All Articles

Alain L. Fymat*

International Institute of Medicine & Science, California, U.S.A

A variety of radiological imaging techniques are used singly or in combination to diagnose and treat neurodegenerative diseases. Their respective roles are reviewed and discussed within the contexts of Alzheimer's disease and Parkinson's disease. In Alzheimer's, MRI and PET scans are usually employed to rule out confounding symptoms from other disorders/diseases and to assess the extent of brain atrophy as the disease progresses. In Parkinson's, CT and MRI are not very informative but can rule out secondary causes of Parkinsonism; 3T-MRI is still under evaluation notwithstanding its high sensitivity and specificity; and PET and SPECT can rule out drug-induced Parkinsonism but are not reliable in distinguishing Parkinson's from other neurodegenerative causes of Parkinsonism. Functional SPECT/ DaTscan is indicated for detecting loss of functional dopaminergic neuron terminals in the striatum of patients with clinically uncertain Parkinsonian syndromes in order to help differentiate essential tremor, multiple system atrophy, and progressive supranuclear palsy from Parkinson's but is unable to discriminate between them. However, DaTscan can help differentiate dementia with Lewy bodies from other forms of dementia. Because of its importance in Parkinson's, the complementary technology of magnetic resonance-guided high-intensity focused ultrasound is also reviewed and compared to electromagnetic brain stimulation and radiosurgery.

Abbreviations

AAD: Alzheimer's Disease; ALS: Amyotrophic Lateral Sclerosis; APP: Amyloid Precursor Protein; CNS: Central Nervous System; CT: Computed Tomography; DBS: Deep-Brain Stimulation; EMBS: Electromagnetic Brain Stimulation; ET: Essential Tremor; fGCA: Frontal Cortical Atrophy; fMRI: functional MRI; HD: Huntington's Disease; HIFUS: High-Intensity Focused Ultra-Sound; MRI: Magnetic Resonance Imaging; MRT:Magnetic Resonance Thermometry; MSA: Multiple System Atrophy; MTA: Medial Temporal lobe Atrophy; NDD: Neurodegenerative Disorder; PA: Posterior Atrophy; PD: Parkinson's Disease; PET: Positron Emission Tomography; PS: Parkinson's Syndrome; PSP: Progressive Supranuclear Palsy; RS: Radiosurgery; SPECT: Single Photon Computed Tomography; US: Ultrasound; VIN: Ventral Intermediate Nucleus.

Isabelle Pastor Bandeira¹*, Washigton Luiz Gomes de Medeiros Junior¹, André Eduardo de Almeida Franzoi¹, Laura Fiuza Parolin², Paulo Roberto Wille³, Marcus Vinícius Magno Gonçalves⁴

¹Department of Medicine, University of the Region of Joinville (UNIVILLE), Brazil

²University of the Region of Joinville (UNIVILLE), Brazil

³University of the Region of Joinville (UNIVILLE), Brazil

⁴University of the Region of Joinville (UNIVILLE), Brazil

Pseudoathetosis is a movement disorder caused by loss of proprioception. The disorder is characterized by involuntary, slow, and writhing movements. Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). The disease is characterized by multiple lesions of the brain and spinal cord. These lesions are disseminated in time and space. The onset of the neuroinflammation is characterized by episodes of neurological dysfunction that usually recover. Reports of MS with pseudoathetosis are extremely rare. The association of these two disorders is uncommon. This article shows a 29-year-old woman who presented pseudoathetosis as the initial symptom of MS. Therefore, this case report is very relevant for medical knowledge due to the rare form presentation of MS.

Mohamed ElSayed Abdelhady¹*, Nida Fatima²*, Yaman Al Kailani¹, Ahmed Own¹, Surjith Vattoth¹

¹Department of Neuro radiology, Hamad General Hospital, Doha, Qatar

²Department of Neurosurgery, Hamad General Hospital, Doha, Qatar

Loris A Chahl

School of Biomedical Sciences and Pharmacy University of Newcastle NSW 2308 Australia

It has been shown previously that rats treated as neonates with capsaicin exhibited hyperactivity in a novel environment and had brain changes, including reduced brain weight, reduced hippocampal area, reduced cortical thickness and increased neuronal density in several cortical areas. These brain changes resembled those found in subjects with schizophrenia. This mini review discusses recent findings on the effects of capsaicin on hippocampal neurons and the role of TRPV1 channels in the central nervous system, which provide a possible explanation for the effects of capsaicin on the developing rat brain. Future studies on the role of TRPV1 channels in the brain hold great promise for further understanding of neuropsychiatric disorders.

