Advanced Technology Identifies "Core" Brain Abnormality in Gulf War Illness

Written by Anthony Hardie, 91outcomes.com

(91outcomes.com) - A discovery by a Minneapolis medical researcher may lead to a new test to help identify Gulf War Illness, a unique disease that affects 250,000 veterans of the 1991 Gulf War, according to official estimates, as well as other U.S. forces.

Using sophisticated brain mapping equipment and techniques called magnetoencephalography (MEG) that looks more like something from a science fiction movie, Dr.  Aposotolos Georgopolous of the Minneapolis VA Medical Center has found a unique visual signature of a “core” brain abnormality in GWI.  

According to Georgopolous, the essence of brain function is communication among neural ensembles, and neural communication is accomplished by ongoing, dynamic interactions among multiple “neuronal ensembles.”  Dr. Georgopolous has used MEG to identify unique visual signatures of the neuron ensembles for an array of other diseases.

Conclusions

Georgopolous’s MEG findings provide further evidence to a large and growing body of objective scientific evidence that shows GWI is a distinctly separate disease entity rooted in damage to, and dysfunction of the brain.  

The findings were presented before the Congressionally chartered Research Advisory Committee on Gulf War Veterans' Illnesses (RAC-GWVI) in public meetings this week in Boston, Mass.  

Georgopolous expressed the need for his current study needs to be extended to larger numbers so as to include detailed examination of subgroups with comorbidities -- other diseases and conditions that may also be simultaneously afflicting some GWI patients.  

However, his current findings remain compelling and his unique identification through highly advanced technology of a “core” brain abnormality in GWI has profound implications.  


References:

Georgopolous AP et al (2010), “The Synchronous Neural Interactions Test”

Haley Team Research Finds Further Evidence of Brain Dysfunction, Chemical Damage in Ill Gulf War Veterans

Written by Anthony Hardie, 91outcomes.com

(91outcomes.com) -  Following on the heels of a presentation of new research findings by Dr. Dane Cook showing powerful objective evidence -- functional magnetic resonance imaging (fMRI) -- of dysfunction in the brains of ill veterans of the 1991 Gulf War, one of the pioneers in the field of Gulf War Illness research presented an overview of findings yesterday that both dovetailed with, and expanded on, Cook’s team’s fMRI findings.

Findings by a large research team led by Dr. Robert Haley, MD, of the University of Texas Southwestern Medical Center, added further confirmation of brain dysfunction in regards to pain processing, cognitive and other functioning in the brains of ill Gulf War veterans.  

Using sophisticated medical research methods, including Quantitative Sensory Testing (QST) fMRI, a national survey of more than 8,000, and a week-long inpatient battery of advanced testing of nearly 100 ill Gulf War veterans, Haley’s team successfully to replicated, validated, and expanded on earlier findings that teased out the specifics of brain dysfunction in ill Gulf War veterans.

Haley’s team’s findings were presented during the first morning of two days of public meetings being held this week by the Congressionally chartered Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC-GWVI) at the Boston University Medical Center in Boston, Mass.

Early Studies

In 1996, medical research findings from a UK scientist (Jamal et al) found a two-fold increase in cooling detection threshold in ill Gulf War veterans, providing some of the first objective evidence of the physiological underpinnings of Gulf War Illness.  

Among the first research related to Gulf War veterans led by Haley was a 1998 medical research study that replicated the 1996 UK study.  This was followed by several studies that looked at possible mechanisms of sensory and pain handling in the brains of ill Gulf War veterans.  All showed objective evidence -- though sometimes difficult to interpret -- of brain dysfunction.

One Syndrome, or Three?

Haley’s definition of Gulf War Illness is unique.  Since the 1990s, he has postulated that there are subsets within Gulf War Illness, an idea that remains controversial today in the scientific community.

Haley’s three GWI subsets are:

• Syndrome 1: “Impaired Cognition,” a symptom complex characterized by inability to “remember things,” as well as profound fatigue.  
• Syndrome 2: “Confusion-Ataxia”, a symptom complex that profoundly affects the veteran’s ability to think, comprehend, or interact.  
• Syndrome 3: “Central Pain,” a symptom complex with chronic widespread pain as its central feature.

Haley said he believes Syndrome 2 and 3 are related, and perhaps different stages of the same disorder, but that he believes Syndrome 1 is something very different from the other two.

