Abnormally high number of Lou Gehrig's disease cases identified among Gulf War veterans

September 22, 2003

DALLAS - Sept. 23, 2003 - An unusually high number of veterans of the 1991 Gulf War are becoming ill and dying of amyotrophic lateral sclerosis (ALS), which typically does not strike until decades later in life, according to Dr. Robert Haley, chief of epidemiology at UT Southwestern Medical Center at Dallas.

A study published in today's issue of Neurology shows that veterans of the first Gulf War under the age of 45 have developed ALS, or Lou Gehrig's disease, as much as three times more frequently than those of comparable ages in the general population.

Another study by the Department of Veterans Affairs - published in the same issue of the journal - confirms Dr. Haley's findings using a different method. The VA undertook its study in 1998, one year after Dr. Haley began his investigation at the request of a 35-year-old Gulf War veteran who was diagnosed with ALS a few years after serving in the Persian Gulf. Michael Donnelly and his father, Tom, contacted Dr. Haley after learning that several other young veterans of the war also had the illness.

"This disease occurred in a very abnormal age group - in people in their 20s and 30s instead of 60s and 70s," Dr. Haley said. "It raises the question whether the condition might have been caused - or triggered prematurely - by unusual environmental exposures in the war."

The papers by Dr. Haley and VA researchers represent the first peer-reviewed studies establishing the increased incidence of ALS among Gulf War veterans.

ALS is a neurodegenerative disorder that attacks nerve cells in the brain and spinal cord, leading to muscle weakness in the arms and legs and difficulty speaking, swallowing and breathing, and eventually loss of all muscle function. It affects about 30,000 Americans, and is most commonly associated with baseball Hall of Fame member Lou Gehrig, who retired in 1939 after being diagnosed with the illness. Although Mr. Gehrig died of ALS two years later at age 37, the disorder occurs almost entirely in patients between the ages of 50 and 70, rarely appearing before age 45.

Dr. Haley identified 17 Gulf War veterans - all under 45 - who were diagnosed with ALS by neurologists between 1991 and 1998. None of them have a family history of ALS or other neurodegenerative diseases, and all of the cases have progressed to advanced stages. Eleven have died of the disease.

In order to calculate the number of expected ALS cases among the veterans, Dr. Haley used U.S. vital statistics data from 1979 to 1998. He projected that, under normal circumstances, less than one case of ALS per year would be expected to occur in the Gulf War veteran population in 1991. In subsequent years, as the population aged, the number of cases per year would be expected to increase. The projection for 1998 was 1.38 cases per year. Dr. Haley found that, in fact, there were five observed cases that year.

"The increasing slope of the epidemic curve beginning three years after the Gulf War and still increasing in 1998 further supports a true excess and raises the possibility of an even larger ALS problem in future years in the Gulf War veteran population," said Dr. Haley.

Dr. Haley also found that two-thirds of the veterans in the study had Gulf War syndrome prior to developing ALS. Dr. Haley first described Gulf War syndrome in a series of papers published in January 1997 in the Journal of the American Medical Association (JAMA). His studies traced veterans' mysterious illnesses to damage to deep brain structures from wartime exposure to combinations of chemicals, including low-level nerve agents, that drifted over thousands of soldiers when U.S. forces detonated Iraqi chemical stores. Symptoms of Gulf War syndrome include depression, difficulty concentrating, joint pain, attention and balance deficits, and chronic diarrhea.

In June 1999 Dr. Haley reported in the journal Toxicology and Applied Pharmacology that some soldiers were genetically predisposed to Gulf War syndrome. The study showed that veterans with a gene that causes them to produce high amounts of a protective enzyme called paraoxanase did not get sick after exposure to certain chemicals, while others who produce low amounts of the same enzyme did get sick. Since this enzyme is only protective against chemical nerve agents, the finding links the Gulf War syndrome with nerve-agent exposure, supporting earlier epidemiologic findings published in JAMA. It also explains why some soldiers exposed to the nerve agents in the Gulf did not develop the syndrome.

