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Need Help Finding Article/gulf War Illness


~Naomi~
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This is interesting about Gulf War illness and sounds familiar... I'd like to locate the study referred to in the first paragraph. I can't seem to find it. Can anyone help? Thanks.

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http://www.dallasnew...erve-damage.ece

Dallas researcher’s team finds Gulf War illness stems from nerve damage

Gulf War illness, which afflicts an estimated 200,000 military veterans, results from extensive damage to the autonomic nervous system, according to a study published Monday by Archives of Neurology, a publication of The Journal of the American Medical Association.

Dr. Robert Haley, an epidemiologist at UT Southwestern Medical Center in Dallas, said he and a team of researchers studied 66 chronically ill veterans and 34 healthy veterans who, together, constitute a scientific representation of the 700,000 veterans who served during the first Gulf War in 1990 and 1991.

Their findings lend scientific weight to the theory that the illness, also called Gulf War syndrome, is not merely a psychological reaction to combat, but a physical disorder involving nerve damage that affects breathing, heart rate, sexual function, perspiration and other body functions.

“Many of these veterans have been told that there is nothing wrong with them,” Haley said Monday in an interview. “Our hope is that the physicians treating our veterans will read this study and recognize the symptoms, and that this will lead to better treatments.”

Haley has been studying Gulf War veterans for more than 20 years. He and other medical experts have repeatedly said they believe Gulf War syndrome was caused by exposure to pesticides and other chemicals in the Persian Gulf.

Other researchers have speculated that pills containing pyridostigmine bromide, an anti-nerve gas agent, could have caused illness. But the new study does not address the causes.

“These guys don’t care what caused it,” Haley said. “They just want to know what it is.”

When U.S. military personnel returned home after the Gulf War, many streamed into veterans hospitals complaining of memory loss, cloudy thinking, breathing difficulty, sleep problems and excessive perspiration. Many physicians were puzzled and assigned a diagnosis of post-traumatic stress disorder, or PTSD, which allowed the veterans to collect benefits for a service-related illness.

But veteran groups and their advocates resented the implication that it was all in the soldiers’ heads and kept fighting to get funding for Haley and other researchers to search for answers.

Paul Sullivan, a Gulf War veteran who heads Veterans for Common Sense in Austin, said the next step is to secure federal funding for research on drugs that might help afflicted veterans. He singled out U.S. Sen. Kay Bailey Hutchison, R-Texas, and Dallas billionaire Ross Perot for supporting Haley’s research at UT Southwestern.

“The scientific evidence is rock solid,” Sullivan said. “Veterans are sick.”

The U.S. House Committee on Veterans Affairs conducted two hearings in 2009 on the status of research into Gulf War illness. Testimony showed that federal agencies spent $350 million on 345 projects related to Gulf War veteran health care needs between 1992 and 2007. But critics say those projects didn’t focus on identifying causes and treatments for Gulf War illness.

Instead, much of the research focused on stress and psychiatric conditions that had little or no relevance to the health of Gulf War veterans, who now range in age from late 30s to late 70s. By contrast, Sullivan said, Haley’s research is leading to answers that promise real help for veterans.

An editorial accompanying the online version of Haley’s article praised the rigor of his research. It noted that he and other researchers believe exposure to toxic chemicals caused the illnesses. But the editorial also said stress can cause illness.

“Experimental and real-world stress results in a repertoire of anatomic, physiological and chemical changes that lead to specific disorders and health outcomes,” the editorial said.

Haley suggested that he may soon address the cause, or causes, of Gulf War illness.

“We’re going to show proof of what causes this,” he said. “It will be a huge study with convincing evidence.”

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Extremely significant article!

The immunologist I see is one of the worlds leading researchers on both CFS and Gulf war illness.

She does extensive immune testing (20 plus pages of data that looks like Greek to me), and people debilitated by CFS and those sick with Gulf War Syndrome have very similar immune findings and devastation. The problem is not only 'immune' but is now classified as 'neuro-immune'.

