Gulf War syndrome


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Gulf War Syndrome

 

Definition

Gulf War syndrome describes a wide spectrum of illnesses and symptoms ranging from asthma to sexual dysfunction that have been reported by U.S. and U.S. allied soldiers who served in the Persian Gulf War in 1990–1991.

Description

Between 1994 and 1999, 145 federally funded research studies on Gulf War-related illnesses were undertaken at a cost of over $133 million. Despite this investment and the data collected from over 100,000 veterans who have registered with the Department of Defense (DOD) and/or Veterans Administration (VA) as having Gulf War-related illnesses, there is still much debate over the origin and nature of Gulf War syndrome. As of early 2001, the DOD has failed to establish a definite cause for the disorder. Veterans who have the illness experience a wide range of debilitating symptoms that elude a single diagnosis. Common symptoms include fatigue, trouble breathing, headaches, disturbed sleep, memory loss, and lack of concentration. Similar experiences among Gulf War veterans have been reported in the United Kingdom and Canada.

Causes and symptoms

There is much current debate over a possible causative agent for Gulf War syndrome other than the stress of warfare. Intensive efforts by the Veterans Administration and other public and private institutions have investigated a wide range of potential factors. These include chemical and biological weapons, the immunizations and preventive treatments used to protect against them, smoke from oil well fires, exposure to depleted uranium, and diseases endemic to the Arabian peninsula. So far investigators have not approached a consensus. In its final report released in December 2000, the Presidential Special Oversight Board for Department of Defense Investigations of Gulf War Chemical and Biological Incidents cited combat stress as a possible causative factor, but called for further research. There is also a likelihood that U.S. and allied forces were exposed to low levels of sarin and/or cyclosarin (nerve gases) released during the destruction of Iraqi munitions at Kharnisiyah, Iraq, and that these chemicals might be linked to the syndrome. In July 1997, the VA informed approximately 100,000 U.S. servicemen of their possible exposure to the nerve agents.
In October 1999, the U.S. Pentagon released a report that hypothesized that an experimental drug known as pyriostigmine bromide (PB) might be linked to the physical symptoms manifested in Gulf War Syndrome. The experimental drug was given to U.S. and Canadian troops during the war to protect soldiers against the effects of the chemical nerve agent soman. It has also been suggested that botulinum toxoid and anthrax vaccinations administered to soldiers during the conflict may be responsible for some manifestations of the syndrome.
Some studies have shown that Gulf War veterans have a higher incidence of positive tests for Mycoplasma fermentans, a bacteria, in their bloodstream. However, other clinical studies have not found a link between the bacterial infection and Gulf War-related illnesses.
Statistical analysis tells us that the following symptoms are about twice as likely to appear in Gulf War veterans than in their non-combat peers: depression, posttraumatic stress disorder (PTSD), chronic fatigue, cognitive dysfunction (diminished ability to calculate, order thoughts, evaluate, learn, and remember), bronchitis, asthma, fibromyalgia, alcohol abuse, anxiety, and sexual discomfort. PTSD is the modern equivalent of shell shock (World War I) and battle fatigue (World War II). It encompasses most of the psychological symptoms of war veterans, including nightmares, panic at sudden loud noises, and inability to adjust to peacetime living. Chronic fatigue syndrome has a specific medical definition that attempts to separate common fatigue from a more disabling illness in hope of finding a specific cause. Fibromyalgia is another newly defined syndrome, and as such it has arbitrarily rigid defining characteristics. These include a certain duration of illness, a specified minimum number of joint and muscle pain located in designated areas of the body, sleep disturbances, and other associated symptoms and signs.
Researchers have identified three distinct syndromes and several variations in Gulf War veterans. Type one patients suffer primarily from impaired thinking. Type two patients have a greater degree of confusion and ataxia (loss of coordination). Type three patients were the most affected by joint pains, muscle pains, and extremity paresthesias (unnatural sensations like burning or tingling in the arms and legs). In each of the three types, researchers found different but measurable impairments on objective testing of neurological function. The business of the nervous system is much more complex and subtle than other body functions. Measuring it requires equally complex effort. The tests used in this study carefully measured and compared localized nerve performance at several different tasks against the same values in normal subjects. Brain wave response to noise and touch, eye muscle response to spinning, and caloric testing (stimulation of the ear with warm and cold water, which causes vertigo) were clearly different between the normal and the test subjects. The researchers concluded that there was "a generalized injury to the nervous system." Another research group concluded their study by stating that there was "a spectrum of neurologic injury involving the central, peripheral, and autonomic nervous systems."

