LOS ANGELES, 24 September 2003 — Veterans of the 1991 Gulf War appear to have a significantly higher risk of the neuromuscular disease amyotrophic lateral sclerosis, better known as Lou Gehrig’s disease, according to two new studies.
The findings, being published in the journal Neurology, found that the fatal disease occurred roughly twice as often in Gulf War veterans compared to civilians and military personnel not deployed to the Gulf.
While the actual number of veterans with ALS was very small in relation to the 700,000 troops who served in the war, the number was still unexpected because ALS is extremely rare and predominantly affects older adults.
The reason for the heightened ALS risk is unknown, but scientists speculate that it may be linked to Gulf War syndrome, an array of far less severe symptoms — including fatigue, memory loss, headaches and joint pain — reported by many veterans after the 1991 conflict.
Gulf War syndrome itself remains a mystery. A variety of potential causes have been offered to explain the numerous reports of veteran health problems, among them exposure to depleted uranium, insecticides or toxic sarin nerve gas that was released by the bombing of Iraqi chemical munitions stores.
The two studies were conducted by Dr. Robert Haley, chief of epidemiology at the University of Texas Southwestern Medical Center in Dallas, and a team led by Ronnie Horner, an epidemiologist with the National Institute of Neurological Disorders and Stroke.
The second study by the US Department of Veterans Affairs and National Institutes of Health reaches similar conclusions as Dr. Haley.
The VA released its preliminary findings in December 2001. “VA has contacted the Gulf War veterans identified in the study to help them file new claims or to expedite existing claims. We have granted disability to 37 Gulf conflict veterans for ALS,” a VA spokesman said. Haley said the finding was significant because it was “only the third real cluster of ALS cases that’s ever been documented.”
“One of the prime suspects in civilian ALS is organophosphate pesticides. Guess what Sarin is? It is an organophosphate pesticide for humans,” he said.
Haley, who has studied Gulf War illnesses since the mid-1990s, said he initiated his study after being approached in 1997 by a 35-year-old Gulf War veteran who had developed ALS.
Haley eventually identified 20 such cases among those who had seen active duty in the Gulf, 17 of them in people less than 45 years of age (ALS is usually diagnosed in people age 45 or older.) Two-thirds of these patients had also reported suffering from Gulf War syndrome, Haley said.
Horner’s group identified 40 people with ALS who had been deployed to the Gulf.
In both studies, ALS was not associated with any particular mission or region of the country, although Horner’s study reported a more than two-fold increased rate among Air Force personnel.
ALS is a disease in which nerves controlling movement slowly degenerate, causing muscles to waste and progressive movement problems leading to paralysis and finally death.
There is no known cure for the disease, which affects an estimated 20,000 Americans.
Dr. Beatrice Golomb, assistant professor of medicine at the University of California, San Diego, said the findings being reported Tuesday are important because they provide the first clearly defined disease that has been linked to serving in the 1991 Gulf War.
But Dr. Michael Rose, a neurologist at King’s College Hospital in London, cautioned that the number of veterans with ALS was small, and that epidemiology with such small numbers is tricky and prone to error.
For instance, he said, the numbers could be distorted if people with ALS who served in the Gulf were more likely to come forward and identify themselves compared with people who were not deployed to the Gulf.
“It doesn’t matter how hard you work or how conscientious you are,” Rose said. “If there’s anything slightly wrong with the methodology, then that figure of twice the risk could vanish.”
Earlier this year the Institute of Medicine reported that not enough studies have been done to link pesticides or any other chemicals to Gulf War Syndrome, a poorly defined group of illnesses seen in many veterans of the 1991 conflict.