The current working hypothesis is that Gulf War Syndrome patients immune systems were devastated by chemicals, and CFS patients were devastated by viral agents. But the details of our immune systems are very similar. (T cells, B cells, NK cells and cytokines)

Much of this immunologists research and grant work is funded by the NIH and other government agencies. Godspeed!

Gulf War Syndrome patients have been dismissed and disrespected by the medical community as severely as CFS patients. Some people have suggested for years that if the gov't acknowledges these as real and debilitating illnesses it will break the back of Social Security. No doubt.

The new Mayo paper lists that about 50% of patients with pots had a 'viral onset'. The immunologist I see is the one who dx me with pots, because OI and POTS is not uncommon in CFS patients, (because of our high viral 'load')

It's uncommon for people with CFS to get diagnosed with pots though.

So you will definitely see patients with CFS and Gulf War Syndrome taking the same drugs, and immune modulators.

Good find Naomi!

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i was told that POTs was first picked up on after the first world war, when men came back demonstrating strange HR and BP patterns. It was given a name back then which i forget now, but it wasnt pots. Must have been the trauma and chemical exposure back then.

Presumably at least some of the patients who fell under the term "Da Costa's Syndrome" had what we now call POTS. That was back in the civil war era, but in world war I, a few british physicians termed a syndrome known as "soldier's heart" whose symptoms closely mirror that of POTS too and perhaps even CFS patients.

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my laptop is not letting me use the edit tool, so...

"Many physicians were puzzled and assigned a diagnosis of post-traumatic stress disorder, or PTSD, which allowed the veterans to collect benefits for a service-related illness."

ha ha!, i find that hilarious as a doc i once saw thinks I got pots from PTSD - no kidding - plus he looks like santa. i was not at a stressbreaking point in my life (for my life) other than being on a very restricted diet more than a year before when I became most symptomatic, so to me, in my head PTSD made no sense as I have had an "eventful" life. he did say that he has vets 20 yrs plus who all of a sudden came down with ptsd, not pots, this just mentioned by him tho. i did like him but now have a big med bill to pay that insurance won't cover Just like an appt. when talking to a psych when I was 16 and yes, btw, they all said my life was a lot to deal with but I was fine. Also, with the doc I mentioned I didn't know at the time that he was an epilepsy neuro, he didn't order any testing, no blood work, nothing, just his thoughts from a 1/2 hr consult he told me to just do my homework and get him the "line drawing" from my eeg that captured brain waive slowing, which I did get to him, thus he also "confirmed" as I understood that there was slowing activity for sure, just not siezure or epilepsy. The whole not testing me stuff doesn't necessarily bother me as I have had an epc call me "pots girl" and not even look me in the eye, less than 10 minute consult after sitting in his lobby for over an hr. My question is, and i kinda wrote the theory of PTSD off and i havn't looked into much research but did anyone find the article niaomi was looking for? and I don't understand, cuz those who aren't vets, why would any sort of nerve gas/toxin flying around in the air only effect some of us, causing dys if we all are breathing it in?

Not to say completely write off anything, I am certainly looking into toxins and such as a cause of chronic illness - although certainly not sold on the mold theory yet. Toxins/never gas etc., I think that would be harder to prove and possibly no safe cure tho....so hoping that is not the reason.

Edited by corina
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Not the original article, but I guess it's as good as we can get - the Archives of Neurology is available by subscription only.

Interesting findings to say the least.

www.medscape.com/viewarticle/775087 - dated Nov 26, 2012.

The same dr published some similar info in 2004

www.usouthwestern.edu/newsroom/news-releases/year-2004/veterans-with-gulf-war-syndrome-have-damage-in-specific-primitive-portions-of-nervous-system.html

Lots of good stuff to read tonight.

Thanks for sharing Naomi

Best

Alex

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"Gulf War illness, which afflicts an estimated 200,000 military veterans, results from extensive damage to the autonomic nervous system, according to a study published Monday by Archives of Neurology, a publication of The Journal of the American Medical Association."

I'm really interested in knowing what specifically he found wrong with the autonomic nervous system in these veterans. He says "extensive damage" - what does that mean and how was it measured?

