Brainstem atrophy in Gulf War Illness

Zhang, Yu; Avery, Timothy J.; Vakhtin, Andrei A.; Mathersul, Danielle; Tranvinh, Eric; Wintermark, Max; Massaband, Payam; Ashford, J. Wesson; Bayley, Peter J.; Furst, Ansgar J.

doi:10.1016/j.neuro.2020.02.006

Cited by 28 publications

(20 citation statements)

References 50 publications

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“…Multiple studies, using multivariable assessment methods, were also consistent in characterizing the most prominent GWI risk factors from among numerous stressors and potentially hazardous exposures that Gulf War troops encountered in theater [ 12 , 13 , 14 , 15 , 16 , 17 ]. In addition, clinical studies conducted in Gulf War veteran populations identified a series of neurological, immune and other pathobiological alterations that significantly distinguished GWI cases from healthy controls [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. In parallel, studies using animal models to simulate the exposure experiences of Gulf War military personnel identified chronic and/or delayed neurological, inflammatory, and behavioral changes that were consistent with veterans’ chronic symptoms [ 26 , 27 , 28 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Brain–Immune Interactions as the Basis of Gulf War Illness: Clinical Assessment and Deployment Profile of 1990–1991 Gulf War Veterans in the Gulf War Illness Consortium (GWIC) Multisite Case-Control Study

et al. 2021

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The Boston University-based Gulf War Illness Consortium (GWIC) is a multidisciplinary initiative developed to provide detailed understanding of brain and immune alterations that underlie Gulf War illness (GWI), the persistent multisymptom disorder associated with military service in the 1990–1991 Gulf War. The core GWIC case-control clinical study conducted in-depth brain and immune evaluation of 269 Gulf War veterans (223 GWI cases, 46 controls) at three U.S. sites that included clinical assessments, brain imaging, neuropsychological testing, and analyses of a broad range of immune and immunogenetic parameters. GWI cases were similar to controls on most demographic, military, and deployment characteristics although on average were two years younger, with a higher proportion of enlisted personnel vs. officers. Results of physical evaluation and routine clinical lab tests were largely normal, with few differences between GWI cases and healthy controls. However, veterans with GWI scored significantly worse than controls on standardized assessments of general health, pain, fatigue, and sleep quality and had higher rates of diagnosed conditions that included hypertension, respiratory and sinus conditions, gastrointestinal conditions, and current or lifetime depression and post-traumatic stress disorder. Among multiple deployment experiences/exposures reported by veterans, multivariable logistic regression identified just two significant GWI risk factors: extended use of skin pesticides in theater (adjusted OR = 3.25, p = 0.005) and experiencing mild traumatic brain injury during deployment (OR = 7.39, p = 0.009). Gulf War experiences associated with intense stress or trauma (e.g., participation in ground combat) were not associated with GWI. Data and samples from the GWIC project are now stored in a repository for use by GWI researchers. Future reports will present detailed findings on brain structure and function, immune function, and association of neuroimmune measures with characteristics of GWI and Gulf War service.

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Section: Introductionmentioning

confidence: 99%

Brain–Immune Interactions as the Basis of Gulf War Illness: Clinical Assessment and Deployment Profile of 1990–1991 Gulf War Veterans in the Gulf War Illness Consortium (GWIC) Multisite Case-Control Study

et al. 2021

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“…The management of chronic pain in veterans often requires a multidisciplinary approach that includes collaboration between various types of providers (pain, anesthesia, psychiatry, and rehabilitation), patient, and caregiver. Left untreated, such pain is debilitating, resulting in pathological anatomical and functional alterations in the brain, which can have long-term physical and psychological consequences (Zhang et al, 2020;Wang et al, 2021).…”

Section: Chronic Pain In Veteransmentioning

confidence: 99%

Immersive Virtual Reality: A Safe, Scalable, Non-opioid Analgesic for Military and Veteran Patients

Peterson¹,

Hitching

Howard

et al. 2021

Front. Virtual Real.

