This Is MS Multiple Sclerosis Community: Knowledge & Support

http://stm.sciencemag.org/content/4/147/147ra111
ABSTRACT

Because it lacks a lymphatic circulation, the brain must clear extracellular proteins by an alternative mechanism. The cerebrospinal fluid (CSF) functions as a sink for brain extracellular solutes, but it is not clear how solutes from the brain interstitium move from the parenchyma to the CSF. We demonstrate that a substantial portion of subarachnoid CSF cycles through the brain interstitial space. On the basis of in vivo two-photon imaging of small fluorescent tracers, we showed that CSF enters the parenchyma along paravascular spaces that surround penetrating arteries and that brain interstitial fluid is cleared along paravenous drainage pathways. Animals lacking the water channel aquaporin-4 (AQP4) in astrocytes exhibit slowed CSF influx through this system and a ~70% reduction in interstitial solute clearance, suggesting that the bulk fluid flow between these anatomical influx and efflux routes is supported by astrocytic water transport. Fluorescent-tagged amyloid β, a peptide thought to be pathogenic in Alzheimer’s disease, was transported along this route, and deletion of the Aqp4 gene suppressed the clearance of soluble amyloid β, suggesting that this pathway may remove amyloid β from the central nervous system. Clearance through paravenous flow may also regulate extracellular levels of proteins involved with neurodegenerative conditions, its impairment perhaps contributing to the mis-accumulation of soluble proteins.

It's a fascinating article. While the imaging is new, the knowledge is not. I thoroughly dicuss the role of the Verchow-Robin perivascular CSF pathways as the lymphatic system of the brain in my book. There is also a drawing of the Verchow-Robin space on page 116 in the book. I copied it from one of my old neurology textbooks, which likewise copied it from an old out of print textbook. I used it because it's the best depiction I have seen of the VR spaces. It's plate 15 and is called, "Subarchnoid and Perivascular Pathways." There are key differences, however, between the lymphatic system and the CSF circulatory system. I discuss one of those key differences in my next book as it causes problems for the brain under certain conditions.

Thanks Dr,
I couldn't have put in words like you have.

The eyes and ears of the World can only detect what they are tuned for hearing!

Regards and have a fantastic weekend!
Nigel

Thanks Dania. It's nice to hear everyone is catching on to the importance of CSF flow. Once we know the cause we can figure out some solutions. Improving drainage via venoplasty is one way. Correcting structural problems in the upper cervical spine is another. I don't think that speeding up CSF flow as suggested in the Science News article is a solution. CSF is meant to flow at a certain rate - not too fast and not too slow. The correct speed is one that is sufficient to produce enough CSF to support and protect the brain, as well as to assist in the delivery of nutrients and the removal of wastes from the brain. The brain prefers and has control mechanisms to help it maintain steady blood flow. There are still other issues that need to be discussed and addressed.

dr. flanagan, there is another thread here on tims just started titled the "glympathic system and csf". this is greek to me but i can think of no one who could answer my question better qualified than you.--my question is about the "i think you call it cranial chiro. or something -but it is where they actually do adjust the skull" as i understand the skull is not a solid one piece bone it does indeed have sections. i found one such person who used this method and word of mouth was told she was very good but her office in pitt. had many steps i can not do. i always thought the skull was something i might try but have not pursued actively. my short question made long is this glympathic thing in the brain this thread is talking about would cranail work maybe have a positive impact on it?


Previously Unknown Cleaning System in Brain: Newer Imaging Technique Brings 'Glymphatic System' to Light
ScienceDaily (Aug. 15, 2012) — A previously unrecognized system that drains waste from the brain at a rapid clip has been discovered by neuroscientists at the University of Rochester Medical Center. The findings were published online August 15 in Science Translational Medicine.
http://www.sciencedaily.com/releases/20 ... 142042.htm

Quote:
The highly organized system acts like a series of pipes that piggyback on the brain's blood vessels, sort of a shadow plumbing system that seems to serve much the same function in the brain as the lymph system does in the rest of the body -- to drain away waste products.


Quote:
"It's as if the brain has two garbage haulers -- a slow one that we've known about, and a fast one that we've just met," said Nedergaard. "Given the high rate of metabolism in the brain, and its exquisite sensitivity, it's not surprising that its mechanisms to rid itself of waste are more specialized and extensive than previously realized." While the previously discovered system works more like a trickle, percolating CSF through brain tissue, the new system is under pressure, pushing large volumes of CSF through the brain each day to carry waste away more forcefully.


Quote:
While a few scientists two or three decades ago hypothesized that CSF flow in the brain is more extensive than has been realized, they were unable to prove it because the technology to look at the system in a living animal did not exist at that time. "It's a hydraulic system," said Nedergaard.