Tao Tao*, Jie Sun, Min-Sheng Zhu

Model Animal Research Center, State Key Laboratory of Pharmaceutical Biotechnology and Department of Neurology of the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing University, China

Ashutosh Gupta

Consultant Neurologist, Department of Neurology, Shree Aggarsain International Hospital, Rohini, Delhi, India

The venom toxins of honeybee cause anaphylactic allergic reactions and/or any type of stroke. Hemorrhagic strokes are more severe than the ischemic strokes. Diverse pathophysiological mechanisms have been postulated for occurrence of these strokes. We discuss here mechanism of acute fatal hemorrhagic and ischemic stroke in a middle age woman, stung by the honeybee on her right arm and who clinically manifested loss of consciousness and tonic clonic seizure, within 3-4 hours followed by hemiparesis. The MRI revealed brain lesions of multiple infarctions with hemorrhagic transformation, subdural (SDH) and subarachnoid (SAH) hemorrhages. This appears to be the first report, wherein a patient had entire spectrum of stroke (infarcts, subarachnoid and subdural hemorrhages), after a single inciting event of bee sting.

Lisa M. James^1,2,3, Apostolos P. Georgopoulos^1,2,3,4*

¹Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, USA

²Department of Neuroscience, University of Minnesota Medical School, Minneapolis, USA

³Department of Psychiatry, University of Minnesota Medical School, Minneapolis, USA

⁴Center for Cognitive Sciences, University of Minnesota, Minneapolis, USA

⁵Department of Neurology, University of Minnesota Medical School, Minneapolis, USA

Human Leukocyte Antigen (HLA) Class II DRB1*13:02 has recently been found to protect against dementia in Continental Western Europe. Here we extend those findings by evaluating the association between the population frequency of two additional Class II HLA alleles – DRB1*01:01 and DRB1*15:01 – alone and in combination with DRB1*13:02, on dementia prevalence in Continental Western Europe. Results indicated that the prevalence of dementia in 14 Continental Western European (CWE) countries significantly decreased exponentially with increasing frequency of any of the three alleles alone and in combination (P’s < 0.001). When combined, the population frequency of the three alleles accounted for 67% of the variance in dementia prevalence. The combined frequency of DRB1*01:01, DRB1*13:02, and DRB1*15:01 was also significantly associated with dementia prevalence in those aged 65 years and older (P = 0.004) and with a change in dementia prevalence between 1990 and 2016 (P = 0.006). These findings, which document the protective effects of three common Class II HLA alleles on dementia prevalence in CWE, are discussed in terms of the role of HLA class II genes in pathogen elimination. More specifically, we hypothesize that dementia prevalence is higher for countries in which the population frequency of these protective alleles is low, prohibiting the successful elimination of pathogens that may play a causal role in dementia.

Lisa M. James^1,2,3, Apostolos P. Georgopoulos^1,2,3,4*

¹Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, USA

²Department of Neuroscience, University of Minnesota Medical School, Minneapolis, USA

³Department of Psychiatry, University of Minnesota Medical School, Minneapolis, USA

⁴Department of Neurology, University of Minnesota Medical School, Minneapolis, USA

Dementia is a leading cause of death worldwide, representing a significant global burden. In addition to genetic and lifestyle factors that have been widely linked to dementia, pathogens are increasingly recognized as contributing to the development of dementia. Here we discuss the role of human leukocyte antigens (HLA) in maintaining brain health by facilitating the elimination of pathogens and highlight evidence suggesting that the inability to eliminate pathogens contributes to dementia. Finally, we briefly review common forms of dementia including Alzheimer’s disease, vascular dementia, frontotemporal dementia, Lewy body dementia, and prion dementia in an effort to contextualize the role of persistent pathogens across the various dementia phenotypes.