However, another of the leading GWI medical researchers argued that the symptom subsets may instead be indvidualized manifestations of the same underlying disease processes.

Pain Processing

Adding further confirmation to Cook’s team’s fMRI brain imagery related to pain processing,  Haley reported that his team saw dramatically more sensitivity (hyperactivation/hyperarousal) with noxious heat pain stimuli in fMRI of Syndrome 1 and Syndrome 2 patients than in controls.  However, the hyperactivation when exposed to noxious heat pain stimuli was inexplicably not present in fMRI of those labeled as Syndrome 3 (chronic pain).  

His team found no difference in fMRI between controls and any of his three Syndromes when exposed to innocuous warm stimulation.  However, the team’s findings in fMRI of Syndromes 1 and 2, which generally have little chronic pain, they had much less brain activation when exposed to innocuous warm stimulation than either controls or Syndrome 3, which is characterized by chronic pain.  
Haley termed the effect in Syndrome 1 and Syndrome 2 of lower than normal pain sensitivity and brain activation to innocuous warm stimulation, but significantly higher than normal pain sensitivity and brain activation to noxious heat pain stimuli, “hypoactivity-hyperarousal” -- objective evidence of brain dysfunction in pain and other processing.  

Different from Fibromyalgia

Haley’s fMRI and other findings differ from other studies of Fibromyalgia (FM) patients.  

In FM, not only does fMRI reveal increased activation in the regions of the brain associated with pain processing when exposed to to noxious heat stimuli, but also to innocuous heat stimuli.  This feeling that virtually everything is more painful than expected is known in medical terms as “allodynia”.  


Brain Chemical Explanation

Haley’s research data suggested that the autonomic dysfunction affected one type of brain chemical effect -- cholinergic -- than another -- adrenergic.  

Haley’s team’s findings found that all three Syndromes had higher scores than controls on the cholinergic symptom scales but not the adrenergic symptom scales.  

Using another advanced testing procedure, QSART, differences were greater in the feet, less in shins and thighs, a pattern that is typical in peripheral nerve involvement.   Haley said this is suggestive that small cholinergic fibers may be dysfunctioning.  

In a study led by Dr. Gail Tillman (et al, 2012), testing of auditory stimuli in fEEG protocol found abnormal functioning of the cholinergic inhibitory (filtering), or “gating of ascending sensory impulses in the RAS of the brainstem.”  

Of note, several other GWI studies have found abnormalities of cholinergic brain function, others have also found abnormalities in the brainstem of Gulf War veterans with GWI, and important theories of chronic pain involve abnormalities in “gating.”

Haley has long argued that even low-level exposure to chemicals -- including organophosphate (OP) pesticides and sarin nerve agent released at the Khamisiyah ammo dump detonations by U.S. troops in southeastern Iraq in March 1991 -- are the root cause of the brain damage and resulting disease state of ill Gulf War veterans.


Conclusions

Dr. Haley stressed the need to learn the underlying mechanisms of the disease.  He said there is hope in the scientific commmunity that as with other diseases, trial and error may lead to effective treatments.  However, he stressed the need to more precisely understand the underlying pathobiology, becuase, he said, “if we don’t stumble on a treatment, we are going to need to find one.”

He also stressed the need for a relatively quick diagnostic test to determine if veterans have GWI, or something else.  As have other medical researchers, he noted that this is important not only for benefits purposes and peace of mind, but also for treatment purposes and potentially in the future to help validate the effectiveness of treatment.


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Additional Sources:
Jamal et al 1996, finding two-fol increase in cooling detection threshold during QST in British GWI GWVs.  

1998 Haley study UT-S confirmed Jamal, then undertook several studies of possible mechanisms of sensory and pain handling.  

Haley et al 2009.  Infused physostigmine, found “abnormal brain response to cholinergic challenge in chronic encephalopathy from the 1991 Gulf War”.  

Li et al, 2008.  Hippocampal dysfunction in Gulf War veterans: investigation with ASL perfusion MRI and physostigmine challenge.

Tillman G et al, 2012. Auditory stimuli in fEEG protocol.  

