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 U.S. Department of Veterans Affairs (VA) as having Gulf War-related illnesses, there is still much debate over the origin and nature of Gulf War syndrome. The VA position as of 2012 was that it preferred not to use the term Gulf War syndrome because symptoms vary widely and do not, therefore, meet the definition of a syndrome. It instead preferred the term medically unexplained illnesses. Veterans who have the condition experience a wide range of debilitating symptoms, including fatigue, difficulty 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, although these additional cases have not made the syndrome any easier to define.

Causes and symptoms

There is much current debate over a possible causative agent for Gulf War syndrome other than the stress of warfare. The VA 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. As of 2000 investigators had 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 was 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.

Some studies have shown that Gulf War veterans have a higher incidence of positive tests for Mycoplasma fermentans, a bacterium, in their bloodstream. However, other clinical studies have not found a link between the bacterial infection and Gulf War-related illnesses.

Statistical analysis suggests that the following symptoms are about twice as likely to appear in Gulf War veterans as in their noncombat 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 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 pains located in designated areas of the body, sleep disturbances, and other associated symptoms and signs.

Researchers 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 are 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 nervous system is much more complex and subtle than other body functions. Measuring it requires equally complex methods. 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 that there was “a spectrum of neurologic injury involving the central, peripheral, and autonomic nervous systems.”

KEY TERMS
Ataxia—
Lack of coordination.
Caloric testing—
Flushing warm and cold water into the ear to stimulate the labyrinth and cause vertigo and nystagmus if all the nerve pathways are intact.
Endemic—
Always present.
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 identify samples 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.

Diagnosis

Diagnosis requires 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 VA have programs devoted to this problem. Both the DOD Comprehensive Clinical Evaluation Program and the VA 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

QUESTIONS TO ASK YOUR DOCTOR

Alternative treatment

The symptoms can be worked with using many modalities of alternative health care. The key to working successfully with people living 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 had not been clinically proven as of 2012.

Prognosis

The outlook for Persian Gulf War veterans is unclear but is likely to 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.

Public health role and response

A number of federal, state, and local public health agencies have been intimately involved in the study of Gulf War syndrome because of its widespread occurrence in the population of men and women who served in the Gulf War. The approach to finding the causative agent(s) for that condition is a classical example of the way in which public health authorities use population data about symptoms, exposure, and other disease-related factors to identify the cause of a disease and determine ways by which that disease can be treated. Perhaps the most fundamental finding about Gulf War syndrome from this type of research has been that no single cause appears to exist, accounting for the reluctance of the VA to use the term Gulf War syndrome. That discovery has not in any way, however, limited the range of treatments that have been developed for individuals who suffer from symptoms generally covered by the term Gulf War syndrome and the programs of education and outreach developed and implemented by public health authorities at all levels of government.

See also Anthrax ; Asthma ; Bronchitis ; Endemic .

Resources

BOOKS

Committee on Gulf War and Health. Gulf War and Health, Vol. 8: Update on Health Effect of Serving in the Gulf War. Washington, DC: National Academies Press, 2010.

Gulf War Syndrome: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego: ICON Health, 2004.

Kilshaw, Susie. Impotent Warriors: Perspectives on Gulf War Syndrome, Vulnerability, and Masculinity. New York: Berghahn Books, 2010.

Pall, Martin L. Explaining “Unexplained Illnesses”: Disease Paradigm for Chronic Fatigue Syndrome, Multiple Chemical Sensitivity, Fibromyalgia, Post–Traumatic Stress Disorder, and Gulf War Syndrome. Binghamton, NY: Harrington Park Press, 2007.

PERIODICALS

Li, Bo, et al. “Longitudinal Health Study of U.S. 1991 Gulf War Veterans: Changes in Health Status at 10-Year Follow-up.” American Journal of Epidemiology 174, no. 7 (2011): 761–68.

Steele, L., et al. “Complex Factors in the Etiology of Gulf War Illness: Wartime Exposures and Risk Factors in Veteran Subgroups.” Environmental Health Perspectives 120, no. 1 (2012): 112–18.

Tillman, G. D., et al. “Impaired Response Inhibition in Ill Gulf War Veterans.” Journal of the Neurological Sciences 297, nos. 1–2 (2010): 1–5.

WEBSITES

Military.com . “Gulf War Syndrome.” http://www.military.com/benefits/veterans-health-care/gulf-war-syndrome.html (accessed September 21, 2012).

Research Advisory Committee on Gulf War Veterans' Illnesses. “Gulf War Illness and the Health of Gulf War Veterans.” http://www.va.gov/gulfwaradvisorycommittee/docs/GWIandHealthofGWVeterans_RAC-GWVIReport_2008.pdf (accessed September 21, 2012).

Veterans Today. “Gulf War Illness (GWI).” http://www.veteranstoday.com/category/medical-and-health/gulf-war-illness-gwi/ (accessed on September 21, 2012).

ORGANIZATIONS

American Legion, 700 N Pennsylvania St., Indianapolis, IN, 46206, (800) 433-3318, http://www.legion.org .

Office of the Special Assistant for Gulf War Illnesses, Force Health Protection & Readiness Policy & Programs Four Skyline Place, 5113 Leesburg Pike, Ste. 901, Falls Church, VA, 22041, (800) 497-6261, http://www.gulflink.osd.mil .

U.S. Department of Veterans Affairs, 810 Vermont Ave. NW, Washington, DC, 20420, (877) 222-8387, http://www.publichealth.va.gov .

Paula Anne Ford-Martin
Ken R. Wells

  This information is not a tool for self-diagnosis or a substitute for professional care.