Abstract
BackgroundGulf War exposures in 1990 and 1991 have caused 25% to 30% of deployed personnel to develop a syndrome of chronic fatigue, pain, hyperalgesia, cognitive and affective dysfunction.MethodsGulf War veterans (n = 31) and sedentary veteran and civilian controls (n = 20) completed fMRI scans for diffusion tensor imaging. A combination of dolorimetry, subjective reports of pain and fatigue were correlated to white matter diffusivity properties to identify tracts associated with symptom constructs.ResultsGulf War Illness subjects had significantly correlated fatigue, pain, hyperalgesia, and increased axial diffusivity in the right inferior fronto-occipital fasciculus. ROC generated thresholds and subsequent binary regression analysis predicted CMI classification based upon axial diffusivity in the right inferior fronto-occipital fasciculus. These correlates were absent for controls in dichotomous regression analysis.ConclusionThe right inferior fronto-occipital fasciculus may be a potential biomarker for Gulf War Illness. This tract links cortical regions involved in fatigue, pain, emotional and reward processing, and the right ventral attention network in cognition. The axonal neuropathological mechanism(s) explaining increased axial diffusivity may account for the most prominent symptoms of Gulf War Illness.
Highlights
Over 25% of the 697,000 veterans deployed to the 1990–1991 Persian Gulf War and 15% of nondeployed veterans have developed a symptom complex of widespread pain, fatigue, headache, gastrointestinal, bladder, and other ‘‘functional’’ nociceptive and interoceptive complaints [1,2,3,4]
Dolorimetry, fatigue, and pain ratings were highly correlated with each other and with elevated axial diffusivity (AD) in cortico-cortical association and corticospinal tracts. These analyses identified four significant correlates of Chronic Multisymptom Illness (CMI) status that were significantly different from controls: ordinal fatigue, McGill total pain scores, dolorimetry and AD of the right inferior fronto-occipital fasciculus (IFOF)
The right inferior fronto-occipital fasciculus links cortical regions involved in fatigue, pain, emotional and reward processing, and the right ventral attention network in cognition
Summary
Over 25% of the 697,000 veterans deployed to the 1990–1991 Persian Gulf War and 15% of nondeployed veterans have developed a symptom complex of widespread pain, fatigue, headache, gastrointestinal, bladder, and other ‘‘functional’’ nociceptive and interoceptive complaints [1,2,3,4]. Gulf War veterans were exposed to a wide variety of exposures that include binary nerve agents, acetylcholinesterase inhibitors, organophosphates, other pesticides and herbicides that may have initiated their symptom complex [3]. This syndrome has been termed Gulf War Illness (GWI). Deployed Gulf War veterans met criteria for Chronic Fatigue Syndrome (CFS) (odds ratio = 40.6) and Fibromyalgia (FM) (odds ratio = 2.32) indicating extensive symptom overlap [5,6,7]. Gulf War exposures in 1990 and 1991 have caused 25% to 30% of deployed personnel to develop a syndrome of chronic fatigue, pain, hyperalgesia, cognitive and affective dysfunction
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