Characterizing Gulf War Illnesses: Neurally mediated hypotension and postural tachycardia syndrome

Lucas, Katherine E.; Armenian, Haroutune K.; DeBusk, Karen; Calkins, Hugh; Rowe, Peter C.

doi:10.1016/j.amjmed.2005.06.034

Cited by 6 publications

(4 citation statements)

References 42 publications

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“…Prior studies have assessed the response to orthostatic stress in GWI using tilt-table testing with [ 37 , 38 ] and without isoproterenol [ 39 ] as well as a clinical wall lean test [ 40 ] with mixed results in terms of hypotension but similar reports of orthostatic symptoms. However, none of these prior studies assessed CBF which is noteworthy as orthostatic symptoms in the absence of hypotension may reflect an underlying orthostatic cerebral hypoperfusion [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Dynamic cerebral autoregulation is impaired in Veterans with Gulf War Illness: A case-control study

2018

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Neurological dysfunction has been reported in Gulf War Illness (GWI), including abnormal cerebral blood flow (CBF) responses to physostigmine challenge. However, it is unclear whether the CBF response to normal physiological challenges and regulation is similarly dysfunctional. The goal of the present study was to evaluate the CBF velocity response to orthostatic stress (i.e., sit-to-stand maneuver) and increased fractional concentration of carbon dioxide. 23 cases of GWI (GWI+) and 9 controls (GWI) volunteered for this study. Primary variables of interest included an index of dynamic autoregulation and cerebrovascular reactivity. Dynamic autoregulation was significantly lower in GWI+ than GWI- both for autoregulatory index (2.99±1.5 vs 4.50±1.5, p = 0.017). In addition, we observed greater decreases in CBF velocity both at the nadir after standing (-18.5±6.0 vs -9.8±4.9%, p = 0.001) and during steady state standing (-5.7±7.1 vs -1.8±3.2%, p = 0.042). In contrast, cerebrovascular reactivity was not different between groups. In our sample of Veterans with GWI, dynamic autoregulation was impaired and consistent with greater cerebral hypoperfusion when standing. This reduced CBF may contribute to cognitive difficulties in these Veterans when upright.

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Section: Discussionmentioning

confidence: 99%

Dynamic cerebral autoregulation is impaired in Veterans with Gulf War Illness: A case-control study

2018

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“…Measurements of orthostatic intolerance and auto-regulatory dysfunction have been inconsistent in GWI [35], [36]. Differences in findings may be due to small intra-subject recording samples and/or different procedures used, such as tilt table testing [35].…”

Section: Discussionmentioning

confidence: 99%

“…Differences in findings may be due to small intra-subject recording samples and/or different procedures used, such as tilt table testing [35]. To overcome this obstacle, we studied autonomic function throughout the four day period.…”

Section: Discussionmentioning

confidence: 99%

Exercise Challenge in Gulf War Illness Reveals Two Subgroups with Altered Brain Structure and Function

et al. 2013

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Nearly 30% of the approximately 700,000 military personnel who served in Operation Desert Storm (1990–1991) have developed Gulf War Illness, a condition that presents with symptoms such as cognitive impairment, autonomic dysfunction, debilitating fatigue and chronic widespread pain that implicate the central nervous system. A hallmark complaint of subjects with Gulf War Illness is post-exertional malaise; defined as an exacerbation of symptoms following physical and/or mental effort. To study the causal relationship between exercise, the brain, and changes in symptoms, 28 Gulf War veterans and 10 controls completed an fMRI scan before and after two exercise stress tests to investigate serial changes in pain, autonomic function, and working memory. Exercise induced two clinical Gulf War Illness subgroups. One subgroup presented with orthostatic tachycardia (n = 10). This phenotype correlated with brainstem atrophy, baseline working memory compensation in the cerebellar vermis, and subsequent loss of compensation after exercise. The other subgroup developed exercise induced hyperalgesia (n = 18) that was associated with cortical atrophy and baseline working memory compensation in the basal ganglia. Alterations in cognition, brain structure, and symptoms were absent in controls. Our novel findings may provide an understanding of the relationship between the brain and post-exertional malaise in Gulf War Illness.

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“…ANS dysregulation in GW veterans was noted in several early studies reviewed in the 2008 RAC report. Findings included significant differences between symptomatic and healthy veterans in relation to 24-h heart rate variability (HRV; Haley et al, 2004 ; Stein et al, 2004 ), increased HRV in symptomatic veterans after exposure to diesel vapors ( Fiedler et al, 2004 ), differential blood pressure, heart rate, and symptomatic responses with tilt table testing ( Clauw, 2001 ; Davis, Kator, Wonnett, Pappas, & Sall, 2000 ; Lucas, Armenian, Debusk, Calkins, & Rowe, 2005 ; Sastre & Cook, 2004 ) and blunted blood pressure response to cognitive stressors ( Peckerman et al, 2003 , 2000 ). No statistical differences were identified in tests of sympathetic skin response and airway pressure response ( Sharief et al, 2002 ).…”

Section: Neuropathology Of Gwimentioning

confidence: 99%

Recent research on Gulf War illness and other health problems in veterans of the 1991 Gulf War: Effects of toxicant exposures during deployment

White

Steele

O’Callaghan

et al. 2016

Cortex

355

398

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Veterans of Operation Desert Storm/Desert Shield – the 1991 Gulf War (GW) – are a unique population who returned from theater with multiple health complaints and disorders. Studies in the U.S. and elsewhere have consistently concluded that approximately 25–32% of this population suffers from a disorder characterized by symptoms that vary somewhat among individuals and include fatigue, headaches, cognitive dysfunction, musculoskeletal pain, and respiratory, gastrointestinal and dermatologic complaints. Gulf War illness (GWI) is the term used to describe this disorder. In addition, brain cancer occurs at increased rates in subgroups of GW veterans, as do neuropsychological and brain imaging abnormalities.Chemical exposures have become the focus of etiologic GWI research because nervous system symptoms are prominent and many neurotoxicants were present in theater, including organophosphates (OPs), carbamates, and other pesticides; sarin/cyclosarin nerve agents, and pyridostigmine bromide (PB) medications used as prophylaxis against chemical warfare attacks. Psychiatric etiologies have been ruled out.This paper reviews the recent literature on the health of 1991 GW veterans, focusing particularly on the central nervous system and on effects of toxicant exposures. In addition, it emphasizes research published since 2008, following on an exhaustive review that was published in that year that summarizes the prior literature (RACGWI, 2008).We conclude that exposure to pesticides and/or to PB are causally associated with GWI and the neurological dysfunction in GW veterans. Exposure to sarin and cyclosarin and to oil well fire emissions are also associated with neurologically based health effects, though their contribution to development of the disorder known as GWI is less clear. Gene-environment interactions are likely to have contributed to development of GWI in deployed veterans. The health consequences of chemical exposures in the GW and other conflicts have been called “toxic wounds” by veterans. This type of injury requires further study and concentrated treatment research efforts that may also benefit other occupational groups with similar exposure-related illnesses.

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Characterizing Gulf War Illnesses: Neurally mediated hypotension and postural tachycardia syndrome

Cited by 6 publications

References 42 publications

Dynamic cerebral autoregulation is impaired in Veterans with Gulf War Illness: A case-control study

Dynamic cerebral autoregulation is impaired in Veterans with Gulf War Illness: A case-control study

Exercise Challenge in Gulf War Illness Reveals Two Subgroups with Altered Brain Structure and Function

Recent research on Gulf War illness and other health problems in veterans of the 1991 Gulf War: Effects of toxicant exposures during deployment

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