Brainstem Atrophy in Gulf War Illness, 2020, Zhang et al

Andy

Andy

Retired committee member
Highlights
• The multiple chronic symptoms developed after 1990-1991 Gulf War, which is known as GWI, has no validated definition or validated diagnostic marker.
• Existing neuroimaging studies have been limited by small sample sizes, inconsistent GWI definition.
• Using automated brain MRI volumetric measurement in a large GWI cohort, this study identified subcortical atrophy in GWI.
• More importantly, this study detected a greatest brainstem abnormality in GWI veterans. This finding will promote further investigations of GWI into the brainstem substructure.
• A novel observation of brainstem volume in correlation with fatigue, memory loss, depression and breath difficulties in GWI demonstrated that the brainstem is a key structure that related to the GWI core symptoms.

Abstract
Background
Gulf War illness (GWI) is a condition that affects about 30% of veterans who served in the 1990-91 Persian Gulf War. Given its broad symptomatic manifestation, including chronic pain, fatigue, neurological, gastrointestinal, respiratory, and skin problems, it is of interest to examine whether GWI is associated with changes in the brain. Existing neuroimaging studies, however, have been limited by small sample sizes, inconsistent GWI diagnosis criteria, and potential comorbidity confounds.

Objectives
Using a large cohort of US veterans with GWI, we assessed regional brain volumes for their associations with GWI, and quantified the relationships between any regional volumetric changes and GWI symptoms.

Methods
Structural magnetic resonance imaging (MRI) scans from 111 veterans with GWI (Age = 49 ± 6, 88% Male) and 59 healthy controls (age = 51 ± 9, 78% male) were collected at the California War Related Illness and Injury Study Center (WRIISC-CA) and from a multicenter study of the Parkinson’s Progression Marker Initiative (PPMI), respectively. Individual MRI volumes were segmented and parcellated using FreeSurfer. Regional volumes of 19 subcortical, 68 cortical, and 3 brainstem structures were evaluated in the GWI cohort relative to healthy controls. The relationships between regional volumes and GWI symptoms were also assessed.

Results
We found significant subcortical atrophy, but no cortical differences, in the GWI group relative to controls, with the largest effect detected in the brainstem, followed by the ventral diencephalon and the thalamus. In a subsample of 58 veterans with GWI who completed the Chronic Fatigue Scale (CFS) inventory of Centers for Disease Control and Prevention (CDC), smaller brainstem volumes were significantly correlated with increased severities of fatigue and depressive symptoms.

Conclusion
The findings suggest that brainstem volume may be selectively affected by GWI, and that the resulting atrophy could in turn mediate or moderate GWI-related symptoms such as fatigue and depression. Consequently, the brain stem should be carefully considered in future research focusing on GWI pathology.
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Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0161813X20300280
Sci hub, https://sci-hub.tw/10.1016/j.neuro.2020.02.006
 
Really important. I’ve no idea if similar has been done in CFS yet but I am constantly experiencing a feeling of having a sickly, neurological “hole” top of neck , base of head where it feels certainly symptoms like touch sensitivity come from. It feels as impactful and as serious as a real hole in the body would.
Obviously the question is what can be done about atrophy? Nothing?
 
Years ago there were studies done that found abnormalities in the brainstem in people with ME.

A healthy functioning brainstem is important for homeostasis from google

"The brain stem consists of a group of structures that lie deep within the brain, including the pons, medulla oblongata, and midbrain. It plays an important role in maintaining homeostasis by controlling autonomic functions such as breathing, heart rate, and blood pressure."

I suspect that POTS and dysautonomia in ME is caused by problems in the brainstem and hypothalamus so may not be the same as that in the otherwise healthy population.

Particularly important because it means that sedentary behaviour may be caused by dysautonomia rather than the other way round.
 
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