In another study published in a June 2000 issue of Radiology, Dr. Haley used advanced brain imaging to show that ill Gulf War veterans have brain cell damage in deep brain structures. Multiple studies published in peer-reviewed journals after Dr. Haley's initial studies have corroborated these findings.

The new study shows a more serious brain disease emerging from the Gulf War.

Two years ago, after meeting with Dr. Haley and VA researchers, VA Secretary Anthony Principi approved full benefits for Gulf War veterans diagnosed with ALS based on initial findings of the two studies.

"I am committed to doing research that provides a better understanding of diseases that affect veterans and providing disability compensation as early as possible," Mr. Principi said at the time. "I intend to make certain that VA's medical resources and research capabilities are fully focused on this issue."

Dr. Haley said, "Taking such action before a published study on the subject was a courageous move that allowed ill veterans to get help at the earliest possible date. The publication of these two studies vindicates his decision."

Dr. Haley said it is likely that the ALS cases he studied represent less than half the true number of young Gulf War veterans with the disease. The VA study identified 40 cases in young Gulf War veterans.
-end-
The Haley-led study was funded by a grant from the Perot Foundation.

To automatically receive news releases from UT Southwestern via e-mail, subscribe at http://lists.utsouthwestern.edu/mailman/listinfo/utswnews.

UT Southwestern Medical Center

Related Amyotrophic Lateral Sclerosis Articles from Brightsurf:

Converting lateral scanning into axial focusing to speed up 3D microscopy
In optical microscopy, high-speed volumetric imaging is limited by either the slow axial scanning rate or aberrations introduced by the z-scanning mechanism.

Ammonium triggers formation of lateral roots
Despite the importance of changes in root architecture to exploit local nutrient patches, mechanisms integrating external nutrient signals into the root developmental program remain poorly understood.

'Reelin' in a new treatment for multiple sclerosis
In an animal model of multiple sclerosis (MS), decreasing the amount of a protein made in the liver significantly protected against development of the disease's characteristic symptoms and promoted recovery in symptomatic animals, UTSW scientists report.

Adjustable lordotic expandable vs static lateral lumbar interbody fusion devices
The objective of this study is to compare the clinical and radiographic outcomes between patients treated with static and expandable interbody spacers with adjustable lordosis for MIS LLIF.

Chirality-assisted lateral momentum transfer for bidirectional enantioselective separation
Chiral nanoparticles which twist the light were theoretically predicted to experience lateral forces perpendicular to light vector but lacks experimental verification.

Not all multiple sclerosis-like diseases are alike
Scientists say some myelin-damaging disorders have a distinctive pathology that groups them into a unique disease entity.

Researchers delay onset of amyotrophic lateral sclerosis (ALS) in laboratory models
Scientists have delayed the onset of amyotrophic lateral sclerosis (ALS) in laboratory models, leaving them cautiously optimistic that the result, combined with other clinical advances, points to a potential treatment for ALS in humans.

Emerging role of adenosine in brain disorders and amyotrophic lateral sclerosis
The role of adenosine in neurodegeneration and neuroregeneration has led to growing attention on adenosine receptors as potential drug targets in a range of brain disorders, including neuroregenerative therapy and treatment for amyotrophyic lateral sclerosis (ALS).

New clues about the origins of familial forms of Amyotrophic lateral sclerosis
A Brazilian study made important progress in understanding the accumulation of one of the proteins involved in amyotrophic lateral sclerosis (ALS).

Recrutement of a lateral root developmental pathway into root nodule formation of legumes
Peas and other legumes develop spherical or cylindrical structures -- called nodules -- in their roots to establish a mutually beneficial relationship with bacteria that convert atmospheric nitrogen into a useable nutrient for the legume plant.

Read More: Amyotrophic Lateral Sclerosis News and Amyotrophic Lateral Sclerosis Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.