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vessels. It is another newly discovered slow pathway for drainage of CSF components. There is much new evidence describing the essential function of sleep in activating this glymphatic pathway that helps to maintain metabolic homeostasis. It seems that the clearance of potentially neurotoxic waste products is increased during sleep by the expansion of these extracellular spaces in the brain (a 60 percent increase in the glymphatic pathways). 21 An alternative important function of the glymphatic system may be to transport small lipid molecules in the CNS. 22 LYMPH IN THE BRAIN PROVEN Still, glymphatic pathways are not lymphatic pathways. For decades, researchers tried to understand the mechanisms directing the entrance and exit of immune cells in the CNS and finally did so in 2015. Two separate teams of researchers, one team at the University of Virginia 23 and one team at the University of Helsinki 24 in Finland, independently found typical lymph vessels in the brain. These vessels, which line the dural sinuses in the brain, carry lymphatic fluid (and immune cells) toward deep nodes of the neck (cervical lymph nodes). We can postulate that manual activation of the lymph flow in the numerous nodes of the neck may stimulate drainage of CNS fluid and waste products, and facilitate transportation of immune cells/ antigen-presenting cells to the nodes. Until now, no lymph vessels had been officially found in the brain itself, so manual lymphatic techniques could not be appropriately applied to this region. With the discovery of lymph vessels in the meninges (the cover of the brain), manual lymphatic techniques can now be applied to the dura matter, the external and thicker layer of the brain. 50 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 6 Astrocytic endfeet Tight junction Arteriole Venule CNS endothelial cell Nucleus of endothelial cell Basal lamina Pericyte Astrocytic endfeet. They cover approximately 99 percent of all blood capillaries in the brain. In the brain, there is a little space between the astrocytes' endfeet covering and the external aspect of the blood capillaries (see the yellow area in Image 3). This space constitutes the "glymphatic system" (gliovascular clearance system, or glymphatic clearance pathway). © Quaghebeur Jörgen. 2 3 The glymphatic system (in yellow) is located between the basement membrane of the central nervous system's blood capillaries and the astrocytes layer. © Quaghebeur Jörgen. Blood Glymphatic system Basement membrane CNS capillary endothelium Perivascular astrocyte endfeet }