What has fibromyalgia to do with the nervous system?

Most neurologists would perish the thought that fibromyalgia has anything to do with the nervous system. Any mention of it would induce sighs and tut tuts. There is however emerging evidence linking fibromyalgia to dysfunctional central pain processing. A prominent advocate of this is anaesthesiology professor Daniel Clauw.

Pain map. vaXzine on Flikr. https://www.flickr.com/photos/vaxzine/2642346629
Pain map. vaXzine on Flikr. https://www.flickr.com/photos/vaxzine/2642346629

Another rheumatologist, Manuel Martinez-Lavin, adds another neurological perspective to fibromyalgia: the association with sympathetic hyperactivity. He makes the very plausible argument that sympathetic hyperactivity would explain the frequent association of fibromyalgia with symptoms such as anxiety, insomnia, and irritable bowel.

By BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff. "Blausen gallery 2014". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. - Own work, CC BY 3.0, Link
By BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff. “Blausen gallery 2014“. Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. – Own work, CC BY 3.0, Link

Martinez-Laviz is also involved in pushing the possible link between fibromyalgia and small fiber neuropathy. This comes from studies of small nerve fibers in the cornea. A recent article in the journal Pain supports this. The title, Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia, does appear to give credibility to the association.

"Vasculitic neuropathy - plastics - intermed mag" by Nephron - Own work. Licensed under CC BY-SA 3.0 via Commons.
Vasculitic neuropathy – plastics – intermed mag” by NephronOwn work. Licensed under CC BY-SA 3.0 via Commons.

 

These findings are all pointing to a new paradigm of fibromyalgia. Perhaps neurologists shouldn’t dismiss fibromyalgia too quickly!

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Neurology blogs update

A quick post to add a couple of blogs to my blogroll.

The first is the Stroke blog. It is clearly for the academic minded!

The other is Brain Watch. More colourful and suited for the general reader.

The neuroscience page of Alltop has an extensive list of neuroscience blogs and sites lists which look quite enticing-I haven’t explored it yet but look quite good.

You may wish to refer to my previous posting on neurology blogs.

Pareidolias-why we see non-existent faces

Human beings are prone to see patterns where none exist. This concept of pareidolias often has religious connotations, and has led to bouts of religious fervour. Wikipedia describes this as a psychological phenomenon wherein ‘the mind perceives a familiar pattern where none actually exists‘. The BBC recently explored why we see these patterns under the title ‘why we see faces in the hills, the moon and toasties‘.

"Holz Geist Gesicht" by Usien - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
Holz Geist Gesicht” by UsienOwn work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

It is not surprising that artists have made free use of this human weakness to play mind tricks.

"Picture puzzle". Licensed under Public Domain via Wikimedia Commons.
Picture puzzle“. Licensed under Public Domain via Wikimedia Commons.

There are however more sinister implications of pareidolias (you would expect this from a brain doctor!). This tendency to see patterns may be a manifestation of complex hallucinations, typically seen in Lewy body disease and has been reported in Parkinson’s disease.

The tendency to see patterns has been used to good effect in neurological imaging. Many radiological diagnostic signs have been assigned names that reflect the false patterns they project on the human mind. This concept of neuropareidolia is excellently explored in this paper. Neurologists and radiologists for example talk of the hot cross bun sign in multiple system atrophy, the panda sign in Wilson’s disease, and the hummingbird sign in progressive supranuclear palsy (PSP). It seems we bring our humanity to the workplace!

"Archilochus-alexandri-003". Licensed under CC BY-SA 3.0 via Commons.
Archilochus-alexandri-003“. Licensed under CC BY-SA 3.0 via Commons.
"Steele-olszewski-richardson disease" by Dr Laughlin Dawes - radpod.org. Licensed under CC BY 3.0 via Commons.
Steele-olszewski-richardson disease” by Dr Laughlin Dawes – radpod.org. Licensed under CC BY 3.0 via Commons.

