chess06 wrote on Nov 19th, 2009 at 4:42am:EVERYTHING I read says that MM is progressive and that surgery is the ONLY option. My neurologist begs to differ and says there have been patients who do not get operated on and who live to a very old age.
Dr. Scott, as you know, a leading MM specialist here in the USA, explains MM progression this way:
All patients with moyamoya disease will develop progressive narrowing of their brain blood vessels over time, and we have never seen an exception to this rule after more than three decades of studying these patients. Along with this progressive narrowing of the brain blood vessels, the patient's clinical condition also worsens; this is why we believe that surgery to increase the brain's borderline blood supply is so important for most patients.
The rate of progression is extremely variable from patient to patient, however, with some patients experiencing a rapid course with many strokes over less than a year, and others a slow and desultory progression, which may take decades to evolve.
I’m very curious to know what percentage of your neurologists' patients lived to a very old age without surgery, and if they ever had a stroke or have disabilities. (??) You’re correct that MM is progressive and surgery is the ONLY option for treatment to avoid a stroke. According to MM experts and research to date, moyamoya disease IS in fact progressive. Unless your neurologist means that in some cases, like Dr. Scott speaks of, where the progression is unpredictable and gaping in some cases and may take decades to evolve, never the less; MM is still PROGRESSIVE, whether it be slow or whether it’s MM disease or MM syndrome, that fact remains that it IS PROGRESSIVE and risky without surgery.
I think anyone can make an argument about the percentage of patients that progress slower than others, but at any percentage, there is still that risk of a life altering stroke/hemorrhage or death with this disease, and we know a patient can have a stroke or hemorrhage without necessarily even having symptoms. MM can be a silent destroyer/killer, and surgery is the only way to help prevent it.
As I understand it, even though a patient may have an adequate blood supply at the moment, (progression or not) those MM vessels are abnormal, weak and fragile vessels that can rupture at any time, any stage. That is a very important risk factor to consider IMO, and why a MM experienced neurosurgeon or MM specialist is so important to evaluate each particular case. Then it’s up to the patient, after learning all his or her facts in their particular case to decide what’s best for them. A second opinion is very wise.
I can’t say if I’ve ever heard of a case like yours or not because we do not know your specifics. You said that your initial results are normal, with no progression. I’m not sure what that means. Have you been diagnosed as definitely having MM? What tests did you have prior and now to compare them to, to know whether it has or hasn’t progressed? What is normal? The definitive test for MM is an angiogram.
My point is, we’ve heard doctors say many things over the years and many times they were way off and not experienced enough with MM, so yes, we've basically heard the same thing many times, but sadly they were wrong, and that’s why we advise a second opinion with a MM specialist. I pray not. I hope you're a rare case that won't experience what this monster disease is capable of.
Keeping you in my prayers.
Mar