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In Iraq and Afghanistan over 75% of the combat casualties suffered by U.S. troops have involved explosive devices. Improvements in body armor and advances in military medicine have significantly reduced the number of combat-related fatalities, but have greatly increased the number of U.S. active component personnel suffering painful trauma injuries. Unfortunately, so far, advances in pharmacologic analgesia pain medications have not kept pace with advances in survivability. For many active component personnel and Veterans, pain is a top health complaint from patients. The opioid epidemic has increased the urgency of developing powerful non-pharmacologic approaches for the management of pain. Immersive VR is proving to be a powerful non-opioid pain management technique for acute pain. However, the cost and usability limitations of pre-2016 VR clinical products resulted in limited treatment adoption rates for clinical use. In recent years, VR technology has become increasingly immersive, portable, and miniaturized, requiring minimal technical expertise to operate, and low-cost, factors that are likely contributing to the recent increase in the clinical use of VR analgesia. VR is greatly benefitting from a growing string of major technological breakthroughs and VR treatment improvements that will likely continue to increase the effectiveness and suitability of VR analgesia for military and VA patients. Regarding acute pain, we propose that the next revision to the current Tactical Combat Casualty Care guidelines consider including VR as an effective and hemodynamically safe approach to the current management of acute trauma pain in military personnel during medical procedures. With recent miniaturization and ruggedization, VR can potentially be used closer to the battlefield in the future. Beyond distraction, innovative VR therapy techniques designed to help reduce chronic pain are discussed. Recent breakthroughs in the mass production of inexpensive, highly immersive lightweight stand alone VR systems and augmented reality systems increase the potential for widespread dissemination of VR analgesia for acute and potentially for chronic pain. For example, the U.S. military recently purchased 22 billion dollar’s worth of Microsoft Hololens mixed reality systems (e.g., for training). Expanded research and development of VR analgesia customized for the unique needs of military and VA patients is recommended.

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“…Numerous brain abnormalities have been associated with GWI [3][4][5][6][7][8][9] . For instance, several recent studies have documented brain atrophy in veterans with GWI [7][8][9][10][11] . In addition, brain functional anomalies in veterans with GWI have been shown to be indistinguishable from those of known autoimmune disorders 6 , supporting theories that GWI may, in part, be related to autoimmunity [12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Association of Lupus Anticoagulant with Brain Atrophy in Gulf War Illness (GWI)

James¹,

Christova²,

Johnson³

et al. 2021

J Immunol Sci

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Separate lines of research have documented brain atrophy and evidence of autoimmune mechanisms in Gulf War Illness (GWI), including the presence of lupus anticoagulant (LAC), in veterans with GWI. Here we evaluated the possible association of LAC and brain volume in veterans with GWI. The presence of LAC was determined using Silica Clotting Time and dilute Russell’s Viper Venom Time assays. MRI data was acquired using a Philips 3T MR scanner from which total gray matter, total cortical gray matter, total subcortical gray matter, and total cerebral white matter were derived. The results demonstrated a statistically significant reduction of brain volume in all regions tested in GWI veterans with positive LAC, as compared to those without LAC. These findings add to the literature implicating autoimmune mechanisms in GWI and point to the presence of prothrombotic antiphospholipid antibodies as contributing to brain atrophy in GWI.

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Brainstem atrophy in Gulf War Illness

Cited by 28 publications

References 50 publications

Brain–Immune Interactions as the Basis of Gulf War Illness: Clinical Assessment and Deployment Profile of 1990–1991 Gulf War Veterans in the Gulf War Illness Consortium (GWIC) Multisite Case-Control Study

Brain–Immune Interactions as the Basis of Gulf War Illness: Clinical Assessment and Deployment Profile of 1990–1991 Gulf War Veterans in the Gulf War Illness Consortium (GWIC) Multisite Case-Control Study

Immersive Virtual Reality: A Safe, Scalable, Non-opioid Analgesic for Military and Veteran Patients

Association of Lupus Anticoagulant with Brain Atrophy in Gulf War Illness (GWI)

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