 

You may check out

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Multiple sclerosis treatment: new kids on the block

Multiple sclerosis is a scourge. It frequently targets the young with devastating, often life-long, effects. It spares no parts of the central nervous system, affecting the brain, spinal cord and major nerves. There are several MS risk factors as discussed in my previous post MS risk factors: the top 6. In this post I address the treatments of MS. There are already several agents available and the most widely used are the Interferons. Other medications are the monoclonal antibodies such as Natalizumab and Alemtuzumab. Oral agents are also gaining ascendance and include Fingolimod and Cladribine. Other drugs include Fumarate and Teriflunomide. This article gives a good overview of MS treatments. The field is however rapidly advancing and I recommend this helpful update.

"Carswell-Multiple Sclerosis2" by derivative work: Garrondo (talk)Carswell-Multiple_Sclerosis.jpg: Robert Carswell (1793–1857) - Carswell-Multiple_Sclerosis.jpg. Licensed under Public Domain via Commons.
Carswell-Multiple Sclerosis2” by derivative work: Garrondo (talk)Carswell-Multiple_Sclerosis.jpg: Robert Carswell (1793–1857) – Carswell-Multiple_Sclerosis.jpg. Licensed under Public Domain via Commons.

MS however remains an elusive condition to treat. Current treatments may reduce episodes of relapses but seem to do little to stop the progression of the disease. Some new drugs are however breaking the mold.

A highly promising drug is Ocrelizumab. This drug excited the recent European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) as discussed in this article in Medscape. It appears to be highly effective and has the advantage of producing fewer side effects than most other agents.

Anti LINGO-1 is another promising treatment in development. Anti-LINGO 1 seems to repair damaged nerves.

"Neuron with oligodendrocyte and myelin sheath" by Neuron_with_oligodendrocyte_and_myelin_sheath.svg: *Complete_neuron_cell_diagram_en.svg: LadyofHatsderivative work: Andrew c (talk) - Neuron_with_oligodendrocyte_and_myelin_sheath.svg. Licensed under Public Domain via Commons.
Neuron with oligodendrocyte and myelin sheath” by Neuron_with_oligodendrocyte_and_myelin_sheath.svg: *Complete_neuron_cell_diagram_en.svg: LadyofHatsderivative work: Andrew c (talk) – Neuron_with_oligodendrocyte_and_myelin_sheath.svg. Licensed under Public Domain via Commons.

Most treatments of MS are directed at the relapsing remitting form but it is hopeful that a new drug, Masitinib, may break the glass ceiling with progressive MS. Masitinib is an oral agent currently in trial stages. This piece from the MS Society gives further details on Masitinib.

Nanotechnology is another development which may be applied to MS treatment. Nanoparticles may be used to deliver antigens that modulate the immune system. So far however, this technology is still in animal trials.

Nanoparticles. Attribution Christopher Johnson and Vilas G. Pol via Flikr https://www.flickr.com/photos/argonne/3974983988
Nanoparticles. Attribution Christopher Johnson and Vilas G. Pol via Flikr https://www.flickr.com/photos/argonne/3974983988

 

To keep a tab on developments in the MS world I recommend the BartsMS Blog.

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Mozart and seizures? The links between epilepsy and music

An odd connection you may say but here are quite a few things that link epilepsy with music. lepsy. The first is the therapeutic effect of on epilepsy. This has been termed ‘The Mozart Effect‘ based on studies which report that listening to Mozart reduces epileptic brain discharges.

This however seems at odds with the known fact that epilepsy may be triggered by music. Music is one of several triggers of epilepsy. People with this musicogenic epilepsy may become frightened of music, a concept called musicophobia. This article in Scientific American gives an example where the music of Sean Paul is the consistent trigger for someone’s seizures. In another anecdote from NME, a Ne Yo song is the culprit.

By CLASSICNEYO - Own work, CC BY-SA 4.0, Link
By CLASSICNEYOOwn work, CC BY-SA 4.0, Link

Finally, music may be a manifestation of epilepsy. These present as musical hallucinations.

To explore these and other musical concepts and epilepsy further, check out Music and the neurologist: a historical perspective from the Annals of the New York Academy of Science.

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6 innovations in the treatment of spinal cord injury

There are very few disabilities worse than paralysis from spinal cord injury. This often results from sudden catastrophes and frequently affects the young and active. It is very poignant that many incidents occur during recreational activities, and horse rising is one prominent example. Nothing exemplifies this more dramatically than the case of Christopher Reeve, famous for playing Superman.

