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Article: Are you getting phone calls about the "Liberation Treatment"?
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Are you getting phone calls about the "Liberation Treatment"?

We asked Dr. Alex Rae-Grant, CMSC website's Project Leader for Neurology, to share his expertise and views about this article "The Liberation Treatment: A whole new approach to MS". Here is his reply:

Multiple sclerosis, even in 2009, remains mysterious and has escaped our full understanding. Why do certain people get it? Why does it affect the brain and spinal cord in the way it does? What causes it? The recent interesting work by Zamboni et al raises an idea from far out in left field; could MS be caused, or at least accompanied by narrowing or blockage of the veins that drain the brain and spinal cord? Ok, so none of the 50 years of research in MS so far have suggested this. And people who are known to have blockage of the veins draining the brain (Cortical vein thrombosis) don't get MS. Pathological studies of MS patients have never suggested this. But on the other hand, it's probably good for us to have an open mind, especially when there are new ideas that can be tested, and possibly ones that have a therapeutic option.

Before we all run out suggest that people with MS get stents in their veins, there may be a few steps along the way.

  1. It will be important for other centers to independently confirm or refute the ultrasound and or venographic findings of Zamboni et al. This work is beginning at the present time. Adequate care in selecting age and sex matched controls and making sure the tests are not biased will be key.
  2. It will be important to understand, if this finding is true, what proportion of the MS population may have such problems. Many in the MS field have felt there are more than one disease within our population; even if 20% of our patients have a venous insufficiency problem, this would be revolutionary.
  3. Any therapeutic claims need to have an unbiased methodology to prove benefit. We know that the placebo effect is strong in MS particularly when we are talking about symptoms and not measurable aspects of the disease such as MRI. A randomized trial of therapy in people shown to have such 'stenoses' would be both ethical and necessary before potentially hundreds of thousands of people are subjected to invasive procedures with measurable risk.

The work of Zamboni et al deserves a long, hard, look; it would be wrong to either clamber on board the bus, or to dismiss this out of hand.


About Dr. Alex Rae-Grant

Dr. Alex Rae-Grant Alex Rae-Grant, MD, recently transitioned from his long-term position at LehighValleyHospital to the Cleveland Clinic. At LehighValleyHospital, he was President of the Medical Staff, Chair of the Ethics Committee, Chief of the Division of Neurology, and founded the MultipleSclerosisCenter of the LehighValley. His role at Cleveland Clinic's MellenCenter is to oversee education about multiple sclerosis in the northeastern Ohio region, assist with clinical trials and be involved with resident and student education at the clinic. He works with regional physicians and MellenCenter staff to distribute approaches to treatment for various aspects of MS.

He was recently awarded the Teacher of the Year award by the neurology residents at the Cleveland Clinic. He is co-director of the neurology clerkship at the Cleveland Clinic and is a Clinical associate professor of medicine at the Cleveland Clinic Lerner College of Medicine. He has previously co-authored two textbooks in neurology, Neurology for the House Officer and 5 Minute Consult in Neurology.

 
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