Effie-Photini C. Tsilibary^1,2, Eric P. Souto¹, Marian Kratzke^1,2, Lisa M. James^1,2,3, Brian E. Engdahl^1,2,4, Apostolos P. Georgopoulos^1,2,3,5*

¹Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, Minnesota, USA

²Department of Neuroscience, University of Minnesota Medical School, Minneapolis, Minnesota, USA

³Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA

⁴Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA

⁵Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota, USA

Gulf War Illness (GWI) is a multisystem disorder of unknown etiology that has afflicted many veterans of the 1990-91 Gulf War who have sustained progressively worsening health since the war¹. Recent studies have demonstrated the presence of active inflammation in GWI^2,3 and, in addition, a positive association of the levels of C-reactive protein (CRP), an inflammatory marker, with GWI symptom severity³. Moreover, we have shown that GWI serum contains substances that are harmful to neural cultures⁴`, a detrimental effect that can be prevented by serum of healthy GW veterans⁴ and partially so by pooled human immunoglobulin G (IgG)⁵. Although possible exposure to environmental toxins in war theater has been traditionally blamed for GWI⁶, the evidence above^3-5 and the fact that the disease also afflicted nondeployed veterans⁷, point to other causes, including the vaccines administered to GW veterans^4,5,7, such as the vaccine against anthrax. Here we present, for the first time, evidence indicating the presence of the harmful anthrax protective antigen PA63 in the serum of 15 veterans suffering from GWI, as follows. First, we confirmed that the addition of GWI serum to the culture had a detrimental effect, including decreased cell spreading and increased cell apoptosis, as reported previously⁴. And second, we found that the concomitant addition of specific polyclonal or monoclonal antibodies against PA63 had a remarkable protective effect on N2A cultures, significantly ameliorating cell spreading and reducing cell apoptosis. These results document that the adverse effects of GWI serum on neural cultures are due, in part, to persistent pathogens derived from the anthrax vaccine. We hypothesize that these anthrax pathogens persisted in the blood of the GWI veterans tested because of inability of those veterans to make antibodies against them, probably due to lack of Human Leukocyte Antigen (HLA) protection⁸. Finally, our findings point to a possible successful intervention in GWI consisting in neutralizing (by administering specific antibodies) and/or removing (by plasmapheresis) those harmful anthrax antigens.

José Berciano¹*, Antonio García², Jon Infante¹

¹Service of Neurology, University Hospital “Marqués de Valdecilla (IDIVAL)”, University of Cantabria, and “Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)”, Santander, Spain

²Service of Clinical Neurophysiology, University Hospital “Marqués de Valdecilla (IDIVAL)”, and “Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)”, Santander, Spain

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a form of ataxia characterized by the combination of bilateral vestibular, cerebellar and somatosensory impairment. In this commentary we summarized our report of five CANVAS cases presenting with spasmodic cough, which antedated the appearance of imbalance in several decades. Furthermore, in the hallmark of a severe sensory ataxia, tendon jerks and T-reflex recordings were almost completely preserved; sparing of muscle spindle afferents (fibres Ia) is probably the pathophysiological basis of normoreflexia.