New UW Research Provides Images of Brain Dysfunction in ill Gulf War Veterans

Written by Anthony Hardie, 91outcomes.com

(91outcomes.com) - Cutting edge research from the University of Wisconsin-Madison is providing new pictorial evidence of marked brain dysregulation in Gulf War veterans suffering from chronic widespread musculoskeletal pain (CMP), one of the most commonly reported symptoms of Gulf War Illness.  

According to lead researcher Dr. Dane Cook of the University of Wisconsin-Madison and the Madison VA Hospital, his research team’s findings also suggest potential avenues for treatment aimed at “resettting” the dysregulated functioning in the brains of ill Gulf War veterans.

Cook’s team’s findings, including powerful images of important brain functional differences, were presented at the opening of public meetings being held this week by the Congressionally chartered Research Advisory Committee on Gulf War Veterans’ Illnesses (RAC-GWVI) at the Boston University Medical Center in Boston, Mass.

In addition to new preliminary findings, Cook presented excerpts of his team’s past research and related research on fibromyalgia (a disease characterized by chronic widespread pain).  Much of Cook’s team’s work has focused on functional Magnetic Resonance Imaging (fMRI) of the brains of Gulf War veterans, including before and after exercise, and during application of painful stimuli.    

Cook says his data show the functioning of the brains of his principal study subjects -- Gulf War veterans who have chronic musculoskeletal pain (CMP) -- differ in important ways from healthy study subjects.  For the purposes of the studies, “Chronic” was defined as long-term, with pain unrelenting for at least six months or longer; most of the study subjects have been experiencing pain for many years.  The pain must also have been widespread, affecting at least three of four body quadrants, so as to rule out a localized injury where pain only affects one part of the body.  

The research results show that Gulf War veterans with CMP are significantly more sensitive to heat pain than healthy Gulf War veteran controls, and fMRI images provide objective confirmation of this.  And, this hypersensitivity to heat pain is magnified following exercise in the Gulf War veterans with CMP, in some cases as much as tripling.  For the healthy Gulf War veterans, sensitivity to heat pain did not change relative to before and after exercise.

Cook said the research findings, including detailed fMRI pictures are, “suggestive of less white matter integrity [density] in the brain,” meaning the brain is not functioning normally in the ill veterans.  

Cook’s research also looked at fatigue in his Gulf War veteran subjects, another major Gulf War Illness symptom.  He said his team’s findings show that the greater the feelings of fatigue in the ill patients, the less the white matter integrity [density]  in brain regions known to be central to pain processing.   In general, Gulf War veterans with CMP show decreased brain white matter integrity (density; “lower FA and higher MD”) in several regions of the brain associated with fatigue and pain processing.  Cook said these objective brain imaging and correlated findings are suggestive of altered communication along spinal tracts that are involved in pain processing and pain modulation.  

Dr. Cook’s team has also been working to examine similarities and differences between fibromyalgia patients and Gulf War veterans with CMP.  In a 2012 study (Shields et al), FM patients’ brains were found to be unable to communicate between brain regions to properly regulate pain.  FM patients were found to be more sensitive to all types of pain, and their brains less able to regulate pain properly.  Interestingly, Dr. Cook’s research has shown Gulf War veterans with CMP show excessive pain sensitivity to one type of painful stimuli -- heat pain -- but not to another, pressure pain.  According to Dr. Cook, the body of fibromyalgia research shows fibromyalgia (FM) patients have hypersensitivity to both heat pain and pressure pain, an important difference between the two groups. ''


And, his team’s research hopes to show whether Gulf War veterans are similar to fibromyalgia patients in another area, too. Research shows that FM patients who are more sedentary -- those who sit for at least 60 minutes at a time during their daily lives, as measured during extended testing -- exhibited more pain processing dysregulation in the brain.  Whether this sedentary behavior is a symptom or -- or is part of the cause of FM's worsened pain symptoms -- remains unclear.  However, Cook expressed hope that additional research related to exercise therapies should help resolve this question.  

Cook suggested that areas for future treatment exploration might include, “anything that might help reset a dysregulated [pain regulation] system” in the brain and central nervous system, including brain stimulation methods.

Corrections to Factually Incorrect Law Firm Article about GWI Funding

Written by Anthony Hardie, 91outcomes


(91outcomes.com) -- A Florida-based law firm aimed at helping veterans has gotten an article about the federal government's Gulf War Illness medical research funding completely wrong, leading to confusion among many Gulf War veterans.

