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Posted by on Mar 25, 2010 in Ethics, Neurology

Better Idea: Close MS Stent Program

Better Idea: Close MS Stent Program

Neck_veins_Grays.gif

Stanford rightly shut down Dr. Michael Dake‘s jugular stent program for patients with multiple sclerosis. Dake, a multi-board-certified physician* and professor of cardiothoracic surgery at Stanford, had placed jugular-vein stents in 40 patients with MS, according to the WSJ, on the basis of Internet-fueled enthusiasm for the implausible idea that MS is due to venous insufficiency.

The hypothesis is the “Big Idea” of Italian vascular surgeon, Paolo Zamboniwho has documented venous-outflow anomalies in patients with MS. These findings were the basis for Zamboni’s uncontrolled study of venous angioplasty in 65 patients with MS, which was reported last year. Despite the fact that the study yielded mixed results, it apparently produced unbridled zeal in chat rooms, and the zeal found its way to Dake.

The WSJ reports that a “number” of Dake’s patients experienced neurologic improvement after jugular angioplasty or stenting (thank you, placebo effect and the highly variable nature of MS), but 1 patient died of cerebral hemorrhage, and the stent of another became dislodged in his heart. The WSJ implies that Stanford and UCSF neurologists were instrumental in getting Dake’s stent program shut down in December.

MS, which is currently treated with evidence-based disease-modifying therapies like interferon beta, is believed to be an autoimmune disorder. While cerebral venous insufficiency may be documentable in MS, it is unknown if this is a consequence of the disorder or merely an epiphenomenon. It is unlikely to be the cause.

* But not a neurologist.

Image of neck veins from Gray’s Anatomy (1918).

bmartin (1127 Posts)

A native East Tennessean, Barbara Martin is a formerly practicing, board-certified neurologist who received her BS (psychology, summa cum laude) and MD from Duke University before completing her postgraduate training (internship, residency, fellowship) at the Hospital of the University of Pennsylvania in Philadelphia. She has worked in academia, private practice, medical publishing, drug market research, and continuing medical education (CME). For the last 3 years, she has worked in a freelance capacity as a medical writer, analyst, and consultant. Follow Dr. Barbara Martin on and Twitter.