Alex- the links you sent don't work for me. Thanks for trying though. :)

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Naomi

that is strange as I tried it several times and it works just fine.

try a google search for medscape medical news gulf war illness linked to cholinergic abnormalities Pauline Anderson

again the direct link

www.medscape.com/viewarticle/775087

(my copy paste feature doesn't work otherwise I'd post the entire article)

Alex

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Gulf War Illness Linked to Cholinergic Abnormalities

Pauline Anderson

Nov 26, 2012

A large new study seems to confirm that the illness plaguing so many veterans of the 1990-1991 Gulf War is due to cholinergic dysfunction.

The study represents "a real game-changer" in terms of how experts should view Gulf War illness, which is characterized by such varied symptoms as cognitive impairment, chronic headaches, joint pain, unexplained fatigue, chronic diarrhea, and respiratory problems, according to the study's lead author Robert W. Haley, MD, professor, internal medicine, and chief, Division of Epidemiology, University of Texas Southwestern Medical Center, Dallas.

"It suddenly takes this out of the realm of a psychological illness and into the realm of a brain illness," said Dr. Haley. "Now we need to turn our attention to looking at treatments that neurologists and internists and other doctors can provide for conditions that involve abnormalities in the cholinergic parts of the nervous system."

Although the study doesn't make any conclusions about the cause of the illness, Dr. Haley believes it's due to exposure to low doses of nerve gas and to pesticides.

The study, published online November 26 in the Archives of Neurology, is the largest to date among a series of studies attempting to track autonomic nervous system abnormalities in soldiers with Gulf War illness.

Controversial Illness

In the early 1990s, about 700,000 US troops were deployed to the Middle East to take part in a 5-week air bombing campaign and a 5-day ground operation that involved almost no traditional combat. Of these soldiers, about 150,000 subsequently became ill, almost all had to leave the service, and many remain unemployable, said Dr. Haley.

ht_121126_robert_Haley_120x156.jpg

Dr. Robert W. Haley

Their illness is controversial; the US government has never acknowledged that Gulf War syndrome is a real illness, and many people still believe it's psychological, he said.

For this latest study, researchers randomly selected 8020 representative Gulf War veterans for detailed interviews and included 97 in the current study. Of these, 66 met the case definition of Gulf War illness that Dr. Haley and his colleagues had previously validated. These case veterans represented 3 forms of the illness included in that definition:


  • Syndrome 1 (mild cognitive impairment; 21 cases): These soldiers have difficulty thinking, concentrating, and remembering, and some have symptoms of depression.

  • Syndrome 2: (confusion-ataxia; 24 cases): Veterans with this form of the illness have balance problems and what Dr. Haley described as "early Alzheimer's disease that doesn't get worse" or chronic neurotoxic encephalopathy.

  • Syndrome 3 (central neuropathic pain; 21 cases): Soldiers with this syndrome describe having a constant pain between their shoulders and down their arms and thighs. They have difficulty riding in a car because of the pain, and nothing seems to relieve it, said Dr. Haley.

Also included in the study were 31 control veterans: 16 who were deployed but did not meet the case definition of Gulf War illness and 15 who were in the military but not deployed

The soldiers completed questionnaires and underwent a battery of standard tests to assess autonomic function and objective tests of autonomic dysfunction.

Symptom Score Elevations

The study found that in the various symptom domains of the Autonomic Symptom Profile (eg, orthostatic intolerance, sleep dysfunction, autonomic diarrhea, pupillomotor symptoms, sexual dysfunction), those with syndrome 2 had the highest scores, but the pattern of symptom score elevations was similar among all 3 syndrome groups.

On objective autonomic tests, those with Gulf War illness differed most from controls on the Quantitative Sudomotor Axon Reflex Test (for example, P ≤ .001 compared with controls for the foot). The degree of difference on this test was related to peripheral nerve length, typical of a length-dependent neuropathy of small-caliber, unmyelinated, peripheral nerve fibers, said the authors.

Veterans with syndrome 2 and 3 had a statistically significant increase in cooling detection threshold. This, said the authors, might also reflect underlying small-fiber impairment.

