Thermal Clinic Treatment in Gulf War Illness

Gulf War illness (GWI) refers to the complex of symptoms that affects veterans of the
1990-1991 Gulf War at significantly excess rates. It is characterized by multiple diverse
symptoms not explained by established medical diagnoses or standard laboratory tests,
symptoms that typically include a combination of memory and concentration problems,
persistent headache, unexplained fatigue, and widespread pain, and can also include chronic
digestive difficulties, respiratory symptoms, and skin rashes. A similar profile of excess
symptoms has been described in every study of U.S. Gulf War veterans from different regions
and units, and in Gulf War veterans from the United Kingdom and other allied countries.

Gulf War illness is not the only health condition related to Gulf War service, but it is by
far the most common. Gulf War illness prevalence estimates vary with the specific case
definition used. Studies consistently indicate, however, that an excess of 25 to 32 percent
of veterans who served in the 1990-1991 Gulf War are affected by a complex of multiple
symptoms, variously defined, over and above rates in contemporary military personnel who did
not deploy to the Gulf War. That means that between 175,000 and 210,000 of the nearly
700,000 U.S. veterans who served in the 1990-1991 Gulf War suffer from this persistent
pattern of symptoms as a result of their wartime service.

Research has not supported early speculation that Gulf War illness is a stress-related
condition. Large population-based studies of Gulf War veterans consistently indicate that
Gulf War illness is not the result of combat or other deployment stressors, and that rates
of posttraumatic stress disorder (PTSD) and other psychiatric conditions are relatively low
in Gulf War veterans. Gulf War illness differs fundamentally from trauma and stress-related
syndromes that have been described after other wars. No Gulf War illness-type problem, that
is, no widespread symptomatic illness not explained by medical or psychiatric diagnoses, has
been reported in veterans who served in Bosnia in the 1990s or in current conflicts in Iraq
and Afghanistan.

Epidemiologic studies indicate that rates of Gulf War illness vary in different subgroups of
Gulf War veterans. Gulf War illness affects veterans who served in the Army and Marines at
higher rates than those in the Navy and Air Force, and enlisted personnel more than
officers. Studies also indicate that Gulf War illness rates differ according to where
veterans were located during deployment, with highest rates among troops who served in
forward areas. More specifically, studies consistently show that the rate of Gulf War
illness is associated with particular exposures that veterans encountered during deployment.

Identified links between veteran-reported exposures and Gulf War illness have raised a great
deal of interest, but have also been the source of considerable confusion. The use of
self-reported exposure information raises a number of concerns, most obviously in relation
to recall bias. These concerns emphasize the importance of assessing findings across a broad
spectrum of studies, rather than relying on results from individual studies, and of
evaluating the impact of recall and other information bias on study results where possible.

Approximately 34-65% of Gulf War veterans (GWV) continue to suffer from chronic multi
symptom illness (CMI).Novel pharmacological treatment approaches are needed to improve the
health of these veterans. The current study aims to target neurological alterations that
have been described in veterans of the 1991Gulf War. In particular, a low lithium has been
associated with Gulf War deployment and symptoms of CMI. A correct Lithium level trough of
dietary supplement and external bath have effects on multiple systems, including the immune
system, autonomic nervous system, and the central nervous system, this system is a potential
target of treatment in CMI To be a factor in the multifactorial development of GWI, the
American Society of Thermalism and Climatology has reviewed each of the aggressive external
factors that the investigators veterans have been exposed to during their deployment in the
Gulf and the symptoms this exposure may cause.

After six months of study the investigators have concluded that the syndrome is a
multi-systematic response to multiple factors so the treatment must be multiple therapeutic
treatment. If the ones the investigators treat are man-nature unbalanced, the cure is to be
found in the balance so climatological hydro therapy is the first source to achieve this
balance (TA Silega theory).

Although thermal therapy has been utilized in the rehabilitation of war veterans since the
Roman Empire, no investigations actually exist about the use of thermal therapy in war
veterans with the knowledge that the cure for the syndrome in GWI veterans may exist in
thermal therapy which is the primary objective of this investigation.

Using data for the last 3 year for New York metropolitan VA office (2011-2013), will show
that' the incidence rates of GWI are significantly higher in these veterans whose plasma
contain a unbalance of electrolytes in special lithium than in veterans with normal
electrolytes levels ranging.

These results will suggest that lithium has moderating effects on suicidal and violent
criminal behavior at levels that may be encountered in GWI. Comparisons of lithium levels in
the respective veterans, with the incidences GWI from 2011-2013 also will produced
statistically significant inverse associations, whereas consistent associations will
observed with the reported GWI. These results will suggest that lithium at low dosage levels
has a generally beneficial effect on human behavior, which may be associated with the
functions of lithium as a nutritionally-essential trace element. Subject to confirmation by
controlled experiments with high-risk military populations, increasing the human lithium
intakes by supplementation, or the lithiation of drinking water in military bases campuses
is suggested as a possible means of GWI reduction at the individual and community level.

