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Testimony of William E. Baumzweiger
Neurology and Psychiatry
18399 Venture Blvd. #245
Tarzana, CA. 91356
08/14/00

Presentation to the Institute of Medicine: Gulf War Illness Its Etiology In Brainstem Dysfunction And Its Treatment

Presented for Dr. Baumzweiger by Ruth McGIII, M.D.

The brainstem is a brain organ in which toxic, traumatic, microbial and other impacts can interact in such a way that will cause chronic inflammatory disease. Such disease could immune suppress the victim. causing eventually new and reactivated infections autoimmunity,and dibilitation. The core constellation of signs and symptoms in Gulf War Illness is caused by simultaneous dysfuntion of the nervous system, immune system and bodily membranes, all negatively impacting on one another. As I indicated to this Institute last year, the disease process appears to be centered in the brainstem. Eventually all parts of the nervous system as well as the immune system manifest the characteristic pathology seen in this illness. The immune system infects the nervous system and the Nervous System in turn Irritates the immune system via Excitotoxicity. (Diagrams)

The pathological process appears to be the result of cumulative effects from multiple wartime'environmental insults: low levels neurotoxic gas, toxins from oil well fires, pyridostigmine tablets, Insect repellants, "depleted Uranium" radiation, neurotoxic and immunotoxic biological weapons. One researcher counted 33 different potential toxic sources in the War Theater. Even the vaccines the fighters were given may have contributed to the severity of their illness the diagnostic complexity of this illness.

The treatment of this disorder is complex, but has provided symptomatic relief for over 100 of my patients. It begins with the cooling down of excitotoxically inflamed neuros with Dlhydrapyridine Calcium Channel blockers or GABA agonists. Ideally, both are used together. Then anti-inflammatories are added to reduce the activity of the arachidonic, leukotrine, and other inflammatory pathways. Then IV immune globulin is used to further stabilize the immune system. IV anti-virals and IV antifungals are given to those patients who are not able to clear microbial fragments out of their neurons and immune cells through the use of oral medications.

After the core neurological and Immune Inflammatory processes are brought under control, the problems of tachycardia; blood pressure abnormalities, pulmonary dysfunction, pleuritis and pericardial inflammation can then be addressed. The gastrointestinal, musculoskeletal, and other systemic problems associated with this illness can then be treated.

Research studies of Dr. Robert Haley at Southwestern University have confirmed the clinical findings. During a conversation Dr. Haley and I had, Dr. Haley had asked why I thought the brainstem was so central to the process. I pointed out that abnormalities of the Cranial Nerve nuclei were found in all ill Gulf War fighters with this syndrome as well as some ill civilians. His subsequent research into the brainstem has followed from that conversation and confirmed its essential ideas. His group has published two articles on the brainstem in this condition, and a third is coming out shortly.

The clinical findings indicate this disease process invariably involves the spread of very characteristic pathological to the multiple organ systems I have indicated. Many investigators, including myself, have described CNS irritability. Headaches, photophobia, cranial nerve nucleus dvsfunction, and even the onset of epilepsy are seen. Dysautonomia is present manifested by orthostatic tachycardia and night sweats; as well as changes in perspiration. Acoustic dysfunction with loss of hearing at low tones and decreased ability to locate sounds is seen. Vagus nerve dysfunctlon is seen. Menstrual disorders and thyroid disorders, from defects in pituitary function appear. The appearance of Diabetes, presumably from immune and / or infectious etiologies is common.

Because of Vagal and autonomic dysfunction, digestive and other abdominal symptoms are seen. Dysregulation of control over circulating blood volume and changes in vascular tone with hypotension or hypertension suggest endocrine dysfunction affecting electrolyte balance and the mechanisms of vascular control in the renal system and great vessels. Immune system activation of coagulation is seen.

There is a connection between this neuroimmune disease and it's associated signs of membrane hyperirritability, This irritability is seen in the irritable bowel and reactive airway disease in the suffering from this illness. Irritability in the musculoskeletal system is frequently seen as well. The membranes of the lungs, heart, bladder, and skin can demonstrate irritability. Clinically explaining this required considerable time researching into and elaborating of concepts as to how patients can develop pathological reactions to normal tissue after neumtoxle / Neurotraumatic, and Neuroinfectious exposure.

The chronic infection / inflammation of the brainstem and other deep brain causes immune suppression. This explains why Gulf War veterans not only have signs of Chemical and Radiation Neurotoxicity, but have signs of high rates of post Gulf War infection from neurotoxic / neurotropic viruses and Mycoplasma. This chronic process also is the cause for the neurobehavioral problems--often mistaken for "phychiatric" diseases such as PTSD or Somatoform Disorders--thea these patients demonstrate.

This process can be worsened by further exposure to toxins, solvents, fumes, or subsequent exposures to environmental pathogens. This process can be worsened by head injury, especially whiplash. It can become chronic due to infection by neurotoxic microbes followed by neurodisimmune conflict between immune and neural systems. The result is a vicious cycle of CNS irritability, Immune attack on the neurons, and autoimmunity simultaneous with infection by neurotropic / neurotoxic microbes. Along with this vicious cycle there arises a defect in the ability to utilize oxygen on a tissue level. Membranes begin to break down leading to inflammation in 'the linings of the lungs and heart. There is loss of energy at a tissue level, with decreased resilience to; environmental impacts. These patients cannot tolerate light, loud noise, odors, and foods or drugs. These patients can develop sleep apnea and other forms of insomnia due to the brainstem disorder. They often need mechanical ventilation at night. They develop abnormalities of their SPECT and PET scans due to the Excitotoxic, metabolic and microbial damage. They all require examinations of the antibody levels to immune, neural and microbial antigens. Proper testing will show autoantibodies, immune suppression, and invasion by environmental pathogens. This illness requires very complex workup and treatment.

Appendix

A. Dr. Haley will be happy to provide reprints of the articles that are mentioned.

B. Immune Mechanisms:

  1. Prostaglandin Pathway
  2. Leukotrine System
  3. Mast Cell-Histamine System
  4. Tumor Necrosis Factor System
  5. Modulation of platelet Serotonin
  6. As yet undefined Immune modulating pathways.
C. For lack of space, confirmatory data from myself and from Immunosciences Laboratory has not been included, but is available on request.

D. The material in the presentation is protected by a pending method patent.