Making Waves against Brain disease

We are living in challenging times as the prevalence of brain diseases- dementia, Parkinson’s disease, ALS, Multiple sclerosis and many others- impacts almost everyone in the world. There have been many theories regarding the causes of these disorders including genetic and environmental factors. The general consensus is that the risk for developing these disorders is “epigenetic†a confluence of genetics combined with exposure to environmental insults. A common and overlapping feature of brain disorders is the propensity to develop pathological  proteins or “protein aggregates†which resemble a misfolded origami . These misfolded proteins begin to accumulate within cells and begin to stifle them to the point that they no longer are functional.

The good news is that our bodies have the ability to digest these misfolded proteins to maintain “house keeping†in our brains. This process involves a recently discovered an intricate web of blood vessels and lymphatic like tissue in the brain called the glymphatic system.

The glymphatic system is the brain’s waste removal system, responsible to literally flush out the misfolded proteins into the spinal fluid to recycle and refresh the ocean like fluid that surrounds the brain. So what goes wrong in neurological diseases and are their plumbing like interventions to help repair the glymphatic system?

Among the many proposed environmental factors one of the most substantiated in ALS for instance is a history of head and neck injuries. These injuries can stretch or interrupt the delicate network of vascular tissue in the brain and cervical spine, essentially blocking the flow of spinal fluid from being adequately filtered. In the past these injuries were unable to be visualized and individuals who complained about the onset of neurological symptoms after head or neck injury were dismissed as being psychosomatic when imaging studies were mostly negative.  However, thanks to advances in neuroradiology by pioneers like Dr. Damidian, scientists now have the capability of assessing the glymphatic system and have unexpectedly discovered that  its dysfunctional in a vast cross section of neurological and neuropsychiatric disorders including autism.

Head injury is not the only cause of glymphatic dysfunction as surprisingly cervical trauma can also lead to obstructions in the flow of spinal fluid due to obstructions in the dura( ‘tough matterâ€) that protects the spinal cord from injury. After an injury involving the neck, the dura can become displaced and compress the very delicate and quite vulnerable network of small blood vessels- both arterial and venous- that maintain the integrity and health of this region of the nervous system. 

What does this mean on a research and clinical basis going forward? The answer is that once we can visualize and confirm that the plumbing system of the brain and spinal cord is backed up, we can explore non invasive ways of “making waves†to literally flush out these misfolded proteins. Some of the modalities that are currently being explored by researchers include the use of ultrasound and magnetic stimulation

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 Making waves

Advanced imaging studies suggest that several pulsatile forces are involved in glymphatic flow, including our heart beat,  respiratory mechanisms and changes in  the sleep wake cycle. Researchers have used these measurements to explore exciting new advances in biophysical approaches to brain diseases. In other words, by generating physical waves through technologies like ultrasound it may be possible to break up these abnormal proteins associated with brain diseases. For instance, Therapeutic focused-ultrasound has been shown to  reduce amyloid plaque in a small group of patients with AD.  (Proc Natl Acad Sci U S A. 2020 Apr 28; 117(17): 9180–9182.d) by enhancing the dispersion of misfolded proteins protein aggregates by  improving glymphatic function. What’s also fascinating to note is that low frequency ultrasound is an FDA approved technology for wound healing

Rotating magnetic field treatments is another area of promising research for individuals with brain and spine injuries as basic science studies have shown that promote neural regeneration by improving tissue oxygenation and enhancement of growth factors that are critically important for optimized brain function. Recent and very promising studies include its potential application in post stroke patients. Neurotherapeutics. 2019 Jan; 16(1): 67–87 Magnetic stimulation treatment has also been shown to significantly increase the capacity for stem cell differentiation. Anat Cell Biol. 2015 Jun; 48(2): 104–113, implying that there may be as yet unexplored synergistic effects between the application of  stem cells combined with magnetic stimulation.

In my next blog I will discuss how lifestyle management including an understanding of the importance of restoring normal sleep can help promote the glymphatic system, including the relationship of melatonin as a neuroprotective agent for the brain. Also, as an Osteopathic trained physician, I am also very bullish on the application of cranio sacral therapies which I perform in my office in NY