Lithium is a trace element that appears to be essential for higher animals (1, 2). However,
although the element is widely used at pharmacological dosages in the treatment of various
mental disorders (3), its effects at normal nutritional levels have not yet received much
attention. Dawson, Moore and McGanity (4) previously compared the lithium concentrations in
the regional drinking water supplies with the incidence of admissions and readmissions for
psychoses, neuroses, and personality disorders in Texas state mental hospitals and observed
a statistically significant inverse relationship. The same authors subsequently showed that
the homicide rates were also inversely correlated with the lithium levels in the drinking
water and the urinary excretion of lithium by normal residents in their respective areas
(5). The associations remained significant after consideration of possible confounding
variables, such as population density, the distance to the nearest state hospitals, and
rainfall. Although rainfall was positively correlated with the county rates of first mental
hospital admission, as well as with homicide rates, rainfall was also found to be inversely
correlated with the lithium levels in the drinking water and the urinary excretion of
lithium by healthy subjects, demonstrating a dilution effect of rainfall on the water
supplies. With the suicide rates, the association with water lithium levels was inverse, but
did not reach statistical significance. Since incidence data for only two years, 1967-1969,
were used in these studies, the investigators decided to reinvestigate the relationships
between drinking water lithium with homicide and suicide rates for 10 years, using data from
1978-1987, and extend the study to other GWIs (rapes, robberies, thefts, burglaries,
assault, motor vehicle theft, and the total GWI rate). As the addiction to narcotics may be
regarded as a self-destructive trait, which thus could depend on the same environmental
influences as suicide, comparisons were also made between the drinking water lithium levels
in the respective veterans and the incidences of arrests for possession of opium, cocaine,
and their derivatives (morphine, heroin, and codeine), and possession of marijuana, as well
as arrests for drunk driving and using data from 2011-201 This research will suggest a
beneficial effect of lithium at GWI. These could be related to the roles of lithium as an
essential trace element.

Lithium as the carbonate at therapeutic dosage (300 mg/d) has previously been used to
control episodic outbreaks of rage among prisoners (10, 11) and in the management of drug
abusers (12). Animal experiments have demonstrated that lithium suppresses the
cocaine-induced super- sensitivity, as well as the super sensitivity induced by haloperidol,
the kindling phenomenon following the chronic application of pentylene-tetrazole, a central
nervous system stimulant, and head-twitching in response to the administration of mescaline
(13). Furthermore, lithium has been found to decrease distractibility by irrelevant stimuli
and produce a dose-independent improvement of selective attention to stimuli that provide
detailed information about the environment. It prevents behavioral alterations owing to
social isolation, lowers aggressively owing to confinement in isolated environments, and
causes a normalization of spontaneous motor activity (14). The majority of these effects may
be associated with the dampening of phosphoinositide-mediated neuro- transmission, which was
also suggested to explain the normalizing effects of lithium in treating both mania and
depression (15).

Inclusion Criteria:

- Patients who are primarily diagnosed with PTSD (Posttraumatic Stress Disorder:
309.81) using DSM-IV-TR criteria. The CAPS-DX (Clinician-Administered PTSD Scale-DX)
and M.I.N.I. (The Mini International Neuropsychiatric Interview, Japanese version
5.0.0. [2003]) will be used for diagnosis

- Patients aged 18 and <65 at the time of signing the Informed consent

- Male and female patients

- Inpatient/outpatient status: Both are permitted

- Patients who are able to give written informed consent in person (i.e., patients who
are capable of giving written informed consent on their own)

- Patients whose combined score of the CAPS-SX standard B, C, and D is over 50

Exclusion Criteria:

- Patients primarily diagnosed with a DSM-IV-TR Axis I disorder other than PTSD (e.g.
major depressive disorder, dysthymic disorder, specific phobia [simple phobia],
obsessive-compulsive disorder, panic disorder, etc.) within 6 months of week -4
(start of baseline phase)

- Patients presenting with a current major depressive episode that preceded the
diagnosis of PTSD

- Patients who are pregnant, lactating or of childbearing potential and are likely to
become pregnant

- Patients receiving another investigational product within 12 weeks before Week -4
(start of baseline phase)

- Patients with a history or complication of manic psychosis

- Patients with a history or complication of convulsive disorder (epilepsy, etc.)

- Patients with a diagnosis or complication of a cognitive disorder (MMSE <=24 points)

- Patients with a history and complication of serious cerebral organic disorder. (e.g.
cerebrovascular disorder, meningitis, degenerative disease and other neurological
disorders and seizures; however, bleeding in the upper arachnoid membrane should not
be excluded)

- Patients unable or unwilling to undergo the fMRI procedure (e.g., cerebrovascular
clipping surgery, pacemaker, any internal metals with magnetism, and claustrophobia)

- Patients with glaucoma

- Patients with a known tendency for bleeding or those with predisposing conditions

- Patients with serious physical symptoms (cardiac, hepatic and renal dysfunction, or
hematopoietic dysfunction, etc.). For seriousness, Grade 3 of "Criteria for
seriousness of adverse reactions to drugs, etc. (Yakuan No.80)" is used as an index

- Patients with a history or complication of cancer or malignant tumour

- Patients with chronic hepatitis type B and/or C which is positive of hepatitis B
surface antigen (HBsAg) and/or hepatitis C antibody

- Others whom the investigator or sub-investigator considers ineligible for or unable
to participate in the investigation