Title: A Game Changer in Neuro-modulation: The Power of Sphenopalatine Ganglion From Autonomic Control to Therapeutic Potential
Author: Dina Soliman, MD
DOI: https://dx.doi.org/10.18535/jmscr/v13i03.06
Abstract
Inflammatory brain diseases of the central nervous system occurs for a variety of reasons. Primary processes are due to a malfunction of the immune system and / or neurogenic inflammation, such as what happens in vasculitis, multiple sclerosis, antibody-mediated inflammatory brain diseases, and acute disseminated encephalomyelitis. Secondary inflammatory diseases occur secondary to infection such as what happens in meningitis.
Inflammation of the brain can be presented with stroke, dizziness, headache, ataxia, parathesia, visual or speech impairment, memory loss, or decreased alertness. It can also be presented with changes in behavior, mood swings, or different psychiatric symptoms.
The sphenopalatine (SP) ganglion is considered one of the largest neuron collection in the head outside of the brain, being exposed to the environment via the nasal mucosa. It is the largest of the four parasympathetic gangliae associated with the trigeminal nerve. Over the years, pain management specialists have showed that cauterization, phenolization, or irrigation of the SP ganglion with lidocaine was effective in the treatment of headache or refractory facial pain. Although this ganglion is a very little-known region in the face, it is a very effective tool in the treatment of many conditions due to its particular anatomic place and its special nerve fibers, and because it has a peculiar connection with the higher centers of the brain.
The role of neurogenic inflammation in the pathogenesis of neurological diseases has gained increasing attention with a particular focus on its effects on modulation of the blood-brain barrier. The neuropeptide substance P has been shown to increase blood-brain barrier permeability and is associated with marked cerebral edema. Accordingly, blocking substance P transient receptor potential vanilloid type 1 ion channels may provide a novel alternative treatment to ameliorate the deleterious effects of neurogenic inflammation in the central nervous system.
Methods: In this paper, irrigation of the SP ganglion with buffered dextrose in 5% concentration has been applied in order to treat many conditions such as depression, anxiety, stress, brain fogue, fibromyalgia, myasthenia gravis, multiple sclerosis, facial palsy, optic neuritis, optic nerve perineuritis, ocular pain, headache, migraine, trigeminal neuralgia, neck pain, shoulder pain, arm pain, gait problem and lower limbs weakness after neck surgery, epiphora, blepharospasm, allergic rhinitis, allergic conjunctivitis, and follicular conjunctivitis.
Conclusions: Treating patients suffering from all of the above mentioned conditions with irrigation of the SP ganglion using buffered dextrose in 5% concentration has shown that this novel approach achieved a very good improvement, and that it was very effective regarding the signs and symptoms of all the patients. After the treatment, Optic nerve CT study became normal regarding the signs of optic nerve perineuritis, and MRI studies of the brain and cervical spine became normal regarding the signs of multiple sclerosis.
Keywords: Sweet nasal irrigation treatment, Lyftogt perineural injection treatment, inflammatory brain disease, optic neuritis, optic peri-neuritis, headache, migraine, multiple sclerosis, fibromyalgia, dextrose.
References
- http://en.wikipedia.org/wiki/Pterygopalatine_ganglion.
- Helen Gharaei and Bahram Naderi Nabi (2015): SP ganglion Block. Journal of Anesthesia & Critical Care 3 (2): 00091.
- Manahan AP, Malesker MA, and Malone PM (1996): SP block relieves symptoms of trigeminal neuralgia. Nebr Med J.; 81: 306-9
- Peterson JN, Schames J, Schames M, and King E (1995): SP block for the management of orofacial pain. Cranio.; 13: 177-81
- Stechison MT and Brogan M (1994): Transfacial access to foramen rotundum and SP in the management of atypical facial pain. Skull Base Surg.; 4: 15-20.
- Olszewska-Ziaber A, Ziaber J, and Rysz J (2007): Atypical facial pains–local treatment of the SP with phenol. Otolaryngol Pol.; 61: 319-21. [Article in Polish]
- Morelli N, Mancuso M, Felisati G, et al. (2009): Does SP block have an effect in paroxysmal hemicrania? May 5.
- Saberski L, Ahmad M, and Wiske P (1999): SP block for treatment of sinus arrest. Headache; 39: 42-4.
- Prasanna A and Murthy P (1997): Vasomotor rhinitis and SP block. J Pain Symptom Manage; 13: 332-337.
- Quevedo J, Purgavie K, Platt H, et al. (2005): CRPS involving the lower extremity. Arch Phys Med Rehabil.; 86: 335-337.
- Shah R and Racz G (2004): Long-term relief of post-traumatic headache by SP lesioning. Arch Phys Med Rehabil.; 85: 1013-1016.
- Berger J, Pyles S, and Saga-Rumley S (1986): Does topical anesthesia of the SP with lidocaine relieve low back pain. Anesth Analg.; 65: 700-702.
- Sluder G (1910): SP neuralgia. Am J Med Sci.;111: 868-878.
- Greenberg DA, Aminoff MJ, and Simon RP (2012): "Chapter 6. Headache & Facial Pain in Clinical Neurology". amazon.com(8thed.). McGraw-Hill. ISBN9780071759052. Archieved from the original on 2016-06-02.
- Schuenke M, Schulte E, Schumacher U, et al.: Head and Neuroanatomy - Latin Nomencl. (THIEME Atlas of Anatomy). Thieme. ISBN: 1588904423.
- Bruni JE and Montemurro D: Human neuroanatomy. Oxford University Press, USA. ISBN: 0195371429.
- McMinn FRCS CSS. Last's Anatomy: Regional and Applied, 12e (MRCS Study Guides). Churchill Livingstone. ISBN: 0702033952.
- https://en.wikipedia.org/wiki/Trigeminal_nerve
- Vilensky Joel, Robertson Wendy, Suarez-Quian and Carlos (2015): The Clinical Anatomy of the Cranial Nerves. Ames, Iowa: Wiley-Blackwell. ISBN 978-1118492017
- https://www.mayoclinic.org/diseases-conditions/optic-neuritis/symptoms-causes/syc-20354953
- https://www.webmd.com/multiple-sclerosis/optic-neuritis-ms-vision#1
- Purvin V, Kawasaki A and Jacobson DM (2001): Optic perineuritis. Arch Ophthalmol; 119 (9): 1299 – 306.
- https://en.wikipedia.org/wiki/Conjunctiva#Nerve_supply
- Soliman, D (2016): Pain Management by Prolotherapy and Perineural Injection therapy. Germany: Lambert Academic Publishing, 13-38.
- Rogers J, Mastroeni D, Leonard B, et al. (2007): Neuro-inflammation in AD and PD. Int Rev Neurobiol;82:235 – 46.
- Natasa K, Franca M and Cosentino M (2018): Peripheral Immunity, Immunoaging and Neuroinflammation in PD. CurrMedChem;doi:10.2174/0929867325666181009161048
- Inserra A, Mastronardi CA, Rogers G, et al. (2018): Neuroimmunomodulation in MDD: Focus on Caspase 1, Inducible Nitric Oxide Synthase, and Interferon-Gamma. Mol Neurobiol; doi: 10.1007/s12035-018-1359-3.