The role of the lymphatic drainage of the brain

In the 1990s, Dr Ray Perrin DO PhD an osteopath and neuroscientist from Manchester, UK originally hypothesized that an important component of ME/CFS and fibromyalgia syndrome (FMS) involves a disturbance of lymphatic drainage from the central nervous system leading to a build-up of pro-inflammatory toxins, especially post-infectious cytokines. Perrin postulated that this results in further disturbed central neurological control of this drainage system, which was discovered in mice by scientists in Rochester, NY in 2012 and named, ‘The Glymphatic System’ as it drains toxins via the lymphatic system from brain cells known as glia.

It is now known that delta waves in deep sleep drive metabolite clearance from the adult human brain. ME/CFS, FMS patients lack delta wave at night which reduces this natural drainage mechanism leading to unrefreshed sleep.

The concept of disturbed glymphatics in ME/CFS has been demonstrated by the presence of physical signs published in a paper in the BMJ online in 2017. The same year when the first scans on human subjects were published that provided visible proof that, indeed, there was a lymphatic system draining the human brain.

Press articles over the past year have highlighted the ‘cytokine storm’ affecting COVID-19 victims. Cytokines are signalling molecules that attract antibodies to attack the virus. However, you need a healthy lymphatic drainage to drain the excess cytokines away otherwise it could lead to major inflammatory changes in the tissue with possible autoimmune disturbance as the body attacks itself. Many studies have linked proinflammatory cytokines to the aetiology of ME/CFS and has been associated with severity of symptoms in ME/CFS and FMS.

In 2003 some post-SARS patients in Toronto, Canada went on to develop an ME/CFS like illness which nearly 20 months on, prevented them returning to work. Post-mortem SARS research indicated the virus had crossed the blood brain barrier into the hypothalamus in the brain via the olfactory pathway. One of the main pathways of the lymphatic drainage of the brain is via spaces around blood vessels supplying the olfactory nerve. If the pathogenesis of coronavirus affects a similar pathway which explains the loss of smell observed in a proportion of COVID-19 patients. In a paper published in November 30th 2020 in Nature Neuroscience scientists in Berlin showed that SARS-CoV-2 can enter the nervous system by crossing in the olfactory mucosa. In a study published Dec.16 in the same journal, researchers found that the spike protein of the virus, can cross the blood-brain barrier.

A disturbed glymphatic system leading to a backflow of cytokines and other toxins into the brain may be responsible for many symptoms affecting patients with ME/CFS, FMS and even Long-Covid such as mental and physical fatigue, brain fog, pain and sleep disturbance.

The science behind his work over the past 30 years has also provided new avenues for diagnosis and treatment of these conditions which are detailed in Dr Perrin’s new book. The Perrin Technique 2nd edition: How to diagnose and treat Chronic Fatigue Syndrome/ME and Fibromyalgia via the lymphatic drainage of the brain. Hammersmith Press. London. on sale 11th March 2021.