1
|
Addiego FM, Zajur K, Knack S, Jamieson J, Rayhan RU, Baraniuk JN. Subcortical brain segment volumes in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Life Sci 2021; 282:119749. [PMID: 34214570 DOI: 10.1016/j.lfs.2021.119749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/20/2021] [Accepted: 06/11/2021] [Indexed: 01/29/2023]
Abstract
AIMS There is controversy about brain volumes in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (CFS) and Gulf War Illness (GWI). Subcortical regions were assessed because of significant differences in blood oxygenation level dependent signals in the midbrain between these diseases. MATERIALS AND METHOD Magnetization-prepared rapid acquisition with gradient echo (MPRAGE) images from 3 Tesla structural magnetic resonance imaging scans from sedentary control (n = 34), CFS (n = 38) and GWI (n = 90) subjects were segmented in FreeSurfer. Segmented subcortical volumes were regressed against intracranial volume and age, then iteratively analyzed by multivariate general linear modeling with disease status, gender and demographics as independent co-variates. KEY FINDINGS The optimal model for all subjects used disease status and gender as fixed factors with independent variables eliminated after iteration. Volumes of anterior and midanterior corpus callosum were significantly larger in GWI than CFS. Gender was a significant variable for many segment volumes, and so female and male subjects were analyzed separately. CFS females had smaller left putamen, right caudate and left cerebellum white matter than control women. CFS males had larger left hippocampus than GWI males. Orthostatic status and posttraumatic distress syndrome were not significant covariates. SIGNIFICANCE CFS and GWI were appropriate "illness controls" for each other. The different patterns of adjusted segment volumes suggested that sexual dimorphisms contributed to pathological changes. Previous volumetric studies may need to be reevaluated to account for gender differences. The findings are framed by comparison to the spectrum of magnetic resonance imaging outcomes in the literature.
Collapse
Affiliation(s)
| | - Kristina Zajur
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - Sarah Knack
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - Jessie Jamieson
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - Rakib U Rayhan
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA
| | - James N Baraniuk
- Pain Fatigue Research Alliance, Georgetown University, Washington, DC 20007-2197, USA.
| |
Collapse
|
2
|
Washington SD, Rayhan RU, Garner R, Provenzano D, Zajur K, Addiego FM, VanMeter JW, Baraniuk JN. Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Brain Commun 2020; 2:fcaa070. [PMID: 32954325 PMCID: PMC7425336 DOI: 10.1093/braincomms/fcaa070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022] Open
Abstract
Gulf War Illness affects 25-30% of American veterans deployed to the 1990-91 Persian Gulf War and is characterized by cognitive post-exertional malaise following physical effort. Gulf War Illness remains controversial since cognitive post-exertional malaise is also present in the more common Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. An objective dissociation between neural substrates for cognitive post-exertional malaise in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome would represent a biological basis for diagnostically distinguishing these two illnesses. Here, we used functional magnetic resonance imaging to measure neural activity in healthy controls and patients with Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome during an N-back working memory task both before and after exercise. Whole brain activation during working memory (2-Back > 0-Back) was equal between groups prior to exercise. Exercise had no effect on neural activity in healthy controls yet caused deactivation within dorsal midbrain and cerebellar vermis in Gulf War Illness relative to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients. Further, exercise caused increased activation among Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients within the dorsal midbrain, left operculo-insular cortex (Rolandic operculum) and right middle insula. These regions-of-interest underlie threat assessment, pain, interoception, negative emotion and vigilant attention. As they only emerge post-exercise, these regional differences likely represent neural substrates of cognitive post-exertional malaise useful for developing distinct diagnostic criteria for Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
Collapse
Affiliation(s)
- Stuart D Washington
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - Rakib U Rayhan
- Department of Physiology and Biophysics, Howard University College of Medicine, Adams Building Rm 2420, 520 W Street NW, Washington, DC 20059, USA
| | - Richard Garner
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - Destie Provenzano
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - Kristina Zajur
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - Florencia Martinez Addiego
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - John W VanMeter
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA.,Department of Physiology and Biophysics, Howard University College of Medicine, Adams Building Rm 2420, 520 W Street NW, Washington, DC 20059, USA.,Center for Functional and Molecular Imaging, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| | - James N Baraniuk
- Department of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd., NW Washington, DC 20057, USA
| |
Collapse
|
3
|