Spyros Charonis^1,2, Lisa M. James^1,2, Apostolos P. Georgopoulos^1,2*

¹Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, 5541, USA

²Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA

Gulf War Illness (GWI) is a chronic, multi-symptom disorder of unknown etiology affecting veterans of the 1990-91 Gulf War. We identified previously¹ a set of 6 Human Leukocyte Antigen (HLA) class II alleles that are protective for GWI, namely DPB1*01:01, DPB1*06:01, DQB1*02:02, DRB1*01:01, DRB1*08:11, and DRB1*13:02. Since the function of HLA class II molecules is to connect with matching extracellular antigens of various pathogens (mostly viruses), as an initial step in the sequence of events leading to the development of antibodies against the matched antigen and its subsequent elimination, we hypothesized that GWI may be due, in part, to the persistence of offending antigens which could not be eliminated^2,3. We further hypothesized^4,5 that such antigens were contained in the 16 vaccines administered to GW veterans against adenovirus, anthrax, botulinum, cholera, diphtheria, hepatitis B, influenza A, Japanese encephalitis, measles, meningococcus, poliomyelitis, rabies, smallpox, tetanus, typhoid, yellow fever⁶. This hypothesis predicts that antigens present in those vaccines should have a high affinity for matching with the 6 HLA class II protective alleles above. Here we tested this prediction by using the Immune Epitope DataBase (IEDB⁷) to determine the ranked affinity of each one of the 6 GWI protective alleles to the 10 most frequently assayed epitopes of each pathogen for which a vaccine was administered. We found that our 6 GWI protective alleles above collectively covered all vaccine antigens except for rubella for which all alleles above showed low binding affinity. Affinity strength varied among antigen-allele pairs, with DRB1*01:01 and DRB1*13:02 showing overall higher affinities. These two alleles also had the highest binding affinities for the anthrax antigen contained in the anthrax vaccine administered to GW veterans. These findings document a good match between the 6 GWI HLA protective alleles above and the antigens contained in the GW vaccines, and support the fundamental assumption that the HLA protection for GWI is mediated through the successful elimination of potentially harmful persistent antigens contained in those vaccines.

Pascal J.D. Grolaux

Department of Osteopathy, Kinesis Health Associates, 2d floor, 155 Ochterloney Street, Dartmouth, B2Y1C9, Nova Scotia, Canada

Background: Generalized anxiety disorder (GAD), chronic pain (CP) and irritable bowel syndrome (IBS) are debilitating inflammatory disorders that are frequently seen in primary care facilities but not sufficiently addressed by classical medical treatments. Transcutaneous vagus nerve stimulation (tVNS) is a promising therapeutic tool for a wide range of conditions that showed already encouraging clinical results. However, the effects of tVNS, on GAD, IBS and CP, were not yet explored in the context of an investigation conducted in a private healthcare center.

Objective: In an uncontrolled, open label, small investigation scale study, we investigated the feasibility, safety and the effects of tVNS for patients suffering from GAD, CP and IBS in a multidisciplinary healthcare center.

Methods: The effects of tVNS on GAD, CP and IBS in 10 participants (anxiety, 40%; chronic pain, 30%; IBS, 30%) were investigated during a 4-week period and a 2-month follow-up. GAD, CP and IBS were assessed using the Generalized Anxiety Disorder GAD-7, the Brief Pain Inventory Short Form questionnaire and the Irritable Bowel Syndrome Severity Scoring System. Transcutaneous vagus nerve stimulation was performed using a transcutaneous electrical nerve stimulation device and ear clip electrodes plugged in the concha area of the ear. All participants, received a bi-weekly 30-minute stimulation for 4 weeks. The tVNS parameters, (GAD: 20Hz-80µs), (CP: 5Hz-200 µs), (IBS: 3Hz-250µs), were set for each group to target different physiological effects meditated by the vagus nerve.

Results: The anxiety and the IBS group showed a non-statistically significant improvement but an improved clinical status (mean score from “severe” to “moderate”) both at the end of the stimulation period (4 weeks) and at 2-month follow-up. The CP group didn’t show any significant clinical improvement (mean score from “moderate” to “moderate”). Furthermore, tVNS was demonstrated to be likely safe and was well tolerated.

Conclusions: Due to low sample size, this study failed to demonstrate significant clinical effects of tVNS on GAD, IBS and CP. However, trend analysis may carefully suggest tVNS to be a noteworthy clinical alternative to be used in private healthcare center in the treatment of chronic inflammation disorders like GAD and IBS. Acute tVNS was well-tolerated and is likely safe. Powerful, double-blind controlled studies are needed to support the use of tVNS on these disorders.

Clinical Trial Registration: http:/www.clinicaltrials.gov. Unique identifier: NCT03440255.

