Gulf War Illness Linked To Brain Changes

March 21, 2013

News Review From Harvard Medical School -- Gulf War Illness Linked To Brain Changes
Veterans with symptoms of Gulf War Illness have more activity in part of their brains. Researchers saw the activity using functional MRI scans. They did the scans on 31 veterans, as well as 12 people without symptoms. Gulf War Illness is also called Gulf War Syndrome. As many as 30% of veterans deployed to the Persian Gulf have reported similar symptoms. They include pain, headaches, digestive problems and fatigue. The study was published March 20 in the journal PLOS ONE. USA Today wrote about it March 21.

By Robert H. Shmerling, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Imagine developing an illness that no one understands, not even your doctor.

That's the situation for thousands of soldiers who served during the Persian Gulf War in 1990 and 1991. Their illness has been called Gulf War Illness, or Gulf War Syndrome.

Symptoms include:

• Fatigue
• Widespread pain
• Headaches
• Digestive problems (such as diarrhea and indigestion)

The results of standard tests are usually normal. As a result, no one has been sure whether Gulf War Illness is due to psychological distress, a reaction to exposure to toxins (such as nerve gas) during deployment, or some other cause.

Not only is the nature of this illness frustrating, but there has been no reliably effective treatment. Considering that one-fourth of Gulf War veterans have developed these symptoms, it's a big problem.

A new study that used a special type of MRI (called functional MRI, or fMRI) could change the thinking about Gulf War Illness. Functional MRI scans provide more than standard images of the brain. They can show differences in brain function. This allows researchers to understand which parts of the brain are most important for certain tasks (such as solving a complicated math problem or writing a poem) and which portions might be impaired by a particular disease.

In this new research, 31 veterans with Gulf War Illness had a special type of fMRI brain scan called diffusion tensor imaging. The scans showed increased activity in part of the brain called the right inferior fronto-occipital fasciculus. This area is involved in pain perception, fatigue and cognitive function. These fMRI findings were not seen in a comparison group of 12 non-combat veterans and civilians.

The authors of this research suggest that the abnormalities seen on the scans of veterans with Gulf War Illness could help explain their symptoms. They also suggest that the type of fMRI used in this study could serve as a diagnostic test. For a potentially debilitating and poorly understood condition that is common among Gulf War veterans, these findings are promising.

While this news may be most important to Gulf War veterans, it also could be important to people who have similar, mysterious conditions. For example, symptoms of Gulf War Illness overlap with those of chronic fatigue syndrome and fibromyalgia.

What Changes Can I Make Now?

If you're a Gulf War veteran trying to understand why you feel unwell, this new research could provide an explanation. However, the new study does not tell us how to treat Gulf War Illness. And it doesn't tell us why the fMRI findings are abnormal.

Are the brain changes due to exposure to a vaccine, a toxin or a medication? We don't know. That means we also don't know what changes to recommend. We also still don't know how to prevent Gulf War Illness.

People with poorly understood conditions (including Gulf War Illness, chronic fatigue syndrome and fibromyalgia) should be reassured by studies like this. Additional research may someday advance our understanding so that these illnesses can be prevented or treated more effectively.

In the meantime, changes that may help include:

• Reduce your physical and emotional stress – For example, avoid over-commitment and get plenty of rest. Gradually increase exercise – Aerobic exercise, balance and strengthening programs can be helpful.
• Talk to your doctor about medicines that may help – A number of drugs may help to ease the pain of fibromyalgia, including acetaminophen, ibuprofen and muscle relaxants. A low dose of an antidepressant is standard treatment for fibromyalgia and may lessen symptoms.
• Meet with a physical therapist – He or she can help to design a stretching and exercise program that you can tolerate.
• Consult with a mental health expert – Up to 60% of people with chronic fatigue also have depression. Treatment of the depression can make a big difference.
• Find a clinical trial in your area – A clinical trial may give you access to an effective treatment that you cannot get elsewhere. Check out ClinicalTrials.gov.

None of these changes is likely to cure your condition. But until we know more, it may be the best you can do.

What Can I Expect Looking to the Future?

A small study showing that fMRIs are abnormal in veterans with Gulf War Illness does not immediately make life better for people with this condition. But, it could be a big step forward.

You are likely to hear more about research into the cause or causes of Gulf War Illness, as well as other symptoms reported by military personnel returning from combat. Current research could provide new insights on causes, prevention and treatments in the near future.