The Glymphatic-Lymphatic Continuum: Opportunities for Osteopathic Manipulative Medicine

Abstract

The brain has long been thought to lack a lymphatic drainage system. Recent studies, however, show the presence of a brain-wide paravascular system appropriately named the glymphatic system based on its similarity to the lymphatic system in function and its dependence on astroglial water flux. Besides the clearance of cerebrospinal fluid and interstitial fluid, the glymphatic system also facilitates the clearance of interstitial solutes such as amyloid-β and tau from the brain. As cerebrospinal fluid and interstitial fluid are cleared through the glymphatic system, eventually draining into the lymphatic vessels of the neck, this continuous fluid circuit offers a paradigm shift in osteopathic manipulative medicine. For instance, manipulation of the glymphatic-lymphatic continuum could be used to promote experimental initiatives for nonpharmacologic, noninvasive management of neurologic disorders. In the present review, the authors describe what is known about the glymphatic system and identify several osteopathic experimental strategies rooted in a mechanistic understanding of the glymphatic-lymphatic continuum.

P. acnes-Driven Disease Pathology: Current Knowledge and Future Directions

“…The link between head trauma and PD (Harris et al, 2013; Jafari et al, 2013; Pearce et al, 2015), together with the notion of a diverse blood microbiome (Potgieter et al, 2015), implies a vast potential for pathogenic opportunism as traumatic breaches in the blood brain barrier occur. With the recent discovery of a brain lymphatic (glymphatic) system (Iliff et al, 2012; Hitscherich et al, 2016) another potential route of brain infection must be considered.…”

Osteopathic Manipulative Treatment Relieves Post-concussion Symptoms in a Case of Polytrauma

“…Zwibel et al provide a summative outline of an osteopathic approach to concussion, including various quantitative assessment tools for patients with concussion, osteopathic structural examination and patient-specific OMT [12]. Several authors describe underlying physiological benefits of OMT for symptoms associated with concussion, including dizziness and imbalance, tension-type headache, autonomic dysregulation and modulation of the glympathic system [7,[13][14][15][16][17][18]].…”

In Search for Symptoms of Impaired Function of Glymphatic System in Older People

“…The knowledge of the real activity of the glymphatic system will lead probably also to the elaboration of specific therapeutic methods [13]. Detection of such symptoms will be possible probably soon by investigations performed in those centers, which can apply the contrast-enhanced MRI techniques [10].…”