Abbreviations: α7nAChR, alpha7 nicotinic acetylcholine receptor; ABVN, auricular branch of the vagus nerve; CAN, central autonomic network; CAP, cholinergic anti-inflammatory pathway; CP, chronic pain; DMVN, dorsal motor nucleus of the vagus; GABA, γ-aminobutyric acid; GAD, general anxiety disorder; HR, heart rate; HPA, hypothalamic pituitary adrenal; HRV, heart rate variability; IBS, irritable bowel syndrome; IL, Interleukin; fMRI, functional magnetic resonance imagery; NF-κB, nuclear factor kappa B; NTS, nucleus tractus solitarius; pNN50, percentage of successive R-R intervals that differ by more than 50ms from the preceding one; PW, pulse width; RMSSD, root mean square of successive R-R interval differences; RR, respiratory rate; RSA, respiratory sinus arrhythmia; SD1, standard deviation of the distance of each point from the y = x axis in a Poincaré plot; TENS, transcutaneous electrical nerve stimulation; TNF, tumor necrosis factor; VN, vagus nerve; nVNS, non-invasive vagus nerve stimulation; tVNS, transcutaneous vagus nerve stimulation.

Lisa M. James^1,2,3,4, Apostolos P. Georgopoulos^1,2,3,4,5*

¹Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA

²Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA

³Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA

⁴Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN 55455, USA

⁵Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55455, USA

Human Leukocyte Antigen (HLA) Class II DRB1*13 alleles have recently been found to protect against age-related brain deterioration, even in the presence of apolipoprotein E4 (apoE4),^1,2 suggesting a possible protection against dementia. Here we evaluated the association between the population frequency of common DRB1*13 alleles and the prevalence of dementia in Continental Western Europe. Prevalence of dementia in Continental Western Europe was derived from published reports on dementia frequency from the Global Burden of Disease Study 2016 and population totals obtained from the Population Reference Bureau. DRB1*13:01 and DRB1*13:02 allele frequencies were obtained from a publicly available database (allelefrequency.net) and apolipoprotein E was obtained from published reports on the world distribution of apoE4. The prevalence of dementia in 14 Continental Western European (CWE) countries, where life expectancy is practically identical, significantly decreases exponentially with increasing frequency of DRB1*13:02 (R2 = 0.452, P = 0.008), even when adjusted for the prevalence of apolipoprotein E4 allele, a known risk factor for Alzheimer’s disease. This finding documents the protective effect of DRB1*13:02 on dementia prevalence in CWE. Since the function of HLA class II genes is to aid in the elimination of pathogens by enabling the production of antibodies against their antigens in specific immunity, the protective effect of DRB1*13:02 points to the presence of persistent harmful antigens as causal factors in development of dementia, antigens specific to DRB1*13:02 that could not be eliminated in its absence.

Uwe Ernsberger

Institute for Clinical Neuroanatomy, Johann-Wolfgang-Goethe University, Frankfurt/Main, Germany

The molecular characterization of postganglionic sympathetic neurons by RNA sequencing has allowed the full assessment of gene expression in individual cells and classification of neurons into subpopulations defined by their gene expression profile and developmental history. The identification of growth factor receptor subunits specifically expressed by select neuron subpopulations enabled the demonstration of GDNF family ligands and the respective receptor subunits as instrumental in the innervation of certain targets. These are first critical steps in the attempt to characterize the molecular processes leading to the establishment and maintenance of target-specific sympathetic efferent pathways.

Jerrod Brown^1,2,3*, Diane Harr¹

¹Concordia University, St. Paul, MN, USA

²Pathways Counseling Center, Inc., St. Paul, MN, USA

³American Institute for the Advancement of Forensic Studies, St. Paul, MN, USA

Traumatic brain injuries (TBI) are a major community health problem in the United States. Traumatic brain injury can result in disruption to normal brain functions and is caused by a bump, blow, or external damage to the head. Ranging from mild to severe in nature, TBIs can result in physical, cognitive, emotional, social, personality, adaptive, and behavioral changes in an individual. These devastating symptoms contribute to individuals with TBIs having the potential for a host of short and long-term issues. Traumatic brain injury can result in cognitive impairments, including disinhibition and risky decision-making behaviors, thus increasing the risk of substance abuse. Because many people do not have visible or physical signs, TBI can be difficult to screen, assess, and diagnose. Despite these difficulties, mental health and substance use disorder professionals can make a positive difference for clients with traumatic brain injury. As such, the current study examines the experiences and perceptions of TBI among treatment staff of Vinland National Center, a substance use disorder treatment facility in Minnesota. Results of this study raise awareness of the challenges of TBI in drug and alcohol treatment centers and offer tips, strategies, and solutions for professionals working with this clientele.