Here's the response back to them, which corrects the many errors:

This is regarding your recent article about Gulf War Illness funding, which is riddled with factual inaccuracies, some of which are 180 degrees opposite of what actually happened.

I understand your firm -- like several others that work to help veterans with their claims -- is providing this kind of news as a service. However, this level of factual inaccuracy begs the question, Is this an indication of the level of service your firm provides to veterans?

First, the Barrow amendment -- and Rep. Barrow himself -- never mentioned or addressed anything related to Gulf War Illness or Gulf War veterans.  The Barrow amendment was merely a proposed (failed by the vote noted in the article) funding increase to the VA's overall research budget to match the *overall VA research* funding levels requested in the VSOs' Independent Budget.   

Contrary to what your article says, the VSOs did not recommend a specific dollar amount for GWI funding (for GWI CDMRP funding in the DoD appropriations bill), and their mention in the context of GWI funding is incorrect and entirely false.  

The amount passed by the House matches the VA's FY13 overall research budget request, which decreases funding for GWI research from $15m to $4.862m.   However, neither Rep. Barrow nor the House specifically mention GWI research (or any other type of research) in their funding, with the exceptions noted below.

The numbers you have included in this article, about some increase from $10m to $25m, are entirely unrelated to the VA budget, the VA-HUD appropriations act passed by the House, or the Barrow Amendment to FY13 VA-HUD.   The House Appropriations Committee previously passed out of committee the FY13 Defense Appropriations Act, which contained $10m in GWI medical research funding under the Congressionally Directed Medical Research Program (CDMRP).  Gulf War veterans' goal is $25m.  The full House has not yet taken action on that bill, which is under a veto threat from the White House.  Your article confuses VA research funding with DoD GWI CDMRP research funding; the two are entirely separate, distinct, and unrelated.

Furthermore, the bill's accompanying report *DID* include the direction to VA to prioritize FGID research, and burn pits.  These were not part of the failed Barrow amendment.  So, your article has it 180 degrees backwards, these measures *passed*, not failed as your article states.

Finally, the funding addressed by VA-HUD and the Barrow Amendment is FY13, not "2012".  

It is rare that I see a short article with so many completely false statements and getting it completely wrong.  I understand you're trying to help veterans, so I ask you all the more urgently, please, get your facts straight.  I've been busy correcting Gulf War veterans who saw your article and believed it.  You do a great disservice to veterans when you write patently false news like this.  

If you have any questions or wish to discuss, please feel free to contact me.  I'm one of the people who remain closely engaged in GWI advocacy issues on the Hill.  As such, I'm happy to help you get your facts straight before putting something awful and damaging and completely factually inaccurate like your article above.  

Thank you.

Anthony Hardie

Madison, Wis.

Gulf War, Other Younger Veterans Have Three Times Greater Urinary Incontinence

Written by Anthony Hardie, 91outcomes.com


(91outcomes.com) - A new medical journal article reports that Gulf War and other veterans age 55 and younger are almost three times more likely to report urinary incontinence than their civilian counterparts.

According to the article by Michele Sullivan, reported in Clinical Psychiatry News:

[Urinary] Urgency was the most common problem, reported by 15% of veterans and 8% of civilians. The rates of stress and mixed incontinence were 4% and 2%, respectively.

Moderate to severe symptoms also were more common among the veterans (19% vs. 3%), whereas 1% of each group reported severe incontinence.

However, Dr. Markland said, when the group was broken down by age, the youngest group was driving the difference. Men aged 55 years and younger were three times more likely to report any urinary incontinence than were the nonmilitary population. The difference remained significant even after investigators controlled for ethnicity, socioeconomic level, body mass index, diabetes, and heart disease.

Dr. Markland is an internal medicine doctor at the Birmingham, Ala. VA Medical Center.   She says that, "there’s no way to tease out any cause and effect information."  

House GOP Pursues Contempt of Congress Charges Related to Document Release

This article is from MSNBC First Read, http://firstread.msnbc.msn.com/_news/2012/06/11/12167268-house-gopers-to-pursue-contempt-of-congress-against-holder?lite 

Contempt of Congress can involve refusal to cooperate with a subpoena issued by a Congressional committee, including providing testimony or requested documents.


