By Jenifer GoodwinHealthDay Reporter Latest Neurology News

TUESDAY, Jan. 18 (HealthDay News) — Preliminary research and reports from patients suggest that a controversial treatment for multiple sclerosis can help relieve fatigue and other symptoms, but many physicians remain highly skeptical of the claims.

The debate started in 2009, when Dr. Paolo Zamboni, a vascular surgeon from Italy, published an intriguing study that suggested that a blockage in the veins that drain blood from the brain and spinal cord and return it to the heart might contribute to multiple sclerosis (MS).

Calling it chronic cerebrospinal venous insufficiency, or CCSVI, Zamboni’s theory was that the blockages disrupt the flow of blood from the brain and spinal cord, causing blood to back up and damage the brain and the spinal cord.

Zamboni began surgically treating people with MS with balloon angioplasty to open their veins. Other CCSVI researchers have tried stents, in which a wire mesh is placed in the vein to prop it open.

The methods of Zamboni and the others set off a heated debate among physicians and patients. many MS physicians consider the claims utter hooey. but many people with MS, desperate for relief, pressed for research, and some, unwilling to wait, sought out physicians abroad who’d do the surgery.

Despite the skepticism, U.S. researchers began investigating venous blockage. in June, the National Multiple Sclerosis Society announced $2.4 million in funding for CCSVI studies, most of which are trying to answer the basic question of whether there is actually a link between venous blockages and MS.

Among those conducting CCSVI research is Dr. Michael Dake, a professor of cardiothoracic surgery at Stanford University School of Medicine.

Dake followed 30 people with MS who had stents implanted to open their veins. Two months after surgery, they reported feeling 50% less fatigued than before surgery, Dake said. they continued to be less fatigued at the one-year mark, even improving slightly from where they were two months after surgery, he said.

People who saw the most benefit were those with the relapsing-remitting form of MS, in which periods of remission, when the person feels relatively good, are followed by MS flares, Dake said.

People with more aggressive or more advanced forms of MS, including primary and secondary progressive MS, reported about a 40% drop in fatigue two months after the surgery, but the effect did not last at the one-year mark, Dake said.

MS is believed to be an autoimmune disease in which the body’s immune system attacks myelin, or the substance that insulates nerve fibers of the central nervous system. The damage disrupts nerve signals traveling to and from the brain, which can lead to numbness, movement difficulties and blurred vision. Other symptoms can include fatigue and cognitive problems, sometimes described by those with MS as being in a fog.

Vein opening is unlikely to help regenerate damaged myelin, which causes the movement difficulties, Dake said, but opening blocked veins looks like it may help alleviate fatigue, at least in people with relapsing-remitting MS.

“It’s a stretch to think opening up veins is going to deal with or reverse an injury that is due to demyelinating plaque, whereas the symptoms that are more general, such as fatigue and brain fog that are much more related to an obstruction in venous outflow from the brain — those could potentially be reversed,” he said.

Dake was scheduled to present his findings this week at the International Symposium on Endovascular Therapy in Miami Beach.

He cautioned that his research was not a randomized, controlled, clinical trial but rather a review of his clinical experience with 30 patients.

Therein lies the problem with CCSVI and its treatments, said Dr. Lily Jung, medical director of the neurology clinic at the Swedish Neuroscience Institute in Seattle.

“There is no clear evidence that MS has anything to do with blocked veins, and to then jump to therapy for blocked veins is premature,” Jung said.

The research done on CCSVI has not consistently established that people with MS are more likely to have venous blockage than are healthy people or those with other neurological diseases, Jung said. nor is it known when venous blockage occurs during the course of the disease or why such a blockage, if it occurs, would cause symptoms of MS.

Until much more is learned, Jung warned people against seeking treatment for CCSVI because of the danger of complications. According to the National Multiple Sclerosis Society, a Canadian man with MS died after seeking angioplasty in Costa Rica, and another had to have emergency open heart surgery to retrieve a stent that dislodged.

“It is not ready for prime time,” Jung said. “We need to first establish how firm the basis for the theory is and, secondly, have a widely accepted agreement about how to diagnose CCSVI before you try treatment for it,” she said.

Dr. James Benenati, president of the Society of Interventional Radiologists, described MS as a heterogeneous disease — meaning that not every person with MS has venous blockages, and not every person with venous blockages has MS. And that, he said, makes the research more difficult.

Benenati said he plans to begin offering the treatment to MS patients at Baptist Cardiac & Vascular Institute in Miami as part of a research study.

“My feeling and the society’s feeling is we don’t have enough data yet to say 100% yes or no,” Benenati said. “But to basically condemn something because there isn’t good data at this time is premature — and not very scientifically sound, either. my own feeling is it is going to pan out to be something of great value.”

In the meantime, not everyone with MS seems willing to wait for the lengthy clinical trials to be completed. “We’re getting a huge number of calls on this,” Benenati said. “It can be overwhelming.”

Copyright © 2011 HealthDay. All rights reserved.

