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Gulf War Fallout Still Sizzles

British study casts doubt on 'syndrome'; U.S. expert disagrees

MONDAY, Nov. 25, 2002 (HealthDayNews) -- The Gulf War officially ended more than a decade ago, but the battle over the illness some say it left in its wake rages on.

The argument, centering on whether Gulf War Syndrome actually exists, has just been refueled by a new study out of Britain that concludes the syndrome probably doesn't exist and, if it does, it is not neurologically based.

In tomorrow's issue of the journal Neurology, London researchers report that they tested veterans for neuromuscular abnormalities but found no Gulf War association with specific impairments of the peripheral nerves, neuromuscular junction or skeletal muscles.

"We approached the study with an open mind, without any preconceptions about the outcome," says the study's author, Dr. Mo Sharief, a consultant neurologist at Guy's Hospital. "It is quite reassuring that we did not find any objective or progressive neurological damage that might have been contributing to the veterans' symptoms."

But an American expert who has done his own research calls the new study "entirely invalid."

"By the case definition, there were few, if any, patients with true Gulf War Syndrome" included in the British study, says Dr. Robert W. Haley, a professor of internal medicine at the University of Texas Southwestern Medical Center who believes that the syndrome exists.

Sharief says he doesn't know what is causing some veterans to report a variety of neurological symptoms. "I do not have the necessary psychological data to speculate as to whether some of these symptoms were psychosomatic in nature. I cannot really explain why many Gulf veterans have reported similar neuromuscular symptoms," he says.

But Haley says he thinks he knows what is causing them. The "strongest association is with low-level nerve gas," he says.

The British study did not look at causality, but impairment, and it found very little. The researchers recruited randomly selected military men from the Royal Navy, Army and Royal Air Force, including those deployed to the Gulf region during conflict, those sent to Bosnia during conflict there, and those who served during the Gulf War but were not sent there.

Of the 110 participants, 26 were "healthy" Gulf War veterans, 49 were symptomatic Gulf War veterans, 13 were symptomatic Bosnian veterans and 22 were symptomatic men not sent to the Gulf.

The men with symptoms complained of fatigue, joint stiffness, muscle weakness, muscle pain, sensory symptoms such as numbness, and autonomic symptoms including disturbances of the bladder.

All underwent a battery of neurological tests. Sharief says they "comprehensively employed all neurophysiologic tests that could be used to investigate human disease." The study found no abnormalities in any of the men, although a few participants in each group were found to have carpal tunnel syndrome. Across the board, the Gulf War veterans fared similarly to all other groups.

"There is no objective evidence of disease in Gulf War veterans who are suffering from neuromuscular symptoms," Sharief says. "Our results should encourage debate as to whether we should look for other causes, and if so, how and where."

However, Haley says the British researchers failed to include anyone who was very sick in their study, and he goes so far as to suggest they might have done that deliberately.

"In medicine, everybody wants this disease to go away," he says.

He adds that the British researchers allowed into the study "people with mild problems of any nature."

Sharief responds, "The neuromuscular questionnaire that was used included all the symptoms that have ever been reported in relation to the Gulf War conflict. These symptoms have been validated in previous articles."

He says, however, that, whatever the cause, "efforts should be made to help the veterans cope with their symptoms, either through appropriate health care provisions or disability."

The UK Ministry of Defense funded the study.

What To Do

Here's a different view about the syndrome from the American Medical Association and another from the Department of Defense.

SOURCES: Mo Sharief, M.D., consultant neurologist, Guy's Hospital, London, U.K.; Robert Haley, M.D., professor of internal medicine, University of Texas Southwestern Medical Center, Dallas; Nov. 26, 2002, Neurology
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