Brain Changes Could Contribute to Gulf War Illness: Study

Small study suggests white matter affected in vets who have been diagnosed with syndrome

Thursday, March 21, 2013

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THURSDAY, March 21 (HealthDay News) -- Many of the soldiers who served in the first Gulf War suffer a poorly understood collection of symptoms known as Gulf War illness, and now a small study has identified brain changes in these vets that may give hints for developing a test for diagnosing the condition.
Around 25 percent of the nearly 700,000 U.S. troops that were deployed to countries including Iraq, Kuwait and Saudi Arabia began experiencing a range of physical and mental health problems during or shortly after their tour that persist to this day. Common symptoms are widespread pain; fatigue; mood and memory disruptions; and gastrointestinal, respiratory and skin problems.
New research suggests that structural changes in the white matter of the brains of these vets could be at least partly to blame for their symptoms. White matter is made up of a network of nerve fibers or axons, which are the long projections on nerve cells that connect and transmit signals between the gray matter regions that carry out the brain's many functions.
Denise Nichols was a nurse in the U.S. Air Force and worked with an aeromedical evacuation team for six months during the war. While still in theater, she developed bumps on her arms and had alternating constipation and diarrhea. Shortly after returning in 1991, her eyesight worsened and she developed intense muscle fatigue and memory problems that made it hard for her to help her daughter with her math homework.
"I'm not working anymore because of it; I just could not do it," said Nichols, now 62. In addition to working as a military and civilian nurse, Nichols used to teach nursing and has helped conduct research on Gulf War illness and participated in studies including the current one. "There's people much worse who have cancers and heart problems, and pulmonary embolism has now started surfacing," she said.
"It's frustrating because VA hospitals have not taught their doctors [how to handle the illness]," Nichols said. She added that a doctor offered a psychological consult and said they could not do anything for her physical problems.
Lead researcher Rakib Rayhan put it this way: "This study can help us move past the controversy in the past decade that Gulf War illness is not real or that vets would be called crazy. Gulf War duties have caused some changes that are not found in normal people."
Rayhan and his colleagues performed an advanced form of MRI for visualizing white matter on 31 vets who experienced Gulf War illness, along with 20 vets and civilians who did not experience the syndrome. Although the researchers focused on white matter in the current study, they are also investigating gray matter regions, said Rayhan, a researcher at Georgetown University Medical Center in Washington, D.C.
The results were published March 20 in the journal PLoS One.
The images suggested that there was loss of structural integrity in several white-matter areas in vets with Gulf War illness, particularly in a region that connects gray-matter areas involved in the perception of pain and fatigue, Rayhan said. The researchers observed more disorganization in this area in vets who reported more severe pain and fatigue, and who had a lower threshold for pain in a test that applied pressure to 18 points on the body.
Dr. Robert Haley, director of epidemiology at the University of Texas Southwestern, in Dallas, said the study is very important, and the first to use this type of MRI to examine Gulf War illness.
The findings agree with previous research that found that white-matter regions in the brains of Gulf War vets were smaller than in controls using conventional MRI, said Haley, who was not involved in the research.
Other research by Haley and his colleagues has identified functional differences in some of the gray-matter regions in Gulf War vets. Damage to both white- and gray-matter regions could be involved in Gulf War illness, Haley said, adding that the current study helps make the case that the physiological damage is not limited to the gray matter.
The changes in white matter seen in the current study, however, have to be shown in other groups of vets in other studies, Haley said. A downside of the current study is that all of the vets with Gulf War illness also met the criteria for having chronic fatigue syndrome and half of them qualified as having fibromyalgia, a chronic widespread pain disorder. So it is possible that the changes in white matter noted in this study were related to these conditions and not Gulf War illness.
But teasing apart the brain changes associated with these conditions could be challenging, Rayhan said, because of the overlap in their symptoms. For example, if you meet the criteria for chronic fatigue syndrome and fibromyalgia and you were in the military in 1990 or '91, your doctor could decide that you have Gulf War illness, he said.
To diagnose Gulf War illness, doctors generally look for at least moderately severe symptoms in the following areas: fatigue; pain; mood and cognition; and gastrointestinal, respiratory and skin problems.
If the differences reported in this study can be supported by other studies, it could open doors for diagnostic testing based on this type of MRI, Haley said. It is a simple, fast test that does not involve radiation, he said.
Such a test would help vets get out of the "your word against theirs" challenge in getting services from VA systems, which includes not only medical treatment, but also benefits for their families, Haley said. Veterans of the recent wars in Iraq and Afghanistan also are in need of a diagnostic test for mild traumatic brain injury in cases where they cannot prove the injury based on having endured an explosion or lost consciousness, he added.
The more researchers understand the brain damage that is underlying Gulf War illness, the further along they will be in developing treatments, Haley said.
Although it is fairly well agreed upon that Gulf War illness is caused by exposure to chemicals, and the likely culprits are chemicals in nerve gas and the pesticides used to protect troops from mosquitoes and other insects, treatments have been elusive, Haley said.

SOURCES: Rakib Rayhan, researcher, Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Washington, D.C.; Robert Haley, M.D., director, division of epidemiology, and professor, internal medicine, University of Texas Southwestern, Dallas; Major Denise Nichols, nurse, U.S. Air Force; March 20, 2013, PLoS One

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