The Composite Autonomic Severity Score (CASS) varied significantly across the clinical groups ( P = .045) and was higher in the syndrome 2 group than in the controls ( P = .02).

Circadian Abnormality

Analysis of 24-hour electrocardiogram monitoring showed that high-frequency heart rate variability (HF HRV) increased normally at night in the control group but not in the 3 syndrome groups.

"Because peripheral vagal baroreflex function was not significantly impaired, this abnormality of circadian variation in HF HRV suggests dysfunction in the central nervous system control of parasympathetic outflow," the authors write. Impaired HF HRV was not explained by smoking, creatinine clearance, psychiatric comorbidity, diagnosis of heart disease, glycated hemoglobin level, body mass index, or medications.

During the day, HF HRV in veterans with syndrome 1 did not differ from controls but the syndrome 2 group had significantly lower HF HRV than controls. Those with syndrome 3 had significantly higher HF HRV than controls, particularly during the morning hours. .

The Composite Autonomic Symptom Scale (COMPASS) of all autonomic symptoms was inversely correlated with HF HRV and was directly correlated with the CASS subscales. The correlation was highest with HF HRV during the day and with the CASS sudomotor subscale. The correlation was lowest with the CASS cardiovagal and adrenergic subscales.

The pattern of autonomic symptoms and objective test results suggest dysfunction in both central and peripheral cholinergic functions, the authors concluded.

Dr. Haley believes that soldiers with syndrome 2, who have the worst symptoms, suffered damage to the hippocampus during their deployment. He described an experiment in which veterans responded abnormally to a cholinergic challenge with an agent that simulates re-exposure to nerve gas.

"The hypothesis was that if nerve gas damaged acetylcholine receptors in these guys' brain — and there's reason to believe that that's what nerve gas does — then their cholinergic receptors wouldn't respond normally to acetylcholine. That's what we found. Those with syndrome 1 responded normally, just like the controls, whereas those in the syndrome 2 and 3 groups didn't slow down; in fact the brain sped up indicating there's an abnormality of cholinergic receptors."

During the 1990-1991 Gulf War, Iraq had large stockpiles of the nerve gas sarin, a colorless, odorless liquid that had been used as a chemical weapon. Production and stockpiling of sarin were outlawed in 1993.

Soon after the end of the Gulf War, an expert panel came up with a dozen or so environmental exposures that might have caused Gulf War illness, said Dr. Haley. Since then, some epidemiologic studies have narrowed the culprit down to low-level nerve gas resulting from US bombing of Iraqi storage facilities. "We bombed big storage warehouses producing fall out clouds that drifted over our troops and rained fallout on them," said Dr. Haley.

Soldiers who were exposed to this nerve gas who also have a weak form of the PON1 gene, which produces an antidote to nerve gas, are the most prone to Gulf War illness, said Dr. Haley. About 20% of veterans have a weak form of this gene, which helps explain why not all exposed soldiers got ill.

Another explanation is that not all soldiers had the same level of exposure to the nerve gas, said Dr. Haley. "The cloud didn't go everywhere, but if you were exposed to the cloud and you had the weak form of the gene, you've got a huge risk of being sick with chronic neurotoxic encephalopathy" which characterizes the syndrome 2 variant of Gulf War illness, he said.

Pesticide 'Overuse'

Dr. Haley is convinced that soldiers with syndrome 1 (mild cognitive impairment) were exposed not to nerve gas but perhaps to a pesticide. During the Gulf War, there was "great overuse of pesticides," which has been linked to cognitive disturbances, he said. "We think that syndrome 1 may be a pesticide problem and that 2 and 3 are very strongly associated with nerve gas exposure and the PON gene."

Another paper that he and his colleagues have prepared is set for publication within the next few months. It includes all the evidence showing how nerve gas might cause symptoms of Gulf War illness and should "end the discussion" on this topic, said Dr. Haley.

This research should set the stage for the development of objective tests that the Department of Veterans Affairs and other groups could run on Gulf War veterans to identify those who have sustained damage to their brain due to their deployment. "That will do 2 things," said Dr. Haley. "One, it will give an objective basis in terms of who to put on disability and who to provide service-connected benefits to. It's also a really important clue as to how to treat this."

