‘Liberation therapy’ to widen veins in multiple sclerosis sufferers has been shown to be worthless after ‘gold standard’ study
A surgical treatment pioneered in Europe that was sought out by thousands of desperate people with multiple sclerosis has been categorically debunked by Canadian researchers.
“Liberation therapy” to widen narrowed veins from the brain and spinal cord was devised by the Italian surgeon Dr Paolo Zamboni, who suggested in 2009 that the neurological disease could be triggered by a build-up of iron where the blood did not flow freely.
Zamboni called this condition chronic cerebrospinal venous insufficiency (CCSVI or CCVI) and widened the veins of people with MS using stents. Many in the medical community were sceptical, and his trials of the technique did not compare people given the procedure with those who were not. But other doctors’ doubts did not stop people with MS from joining the waiting list.
In 2013, a paper was published in the Lancet medical journal by Dr Anthony Traboulsee from the University of British Columbia and colleagues, funded by the MS Society of Canada, which found that Zamboni’s hypothesis was fundamentally flawed. The researchers’ study showed that narrowing of the veins that run from the brain to the heart was as common in people without MS as in those with the condition.
The same team has now carried out a more ambitious study. They performed the vein-widening venoplasty procedure on 49 people, inserting a catheter and inflating their veins with a small balloon and a “sham” operation on 55 others, who just had the catheter insertion. Neither the patients nor the researchers knew which people had undergone which operation.
One year later, assessments involving brain imaging and doctors’ and patients’ own assessment of their symptoms, showed that there was no difference between the disease progression of the two groups.
“We hope these findings, coming from a carefully controlled, ‘gold standard’ study, will persuade people with MS not to pursue liberation therapy, which is an invasive procedure that carries the risk of complications, as well as significant financial cost,” said Traboulsee, a UBC associate professor of neurology.
“Fortunately, there are a range of drug treatments for MS that have been proven, through rigorous studies, to be safe and effective at slowing the disease progression.”
In spite of the earlier Lancet paper, people are still seeking liberation therapy, Traboulsee said. “It is less popular. But there is still an advocacy group that has a conference once a year with guest speakers such as Dr Zamboni,” he said. “There are still researchers dedicated to the topic, not just Dr Zamboni. It has been proposed as important for treatment of Ménière’s [disease] and for dementia diseases.”