Research Uncovers Damage to Nerves in Gulf War Vets

By: MARILYNN MARCHIONE of the Journal Sentinel staff [MILWAUKEE JOURNAL, December 1,1999]

Research uncovers damage to nerves in Gulf War vets Scientists say study proves symptoms are physical problems, not psychological :By Marilynn Marchione of the Journal Sentinel staff. Brain scans for the first time have documented nerve damage in veterans exposed to chemicals during the Persian Gulf War, proving that the disease is real and no longer should be considered an unexplained or unconfirmed syndrome, researchers reported Tuesday. 

"This is the first evidence of brain damage in Gulf War vets," said lead researcher James Fleckenstein of Dallas. "The patients are validated. They're not crazy, they're not depressed. It's not stress. They have a disease. For the sickest patients, there is very clear evidence of a marked loss of brain cells." Fleckenstein, a radiologist at University of Texas Southwestern Medical Center, presented the study at a meeting of the Radiological Society of North America, a conference of 60,000 radiology experts from all over the world. The study received some funding from the U.S. Department of Defense and the Perot Foundation of Dallas. He and colleagues used a variation of magnetic resonance imaging to show that levels of a specific brain chemical were 10% to 25% lower in soldiers complaining of Gulf War syndrome symptoms than in healthy veterans. That indicates a loss of neurons, or nerve cells. "We think the evidence is overwhelming (that) this is a chemical injury," said Fleckenstein's colleague, Robert Haley, an epidemiologist at the University of Texas who has been one of the nation's leading researchers on Gulf War veterans. 

As many as 100,000 of the 700,000 soldiers who served in Operations Desert Storm and Desert Shield and the Persian Gulf War in 1990 and 1991 after Iraq invaded Kuwait have complained of vaguely defined and widely varying symptoms that have come to be called Gulf War syndrome. Some researchers, government officials and military leaders have expressed doubt that the syndrome is real or that chemical exposure is to blame for the soldiers' symptoms, rather than post-traumatic stress disorder or other psychological problems. But having evidence of damage to veterans' brains means it's now time to drop the "syndrome" and move to an era "when Gulf War disease can be diagnosed and, hopefully, effectively treated," Fleckenstein said. The researchers used a technique akin to MRI called magnetic resonance spectroscopy, or MRS. An MRI produces images based on the body's large water content. In MRS, the water is dropped as an imaging element, so that levels of chemicals can be seen. The result is something that resembles an EKG or an EEG, but with specific brain chemicals representing the peaks and valleys. These scans were on an area of the brain stem and the basal ganglia, areas that control reflexes, movement, memory and emotion. Study subjects were 22 ill soldiers from Dallas and another Western state, and 18 healthy Gulf War veterans.

To ensure scientific validity, radiologists who interpreted test results did not know whether a test involved a soldier complaining of symptoms or a healthy "control" subject. The ill soldiers had consistently lower than normal levels of the chemical N-acetyl-aspartate, or NAA -- a substance produced by healthy neurons. Lower levels means fewer nerve cells are functioning, but it's unclear whether those cells are "dead," the researchers said. If they are still intact, it may be possible to develop a drug to spur production of NAA in the brain that might restore neural function, they said.
 
The brain scan evidence also goes against the theory that depression is behind the soldiers' symptoms, Fleckenstein said. The scans showed no signs of the chemical "footprints" of depression. Evidence of Gulf War disease has been building. Last month, a Pentagon-commissioned report concluded that use of the drug pyridostigmine bromide, or PB, by 250,000 soldiers "cannot be ruled out" as a cause of lingering illnesses in some veterans. The drug was administered to protect against a type of nerve gas. 
In January, a study of more than 8,000 British troops found that Persian Gulf War veterans had a rate of general ill health at least twice as high as forces sent to Bosnia or those who stayed home. 

Haley and others at the University of Texas published a study in JAMA, the Journal of the American Medical Association, in January 1997 that described three distinct clusters of symptoms related to exposures to specific chemicals: The "impaired cognition" syndrome. Symptoms included memory lapses, depression, insomnia, fatigue, slurred speech, confusion and migraine-like headaches. Veterans who wore flea collars to ward off desert bugs were in this group. 

A "confused/dizzy" syndrome. Symptoms included disorientation, dizziness, balance problems, impaired thinking and reasoning, and impotence. The group included veterans who took the drug PB and those exposed to Iraqi chemical weapons. The MRS scans showed the most brain impairment in this group, Fleckenstein said. A joint-muscle pain syndrome. Symptoms included pain, muscle weakness and tingling limbs. Veterans exposed to the pesticide DEET and the PB pills were in this group.