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It's a paradigm shift





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Managed to engage a discussion with Franz Schelling about Dawsons fingers and mechanical issues in MS.
https://www.facebook.com/groups/msfrien ... ment_reply

Quote;
Franz Schelling Nigel Wadham Hi Any increase in arterial as venous pressure within the craniovertebral space "pumps CSF" and displaces opposing tissues.
The question is: Why is this specifically injurious along the "Dawson-finger-embedded" segments of the periventricular veins

Quote;
Nigel Wadham Hi Franz, I would think along the lines that Michael Flanagan suggests that the first point of resistance (eventual weakening) to refluxing flow would be where the weakest point. The entry across the BBB is important and it is where the immune system becomes active eventually, and the visual scaring is seen after the fact by MRI.
The BBB breach sends all sorts of cells all around the brain by the CSF flow.
In my thoughts the places that the 'symptom damage' occurs may not be at the site of the original breach.
The use of the episodic version of MS as a model of MS is wrong in my opinion. The progressive form of MS is a true 'disease form'.
The episodic form is the bodies breakdown under conditions such as stress, accident/physical trauma, diet, lack of exercise etc, etc.
The episodes need to be understood not guessed at by Drug Manufacturers!
I believe from reading and watching and listening to all the CCSVI discussions over the last few years that CCSVI is primarily a mechanical or physical vascular flow issue and there are many additional factors that add to create many diseases that are poorly understood because technology has not been able to explain the processes.
The talk about CSF flow and importance has come from technology showing what Michael Flanagan has published and talked about for years in the same way you have explained the vascular flow issues for years Franz.

Hello Blossom,
As I mentioned in my reply to Nigel, I discuss CSF as the lymphatic system of the brain in my book. The term "glymphatic system" was coined because of the connection to glial cells. Glial cells were once considered to be simply structural cells in the brain not nerves that conduct signals. We know now that they are far more complicated than simply structural cells. They do many thing and are too complicate to go into here. There are different types of glia cells. Oligodendrocytes are glial cells that make myelin. Astocytes are another type of glial cells. It is the so called "feet" of astrocytes that make up the blood brain barrier. What the latest imaging research shows is that CSF in the Verchow-Robbin (perivascular) spaces is connected via tiny pores to channels made from glial cells. The channels are the extension of the CSF system into the interstitial spaces of the brain. The idea is not new. The fact that we can see the glial channels is, as well as the fact that they move at different speeds. The hydraulic connection is not new. It's basic physics. I will discussing hydraulics and poroelasticity in my next two wordpress blogs. The last one was on Dandy-Walker Syndrome. I suspect that CSF hydraulics damages the brain in DWS and neurodegenerative diseases.

Among other things, I use craniopathy. It is an excellent method of working on the musculoskeletal system of the head. In the right hands it has a great deal to offer. One of the primary goals of craniopathy is to restore CSF flow. The theory behind craniopathy is called the craniosacral primary respiratory rhythm. The theory is based in part on the movement of the bones of the skull. That's how I got started in my investigation because Dr. Harry Shapiro, a physical anthropologist and expert on the human skull disagreed that the bones of the healthy skull stay open and move. He was right. Craniopathy is wrong but it still works. The theory needs to be updated. The problem with craniopathy is that it uses a highly subjective approach to analysis of the mechanical strain. You can't show craniopathic lesions on x-rays or MRI. Craniopathy is also sorely lacking when it comes to specific protocols or triage. Specific upper cervical x-rays and upright MRI as used by Dr. Rosa clearly define the strain (misalignment). That said, I have had excellent results with my specific craniosacral approach which includes craniopathy, full spine and pelvic correction.

Good discussion Nigel. I suspect that the reason for the classic periventricular, supratentorial and perivascular location of Dawson's fingers mentioned by Dr. Schelling are due to violent venous backjets. Many MS signs and symptoms come from structures in the posterior fossa, which is called infratentorial. In light of MS being potentially due to drainage issues, it is interesting that the classic lesions aren't found in the posterior fossa, which is the lowest point of drainage in the brain. Instead they are found higher up in the brain above the posterior fossa. Violent inversion flows from trauma make the most sense. On the other hand, lesions aren't always perivenular.

In contrast to venous backjets, I suspect that the hydraulics caused by CSF backjets and turbulence compress and damage the brain. I will be covering hydraulics and poroelasticiy in my next two wordpress blogs.

hi dr. flanagan, a while back you had said that your studies and research and findings to gain recognition would need a push of an army of patients such as ccsvi did when it became known about.

well, it's finally getting there. and none too soon. can you hear them marching and the wheelchairs rolling and even the ones wearing blinders are forced to take a look. "the army will be "massive" and a force to be reckoned with.

every army needs a leader--"and that be you General"!

in my meager way through the yrs. i would sit on my little wooden bridge over my creek and watch the flow. if there was an obstruction at the top the water would hop over it with a rush or try to sidetrack-then on down a ways it just kinda rolled around if obstructed--then at the near end if obstructed the water would stagnate somewhat and bobble around trying to work its way up against a force it couldn't fight so it overflowed. i'd sit there after i'd get the debri cleared best i could and watch the water flowing so peaceful going right down where and how it should. and wish somehow i could get my spine back to the way it felt before i had all that debri and was flowing right. so, although the top of the creek is the head of things and has a great impact i agree that treating the whole creek "spine" as you suggest would be the ultimate--if conditions permit.

your leadership and guidance here is so much needed and appreciated.

dania, that's a neat and interesting article. thanks.

Thanks Blossom. Very well put.

Blossom I think your analogy is right on. Thanks.

I would like to remark this:

"Animals lacking the water channel aquaporin-4 (AQP4) in astrocytes exhibit slowed CSF influx through this system and a ~70% reduction in interstitial solute clearance, suggesting that the bulk fluid flow between these anatomical influx and efflux routes is supported by astrocytic water transport"

Precisely this water channel AQP4 is the one destroyed in the MS-like disease NMO. I have never seen NMO or MS lesions, but they are reported to be similar and both kinds of lesions can be confused in MRIs. A new connection.

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You can get a worldwide list of available sites for CCSVI at http://www.ccsviclinic.info