"C Reeve in Marriage of Figaro Opening night 1985" by Jbfrankel - Own work. Licensed under CC BY-SA 3.0 via Commons.
C Reeve in Marriage of Figaro Opening night 1985” by JbfrankelOwn work. Licensed under CC BY-SA 3.0 via Commons.

The damage is typically catastrophic and this MRI scan shows how a fracture of the vertebrae could seriously damage the spinal cord, in this case it affects the neck. Spinal cord injuries often mean a life on a wheelchair or even worse, a bed-bound existence. Rehabilitation is often limited to maximizing potential.

"Cervical Spine MRI (T2W)" by Андрей Королев 86 - Own work. Licensed under CC BY-SA 3.0 via Commons.
Cervical Spine MRI (T2W)” by Андрей Королев 86Own work. Licensed under CC BY-SA 3.0 via Commons.

There are however several scientific advances that will hopefully change the outlook for spinal cord injuries. Here are 6 rays of light at the end of the tunnel.

1. EPIDURAL SPINAL CORD STIMULATION

By Hyung5kim, CC BY-SA 2.5, Link
By Hyung5kim, CC BY-SA 2.5, Link

This is the relatively more established of the 6 procedures. It consists of direct spinal cord stimulation. Research that has shown the benefit is supported by the Dana and Christopher Reeve Foundation-a clear example of celebrity supporting neurology.

2. NON-INVASIVE SPINAL CORD STIMULATION

Proteomics and Spinal Fluid. EMSL on Flikr. https://www.flickr.com/photos/emsl/4799920283
Proteomics and Spinal Fluid. EMSL on Flikr. https://www.flickr.com/photos/emsl/4799920283

By delivering electrical impulses to the spinal cord, researchers have successfully got spinal cord injured subjects to make walking movements. The advantage of this procedure is that it is not invasive. It’s not yet walking, but its a step in the right direction.

3. ROBOTIC EXOSKELETON

Exoskeleton Test Pilot and Ambassador Paul Thacker (AKA Thax) at TEDMED 2011. Ekso Bionics on Flikr. https://www.flickr.com/photos/eksobionics/6644753369/in/photostream/
Exoskeleton Test Pilot and Ambassador Paul Thacker (AKA Thax) at TEDMED 2011. Ekso Bionics on Flikr. https://www.flickr.com/photos/eksobionics/6644753369/in/photostream/

A bit more SciFi is the use of a robotic exoskeleton. Its only one case but anything that may work is worth it.

4. SPINAL CORD REGROWTH

Danio rerio. Thiery Marysael on Flikr. https://www.flickr.com/photos/thierrymarysael/5546556947
Danio rerio. Thiery Marysael on Flikr. https://www.flickr.com/photos/thierrymarysael/5546556947

The future is however more futuristic if trial of regrowing the spinal cord. Its mainly in zebrafish and rats for now, but there is at least a report of using nasal cells to repair the spinal cord in man.

5. NEUROSPINAL SCAFFOLDING

By This image was taken by Ævar Arnfjörð Bjarmason on 2004-04-11 in the Lillebælt, Denmark using a Kodak EasyShare DX4330 camera., CC BY-SA 3.0, Link
By This image was taken by Ævar Arnfjörð Bjarmason on 200404-11 in the Lillebælt, Denmark using a Kodak EasyShare DX4330 camera., CC BY-SA 3.0, Link

And finally, neurospinal scaffolding-this promises to do what it says on the package! It acts as a bridge across the spinal cord injury to aid healing.

6. HEAD TRANSPLANTATION

By Anonymous (Egypt) - Walters Art Museum: Home page  Info about artwork, Public Domain, Link
By Anonymous (Egypt)Walters Art Museum: Home page  Info about artwork, Public Domain, Link

Another potential method is head transplantation, which is essentially spinal cord reattachment. See my previous post on this titled Head transplant, anyone?

https://pixabay.com/en/snake-skeleton-spine-museum-london-955331/
https://pixabay.com/en/snake-skeleton-spine-museum-london-955331/

If you are keen on  more academic take on this topic, an article in Nature titled Spinal cord repair strategies: why do they work? is just the thing for you, and it shows it’s not all doom and gloom.

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