Do you know of anyone doing clinical research into cognitive impairment from bipolar illness ? Because they are doing it wrong.

And they don’t realize it.

Do you know of anyone doing clinical research into cognitive impairment from bipolar illness or migraine or iron deficiency or thiamine deficiency or any other brain illnesses potentially caused by secondary problems far away from the brain? [ Sorry, there are treatments for iron deficiency and thiamine deficiency but these are hard to diagnose and easy to miss. They affect the brain because they affect all cells. ].

These are hard problems for which we have no good consistent knowledgeable treatments.

To figure it out, we need all the clues we can gather. No one since* Dr Emile Kraepelin has attempted to do this. * Manic Depressive Insanity Ch. 3 Bodily Signs 1926.

Dr Kraepelin found the vital signs in bipolar patients to be abnormal in different ways depending on whether the patient had depressive attacks or manic ones. Heart rate, blood pressure, body temperature, higher mental functions, appetite, sleep and respiratory rate were all abnormal.

He concluded that bipolar attacks must be due to a metabolic problem. But he did not have the tools to investigate further.

Today, investigators are looking into the possibility that endogenous ouabain is involved in both depressive and manic attacks of bipolar illness.

Endogenous ouabain affects the sodium/potassium pump and can provoke intracellular edema of the brain.

Brain Swelling Due to Intracellular Edema

This has been called “metabolic” or “cytotoxic” edema. It is caused by anything which damages cell metabolism, in particular the sodium pump mechanism, producing a change in the osmotic balance across the cell membrane and intracellular edema. This type of edema corresponds to the dry edematous brain, because the edema is contained in the cells and the cut surface of the brain is, therefore, not unduly wet. It can be produced experimentally with a wide range of poisons such as cyanide and hexachlorophene, by specific sodium pump inhibitors such as ouabain and by direct damage to the cell with trauma, including cold.                   Stroke    A Journal of Cerebral Circulation    1979    Ischemic Cerebral Edema. A Review     M.D. O’BRIEN, M.D., M.R.C.P

Incidentally, although cytotoxic edema (oncotic cell swelling) is referred to as “edema” for purely historical reasons, it results in intracellular, rather than extracellular, fluid accumulation, it does not include a swelling component, and it is best regarded as a premorbid precursor to extracellular ionic edema. Molecular pathophysiology of cerebral edema Jesse A Stokum,1 Volodymyr Gerzanich,1 and  J Marc Simard J Cereb Blood Flow Metab. 2016 Mar; 36(3): 513–538.

Intracellular changes to brain cells are difficult to measure, as you can imagine. So we are left with observations of behaviour changes and possible, patterns of vital signs.

Interestingly, injection of ouabain-one of the the cardiac steroid poisons- causes the behavioural symptoms of mania and depression in animals, most likely, in my opinion, from cytotoxic edema or intracellular fluid accumulation.

To be continued, will include references…….

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