Letter from Prof Grozdinski

After hearing about a new doctor working on patients in Bulgaria I decided to contact him to find out what his team offers.  The following is his response, his email is: grozdinski (at) mail.bg

Multiple sclerosis (MS) is a progressive inflammation disease of the central nervous system in which the myelin sheaths around the axons of the brain are damaged and the transmission of nerve signals is blocked, which leads to the occurrence of paralysis and loss of vision. Until recently MS was considered a disease of the autoimmune system with a possible virus genesis, which has hereditary predisposition. But the basic cause of the disease remained undetermined which brought for serious problems in its treatment and prophylaxis.

In 2008 – 2009 the Italian Dr. Paolo Zamboni made public a theory according to which MS is caused by chronic cerebrospinal venous insufficiency (CCVI). He established that about 90% of the MS patients have a severe blockage of the venous draining of the brain, leading to damage of the venous endothelium, followed by invasion and buiding-up of toxic substances (iron) in the brain tissue, which is the cause of chronic inflammation of the sheathing around the brain nerves. Dr. Zamboni developed his research further. For a group of 65 MS patients he used an inflated small balloon to clear out the blockage of the brain draining veins, which brought for a considerable improvement in the status of most patients. As a follow-up now several centers in Europe have started venous diagnostics and treatment of MS patients.

The first examinations which took part in Bulgaria in two specialized hospitals through a color echo doppler and computer tomography – phlebography – confirmed the presence of venous pathology in MS patients. We worked out a scheme for the examination of MS patients, including 3 basic procedures:  testing with a color echo doppler (a non-invasive examination), computer tomograph phlebography (a non-invasive examination) and phlebography with balloon dilatation, or a metal stent to hold the vein open permanently. This treatment can take place in a Bulgarian specialized hospital with the patent being hospitalized for 3 to 5 days. In actual fact this treatment is harmless and complications are not to be expected. The presumption of this treatment is that by eliminating the cause of MS – the cerebrospinal venous insufficiency – improvement will take place and the progressive development of the disease will be stopped. This treatment should be undertaken alongside with anti-inflammation therapy, conducted by neurologists, as for the time being the role of the venous disturbance in the etiopathogenesis of MS is not clear – it may be either a basic cause, a triggering mechanism or a concomitant process. The possibilities of contemporary phlebology (the veins science) in Bulgaria and elsewhere for diagnosing and effective treatment of venous pathology in patients with MS are with a big potential and we hope to be able to help thousands of patients who suffer from this debilitating disease.

We created a working group of phlebologists – specialists in venous and ultrasound diagnostics, specialists in computer-tomograhy diagnostics and endovascular therapy, to conduct the venous diagnostics of MS patients and in cases of pathology findings to provide the necessary treatment: dilatation of the blocked veins.

Foreign citizens, who want to be diagnosed and treated for multiple sclerosis at a Bulgarian center should apply for it by e-mail and as a reply will get additional offer of tentative costs of the procedures to be diagnosed and treated, and afterwards will be provided with dates for the hospital treatment.

Requirements for the diagnostics and treatment of patients with CCSVI, which can be performed in Sofia, Bulgaria at a Bulgarian hospital, specializing in the field of cardio-vascular diseases, are as follows:

1. Patient should be diagnosed with MS through magnetic resonance imaging (MRI).
2. He or she should have his MS epicrisis translated into English.
3. Conclusions by a consulting neurologist should give the objective status of the present condition of the patient.
4. Patient should have a health insurance.
5. Upon hospitalization patient should give in writing his/her agreement to undergo the needed procedures for diagnostics and treatment.

Hospitalization of foreign citizens at the center for diagnostics and treatment of patients with CCSVI will start in April 2010. It will include the following procedures:

1. Echo-doppler of the venous system.
2. Computer tomography (СТ) – phebography of the veins.
3. Phlebography of vena cava, vena jugularis and vena azygos.
4. If at the time of phlebography vein stenosis has been diagnosed, momentous balloon dilatation or stent implementation will be performed.
5. Parallel to these examinations the patient will undergo comprehensive blood tests, electrocadiography and consultations with a phlebologist, cardiologist and neurologist.
6. Duration of hospital treatment will be 3 days.
7. Upon release from the hospital patients will be provided with epicrisis with the confirmed diagnosis and description of the implemented treatment.

Instructions for further treatment and date of the following checkup will also be provided.

The total cost of the hospital treatment and the performing of all procedures for diagnostics and treatment will be 3,000 euro.

In cases when no venous pathology has been found and no balloon dilatation has been performed cost will be 2,000 euro.

If you are interested in undergoing treatment in Sofia in agreement with the above mentioned requirements please e-mail to me your request, including your names and address, so that we can provide you with the date for hospitalization and additional detailed information.

Prof. Grozdinski

Chairman of the Bulgarian National Phlebology Society