Diagnosis

Until there is a clear definition of the disease, diagnosis is primarily an exercise in identifying those Gulf War veterans who have undefined illness in an effort to learn more about them and their symptoms. Both the Department of Defense and the Veterans Administration currently have programs devoted to this problem. Both the DOD's Comprehensive Clinical Evaluation Program and the VA's Persian Gulf Registry provide free, in-depth medical evaluations to Gulf War veterans and their families. In addition to providing individual veterans with critical medical care, these organizations use the cumulative data from these programs to advance research on Gulf War Syndrome itself.

Treatment

Specific treatment awaits specific diagnosis and identification of a causative agent. Meanwhile, veterans can benefit from the wide variety of supportive and non-specific approaches to this and similar problems. There are many drugs available for symptomatic relief. Psychological counseling by those specializing in this area can be immensely beneficial, even life-saving for those contemplating suicide. Veterans' benefits are available for those who are impaired by their symptoms.

Alternative treatment

The symptoms can be worked with using many modalities of alternative health care. The key to working successfully with people living their lives with Gulf War syndrome is long-term, ongoing care, whether it be hypnotherapy, acupuncture, homeopathy, nutrition, vitamin/mineral therapy, or bodywork.
Experimental treatment with antibiotics is advocated by some healthcare professionals who believe that Gulf War illness is related to a Mycoplasma fermentans bacterial infection. However, a conclusive link has not been clinically proven.

Prognosis

The outlook for Persian Gulf War veterans is unclear, but will hopefully improve as more information is gathered about the illness. Gradual return to a functioning life may take many years of work and much help. It is important to note that even in the absence of an identifiable and curable cause, recovery is possible.

Key terms

Ataxia — Lack of coordination.
Caloric testing — Flushing warm and cold water into the ear stimulates the labyrinth and causes vertigo and nystagmus if all the nerve pathways are intact.
Endemic — Always there.
Paresthesia — An altered sensation often described as burning, tingling, or pin pricks.
Syndrome — Common features of a disease or features that appear together often enough to suggest they may represent a single, as yet unknown, disease entity. When a syndrome is first identified, an attempt is made to define it as strictly as possible, even to the exclusion of some cases, in order to separate out a pure enough sample to study. This process is most likely to identify a cause, a positive method of diagnosis, and a treatment. Later on, less typical cases can be considered.

Resources

Books

Wheelwright, Jeff. The Irritable Heart. New York: W.W. Norton & Co., 2001.

Organizations

The American Legion. Gulf War Veteran Issues. 〈http://www.legion.org/gulftoc.htm〉.
Office of the Special Assistant for Gulf War Illnesses. 5113 Leesburg Pike, Suite 901, Falls Church, VA, 22041. (703) 578-8518. http://www.gulflink.osd.mil.
U.S. Department of Defense. Comprehensive Clinical Evaluation Program (CCEP). (800) 796-9699.
Veterans Administration. Persian Gulf Medical Information Helpline. 400 South 18th Street, St. Louis, Missouri 63103-2271. (800)749-8387.
Veterans Administration. Persian Gulf Registry. (800)PGW-VETS (800) 749-8387. http://www.va.gov.

Other

Office of the Special Assistant for Gulf War Illnesses. Fourth Annual Report: Office of the Special Assistant for Gulf War Illnesses. Falls Church, VA: Office of the Special Assistant for Gulf War Illnesses, 2000. http://www.gulflink.osd.mil/library/annual/4thannual_report_jan01.htm.

Gulf War syndrome

a syndrome of various health problems experienced by U.S. military personnel after serving in the Persian Gulf conflict of 1991; includes fatigue, musculoskeletal pain, headaches, dyspnea, memory loss, and diarrhea; thought to be related to exposure to low levels of neurotoxins, including sarin, pesticides, and pyridostigmine bromide (the latter supplied to troops as a protective anti-toxin).

