Veterans of the 1990–1991 Persian Gulf War may be at increased risk for developing amyotrophic lateral sclerosis as well as psychological conditions, according to a report by the Institute of Medicine.
The link between military service in the Gulf and developing amyotrophic lateral sclerosis (ALS) is still inconclusive, but the committee that prepared the Institute of Medicine (IOM) report called for follow-up studies to evaluate the prevalence of the condition among Gulf War veterans.
The report is based on a review of 850 studies including both self-reported data from veterans and studies using objective measures of symptoms and exposures. Released in September, the report was sponsored by the Department of Veterans Affairs (VA).
The IOM committee did not find evidence to declare a definitive link between reports of multisymptom illness and Gulf War service. Although nearly 30% of Gulf War veterans reported that they experienced some type of multisymptom illness, compared with about 16% among nondeployed veterans, there were no objective test results to support those reports, the IOM committee wrote. The multisymptom conditions that were reported more commonly among Gulf War veterans include fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity.
The report also notes that there is no single unique cluster of symptoms that make up Gulf War illness.
“Gulf War veterans consistently report experiencing a wide range of symptoms, and this is the case for both American veterans and military personnel from Canada, Australia, and other countries who served in the Persian Gulf,” Dr. Lynn R. Goldman, IOM committee chair and professor of occupational and environmental health at Johns Hopkins University in Baltimore, said in a statement.
The symptoms “do not point to a syndrome unique to these veterans. Unfortunately, because of the lack of objective predeployment health information, we do not have the baseline data needed to draw more definitive conclusions about many aspects of these veterans' long-term health.”
The idea that there is no unique Gulf War syndrome is “sort of a side issue,” said Lea Steele, Ph.D., an epidemiologist at Kansas State University, Manhattan. Veterans continue to be sick and to have unexplained symptoms, said Dr. Steele, who is also the scientific director of the congressionally chartered Research Advisory Committee on Gulf War Veterans' Illnesses.
Currently, most veterans are being treated for symptoms, but there have been few treatment studies to date, Dr. Steele said.
Research in the area of veterans' multisymptom illnesses has been challenging, said Dr. Samuel J. Potolicchio, professor of neurology at George Washington University in Washington, and a member of the IOM committee that wrote the report. Part of the problem is that the syndromes are ill defined and there is no test to diagnose these problems, he said.
The IOM committee also found that:
▸ Deployment to the Gulf puts veterans at increased risk for posttraumatic stress disorder, anxiety, depression, and substance abuse.
▸ There does not appear to be an increase in the prevalence of peripheral neuropathy in deployed Gulf War veterans, compared with their nondeployed counterparts. This finding is based on history, physical examination, and electrophysiologic studies.
▸ There was no statistically significant difference in the rates of hypertension between deployed and nondeployed veterans in primary studies.
▸ Two studies have shown some evidence of an increased risk for birth defects in the offspring of Gulf War veterans, but the studies have been difficult to interpret, according to the IOM report. Urinary tract abnormalities are the only set of defects that has been found in more than one well-designed study, the report said.
The report is available at www.iom.edu.
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