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Effect of Basal Ganglia Injury on Central Dopamine Activity in Gulf War Syndrome
Correlation of Proton Magnetic Resonance Spectroscopy and Plasma Homovanillic Acid Levels
Robert W. Haley, MD;
James L. Fleckenstein, MD;
W. Wesley Marshall, MD;
George G. McDonald, PhD;
Gerald L. Kramer, BS;
Frederick Petty, PhD, MD
Arch Neurol. 2000;57:1280-1285.
Background Many complaints of Gulf War veterans are compatible with a neurologic illness involving the basal ganglia.
Methods In 12 veterans with Haley Gulf War syndrome 2 and in 15 healthy control veterans of similar age, sex, and educational level, we assessed functioning neuronal mass in both basal ganglia by measuring the ratio of N-acetyl-aspartate to creatine with proton magnetic resonance spectroscopy. Central dopamine activity was assessed by measuring the ratio of plasma homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenlyglycol (MHPG).
Results The logarithm of the age-standardized HVA/MHPG ratio was inversely associated with functioning neuronal mass in the left basal ganglia (R2 = 0.56; F1,27 = 33.82; P<.001) but not with that in the right (R2 = 0.04; F1,26 = 1.09; P = .30). Controlling for age, renal clearances of creatinine and weak organic anions, handedness, and smoking did not substantially alter the associations.
Conclusions The reduction in functioning neuronal mass in the left basal ganglia of these veterans with Gulf War syndrome seems to have altered central dopamine production in a lateralized pattern. This finding supports the theory that Gulf War syndrome is a neurologic illness, in part related to injury to dopaminergic neurons in the basal ganglia.
From the Departments of Internal Medicine (Drs Haley and Marshall), Radiology (Drs Fleckenstein and McDonald), and Psychiatry (Dr Petty), University of Texas Southwestern Medical Center at Dallas, and the Dallas Veterans Affairs Medical Center (Mr Kramer and Dr Petty).
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