Veterans of the 1991 Persian Gulf War suffering from chronic pain and fatigue have brain damage to their white matter, the connective nerve fibers that transmit electrical impulses among the brain’s gray matter, a Georgetown University Medical Center study finds.
Using advanced scans called diffusion tensor imaging, researchers discovered that the brains of 31 veterans who served in the Gulf War had significant changes to the axon bundles — the white matter — in the parts of the brain that process pain and fatigue.
Patients without Gulf War illness did not have the neuronal changes, study lead investigator Dr. James Barniuk said.
“This provides a completely new perspective,” Barniuk said. “While we can’t exactly tell how this tract is affected at the molecular levels, the scans tell us these axons are not working in a normal fashion.”
The research, published online Wednesday in PLOS ONE, appears to support previous studies that have shown brain changes in veterans exposed to different neurotoxins, including anti-nerve agent pills, insect repellent, Sarin nerve gas and environmental pollutants such as burn pits and oil well fires.
A 2009 study by the Veterans Affairs Department, University of Texas Southwestern Medical Center and Southern Methodist University of brain changes in 21 chronically ill Gulf War veterans showed that symptoms varied depending on the level of environmental exposures.
In 2010, Linda Watkins, a neuropsychologist at the University of Colorado, found that white-matter damage could be responsible for fatigue, pain and anxiety associated with Gulf War illness.
The Georgetown University study is small — just 31 veterans and 19 control patients — but it provides enough results to indicate that the axonal damage could serve as a biomarker for diagnosing others with Gulf War illness.
Physicians with access to a functional MRI could definitively diagnose Gulf War illness and adapt treatments to their patients, lead study author Rakib Rayhan said
It also could lead to research into common but little understood diseases like fibromyalgia and chronic fatigue syndrome, he added.
“My hope is that we can move forward to explore treatments. This is not controversial anymore. They are not psychotic; they are not crazy. They are affected and they are suffering. Let’s move forward and find treatment to make their lives better,” he said.
About one in four Persian Gulf War veterans, or 250,000 troops, report symptoms of Gulf War illness, including pain, fatigue, irritable bowel syndrome, chronic headaches and memory loss.
Many veterans have had problems receiving medical care or compensation related to their service in the Gulf War because their illnesses have been difficult to prove or pinpoint.
Despite 20 years of reports of symptoms related to exposures while serving, many within the VA continue to present Gulf War illness as an ambiguous set of symptoms that aren’t connected to service in that conflict, Baylor University researcher Lea Steele told members of the House Veterans’ Affairs Committee on March 13.
“This pattern of chronic symptoms has been well documented. … We know that Gulf War illness is not a stress-induced or psychiatric disorder,” Steele said.
She said Baraniuk’s study and others have identified distinctive physical manifestations of Gulf War illness that should guide VA to better treatment approaches.
“It would be very useful to have a Gulf War illness biomarker, for veterans as well as their healthcare providers,” she said.
The study also could pave the way for advances in tests and treatments for veterans of the Iraq and Afghanistan wars, some of whom suffer from a host of illnesses they believe are related to exposure to toxins from burning waste materials, as well as contamination and pollutants in inhaled sand and dust.
“There are so many exposures involved,” Rayhan said. “If you are burning waste made up of chemicals, or you’ve taken vaccines or medications, insect repellent ... there are a lot of components that could be a part of this.”
The Georgetown study does not determine what may have caused the brain damage.
“The hope is to eventually find a causal agent, but in terms of priority, it’s to find treatments first. These veterans are suffering,” Rayhan said.
The study was funded by the Congressionally Directed Medical Research Program, an initiative in which Congress directs the Defense Department to spend funds on research into certain diseases and conditions.
Sen. Bernie Sanders, I-Vt., has been a staunch advocate for Gulf War illness research and continued funding.
Sanders spokesman Steve Robertson said continued investment is needed to “allow the science behind effective treatments to catch up with the symptoms.”
“As the Senate begins budget discussions, Sen. Sanders will remain steadfast in championing research for veterans’ health care needs,” Robertson said.