to develop MS as men. The condition usually affects people between the ages of 20 and 50 years, and the average age of onset is approximately 34 years.
(SOURCE: National Institute of Neurological Disorders and Stroke, NINDS Multiple Sclerosis Information Page)

Signs and Symptoms: Most people experience their first symptoms of MS between 20 and 40 years of age. Initial symptoms often include blurred or double vision, red-green color distortion, or blindness in one eye. Many MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. The symptoms may be severe enough to impair walking and standing and can produce partial or complete paralysis. MS patients also typically experience numbness, prickling, or "pins and needles" sensations, and pain. Hearing loss, speech impediments, tremors, and dizziness are other frequent complaints. Nearly half of all MS patients experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked.
(SOURCE: National Institute of Neurological Disorders and Stroke, NINDS Multiple Sclerosis Information Page)

Treatment: There are several treatment options for multiple sclerosis. They range from oral medications to injections. One newer and somewhat controversial treatment option is known as venoplasty for chronic cerebrospinal venous insufficiency or CCSVI. CCSVI treatment is a non-operative, minimally invasive intervention. It is typically performed as part of a catheter-based endovascular procedure. CCSVI treatment requires either balloon angioplasty and/or stent placement to open or clear obstructions from the veins that drain the brain and spinal cord. Treatment risks include post-procedural bruising, infection and short-term (1-2 hours) post-procedure dizziness or headache.

The procedure was coined by Italian vascular surgeon, Paolo Zamboni, whose wife has MS. Zamboni theorized blood flow might be impaired by iron deposits clustered near the jugular veins. Almost all the patients Zamboni tested with Doppler ultrasound had veins in the neck that were narrowed, twisted or blocked. In 2009, Zamboni published results of a study after trying the balloon procedure on a small group, including his wife and finding that most had fewer MS attacks and improved quality of life. Patients reported abandoning their wheelchairs, being able to think more clearly and having better vision.
(SOURCE: ccsvi.org)

Moffitt Cancer Center: Bulent Arslan, M.D., from Moffitt Cancer Center performs the venoplasty procedure. "The reason we started performing this specific procedure at Moffitt is because a patient contacted me personally after checking the Society of Interventional Radiology website and found out that I am an interventional radiologist with experience and interest in vein treatment. I agreed to provide this service to her and once she had a very good outcome, she referred more patients. As patients had good outcomes, we continued performing the procedure. Although the mission of Moffitt Cancer Center is obviously to help prevent and cure cancer, the center is not opposed to helping other patients in need if the physicians have time and ability to treat them."

For more information, please contact:
*Kim Sarratea, Assistant to Dr. Arslan
Moffitt Cancer Center
(813) 745-8425
Kimberly.Sarratea@moffitt.org


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