Request from Robert Phair re Brainstem connectome diagram

Jaybee00

Senior Member (Voting Rights)
From this PR open thread:

https://forums.phoenixrising.me/thr...-syndrome-m-baraniuk-2022.86742/#post-2390443

“Those of you with long memories will remember that Pyrrhus' second diagram of "the ascending arousal network" is the same network that led to some of the hypothesized consequences of the IDO1 metabolic trap in the Raphe nucleus. But that's not why I'm writing this post. The combination of recent successes 1) from surgical correction of CCI and, 2) from stellate ganglion block, have drawn me back to the midbrain. I'm still working on the itaconate metabolic trap as my day job, but there's a useful concept called night-science when you are free to work on something new that feels important - and right now, my night-science is focused on the possibility of bistabilities in brainstem neural circuits. I could use some help. What I want to find is the best, most detailed diagram of the brainstem connectome that's available. I've been to the Allen Brain Institute site and got lost somewhere around the hypothalamus. Modern neuroscience appears fixated on the cerebral cortex, but there is a lot that we (or at least I) do not understand about the organization of the brainstem, what neurons project where, and what neurotransmitters are crossing those synapses. If all the smart people on PR would send me the one or two best diagrams they can find in an hour of searching, I'd really appreciate your help. Thanks.”
 
The combination of recent successes 1) from surgical correction of CCI
Is there any good evidence of this?
and, 2) from stellate ganglion block
I don't think I've heard about this.
A stellate ganglion block is an injection of local anesthetic in the sympathetic nerve tissue of the neck. These nerves are a part of the sympathetic nervous system. The nerves are located on either side of the voice box, in the neck.

A stellate ganglion block blocks the sympathetic nerves that go to the arms, and, to some degree, the sympathetic nerves that go to the face. This may in turn reduce pain, swelling, color and sweating changes in the upper extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving an arm or the head and face.

I guess I'd ask the same question about it though - is there any good evidence that it helps people with ME/CFS?

'Itaconate metabolic trap' - this seems to be different to the tryptophan kynurenine trap. I don't know much about it, but it looks interesting. Is the tryptophan trap possibility now regarded as unlikely to be relevant?
 
Hah! Sorry @Milo I must have mis-typed "stellate" or "ganglion" in the search box when I tried to find our existing link.

I've replied on PR with a picture and some references which I think is relevant to his enquiry (they're recent, though I presume Dr Phair already has these). Reposting here, for interest. Looks complicated...

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See
 
I'm still working on the itaconate metabolic trap as my day job, but there's a useful concept called night-science when you are free to work on something new that feels important - and right now, my night-science is focused on the possibility of bistabilities in brainstem neural circuits.

So it appears that Robert has stopped working on the tryptophan hypothesis and is now working on the itaconate metabolic trap hypothesis, but has recently also started working on a 'bistabilities in brainstem neural circuits' hypothesis.

I'm well disposed towards Robert, I'm glad that he's interested in the ME/CFS puzzle and I'm glad that he takes the time to communicate with patients. Surely he has more than some very unclear anecdotes about CCI and a paper written by the owner of a company in Alaska suggesting that two women with Long Covid had symptom improvement after having the SGB treatment the company sells before he starts developing a theory?
 
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Robert Phair responded to @Hutan on PR.
Also expanded on the itaconate metabolic trap.

“It's a trap in mitochondrial central carbon metabolism that purports to account for the "hypometabolic" phenotype of ME. Also seems, so far, to be consistent with Chris's longstanding ME hypothesis centered on amino acid catabolism.”
 
I have seen more people say that the SGB therapy did not help them than people saying that it did - even just on Phoenix Rising. I've seen one social media post saying that it was a disaster for them, that they are more ill than before and that the treatment has made them highly sensitive to their phone. We could build a theory about that anecdote too, but it probably wouldn't get us very far.

I have seen lots of people say that they have had no benefit or even been harmed CCI treatment, but I don't think I've seen any credible report of ME/CFS symptoms being sustainably cured as a result of CCI surgery. When I was first ill and seemed a bit better after a course of paromomycin, for a week I was sure that it was the answer, and that the cause of my symptoms was a gut parasite - I even told people that. I desperately wanted there to be an answer. I think we need to be extremely careful about working out if a therapy really is likely to help - both before desperate people go off on wild and expensive and potentially harmful goose chases, and before channelling scarce research resources its way.

Even details of stellate ganglion neuroanatomy would be valuable.
Yes, I think a good question to be asking is - is there any biological mechanism that might plausibly explain how this therapy might work? I'm not seeing much science behind the stellate ganglion block therapy. Have you see the thread we have about the therapy, and the thread on the Alaskan paper?
 
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Even details of stellate ganglion neuroanatomy would be valuable.

There is this paper by the Griffith University group that may be relevant to "Intra-brainstem connectivity is impaired in Chronic Fatigue Syndrome", but it uses the Fukuda criteria.

These papers might ahve some useful figures for you, it's beyond my knowledge base tbh.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827322/

https://www.sciencedirect.com/science/article/abs/pii/S1053811916300155?via=ihub
 
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