Why did it take 2 decades to seemingly get to the bottom of Gulf War illness? Part of it was that veterans, like everyone else, have difficulty expressing issues related to heart rate, digestion, sexual desire, and other aspects of the autonomic nervous system, said Dr. Haley.

Symptoms and health problems similar to those experienced by US troops were also reported by servicemen and -women from Canada, the United Kingdom, Australia, and Denmark. There were also reports of a higher incidence of cancers, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease, birth defects, and other disorders.

Manifestations of Stress

Not everyone is convinced that psychological stressors have no role in the Gulf War illness. In anaccompanying editorial, Roy Freeman, MBChB, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, provides extensive data from various experiments and studies showing a wide array of objective structural, physiologic, and clinical manifestations of stress.

"Proposing a primary, supplementary, or synergistic role for stress in the Gulf War syndrome neither invalidates nor minimizes the associated symptoms, suffering, health outcomes, and public health import of the syndrome," he writes. "On the contrary, it provides a framework for valid scientific analysis, study, and rational dissection of the clinical features of the disorder."

Dr. Freeman pointed out that there is no widely accepted cause of the symptoms and health problems experienced by Gulf War veterans.

"Independent reviews of the evidence to date have reached discrepant conclusions," he writes. "On the one hand, the Institute of Medicine report concluded that the current evidence was inadequate to determine whether an association exists between multisymptom illness and any specific battlefield exposure(s). In contrast, a report by the Research Advisory Committee on Gulf War Veterans' Illnesses concluded that Gulf War illness was a direct consequence of exposure to toxins including pyridostigmine bromide [which was taken as nerve gas prophylaxis] and pesticides."

This study was supported by Indefinite Delivery Indefinite Quantity contract VA549-P- 0027, awarded and administered by the Department of Veterans Affairs Medical Center, Dallas, Texas; by grant DAMD17-01-1-0741 from the US Army Medical Research and Materiel Command; and by grant UL1RR024982-05, titled North and Central Texas Clinical and Translational Science Initiative, from the National Center for Research Resources, a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Dr. Haley received an honorarium from Targeted Medical Pharma Inc for critical review of a Food and Drug Administration new drug application for a nonpharmaceutical medication to treat fatiguing illness of possible benefit to Gulf War veterans. Dr. Freeman has disclosed no relevant financial relationships.

Arch Neurol. Published online November 26, 2012.

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WOW. Thank you, Alex! Ok, syndrome 2 describes how I feel. All the things they looked at... QSART, Small Fiber Involvement, Compass, etc. sounds like us. My original curiosity was why are CFS and Gulf War Illness often lumped together. I was surprised to see this about the ANS. It's interesting that CFS and POTS often go together and GWI looks like CFS... and all three have the autonomic nervous system in common. This suspicion about Pyridostigmine is a bit disturbing considering this is what they're handing out for POTS. Doesn't sound like they've proven it caused anything, but still makes you raise an eyebrow.

Kitt - it's interesting what your immunologist says about the immune system and why CFS and Gulf War Illness have symptoms in common. What is the "neuro" component though? Did your Dr. say why/how the ANS specifically is affected? I keep hearing neuro-immune, but I'm not sure what it means.

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Naomi,

You asked about neuro-immune, and what it means.

MS is a classic 'neuro' or neurologic disease. MS patients neurological systems are severely compromised. They may have a few anomalies in their immune systems, but not enough to call MS a neuro-immune disorder. MS along with many other illnesses is a classic neurological disease.

In the mid 1980's when CFS emerged, it emerged in 'clusters' around the country. Most doctors felt it was probably caused by an unknown viral agent because of the 'clusters' that broke out in various areas in the U.S. Viruses are communicable, so clusters of patients in one small town made doctors think 'viral'. Doctors are still focused on 'viral' as a cause, but some doctors are focusing on other pathogens as either a cause or a co-factor in trying to determine the 'cause' or etiology of CFS.

