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Gulf War Syndrome

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Chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity ... No increased risk for SLE or fibromyalgia. Nerve agent exposure ... – PowerPoint PPT presentation

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Title: Gulf War Syndrome


1
Gulf War Syndrome
  • Exposing the Myths
  • or

2
Outline
  • History
  • Definition
  • Etiologies
  • Beliefs
  • Facts
  • Conclusions

3
History of Gulf War Syndrome
  • Tens of thousands of U.S., British, Canadian, and
    Australian soldiers experienced sudden onset of
    unexplained symptoms during or following
    deployment to Persian Gulf in 1990-91
  • Initially attributed to post-traumatic stress
    disorder
  • Psychiatric interviews did not support PTSD as
    etiology, prompting further investigation

4
What is Gulf War Syndrome?
  • No specific definition
  • No identifiable marker
  • Constellation of symptoms
  • Common complaints fatigue, joint pain, muscle
    pain, headache, cognitive problems, rash
  • Heterogeneity of symptoms group of syndromes
  • Complicated by similarity to other conditions
  • Chronic fatigue syndrome, fibromyalgia, multiple
    chemical sensitivity

5
Possible Etiologies of GWS
  • Psychiatric PTSD
  • Infectious
  • Leishmaniasis, Sand Fly Fever, Mycoplasma
  • Toxic exposure
  • Pyridostigmine bromide, sand, pesticides,
    nerve/mustard chemical weapons, depleted uranium,
    petroleum-based fuels, smoke from burning oil
    wells, vaccinations

6
Toxic Exposures
  • Increased acute respiratory symptoms seen due to
    sand exposure
  • Smoke, pesticides, and long-term effects of
    exposure to chemical warfare agents have unknown
    relationship to GWS
  • Depleted uranium exposure not appreciably higher
    than background
  • Less radioactive, toxic due to chemical properties

7
Toxic Exposures
  • Pyridostigmine bromide
  • Taken prophylactically for nerve agents
  • Can cause neurologic symptoms at high doses
  • Vaccines anthrax
  • Half of British soldiers refused vaccine prior to
    2nd Gulf War

8
Toxic Exposures
  • Sarin nerve agent
  • Declassified information from CIA demonstrated
    widespread, low-level exposure
  • GWS patients found to have decreased activity of
    paraoxonase, an enzyme that breaks down
    organophosphates
  • Autonomic nervous dysfunction
  • Animal studies show low-level exposure of Sarin
    leads to damage to deep grey matter (basal
    ganglia)
  • N-acetylaspartate levels decreased in basal
    ganglia and pons of GWS patients

9
Toxic Exposures
  • Difficult to study because no reliable metric
    exists to quantify exposure
  • Self-reporting exposure results in over-reporting

10
Beliefs and Functional Status
  • Increased impairment reported with
  • Belief that symptoms caused by anthrax
  • Requirement of medical treatment
  • Disability or worsening impairment
  • Decreased impairment reported with
  • Belief that symptoms caused by stress
  • Amelioration of symptoms with medication
  • Symptoms improvement
  • Treatment requiring a specialist

11
Beliefs and Functional Status
  • Presence of mental health symptoms (PTSD,
    depression) predicted increased frequency and
    severity of somatic symptoms
  • Model of Illness
  • Four axes seriousness, locus of control,
    controllability, changeability
  • Severe symptoms and poor function associated with
    high level of seriousness and external locus of
    control

12
GWS What we do know
  • Information based predominantly on registries
    available to Gulf War Veterans
  • Evaluation involved screening exam, medical
    record review, questionnaires, and surveys
  • Twenty studies of registry info from 1995-2002
  • Sample size ranged from 41-18,000
  • Over 130,000 veterans examined as of 2003
  • Presence of GWS always self-reported
  • Confounded by self-selection bias, recall bias,
    and media reports
  • Army, Reserve, National Guard, older, and female
    personnel more likely to report
  • Most common risk factor was deployment to Persian
    Gulf during or before the war

13
GWS What we do know
  • Gulf War veterans have increased rate of
    hospitalizations and injuries
  • Pre-existing conditions, increased risk taking
    behavior, stress, alcohol, PTSD
  • Gulf War veterans have higher rates of alcohol-,
    drug-, and stress-related disorders
  • Strongest predictor was pre-war status
  • No relationship to combat (except with EtOH)

14
GWS What we do know
  • Female Gulf War veterans found to be at increased
    risk for ectopic pregnancies and spontaneous
    abortions as compared to nondeployed peers
  • No increased rate of birth defects

15
GWS What we do know
  • Amyotrophic lateral sclerosis (ALS)
  • 18 increased risk for ALS development as
    compared with nondeployed peers
  • No increased risk for SLE or fibromyalgia
  • Nerve agent exposure
  • Subclinical exposure in March 1991 near
    Khamisiyah, Iraq
  • Relative risk of 1.23 for development of
    dysrhythmias

16
Conclusions
  • No unique constellation of signs or symptoms has
    been identified
  • Symptoms overlap with other multi-symptom
    conditions
  • No specific, etiologic exposure is evident
  • One Study There is probably a causal link
    between deployment to the Persian Gulf theater of
    operation and the development of the poorly
    defined multi-symptom illness known as GWS.

17
Conclusions
  • Gulf War veterans have increased rates of
    injuries, mental health disease, and
    multi-symptom conditions
  • Very similar to veterans from previous conflicts
  • Relationship between GWS, ALS, nerve agent
    exposure, and dysrhythmias merits further study

18
Outline
  • History
  • Definition
  • Etiologies
  • Beliefs
  • Facts
  • Conclusions

19
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20
References
  • Hunt S., Richardson R., Engel C., Atkins D., and
    M. McFall. Gulf War Veterans Illnesses A Pilot
    Study of the Relationship of Illness Beliefs to
    Symptom Severity and Functional Health Status. J
    Occup Environ Med. 2004 46818-827.
  • Gronseth G. Gulf War Syndrome A Toxic Exposure?
    A Systematic Review. Neurol Clin. 2005
    25523-540.
  • Gray G., Gackstetter G., Kang H., Graham J., and
    K. Scott. After More than 10 Years of Gulf War
    Veteran Medical Evaluations, What Have We
    Learned? Amer J of Preven Med. 2004
    26(5)443-452
  • Haley R. Gulf War Syndrome Narrowing the
    Possibilities. Neurology. 2003 2272-273
  • Kerr C. Anthrax Vaccine Gets Cold Shoulder from
    Troops. Canadian Med Assoc Journal. 2003
    168(10).
  • Young H., Simmens S., Kang H., Mahan C., and P.
    Levine. Factor Analysis of Fatiguing Syndrome in
    Gulf War Era Veterans Implications for Etiology
    and Pathogenesis. J Occup Environ Med. 2003
    451268-1273
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