Keiko Naruse

Department of Internal Medicine, School of Dentistry, Aichi Gakuin University, Japan

Rémy Cohan^2,8, Karolina A. Bearss^1,2,4,6, Joseph F.X. DeSouza^1-8

¹Centre for Vision Research, York University, Canada

²Department of Psychology, York University, Canada

³Department of Biology, York University, Canada

⁴Neuroscience Graduate Diploma Program, York University, Canada

⁵Interdisciplinary Graduate Studies, York University, Canada

⁶Canadian Action and Perception Network (CAPnet), York University, Canada

⁷Vision: Science to Applications (VISTA) Program, York University, Canada

⁸Multisensory Neuroscience Laboratory, York University, Canada

Despite advancement in neuroimaging, the link between motor and cognitive processes, and the role of oscillations in motor behaviour remain unclear. Current research in neurodegenerative disorders (e.g., Parkinson’s and Alzheimer’s disease) indicates that changes in oscillatory brain rhythms (OBRs) observed from electroencephalographic (EEG) studies could be utilized to quantify and understand the neural network changes in the presence of pathology. Research suggests, that rhythmicity is a common feature amongst biological entities, and cyclic fluctuations in neurological systems in response to incoming stimuli from the environment, grant a great degree of flexibility to such systems in order to interact with their surroundings at an optimal level. This reciprocity between exogenous stimuli and endogenous mechanisms in the brain creates a two-way pathway that awards a bi-directional relationship between the environment, and the brain. Here, in this mini review we explore the role of OBRs, and review the current literature supporting the putative role of frequency-specific OBRs as potential biomarkers in neurodegenerative disorders, mainly Parkinson’s disease (PD), which in turn, may allow clinicians to identify effective therapies based on these biomarkers, expanding the armamentarium for delaying the rate of disease progression and symptom management.

Hannah C. Saternos¹ and Wissam A. AbouAlaiwi¹*

¹University of Toledo, College of Pharmacy and Pharmaceutical Sciences, Department of Pharmacology and Experimental Therapeutics, Toledo, Ohio, USA

Lisa M. James^1,2,3, Brian E. Engdahl^1,2,4, Rachel A. Johnson¹, Apostolos P. Georgopoulos^1,2,3,4,5*

¹Brain Sciences Center, Department of Veterans Affairs Health Care System, Minneapolis, MN, 5541, USA

²Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN 55455, USA

³Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55455, USA

⁴Department of Psychology, University of Minnesota Medical School, Minneapolis, MN 55455, USA

⁵Department of Neurology, University of Minnesota Medical School, Minneapolis, MN 55455, USA

Gulf War Illness (GWI) is a chronic multi-system condition that has affected one-third of U.S. veterans who served in the Persian Gulf. Although GWI etiology remains unclear, mounting evidence points to immune system involvement and inflammation, in particular, as underlying the host of symptoms associated with the condition. Here we investigated the association between GWI symptoms and C-reactive protein (CRP), a marker of inflammation, in 76 veterans with GWI. Results indicated a highly significant positive association between CRP and mean GWI symptom severity. At the symptom domain level, CRP was significantly and positively associated with Pain, Neurocognitive/Mood, Fatigue, and Respiratory symptom severity but not with Skin or Gastrointestinal symptom severity. These results support the premise that GWI symptoms, particularly those implicating brain involvement, are a result of neuroinflammation. The cause for inflammation is not known. We have hypothesized that at the root of GWI are harmful persistent antigens stemming from environmental exposures associated with service during the Gulf War that could not be successfully eliminated due to lack of specific immunity^1,2. Work is underway in our laboratory to identify and eliminate persistent antigens in veterans with GWI which we anticipate will result in reduced inflammation and reduced GWI symptoms.