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House GOPers to pursue contempt of Congress against Holder

By NBC's Frank Thorp and Mark Murray

According to an aide at the House Oversight and Government Reform Committee, the committee will proceed with a motion on June 20 to hold Attorney General Eric Holder in contempt of Congress in relation to the investigation into the so-called "Fast and Furious" gun-running operation.

Charles Dharapak / AP

Attorney General Eric Holder testifies on Capitol Hill, Thursday, June 7, 2012, before the House Judiciary Committee oversight hearing on the Justice Department.

The motion will have to pass through committee before it sees a full vote in the House.

The AP reports that House Republicans are pursuing this motion against Holder "for failing to produce some documents the panel is seeking.... To date, the the Justice Department has produced 7,600 pages of documents to the committee."

More from the AP:

Rep. Darrell Issa, chairman of the House Oversight and Government Reform Committee, says Congress needs to examine records regarding the Justice Department's conduct following public disclosures in early 2011 that hundreds of guns illicitly purchased at gun shops on the U.S. side of the border wound up in Mexico, many of them at crime scenes.

The Justice Department says many of the documents deal with open criminal investigations and prosecutions -- matters relating to sensitive law enforcement activities that cannot be disclosed.

If found in contempt of Congress, punishments can range from jail time, to fines, to probation, but it typically does not get that far.Contempt of Congress is used when the House or Senate wants to punish a recalcitrant witness for not complying with an investigation and, by doing so, is done to deter others from similar conduct.

If the committee passes this motion to proceed June 20, it is then sent to the full House of Representatives for a vote. If it passes through the full House, it then is referred to the U.S. Attorney.

Two recent contempt of Congress considerations:

2008: Democrats on the House Judiciary Committee found White House counsel Harriet Miers and Chief of Staff John Bolton in contempt for not cooperating with an investigation into possible political motivation in the handling of federal prosecutors by the Bush adminstration. The full House passed the measure, but most Republicans (including Boehner and Issa) boycotted the vote.

1998: Janet Reno was found in contempt of Congress by Republicans on the House Oversight and Government Affairs Committee for not complying with a subpoena regarding possible campaign-finance law violations. The full House never voted on the measure after the documents they had requested were turned over.

Bill Introduced to Create National Desert Storm War Memorial

The legislation to create the National Desert Storm War Memorial is authored by Rep. Phil Roe, M.D. (R-Tenn.). This article is from http://wap.myfoxhouston.com/w/news-top/story/63583667/ Long overdue memorial for Gulf War veterans Jun 8, 2012 10:17 p.m. It has been more than 21 years since the end of the first Gulf War. And some say it is long overdue for a permanent landmark in our nation's capital. That effort took a big step forward on Thursday with the filing of a bill in the US Congress to commemorate Americans who served and died back in 1991. "It's HR 5914, which is going to create a national Desert Storm/Desert Shield war memorial in Washington D.C.," said Scott Stump, the president of the National Desert Storm War Memorial Association. Today, we remember Desert Storm as a 100-hour ground conflict with minimal casualties. That's if we remember it, at all. But at the time, there were real fears Saddam Hussein's Republican Guard would put up a fierce fight, perhaps with chemical weaponry. "There were thousands upon thousands of body bags up at Dover Air Force Base waiting to be filled," recalled Stump, who logged 5 months in a Marine Corps infantry unit during the conflict. "Everybody was on high alert. We were really expecting the worst case scenario, or we were prepared for the worst case scenario." It was a scenario that never materialized. With the US in the lead, the Coalition victory was quick and decisive. "Fortunately, not many were killed," said Rice University political science professor Ric Stoll. "But some people made the ultimate sacrifice for the United States and I think it's perfectly appropriate that we should commemorate that." In Stoll's opinion, Coalition casualties should not be the sole metric in assessing the first Gulf War and whether it is deserving of a permanent memorial. After all, there were lingering costs. "Gulf War Syndrome," for example, affected more than 30 percent of the almost 700,000 US troops, to varying degrees. "A lot of people were hurt by that war," explained Stoll, "even if they weren't wounded in battle, even if they weren't killed." And don't forget, says Stump: Desert Storm helped wipe away America's lingering military insecurities, after Vietnam. "Something (is) needed...in Washington as a lasting reminder of what was accomplished way back when," he said. FOX 26 News was unsuccessful in getting reaction on Friday from former President George H.W. Bush, who prosecuted the first Gulf War. But Scott Stump believes the bill establishing a Desert Storm war memorial should be an easy sell in Congress, since it would be funded entirely by donations and not tax dollars. For more information on the National Desert Storm War Memorial Association, click here: http://www.nationaldesertstormwarmemorial.org/