SOURCES: Michael Dake, M.D., professor, cardiothoracic surgery, Stanford University School of Medicine, Stanford, Calif.; James Benenati, M.D., medical director, peripheral vascular laboratory, Baptist Cardiac & Vascular Institute, Miami; Lily Jung, M.D., medical director, neurology clinic, Swedish Neuroscience Institute, Seattle; presentation, Jan. 17, 2011, International Symposium on Endovascular Therapy, Miami Beach

Because several newspapers are reporting that Aretha Franklin has been diagnosed with pancreatic cancer, we at Vital Signs decided to take a closer look at this deadly disease.

First, let’s start with the bad news: this is one of the deadliest of cancers. According to the American Cancer Society, approximately 38,000 people are diagnosed with pancreatic cancer and about 34,000 people die from the disease each year.

Because its symptoms are often silent, many patients do not see a doctor until the disease has advanced.  That’s why only four percent of people diagnosed with pancreatic cancer survive five years or longer.

For many people, the first sign of the disease is jaundice — yellowing of the skin or the whites of the eyes.  Jaundice is one of the most common symptoms because 75 percent of pancreatic cancers are located in the head of the pancreas, according to Dr. Jason Klapman, assistant member of the gastrointestinal oncology program at Moffitt Cancer Center in Tampa.

A tumor located in the head of the pancreas causes blockages of the bile duct, Klapman said, and results in jaundice.

People with pancreatic cancer may also experience severe abdominal pain or new onset of diabetes, Klapman said. In 75 percent of cases, he said, the cancer has spread beyond the pancreas and is inoperable.

But pay attention for early signs of the disease. “if you develop diabetes or you notice you’re losing weight — unexplained weight loss with abdominal pain — things like that should be reported to your doctor,” said Dr. Klapman. “unfortunately, most of the time it’s silent.”

Who’s at risk for getting the disease? Blacks are at higher risk than whites and they often get the disease earlier than whites, though doctors aren’t sure why. Smokers are at higher risk, as are people who eat diets high in meat and fat. Also at risk: people who have cirrhosis (a chronic liver disease), diabetes or chronic pancreatitis.

Genetics also play a role. People who have two or more family members with the disease are at higher risk, as are those with the BRCA2 breast cancer genetic mutation.

There have been some reports — though the information is still sketchy — that Aretha Franklin has been operated on and that she described the surgery as “successful. “  if she has pancreatic cancer, doctors say that  may indicate that her cancer was limited to the pancreas and hasn’t spread to nearby blood vessels. In those instances, doctors recommend surgery to remove the tumor. 

Still, the outlook is not promising — even for patients whose tumor is completely removed. Only 20 percent of patients who have surgery survive five years or more. “there is no guarantee, but we always recommend operation if possible,” Klapman said.

Because the traditional treatments for pancreatic cancer — which consist of chemotherapy and radiation — have such poor results, Klapman recommends that anyone who is diagnosed with the disease go to a cancer institute, such as Moffitt or M.D. Anderson Cancer Center, to enroll in a trial for new drugs and new treatments.

Canadian medical bodies should assess as quickly as possible whether there is merit to Paolo Zamboni’s theory of multiple sclerosis: that vein blockages play a key role, and that a simple treatment that opens the veins alleviates many of the symptoms.

Putting Dr. Zamboni’s theory to the test may, as critics say, give false hope to patients who suffer greatly from a neurological disease that may disturb their ability to hear, see, remember and move. Then again, the tests may prove promising. the real question is whether there’s a credible case for pressing ahead with more study.

It is not as if Dr. Zamboni, of Italy, dismisses the idea that multiple sclerosis is an autoimmune disorder. far from it. He says that vein blockages draining blood from the head back to the heart may also contribute to the disorder. his preliminary work suggests it does.

St. Joseph’s Healthcare Hamilton, a leading Ontario hospital affiliated with McMaster University, believes Dr. Zamboni’s theory is worth testing. the hospital is not offering to unblock people’s veins. it will use magnetic resonance imaging and ultrasound to determine whether people with MS are more likely to have vein blockages than those who don’t have MS. the University of Buffalo has begun a similar study, and preliminary results confirmed Dr. Zamboni’s suspicions; 56 per cent of the MS patients had the blockages, more than twice the rate as in those without MS. But studies from Sweden and Germany have reported no differences in the rate of vein blockages.

MS wouldn’t be the first disease to undergo a rethinking. In 2005 Barry Marshall and J. Robin Warren won the Nobel Prize in medicine for challenging “prevailing dogmas” (as the Nobel committee put it) on peptic ulcer disease. (Dr. Marshall drank a glass of bacteria and infected himself to prove the skeptics wrong.) “Revolutionary ideas don’t sit comfortably with the medical community,” says Ian Rodger, the vice-president of research at St. Joseph’s. Skepticism is justified, but it shouldn’t shut down exploration.

Saskatchewan Premier Brad Wall gave life to a national debate when he announced that his province would fund clinical studies of the treatment. this week, Manitoba’s Health Minister, Theresa Oswald, called on her provincial counterparts to support multi-site trials. Quebec Health Minister Yves Bolduc expressed interest on Wednesday. They are right to be having this discussion. Saskatchewan has the country’s highest rate of MS, and with up to 75,000 patients, Canada has among the highest rates in the world. There’s an obligation not to sit on our hands.

Canada should examine its options for testing Dr. Zamboni’s hypotheses, and answer definitively whether the hope is false or real.