Ashutosh Gupta¹*, Suman Kushwaha²

¹Department of Neurology, Institute of Human Behavior and Allied Sciences, Delhi, India

F. Haour¹*, E. Dobbelaere^1,2, C. de Beaurepaire³

¹EMDR France Association, 9 rue Papillon, 75009 Paris, France

²Université Paris 5, 75006 Paris, France

³EPS of Maison-Blanche, 6-10, Pierre-Bayle Street, 75020 Paris, France

Palalle G. Tharushi Perera¹, Olha Bazaka², Kateryna Bazaka³, Dominique Appadoo⁴, Rodney J. Croft⁵, Russell J. Crawford², Elena P. Ivanova²*

¹Faculty of Science, Engineering and Technology, Swinburne University of Technology, PO Box 218, Hawthorn, Vic 3122, Australia

²School of Science, RMIT University, PO Box 2476, Melbourne, Vic 3001, Australia

³Institute for Future Environments, Queensland University of Technology, GPO Box 2434. Brisbane, QLD 4001, Australia

⁴THz/Far-Infrared Beamline, Australian Synchrotron, Clayton, VIC 3168, Australia

⁵School of Psychology, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522, Australia

Pheochromocytoma PC 12 cell line is an established model system for neurosecretion and neuronal differentiation, particular to study cellular responses to nerve growth factors (NGF) and how these lead to expression of differentiation-specific proteins and differentiation. More recently, PC 12 has become a model system for investigating cell membrane permeabilization and cell attachment on different substrata. Of particular interest is the use of PC 12 to study the fundamental responses of cells to electromagnetic fields (EMFs) of 18 GHz and THz in the range of 0.3-19.5×1012 Hz, a type of radiation treatment shown to induce membrane depolarization and transient increase in permeability with no changes in cell viability, morphology, proliferation and cellular physiology. This makes EMFs of 18 GHz and THz radiation a promising alternative to conventional poration techniques for drug and gene delivery applications. This article will review recent progress in the use of PC 12 to investigate EMF radiation-induced cell membrane permeability, as well as to study mammalian cell attachment preferences and differentiation on polymer surfaces, including those coated with high molecular weight proteins of the extracellular matrix, e.g. laminins, poly-l-lysine, fibronectin, and on novel metallic surfaces of nanostructured titanium.

Yoshikuni Mizuno

Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan

In 2018, we wrote a paper on the drug treatment of Parkinson's disease. In this article, we obtained that the wearing off was observed in 77%, but the incidence of dyskinesia was 37.7% for the Parkinson?s disease patients from the onset of the disease 16-20 years. In this review article, we will discuss some of the newer treatments of Parkinson?s disease first, i.e., transplantation with induced pluripotent stem cell-derived cells, gene therapy, deep brain stimulation, levodopa/ carbidopa intrajejunal gel infusion, MRI-supported focused ultrasound, and IPX066. Then, we will discuss our opinion on the mechanism of wearing off and dyskinesia, and modifications of levodopa treatment after the wearing off sets in.

Marianna Stamou¹, Pamela J Lein²

¹1Department of Molecular Biosciences, School of Veterinary Medicine, 1089 Veterinary Medicine Drive, University of California, Davis, CA 95616

²2ETH Zurich, Department of Health Sciences and Technology, Institute of Molecular Systems Biology, 8093 Zürich, Switzerland

Monica Ines¹, Joao Costa^1,2,3*

¹Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisboa, Portugal

²Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisboa, Portugal

³Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisboa, Portugal

Transthyretin-associated familial amyloid polyneuropathy (TTR-FAP) is a neurological disease that affects severely patients and their families and caregivers over generations. It is a rare, progressive, and if untreated fatal autosomal dominant hereditary disorder. The disease may affect multiple organ systems and if untreated progress rapidly to death. TTR-FAP affects nearly 10,000 people worldwide, with known endemic regions in Portugal, Sweden, and Japan. Until recently only liver transplantation and tafamidis were treatment options across several world regions. Despite the worldwide use of these disease-modifying treatments to delay disease progression, challenges in clinical assessment and management remain because of disease heterogeneity, phenotypic diversity, small patient populations, incomplete natural history and uncertainty of treatment effect in survival. The two new treatment options (inotersen and patisiran) appear to provide important benefits for patients, based on clinical trials short-term evidence. In this review, we discuss the disease natural survival course and currently available treatments impact on survival. We also discuss the importance of treatment choice (and or sequence of treatments) to maximize survival, while preserving the patient’s health-related quality of life.