During those early years in CFS doctors that were dedicated to treating and researching CFS did testing and found profound immune damage in CFS patients. T cells, B cells, NK cells, and cytokines all pointed to CFS being an immune disorder.

Over the years theses same doctors, (along with many more doctors and researchers) began documenting profound neurologic disturbances as well as immune issues in CFS patients. (I'm not referring to autonomic neurologic issues, but overall neurologic issues) Cognitive problems, gait, balance, the list is very long...Brain scans have shown neurologic damage in CFS that I can't begin to speak to.

Thus the term 'neuro-immune' to describe CFS patients who have both neurologic abnormalities and immune abnormalities. GWS also have 'neuro-immune' problems. (I'm still not narrowing this to the autonomic nervous system, or referring to autonomic neurologic issues.) Neuro-immune means the neurologic system as a whole as well as the immune system as a whole.

Some CFS patients have developed autonomic problems, primarily OI and POTS but the majority of CFS patients do NOT have dysautonomia.)

So neuro-immune does not refer to the autonomic system.

So GWS patients do have a neuro-immune disease that falls into catagory I just explained, but it appears from the posts listed in this link they also have profound autonomic issues!

A fascinating piece of information!

Am just pointing out that dysautonomia is not something that most CFS patients have. Plenty of CFS patients do have POTS and OI, and it's been proven that they're is a STRONG viral link with pots. The new Mayo paper says about 50% of people with pots have a viral onset. Lots of people without CFS have a viral onset that causes pots too.

Thanks for posting the Gulf War Syndrome info.

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Thank you, Kitt. I understand the term neuro-immune - what I was questioning is how the two are linked. I know for sure the brain can be affected as evidenced by my own Spect Scan and my neurologic symptoms are not just autonomic (as you described). But how can an immune system disorder cause neurologic damage. After pondering this, I think I just answered my own question... AIDS dementia. Maybe something similar happens in CFS.

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Naomi, it's so complex it boggles the mind, yet sometimes it seems as simple as 'the knee bone is connected to the thigh bone' song. In the end it's just plain complicated. I had a Spect Scan too. Did you get good information from yours?

Yes, HIV is a good example of neuro-immune. Perhaps the best example.

Ironically, people with HIV are able to do very well with good health care! I know a man who has been HIV positive since 1981, and he's doing great! Working full time, traveling, living the dream. Amazing. If those of us with CFS and dysautonomia were dying, and IF our illnesses were sexually transmitted you can bet countries all over the world would find a cure.

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Kitt - you're so right. Did you hear Dr. Klimas say (something like) her HIV patients are functioning better than her CFS patients - that she'd rather have HIV? My Spect showed hypoperfusion in areas of the brain which could account for some of my more troubling symptoms. My CFS Dr. said based on the areas affected, it was consistent with a typical CFS pattern. Did yours show anything?

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Naomi, Dr. Klimas went on record in Newsweek magazine saying that if she had to choose between having HIV or CFS, she would choose to have HIV because her HIV patients are hale and hearty, and went to talk about CFS patients and the poor quality of life they have.

My spect scan was done many many years ago and showed profound CFS indications. I don't have the notes to be more specific.

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This a very interesting topic, it may take me a while to clear my head enough to fully understand all it applications but there are some similarities for sure. My fiance is a veteran and has been exposed to countless harmful "agents" as well as combat realted injuries both physical and physcological. He diagnosed ptsd and tbi (traumatic brain injury) with other contributing factors. His symptoms def have some simularities to pots. I would say to the hyper form though. He is alos treated with a lot of similar meds as hyper pots so this is something I would like to look into somemore. Thx for all the good reading here =)

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  • 3 months later...

http://www.ncbi.nlm.nih.gov/pubmed/17662618
NOTE finding of significance: "The odds of having GWIs increased by 1.3% for every PB pill taken (95% confidence interval 1.001-1.02). There were significant trends toward worse health with greater intake of PB."

