The full report is available online at www.va.gov/RAC-GWVI.
It's been a long time coming for veterans whose health complaints have been met with skepticism, but a federal panel has determined that Gulf War syndrome is not only real, it is tied to two causes: exposure to pyridostigmine bromide and certain pesticides during the 1990–1991 Persian Gulf War.
Members of the federal Research Advisory Committee on Gulf War Veterans' Illnesses that wrote the 450+ page report also called for research efforts to shift away from establishing the existence of a Gulf War syndrome to focus on treatment and diagnostic tests. “There's no way to say that [Gulf War illness] is not real at this point,” said Lea Steele, Ph.D., an epidemiologist and faculty member at Kansas State University, Manhattan, and a member of the committee that prepared the report.
However, that doesn't mean the condition is any easier to diagnose. In an interview, Dr. Steele said that routine neurologic examinations and standard EEG tests, CT scans, MRI scans, and peripheral nerve testing seldom identify clinical abnormalities related to Gulf War illness, though they can be useful in ruling out other conditions. “Research studies have identified a number of central and autonomic alterations in symptomatic veterans that distinguish groups of ill veterans from healthy controls. None of these findings has yet resulted in clinical diagnostic tests, however,” she added.
And although neuropsychologic testing may provide objective measures of neurocognitive impairment in some, that isn't the case in all symptomatic veterans.
“It is important that neurologists listen carefully to patients who served in the Gulf War who exhibit symptoms consistent with Gulf War illness, and provide evaluations aimed at identifying or ruling out diagnosable problems—both neurological and psychiatric,” she said.
At least a quarter of the nearly 700,000 U.S. military members who served in the Gulf War have experienced some type of chronic, multisymptom illness since returning home. The symptoms are not explained by established medical diagnoses and typically include a combination of memory and concentration problems, widespread pain, and unexplained fatigue, and can include chronic diarrhea, skin rashes, and respiratory problems. According to Dr. Steele, persistent migraines also are reported at significantly increased rates in Gulf War veterans, and studies suggest that some symptomatic veterans are affected by seizures and sleep disorders. Posttraumatic stress disorder and depression also are present in a minority of symptomatic veterans.
Dr. Steele expressed concern that veterans with the illness “often had difficulty obtaining supportive treatment from clinicians who are knowledgeable about their condition and/or familiar with treatment options that can be useful. “Veterans report that clinicians frequently are dismissive of their symptoms.”
These panel's conclusions are based on an analysis of available evidence on Gulf War illnesses. The committee consulted about 1,600 sources for its current report, said Roberta F. White, Ph.D., the scientific director of the committee and chair of the department of environmental health at the Boston University School of Public Health.
It's the large number of sources reviewed that allowed the committee to reach a conclusion on the existence and causes of Gulf War illness where others have not, Dr. White said. For example, a 2006 report from the Institute of Medicine did not find evidence of a definitive link between reports of multisymptom illness and Gulf War service. The IOM committee cited a lack of objective predeployment health information as one reason why they could not reach a more definitive conclusion about the issue.
Now that the syndrome's existence has been confirmed, it's time to focus research efforts on the development of diagnostic tests and treatments, according to the committee members.
“We need to be solving the problem now, not debating the problem,” Dr. Steele said.
There are no proven treatments currently available for Gulf War illness. But some promising research efforts were recently started at the Departments of Defense and Veterans Affairs, the report said.
Researchers do have ideas about what could work, and there are some alternative medicine treatments that veterans have been trying, Dr. White said. All of these ideas need to be aggressively pursued through clinical trials, she said.
Dr. Steele added that current treatment for veterans with signs of Gulf War illness mostly centers around alleviating symptoms such as persistent pain, migraines, disordered sleep, and mood difficulties. And although the Departments of Defense and Veterans Affairs provided guidelines for treating undiagnosed symptomatic illness in Gulf War veterans in 2001 (based largely on treatments for chronic fatigue and fibromyalgia), “very little research has been conducted to evaluate treatments for Gulf War illness,” said Dr. Steele.
“Published studies indicate limited or no benefit with cognitive-behavioral therapy and a graded exercise interventions,” she said. Antibiotics for persistent diarrhea, continuous positive airway pressure (CPAP) for disordered sleep, and CoQ-10 to address fatigue and other symptoms have also been considered.
The committee also called on Congress to allocate at least $60 million annually for the federal government's Gulf War research portfolio. Since 1994, the federal government has spent more than $440 million on Gulf War research primarily at the Departments of Defense and Veterans Affairs, but in recent years the budgets in both agencies have been cut. In 2006, DOD spent just $5 million and the VA spent $4 million on research related to the Gulf War.
At press time, officials at the VA and members of the VA committees in Congress were reviewing the report.
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