CONWAY: Brain waves

RIVER VALLEY and OZARK AREA — Patrick Carmack hopes the research he is doing will not only help veterans of the first Gulf War, but also patients with Alzheimer’s disease and other neurological conditions.

A math professor at the University of Central Arkansas, Carmack has been involved since 2002 in a research effort into Gulf War Syndrome. He became part of a large team organized by epidemiologist Dr. Robert Haley, who started the work in the mid-1990s, Carmack said. At the time, Carmack was a graduate student in the statistics department at Southern Methodist University.

“Ultimately, I want to be able to help people,” he said.

Carmack noted that he remembers Ph.D.’s coming to his graduate school and talking about what they were working on. One was working with a snack company on making a better potato chip. While the problem was likely challenging, Carmack said, that was not the kind of work he wanted to do.

“I wanted a combination of something that was hard to work on from my field’s point of view ... and useful to humanity,” he said.

Carmack said that in the mid-1990s, Ross Perot volunteered to fund an initial study into symptoms that veterans of the first Gulf war were reporting. Some of them had been diagnosed with post traumatic stress disorder, but their symptoms suggested a neurological cause, Carmack said. Perot approached the University of Texas Southwestern Medical Center at Dallas, which looked to Haley. Several years later, Haley recruited help from SMU, which is how Carmack became involved. Carmack later became an assistant professor at the University of Texas Southwestern in Dallas before coming to UCA a year and a half ago, working half time for each university.

Carmack explained that there are multiple causes of Gulf War syndrome. Early in the war, the U.S. military bombed a weapons depot in Iraq that contained sarin gas, a neurotoxin. The weather forecast predicted the winds would be blowing into Iraq, but instead, high winds blew the toxin over the troops, he said.

“Fleas are terrible in the desert, so the Army sent over pesticide, but being the Army and being efficient, they sent in drums of undiluted pesticide,” Carmack continued.

He said the soldiers sprayed one another down with undiluted pesticide to keep off the fleas, and sweating caused their pores to open up and allowed the toxins to seep in.

Also, Carmack said the military suspected that Iraq had neurotoxins and thus gave military personnel pyridostigmine bromide, a medication used since the 1950s to treat a neurological disorder. The military intended the drug for use as a protection against neurotoxins, but Carmack said the chemical made troops more susceptible to the toxins.

Haley and his collaborators discovered that because of individual genetics, not everyone is equally susceptible to neurotoxins. Three-fourths of the population has an enzyme called PON1 that breaks down neurotoxins, Carmack said. One-fourth of the military population, or about 100,000 people, would be more susceptible to neurotoxins than the rest, he said.

“If you give a diabetic insulin, that’s a good thing, but if you give a healthy person insulin, that’s not a good thing,” he said.

Haley and his fellow researchers had circumstantial evidence of neurological damage in troops, but nothing concrete. An expert in brain chemistry noted that if researchers could shock the cholinergic system, then scan a damaged brain, they probably would not see a reaction as in a healthy brain. Sarin gas attacks the cholinergic system, or deep brain, which controls basic functions, such as visual information, temperature sensitivity and digestion.

Researc hers gave physostigmine, a drug to depress thedeep brain, to normal and ill subjects, then did brain scans. At the time, however, the stateof-the-art technology could not pick up the differences in the scans, Carmack said.

When Carmack joined the research team in 2002, Haley said he did not trust the results of the data and did not want to go public with it. It took about a year and a half for new researchers to learn what the team had been doing and what they had done wrong. They then developed a more sensitive way to analyze the brain scans using spatial modeling and were able to find consistent results that made sense, given the symptoms, Carmack said. They discovered that subjects with symptoms did have damage to the deep brain.

“ The initial study was promising, but it was only on 37 or 38 guys,” he said.

Based on the results of the study, Kay Bailey Hutchinson, a senator from Texas, succeeded in getting UT Southwestern a contract with the U.S. Department of Veterans Affairs for $75 million over five years.

Researchers began using functional MRIs to study more subjects’ brains. Several institutions became involved, including UCA, UT Southwestern, SMU, the University of Texas at Arlington, the University of Texas at Dallas, the University of Florida, Emory University and Johns Hopkins University, Carmack said.

Last year, however, the VA announced it was canceling the contract with UT Southwestern, citing “persistent noncompliance and numerous performance deficiencies,” according to a statement from the Department of Veterans Affairs.

“Research into the illnesses suffered by Gulf War Veterans remains a priority for the VA,” Dr. Gerald M. Cross, the VA’s Acting Under Secretary for Health, said in an Aug. 26 statement. “As part of our commitment to this vital effort, we must make certain thatour resources are used to support effective and productive research.”

Carmack said the VA has a history of denying problems, including Gulf War syndrome. He said the contract relationship between UT Southwestern and the VA has been a contentious one, involving stalls in funding.

He said UT Southwestern reached an agreement with the VA that would extend the contract through May.

“We will have all this data to analyze, but we need to secure more funding, since VA funding has fallen through. All the universities are seeking alternate funding.”

Carmack said veterans and control patients will continue to have MRIs until May.

“Once you say there’s a problem, you work on a treatment. We were supposed to have two more years,” he said, although he noted that researchers are probably five years away from finding a treatment.

“We want to develop a diagnostic tool so if a Gulf War I veteran comes in and says, ‘I’m sick,’ we can put them in a scanner and say, ‘You are’ or ‘You’re not.’ Something we can hand off to the VA. We want to automate and package it. Right now, everything is very manual.”

He said the next question is, “How does (deep brain damage) affect the cortex? That’s what makes us unique in the animal kingdom - we have the most highly developed cortex. This is part of a bigger picture of how does the brain work, and then how do we treat its disorders?”

With all the expertise they have gained, the researchers want to work toward treating other problems, such as traumatic brain injuries, Alzheimer’s, schizophrenia and substance abuse, Carmack said.

“They all want to apply it to their various disciplines. There’s a lot coming in the next 10 years,” he said.

River Valley Ozark, Pages 63 on 02/25/2010

Print Headline: CONWAY Brain waves