Illness Persists In Gulf War Veterans
(Ivanhoe Newswire) =96 Nearly 20 years after the Gulf War, illnesses
persist, with blood flow abnormalities in the brains of the veterans.
"We confirmed that abnormal blood flow continued or worsened over the
11-year span since first being diagnosed, which indicates that the
damage is ongoing and lasts long term," principal investigator Robert
W. Haley, M.D., chief of epidemiology in the Departments of Internal
Medicine and Clinical Sciences at the University of Texas (UT)
Southwestern Medical Center in Dallas, was quoted as saying.
"We also identified a special MRI procedure that better diagnoses and
distinguishes between the three main types of Gulf War illness."
Gulf War illness is a poorly understood chronic condition associated
with exposure to neurotoxic chemicals and nerve gas. It affects an
estimated 25 percent of the 700,000 military personnel deployed to the
1991 Persian Gulf War, according to the U.S. Department of Veterans
Affairs' scientific advisory committee.
There are three main syndromes associated with Gulf War illness,
producing a variety of symptoms, including fatigue, neuropathic pain,
memory and concentration deficits, balance disturbances and
depression.
The hippocampus is the part of the brain responsible for forming
long-term memories and helping with spatial navigation. Many Gulf War
illness neurological symptoms, such as memory loss, confusion,
irritability and disorders in motion control suggest impairment of the
hippocampus.
In this study, the researchers used a novel technique called arterial
spin labeled (ASL) MRI to assess hippocampal regional cerebral blood
flow (rCBF) in 13 control participants and 35 patients with Gulf War
syndromes 1 (impaired cognition), 2 (confusion-ataxia) and 3 (central
neuropathic pain).
Each patient received intravenous infusions of saline in an initial
session, and physostigmine in a second session 48 hours later.
Physostigmine is a short-acting cholinesterase inhibitor, used to test
the functional integrity of the cholinergic system, a neurotransmitter
system involved in the regulation of memory and learning.
"ASL scanning after giving this medication is particularly well suited
to diagnosing Gulf War illness, because it picks up brain
abnormalities too subtle for regular MRI to detect," co-author Richard
W. Briggs, Ph.D., professor of radiology at UT Southwestern, was
quoted as saying. "This allows us to make the diagnosis in a single
two-hour session without the need for exposure to ionizing radiation."
"Having an objective diagnostic test allows researchers to identify
ill veterans for future clinical trials to test possible treatments,"
Dr. Haley said. "It is also critical for ongoing genomic studies to
see why some people are affected by chemical exposures, and why others
are not."
SOURCE: Radiology, published online September 9, 2011
Brain Abnormalities in Gulf War Syndrome: Evaluation with 1H MR Spectroscop=
y
Robert W. Haley, MD, W. Wesley Marshall, MD, George G. McDonald, PhD,
Mark A. Daugherty, RT, Frederick Petty, PhD, MD and James L.
Fleckenstein, MD
+ Author Affiliations
1From the Depts of Internal Medicine, Section of Epidemiology (R.W.H.,
W.W.M.), Radiology (G.G.M., M.A.D., J.L.F.), and Psychiatry (F.P.),
University of Texas Southwestern Medical Center at Dallas, 5323 Harry
Hines Blvd, Dallas, TX 75390-8874, and Dallas Veterans Affairs Medical
Center, Tex (F.P.). From the 1999 RSNA scientific assembly. Received
Nov 8, 1999; revision requested Jan 7, 2000; revision received Jan 28;
accepted Mar 13. Supported by the U.S. Army Medical Research and
Materiel Command under cooperative agreement no. DAMD17-97-2-7025; by
U.S. Public Health Service grant M01-RR00633; by a grant from the
Perot Foundation; and by a grant from Philips Medical Systems of North
America. Address correspondence to R.W.H.
Abstract
PURPOSE: To test for neuronal brain damage in the basal ganglia and
brainstem in Gulf War veterans by using magnetic resonance (MR)
spectroscopy.
MATERIALS AND METHODS: Twenty-two Gulf War veterans with one of three
factor analysis=96derived syndromes (case patients); 18 well veterans
matched for age, sex, and education level (control subjects); and six
Gulf War veterans with syndrome 2 from a different population
(replication sample) underwent long echo time (272 msec) proton
(hydrogen 1) MR spectroscopy on a 4 =D7 2 =D7 2-cm voxel in the basal
ganglia bilaterally and a 2 =D7 2 =D7 2-cm voxel in the pons. Syndromes
1=963 are described as =93impaired cognition,=94 =93confusion-ataxia,=94 an=
d
=93central pain,=94 respectively.
RESULTS: The N-acetylaspartate=96to-creatine (NAA/Cr) ratio, which
reflects functional neuronal mass, was significantly lower in the
basal ganglia and brainstem of Gulf War veterans with the three
syndromes than in those structures of the control subjects (P =3D .007).
The finding was corroborated in the replication sample (P =3D .002).
Veterans with syndrome 2 (the most severe clinically) had evidence of
decreased NAA/Cr in both the basal ganglia and the brainstem; those
with syndrome 1, in the basal ganglia only; and those with syndrome 3,
in the brainstem only.
CONCLUSION: Veterans with different Gulf War syndromes have
biochemical evidence of neuronal damage in different distributions in
the basal ganglia and brainstem.
Footnotes
The content of this paper does not necessarily reflect the position or
the policy of the U.S. government, and no official endorsement should
be inferred.
For the full study: http://radiology.rsna.org/content/215/3/807.full
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