Dizziness, Vertigo, and Mental Health Comorbidity in Gulf War Veterans

Fox, Apollonia; Riska, Kristal M.; Tseng, Chin‐Lin; McCarron, Kelly K.; Satcher, Serena; Osinubi, Omowunmi; Helmer, Drew A.

doi:10.3766/jaaa.17122

Cited by 3 publications

(2 citation statements)

References 36 publications

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“…show a VSS baseline score about 14, while our VSS baseline mean is 32.9. The VSS threshold (>12) suggests “severe dizziness” in other studies (Fox et al., 2019 ; Wilhelmsen et al., 2008 ). The baseline score of PHQ‐9 is about 5 in the study from van Vugt et al.…”

Section: Discussionmentioning

confidence: 62%

Web‐based vestibular rehabilitation in persistent postural‐perceptual dizziness

et al. 2021

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Objectives:The aims of the study were to investigate the feasibility and preliminary outcome of a Norwegian web-based self-help application for vestibular rehabilitation (VR) among patients with high symptom burden of chronic dizziness fulfilling the criteria for persistent postural-perceptual dizziness (PPPD). Materials and methods:The web application consists of six weekly online sessions, with written information and video presentations. It is self-instructive and freely available on NHI.no (https://nhi.no/for-helsepersonell/vestibular-rehabilitering/). Ten consecutive patients referred to a neurologic outpatient clinic for chronic dizziness were included. They signed informed consent forms and were examined at inclusion and after three months. State of health and symptom burden were recorded using Vertigo symptom score (VSS), Niigata symptom score (NPQ), Patient Health Questionnaire (PHQ-9) and health-related quality of life score (EQ5D-5L). Experiences with the program were measured using a semi-structured interview at the end of the study.Results: Nine out of ten patients completed the program. The findings suggest that the web application was easy to use, instructive and educatable. Challenges were the load of exercises, motivation to continue training during relapses and performing the body rolling on the floor. Participants had high symptom burden (VSS mean 32.9) and long duration of symptoms in years (mean 11.5). The participants improved on average 6.9 points on the VSS score.Conclusions: This web application for chronic dizziness appears to be feasible and may reduce symptoms in patients who have struggled with serious and long-lasting dizziness.

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Section: Discussionmentioning

confidence: 62%

Web‐based vestibular rehabilitation in persistent postural‐perceptual dizziness

et al. 2021

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“…Taken together, except the observation of greater PAG volume in veterans, the patterns of smaller volume in the gross brainstem and impaired brainstem tracts are anatomically consistent with the autonomic nervous system that centrally controls body energy, sleep, pain management, and many neurological regulations. Several studies have suggested that dysregulation of the autonomic nervous system is a common feature in GWI (Fox et al, 2019;Martinez-Lavin and Tejada-Ruiz, 2020;Avery et al, 2021). Hence, our findings could suggest that the presence of CMI in veterans deployed to both Gulf War and Iraq/Afghanistan conflicts is highly relevant to structural alterations in the brainstem.…”

Section: Structural Alterations Of the Brainstem In Veterans With CMImentioning

confidence: 57%

The role of the brainstem in sleep disturbances and chronic pain of Gulf War and Iraq/Afghanistan veterans

Zhang,

Moore,

Jennings

et al. 2024

Front. Mol. Neurosci.