House Passes VA Budget with two-thirds GWI research cut intact but Urges VA to Prioritize Gulf War Syndrome Gastrointestinal Disorders, Burn Pits Research

Written by Anthony Hardie, 91outcomes.com

(91outcomes.com) - The Republican controlled U.S. House of Representatives yesterday passed a VA appropriations bill by a vote of 407-12 that mirrors the Administration's $582,674,000 request for prosthetics and other medical research.

The funding falls far short of the $611 million recommended in The Independent Budget by AMVETS, Disabled American Veterans (DAV), Paralyzed Veterans of America (PVA), and the Veterans of Foreign Wars (VFW), four of the nation's largest and most influential veterans service organizations.  Along with nearly 60 other veterans, health, and other advocacy organizations, the four make annual recommendations independent of VA, as their budget document's title implies, usually at amounts substantially larger than what VA requests.  

Several of the veterans service organizations have sharply criticized the Administration's low-balled research budget.  An amendment proposed by Rep. John Barrow (D-Ga.) that would have increased the medical research funding by the amount recommended in The Independent Budget, $28.3 million, failed along party lines by a vote of 188-230.

Of potential impact on the one-third of veterans of the 1991 Gulf War afflicted by Gulf War Illness, a debilitating, chronic multi-symptom illness, a House Appropriations Committee report accompanying the bill specifically urged VA to to prioritize research on functional gastrointestinal disorders (FGIDs) and Gulf War syndrome.

Gastrointestinal disorders and Gulf War syndrome- The Institute of Medicine (IOM) identified a link between Gulf War service and the development of functional gastrointestinal disorders in its 2010 report on Gulf War service and health. These disorders can be painful and debilitating for veterans, and the Committee urges VA to prioritize this important research area. (1)

However, neither the Committee nor the full House added funding to the VA's Gulf War Illness research budget, which was quietly recommended for a two-thirds cut by VA officials.  The House bill appears to have retained the unprecedented cut.

The House had strong words for the VA regarding the respiratory effects of exposure to burn pits, which are quickly becoming another signature injury for veterans of the wars in Iraq and Afghanistan and an area long left under-researched by VA for earlier eras of veterans.  

Respiratory exposures/burn pits.—There is a reported increase in
respiratory conditions such as atypical pneumonias, asthma and
bronchiolitis among military personnel who were exposed to burn
pits, increased particulate matter and other potential hazards
while serving in Iraq, Kuwait, and Afghanistan. The Committee
notes the research recommendations in the IOM report entitled
‘‘Long-Term Health Consequences of Exposure to Burn Pits in Iraq
and Afghanistan’’ and encourages the Department to allocate the
resources needed to address the key research questions identified
by the IOM report. (1)

The FY13 Defense appropriations bill remains stalled in the House.  The House Appropriations Committee included $10 million in funding for the treatment focused, peer reviewed Gulf War Illness Congressionally Directed Medical Research Program.  

While the recommended funding was the same as the previous year, Gulf War veteran advocates have sought an increase to $25 million to pay for three cutting edge, interdisciplinary, inter-institutional consortia developed with earlier funding and to offset the two-thirds cut to the VA's GWI medical research budget.  

Earlier this year, nearly 60 Democratic members of the House joined perennial lead author Rep. Dennis Kucinich (D-Oh.) in calling for the funding to be increased to $25 million. Six Republican members, including House Veterans' Affairs Committee Chair Rep. Jeff Miller (R-Fla.) joined Rep. Phil Roe (R-Tenn.) in calling for the program to be continued at "adequate" levels.  

It remains to be seen whether a House champion can be found to lead an amendment to the House bill that would add the much needed GWI medical research funds.

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(1) H. Rpt. 112-491, p. 43. http://www.gpo.gov/fdsys/pkg/CRPT-112hrpt491/pdf/CRPT-112hrpt491.pdf