Hope or science? Multiple sclerosis surgical ‘procedure’ triggers debate

Pritha Chatterjee Posted online: Tue Jul 19 2011, 02:31 hrs

New Delhi : A debate has started over the use of a relatively new surgical procedure as treatment for Multiple Sclerosis (MS) in some hospitals in India. Critics say that the results are not scientifically established and the treatment not approved by regulatory authorities, but doctors are going ahead in the belief that MS, an autoimmune degenerative disorder, can be attributed to vascular reasons.At least three leading hospitals in different parts of the country have been offering the process, commonly known as ‘liberation therapy’, since June last year. At 170 cases, Medanta Medicity in Gurgaon has handled the largest number of cases. Fortis Hospital in Delhi is next with 38, followed by Apollo, Chennai, with around 12 patients.Based on Italian physician Dr Paolo Zamboni’s 2009 hypothesis that MS can be attributed to vascular reasons, hospitals argue that it should be treated the same way as in the case of blockages in the heart. Others point out that the long-term effects of such a surgery haven’t been established yet.

Dr Vipul Gupta, senior vascular surgeon at Medanta Medicity who has done a number of such procedures, says Medanta defines the procedure as an “internal study” since the treatment is not yet established, though patients are charged for the procedure.

“Implanting stents for vascular blockages is a routine procedure. Why does it have to be a special case for MS patients?” says Dr Ashok Chordiya, Director of Fortis Noida.

Dr Gupta identifies the condition as “Chronic Cerebrospinal Venous Insufficiency (CCSVI), where blockages caused by iron deposits in veins cut down the blood supply to the brain”. These deposits, he says, are surgically removed by balloon angioplasty, followed by the implantation of a stent. He claims about 30-40 per cent of patients at Medanta have shown short-term improvement.

According to a written statement from Fortis, no adverse effects have been reported so far.

But Dr V Balaji, senior consultant in vascular surgery at Apollo Chennai, who performed the first CCSVI procedure in India last April, admits that “patients say they feel good subjectively, but we have scientifically established only 0.5 per cent improvement in aspects like mobility and balance.” He adds that the demand for the therapy is high, even from abroad.

Patients who underwent the surgery have mixed responses. Surbhi Chichra, 35, underwent balloon angioplasty at a Noida hospital in June last year. A year later, Surbhi, now being treated at AIIMS, says, “after spending Rs 1.5 lakh for the procedure, my mobility has hit its lowest since I was first diagnosed with MS.”

Kavita Aggarwal, 38, also underwent the procedure last year. She says the hospital gave her a “slight ray of hope”, and that now that is gone.

But Teena Gera, 35, who got operated in February this year, says her perceptions of temperature have improved and she does not feel “so cold anymore”.

Says Dr M V Padma, Professor of Neurology at AIIMS, “Dr Zamboni’s study on 70-odd patients was without a control group. He could not establish that these vein blockages were a cause for MS. Till the treatment is proven and approved, it is not ethical to capitalise on the condition of helpless patients.”

Dr Anshu Rohatgi, consultant in neurology at Delhi’s Gangaram Hospital, says, “a study presented by the State University of New York at the American Academy of Neurology in April this year found that vein blockages were not a cause of MS.”

The disease

MS is a multifactoral disease, the precise cause of which remains unknown. The famyelin sheaths that cover nerves are damaged by the body’s immune system. Since 1995, disease-modifying drugs have been approved by the FDA for controlling the problem, but there is no established cure for MS — these drugs help manage and control it, delaying the onset of disability.

At least three leading hospitals in the country have been offering the ‘liberation therapy’ since June last year. At 170 cases, Medanta Medicity, Gurgaon, leads, followed by Fortis Hospital, Delhi, with 38 cases, and Apollo, Chennai, with 12.

source: Indian Express

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