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IntroductionGulf War Illness is a type of chronic multisymptom illness, that affects about 30% of veterans deployed to the 1990–91 Persian Gulf War. Veterans deployed to Iraq/Afghanistan after 2000 are reported to have a similar prevalence of chronic multisymptom illness. More than 30 years after the Persian Gulf War, Gulf War Illness still has an unexplained symptom complex, unknown etiology and lacks definitive diagnostic criteria and effective treatments. Our recent studies have found that substantially smaller brainstem volumes and lower fiber integrity are associated with increased sleep difficulty and pain intensity in 1990–91 Persian Gulf War veterans. This study was conducted to investigate whether veterans deployed to Iraq/Afghanistan present similar brainstem damage, and whether such brainstem structural differences are associated with major symptoms as in Gulf War Illness.MethodsHere, we used structural magnetic resonance imaging and diffusion tensor imaging to measure the volumes of subcortices, brainstem subregions and white matter integrity of brainstem fiber tracts in 188 veterans including 98 Persian Gulf War veterans and 90 Iraq/Afghanistan veterans.ResultsWe found that compared to healthy controls, veterans of both campaigns presented with substantially smaller volumes in brainstem subregions, accompanied by greater periaqueductal gray matter volumes. We also found that all veterans had reduced integrity in the brainstem-spinal cord tracts and the brainstem-subcortical tracts. In veterans deployed during the 1990–91 Persian Gulf War, we found that brainstem structural deficits significantly correlated with increased sleep difficulties and pain intensities, but in veterans deployed to Iraq/Afghanistan, no such effect was observed.DiscussionThese structural differences in the brainstem neurons and tracts may reflect autonomic dysregulation corresponding to the symptom constellation, which is characteristic of Gulf War Illness. Understanding these neuroimaging and neuropathological relationships in Gulf War and Iraq/Afghanistan veterans may improve clinical management and treatment strategies for modern war related chronic multisymptom illness.

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The Effect of the Low Glutamate Diet on the Reduction of Psychiatric Symptoms in Veterans With Gulf War Illness: A Pilot Randomized-Controlled Trial

et al. 2022

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The objective of this pilot study was to examine the effects of the low glutamate diet on anxiety, post-traumatic stress disorder (PTSD), and depression in veterans with Gulf War Illness (GWI). The low glutamate diet removes dietary excitotoxins and increases consumption of micronutrients which are protective against glutamatergic excitotoxicity. This study was registered at ClinicalTrials.gov (NCT#03342482). Forty veterans with GWI completed psychiatric questionnaires at baseline and after 1-month following the low glutamate diet. Participants were then randomized into a double-blind, placebo-controlled crossover challenge with monosodium glutamate (MSG; a dietary excitotoxin) vs. placebo over three consecutive days per week, with assessments on day three. Data were analyzed across the full sample and with participants categorized by baseline symptom severity. Pre-post-dietary intervention change scores were analyzed with Wilcoxon signed-rank tests and paired sample t-tests across the full sample, and changes across symptom severity categories were analyzed using ANOVA. Crossover challenge results were analyzed with linear mixed modeling accounting for challenge material (MSG v. placebo), sequence (MSG/placebo v. placebo/MSG), period (challenge week 1 v. week 2), pre-diet baseline symptom severity category (minimal/mild, moderate, or severe), and the challenge material*symptom severity category interaction. A random effect of ID (sequence) was also included. All three measures showed significant improvement after 1 month on the diet, with significant differences between baseline severity categories. Individuals with severe psychological symptoms at baseline showed the most improvement after 1 month on the diet, while those with minimal/mild symptoms showed little to no change. Modeling results from the challenge period demonstrated a significant worsening of anxiety from MSG in only the most severe group, with no significant effects of MSG challenge on depression nor PTSD symptoms. These results suggest that the low glutamate diet may be an effective treatment for depression, anxiety, and PTSD, but that either (a) glutamate is only a direct cause of symptoms in anxiety, or (b) underlying nutrient intake may prevent negative psychiatric effects from glutamate exposure. Future, larger scale clinical trials are needed to confirm these findings and to further explore the potential influence of increased micronutrient intake on the improvements observed across anxiety, PTSD, and depression.

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Dizziness, Vertigo, and Mental Health Comorbidity in Gulf War Veterans

Cited by 3 publications

References 36 publications

Web‐based vestibular rehabilitation in persistent postural‐perceptual dizziness

Web‐based vestibular rehabilitation in persistent postural‐perceptual dizziness

The role of the brainstem in sleep disturbances and chronic pain of Gulf War and Iraq/Afghanistan veterans

The Effect of the Low Glutamate Diet on the Reduction of Psychiatric Symptoms in Veterans With Gulf War Illness: A Pilot Randomized-Controlled Trial

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