In a recent Washington Post article (explaining why soldiers were given the Mestinon); the question is what is causing the abnormal brain scans the chemical exposure and/or the effects of the PB:



Gulf War veterans show abnormalities in scans of their brains
  • By Sara Reardon, Published: March 25 | Updated: Tuesday, March 26, 6:02 PM

When she returned from the Persian Gulf War in 1991, Air Force nurse Denise Nichols experienced sudden aches, fatigue and cognitive problems, but she had no idea what was causing them. They grew worse: Even helping her daughter with multiplication tables became difficult, she says, and eventually she had to quit her job.

Nichols wasn’t alone. About a third of Gulf War veterans — possibly as many as 250,000 Americans — returned with similar symptoms.

Now an imaging study has found that these veterans have what appear to be unique structural changes in the wiring of their brains. This fits with the scientific consensusthat Gulf War Syndrome, or GWS, is a physical condition rather than a psychosomatic one and should be treated with painkilling drugs instead of counseling.

Military authorities in various countries consistently denied in the past that there was a physical basis to GWS. Although the Department of Veterans Affairs now accepts that the disorder is physical, the issue has been mired in controversy.

Steven Coughlin, a former senior epidemiologist at Veterans Affairs, testified this month before a congressional panel that the VA had suppressed and manipulated research data so as to suggest that the disorder was psychosomatic.

Coughlin told the panel: “If the studies produce results that do not support the [VA’s] unwritten policy, they do not release them. . . . On the rare occasions when embarrassing study results are released, data are manipulated to make them unintelligible. . . . Anything that supports the position that Gulf War illness is a neurological condition is unlikely to ever be published.”

In response, the VA said that the organization has a “long history of conducting world-class research studies that meet accepted and rigorous scientific standards.” They also note that “all allegations of malfeasance are taken seriously and are investigated fully.”

Causes still sought

Whatever the cause of GWS, it is certainly not psychological, says Bernard Rosof of Huntington Hospital in New York, although no single cause is known. Suggested causes include exposure to low levels of sarin gaswhen chemical munitions were destroyed, and a drug called pyridostigmine bromide, which soldiers were given to protect them from sarin.

It’s vital to find an objective test that will allow physicians to make a diagnosis, says James Baraniuk, an associate professor at Georgetown University Medical Center and one of the co-authors of the new imaging study.

To that end, Baraniuk and Georgetown colleague Rakib Rayhan examined 31 veterans with GWS, including Nichols. They scanned their brains using a technique called diffusion tensor imaging, which highlights the bundles of nerves, or white matter, connecting brain regions. They compared these to scans of 20 veterans who were not deployed in the Gulf.

The images indicate that in GWS, these nerve bundles break down and may have trouble forming connections, a phenomenon that has not been associated with any other illness. This suggests that the brain circuitry, rather than any specific brain area, is disrupted in people with the condition. Veterans with the worst symptoms tended to have the most pronounced abnormalities in their white matter.

Easily distracted

The damaged areas tended to be in fibers that connect pain-registering nerves to higher brain centers responsible for interpreting pain. Another affected area was the ventral attention network, which allows people to break their concentration to respond to a stimulus. This fits with the affected veterans’ tendency to be easily distracted and to have trouble with memory formation.

Because the number of people studied was small, it is not yet possible to draw a clear distinction between an affected brain and a normal brain, Baraniuk says. He next wants to look at similar scans of people with chronic fatigue syndrome or fibromyalgia, both of which share some symptoms with GWS.

“It’s a very important paper,” says Robert Haley of the University of Texas Southwestern Medical Center in Dallas, not least because it helps establish GWS as a treatable, physiological problem. But he says the team will have to examine dissected brain tissue from deceased veterans to better understand what the scans show.

The findings still do not pinpoint a specific cause or mechanism for the disorder. However, this type of scan might help physicians distinguish people with the syndrome from others with similar symptoms. This could ensure that they receive long-term pain management rather than psychotherapy.

That’s good news for such people as Denise Nichols, who believes that the VA has avoided addressing the problems people like her have experienced.

“We need help. Our bright hope is these researchers,” she said.

“We will continue to learn and examine ways to improve treatment, process claims and better care for these Veterans,” the VA said in a statement.

This story was produced by New Scientist magazine.

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