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SPECIAL BRAIN SCAN SUGGESTS EXISTENCE OF GULF WAR SYNDROME

CHICAGO -- Special magnetic resonance (MR) scans of soldiers who believe they suffer from Gulf War Syndrome for the first time indicate that their brains were, indeed, damaged by chemicals they were exposed to during the war, suggests new research being presented here today at the 85th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

In a University of Texas Southwestern Medical Center at Dallas study, veterans who complained of symptoms of Gulf War Syndrome were found on Magnetic Resonance Spectroscopy (MRS) to have up to 25 percent lower levels of a certain brain chemical than healthy subjects. Lower-than-normal levels of the chemical NAA (N-Acetyl-Aspartate) detected in the brain stem and basal ganglia suggest a loss of neurons in those areas. The brain stem controls some of the body's reflexes, and the basal ganglia is the brain's switching station for movement, memory and emotion.

"Some of these patients are profoundly disabled -- there are stories of some real heroes who now barely are able to drive to the store," said James L. Fleckenstein, M.D., professor of radiology, University of Texas Southwestern Medical Center at Dallas. "Although the existence of Gulf War Syndrome is considered controversial, this is evidence supporting a physical mechanism for the problem. The findings suggest a substantial loss of brain cells in the areas that could explain the veterans' symptoms. The brain damage can be detected using a widely available technology, although the findings may be subtle and analysis of the data can be difficult."

As many as 100,000 of the 700,000 soldiers who served during Operation Desert Storm and Desert Shield and the Persian Gulf War in 1990 and 1991 complain of suffering from Gulf War Syndrome, which they attribute to being exposed to chemicals during the war, which was provoked by the Iraqi invasion of neighboring Kuwait. The symptoms include memory loss, balance disturbances, sleep disorders, depression, exhaustion, body pain, chronic diarrhea and concentration problems. Although the existence of Gulf War Syndrome still is debated, growing research, including a recent Pentagon-released report, suggests its validity.

Findings in 22 Gulf War veterans who complained of illness suggest they had lower levels of NAA in their brains, ranging from 10 percent to 25 percent below levels detected in 18 healthy veterans. This result was highly statistically significant and was repeated in a second sample of 6 Gulf War veterans. The study was blinded, meaning radiologists interpreting the results did not know which patients were complaining of symptoms and which ones were the healthy subjects.

Only recently used as a routine diagnostic tool, MRS measures chemicals in brain cells and can provide more detail in some cases than standard magnetic resonance imaging (MRI). Rather than a picture image, MRS gives a readout that looks like an EKG or EEG, although it measures brain chemicals, not electrical output. It is used to detect chemical changes in people with certain illnesses, such as early Alzheimer's Disease, which may not be apparent on MRI. It may soon be used more frequently to measure toxic insults to the brain, such as those believed associated with Gulf War Syndrome. MRS is available at academic medical facilities around the world.

This radiological study was undertaken to test the neurotoxicity theory of Gulf War Syndrome advanced in research published in 1997 by the UT Southwestern team led by Robert W. Haley, M.D., an associate professor of internal medicine and chief of epidemiology at UT Southwestern.

"In earlier phases of our research, we identified three primary syndromes in ill Gulf War veterans," Dr. Haley said. "Each syndrome has a slightly different pattern of brain impairment implicating different combinations of neurotoxic chemicals, including chemical nerve gas, side effects from the anti-nerve gas tablets, DEET in insect repellants and pesticides in flea collars."

The group's most recent discovery pointed to a genetic predisposition for the brain injury. Compared with well veterans, the sick veterans were born with a low blood level of the enzyme that breaks down the chemical nerve gas sarin. The implicated chemicals are known to affect the deep structures of the brain, such as the basal ganglia and the brain stem.

"On the basis of those results and the veterans' symptoms, we predicted that MR Spectroscopy would show a loss of brain cells in these areas," Dr. Haley said. "This finding validates our earlier work."

The study was supported by funding from the U.S. Department of Defense and the Perot Foundation of Dallas.

In addition to Dr. Haley, co-authors of a paper on the topic being presented at RSNA by Dr. Fleckenstein are: Frederick J. Bonte, M.D.; Michael D. Devous, Ph.D.; W. Wesley Marshall, M.D.; George G. McDonald, Ph.D.; and Frederick Petty, Ph.D, M.D.

The RSNA is an association of 31,000 radiologists and physicists in medicine dedicated to education and research in the science of radiology. The Society's headquarters are located at 820 Jorie Blvd., Oak Brook, Illinois 60523-2251.

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Note: Copies of 1999 RSNA news releases are available online at http://www.pcipr.com/rsna beginning Monday, Nov. 29.