Gulf War syndrome

or

Gulf War illness

n.
A medical condition that has been reported in some veterans of the Gulf War, characterized by a multitude of symptoms including chronic fatigue, headache, joint pain, eczema, dyspepsia, neurologic dysfunction, and respiratory disorders, and attributed to exposure to toxic chemicals.

Gulf War syndrome

a group of medical and psychological complaints, including fatigue, skin rash, memory loss, and headaches, experienced by men and women who served in the 1991 Persian Gulf War. Researchers observed similar physical effects in laboratory animals exposed to a mixture of cholinesterase inhibitor insecticides and pyridostigmine; soldiers were exposed to both agents during the war.
A condition described in veterans of the Gulf War

Gulf War syndrome

Military medicine A condition described in veterans of the Gulf War Clinical Fever, headache, ↓ short-term memory, loss of vision, SOB, coughing, diarrhea, skin changes, bleeding gums, loss of hair and teeth, numbness, tingling, aching joints, fatigue
Gulf War syndromes
Impaired cognition syndrome Sx include distractibility, memory loss, depression, insomnia, fatigue, slurring of speech, mental confusion, migraine-like headaches
Confusion-ataxia syndrome Defects in thinking, balance, reasoning ability, confusion, disorientation, carrying a diagnosis of posttraumatic stress diorder, depression, liver disease, and sexual impotence
Arthromyoneuropathy syndrome Generalized joint & muscle pain, ↑ difficulty in lifting heavy objects, fatigue, tingling/numbness of hands, feet, arms, legs AMN 20/1/97, p18, from 15/1/97 JAMA

Gulf War syn·drome

(gŭlf wōr sin'drōm)
A constellation of findings (e.g., dermatologic disorders, mental problems) comprising a condition experienced by those who fought in the first Gulf War in 1990; still subject to diagnostic dispute by some clinicians.

Gulf war syndrome

A disorder, or group of disorders as yet unproven to be related to service in the Persian Gulf War against Iraq of early 1991. About 1500 UK troops and many more Americans are convinced that they, and even, in some cases, their subsequently-born children, suffered, or suffer, one or other of a wide variety of disorders as a result of this military service. Most believe these to be caused by the large range of vaccines and drugs given to them as protection against possible biological and chemical warfare, or by exposure to organophosphate agents. The matter has been the subject of long study in the United States by a Presidential Advisory Committee which submitted its final report in September 1997. No single cause had been found and the Committee suggested that stress was the most likely explanation for post-Gulf war symptoms experienced by miliary personnel. This opinion is hotly challenged by many.
References in periodicals archive ?
Janet refused to give up and last month a Pensions' Appeal Tribunal in Edinburgh ruled that the "injury on which the claim was based, Gulf War Syndrome, was attributable to service".
After plotting the subtle alterations in heart function using a mathematical technique called spectral analysis, researchers found that parasympathetic brain function, which usually peaks during sleep, barely changed in veterans with Gulf War syndrome even though they appeared to be sleeping.
SICKNESS: Premature baby Scott Bowen may be the youngest sufferer of Gulf War Syndrome according to his parents Victoria and Justin,below, who both served in Iraq
The group is awaiting a High Court judgment on the Ministry of Defence's appeal against the award of a pension for Gulf War Syndrome to a former soldier.
According to Showalter, hysteria lives on in conditions like chronic fatigue and Gulf War syndrome.
Like many vets afflicted with Gulf War Syndrome, Lovett suffers from a variety of ailments, including arthritis, congestive heart failure, seizure disorder, and thyroid troubles.
On September 7, the US Institute of Medicine announced that, despite a comprehensive investigation, it was unable to identify a "single cause" for the Gulf War Syndrome that plagues 90,000 veterans.
Fifty ex-servicemen and relatives and friends of Gulf War Syndrome victims marched through Central London to Downing Street to hand over a 2,000 name petition backing the call for an investigation.
Memorial Day Weekend Showing Documents Gulf War Syndrome
On closer examination, diagnoses of Gulf War syndrome are often replaced by findings of depression, stress reactions, and related disturbances, reports a team led by internist Michael J.
The cover of the November 1995 edition, for instance, featured a bare-chested man next to the headline GULF WAR SYNDROME AND THE AIDS COVER-UP.
who has butted heads with the Pentagon repeatedly on Gulf War syndrome, says that regardless of whether the ailments are attributable to stress or, as he believes is more likely, physiological causes, "We can't just walk away.