Washington SD, Rayhan RU, Garner R, Provenzano D, Zajur K, Addiego FM, VanMeter JW, Baraniuk JN. Exercise alters cerebellar and cortical activity related to working memory in phenotypes of Gulf War Illness. Brain Commun 2020; 2:fcz039. [PMID: 32025659 PMCID: PMC6989731 DOI: 10.1093/braincomms/fcz039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/04/2019] [Accepted: 10/17/2019] [Indexed: 11/20/2022] Open
Abstract
Gulf War Illness affects 25–32% of veterans from the 1990–91 Persian Gulf War. Post-exertional malaise with cognitive dysfunction, pain and fatigue following physical and/or mental effort is a defining feature of Gulf War Illness. We modelled post-exertional malaise by assessing changes in functional magnetic resonance imaging at 3T during an N-Back working memory task performed prior to a submaximal bicycle stress test and after an identical stress test 24 h later. Serial trends in postural changes in heart rate between supine and standing defined three subgroups of veterans with Gulf War Illness: Postural Orthostatic Tachycardia Syndrome (GWI-POTS, 15%, n = 11), Stress Test Associated Reversible Tachycardia (GWI-START, 31%, n = 23) and Stress Test Originated Phantom Perception (GWI-STOPP, no postural tachycardia, 54%, n = 46). Before exercise, there were no differences in blood oxygenation level-dependent activity during the N-Back task between control (n = 31), GWI-START, GWI-STOPP and GWI-POTS subgroups. Exercise had no effects on blood oxygenation level-dependent activation in controls. GWI-START had post-exertional deactivation of cerebellar dentate nucleus and vermis regions associated with working memory. GWI-STOPP had significant activation of the anterior supplementary motor area that may be a component of the anterior salience network. There was a trend for deactivation of the vermis in GWI-POTS after exercise. These patterns of cognitive dysfunction were apparent in Gulf War Illness only after the exercise stressor. Mechanisms linking the autonomic dysfunction of Stress Test Associated Reversible Tachycardia and Postural Orthostatic Tachycardia Syndrome to cerebellar activation, and Stress Test Originated Phantom Perception to cortical sensorimotor alterations, remain unclear but may open new opportunities for understanding, diagnosing and treating Gulf War Illness.
Collapse
Affiliation(s)
- Stuart D Washington
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Rakib U Rayhan
- Department of Physiology and Biophysics, Howard University College of Medicine, Washington, DC 20059, USA
| | - Richard Garner
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Destie Provenzano
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057, USA
| | - Kristina Zajur
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057, USA
| | | | - John W VanMeter
- Center for Functional and Molecular Imaging, Georgetown University Medical Center, Washington, DC 20057, USA
| | - James N Baraniuk
- Department of Medicine, Georgetown University Medical Center, Washington, DC 20057, USA
| |
Collapse
|
4
|
Rayhan RU, Washington SD, Garner R, Zajur K, Martinez Addiego F, VanMeter JW, Baraniuk JN. Exercise challenge alters Default Mode Network dynamics in Gulf War Illness. BMC Neurosci 2019; 20:7. [PMID: 30791869 PMCID: PMC6385399 DOI: 10.1186/s12868-019-0488-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Gulf War Illness (GWI) affects 30% of veterans from the 1991 Gulf War and has no known cause. Everyday symptoms include pain, fatigue, migraines, and dyscognition. A striking syndromic feature is post-exertional malaise (PEM). This is recognized as an exacerbation of everyday symptoms following a physically stressful or cognitively demanding activity. The underlying mechanism of PEM is unknown. We previously reported a novel paradigm that possibly captured evidence of PEM by utilizing fMRI scans taken before and after sub-maximal exercises. We hypothesized that A) exercise would be a sufficient physically stressful activity to induce PEM and B) Comparison of brain activity before and after exercise would provide evidence of PEM's effect on cognition. We reported two-exercise induced GWI phenotypes with distinct changes in brain activation patterns during the completion of a 2-back working memory task (also known as two-back > zero-back). RESULTS Here we report unanticipated findings from the reverse contrast (zero-back > two-back), which allowed for the identification of task-related deactivation patterns. Following exercise, patients developed a significant increase in deactivation patterns within the Default Mode Network (DMN) that was not seen in controls. The DMN is comprised of regions that are consistently down regulated during external goal-directed activities and is often altered within many neurological disease states. CONCLUSIONS Exercise-induced alterations within the DMN provides novel evidence of GWI pathophysiology. More broadly, results suggest that task-related deactivation patterns may have biomarker potential in Gulf War Illness.
Collapse
Affiliation(s)
- Rakib U Rayhan
- Department of Physiology and Biophysics, Howard University College of Medicine, Adams Building Rm 2420, 520 W Street NW, Washington, DC, 20059, USA. .,Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA.
| | - Stuart D Washington
- Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - Richard Garner
- Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - Kristina Zajur
- Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - Florencia Martinez Addiego
- Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - John W VanMeter
- Center for Functional and Molecular Imaging, Georgetown University Medical Center, 3900 Reservoir Road Suite LM14, Washington, DC, 20007, USA
| | - James N Baraniuk
- Chronic Pain and Fatigue Research Center, Georgetown University Medical Center, Pre-Clinical Science Building, Rm LD3, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| |
Collapse
|