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Question answered:26/04/02 Warning! this question is over two years old.
Merck manual has a section on Gulf War syndrome (1). They state:
"Most cases lack objective clinical findings, but in some, physical illness is demonstrable and often severe. The diversity of complaints makes study difficult. Epidemiologic studies have not documented clear-cut exposure to pathogens or excess mortality (other than from injuries) in the exposed population, and descriptive studies have used self-reported complaints rather than objective measures.
The etiology is unknown. Gulf War veterans potentially experienced either separate multiple exposures to an individual agent or one or more exposures to a combination of chemical weapons, insecticides, vaccines, smoke from burning oil, and other toxic compounds. However, none of these exposures has been convincingly linked to causation or illness.
Symptoms are predominantly neurologic, and although many tend to fall into several overlapping patterns, they consist primarily of impaired cognition with problems of attention, memory, reasoning, insomnia, depression, fatigue, and headaches. Complaints of disorientation, balance disturbances, vertigo, impotence, muscle pains, muscle fatigue, weakness, and paresthesias are also common.
Diagnosis and treatment cannot be established because the etiology and mechanisms are not yet clinically defined. Evaluation of Gulf War veterans should be guided by specific complaints, and treatment chosen by the results of that evaluation
BMJ published a paper in 1999 that reported clinical findings from the first 100 Gulf war veterans in the MoDs medical assessment programme (1). The authors state that they were unable to give an estimate of the prevalence of the condition as the participants were volunteers rather than randomly selected.
The assessment process included an initial questionnaire about their military service and relevant experiences in the Gulf, including exposure to potentially harmful factors. The routine test administered included
- Full blood count
- Blood chemistry tests: urea and electrolytes, liver function, thyroid function, serum calcium and phosphate, creatinine, C reactive protein, creatine phosphokinase, sugar, immunoglobulins, serum electrophoresis
- Serology tests: amoebic indirect fluorescent antibody test, tests for borrelia, brucella, and cytomegalovirus, phase 2 complement fixation test for coxiella, test for Epstein-Barr virus, enterovirus screen, tests for Leishmaniasis A and B, Lyme disease, and sandfly fever
- Urine analysis, including midstream urine, for microscopy and culture
- Electrocardiography
- Chest radiography
- Abdominal ultrasonography
- Lung function tests
They report the same cluster of complaints as listed by the Merck manual postulate that some of the illnesses could be attributed to a general postwar syndrome as opposed to a specific Gulf war syndrome.
Chalder et al reported their study on the prevalence of the syndrome amongst Gulf War veterans (3). They sent 4250 questionnaires to a random sample of British gulf war veterans; 2961 recipients responded. In their results they note that 17.3% of respondents believed that they had Gulf war syndrome.
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- http://www.merck.com/pubs/mmanual/section21/chapter287/287b.htm
- Coker WJ et al, Clinical findings for the first 1000 Gulf war veterans in the Ministry of Defence’s medical assessment programme, BMJ 1999, 318: 290.
- Chalder et al, Prevalence of Gulf war veterans who believe they have Gulf war syndrome: questionnaire study, BMJ 2001; 323: 473.
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