What is Gulf War syndrome?

Causes and Symptoms

A 2008 report by the US Department of Veterans Affairs, Research Advisory Committee on Gulf War Veterans’ Illnesses, concluded that what has been called Gulf War syndrome should be recognized as an illness, characterized by a complex of multiple symptoms, that resulted from service in the 1990–1991 Gulf War. This illness affected more than 25 percent of the 700,000 veterans of this war.

Gulf War syndrome is characterized by flulike symptoms, which sufferers complain of experiencing simultaneously but that do not indicate any specific known disease. Such physical symptoms include chronic fatigue, fever, muscle and joint pain and weakness, and intense headaches. Some patients report episodes of memory loss, insomnia, nightmares, and limited attention spans as well as neuropsychological disorders, such as depression, anxiety attacks, and mood swings. Respiratory problems, diarrhea and gastrointestinal distress, blurred vision, arthritis, bleeding gums, hair loss, and skin rashes sometimes accompany other symptoms.

When returning veterans first complained about these symptoms, physicians disagreed about the causal factors of Gulf War syndrome. Many of the symptoms could also be signs of other war-related disorders, such as post-traumatic stress disorder (PTSD), or exposure to wartime toxins, bacteria, or viruses. Furthermore, it was difficult for researchers to prove any laboratory abnormality or unique characteristic for this disorder or to isolate any organ system as the primary system affected by this condition. Given this, most medical professionals assumed that Gulf War syndrome was a condition representing factors of several diseases but that is not a separate disease. This diagnostic ambiguity frustrated many Gulf War veterans, who wanted and needed accurate diagnoses and effective treatments.

Gulf War illness is associated with biological alterations primarily in the nervous system and brain. Strong evidence exists that the illness is associated with exposure to two types of neurotoxins: pyridostigmine bromide (PB) pills, which had been intended to protect humans from the effects of nerve agents; and organophosphate pesticides, used during deployment. Early evidence suggested that the illness was related to exposure to substances such as multiple vaccines or fumes from burning oil wells, but these causes have since been ruled out. What is clear, however, is that Gulf War illness is not just PTSD. It is true that some Gulf War veterans have PTSD, but this does not explain the separate problem of Gulf War illness. A 2013 study published in PLoS ONE identified a number of characteristic brain changes in veterans with Gulf War syndrome, particularly increased axial diffusivity in the right inferior fronto-occipital fasciculus, a part of the brain involved in fatigue, pain, and emotional regulation. Researchers hope that this discovery will lead to the development of more accurate diagnostic criteria for Gulf War syndrome.

Treatment and Therapy

Because they do not think their concerns are being seriously addressed, many veterans rely on self-diagnosis based on other veterans’ accounts exchanged orally, in the press, or on the Internet. Self-medication with over-the-counter pain relievers is a common treatment that many veterans depend on for the alleviation of symptoms. Physicians prescribe more potent pharmaceuticals and physical therapy to alleviate symptoms and to reinforce patients’ immune systems. The American, Canadian, and British governments have established medical programs through publicly funded veterans’ administrations and privately endowed medical institutions to research the syndrome’s causes, ascertain its etiology, identify derivative presentations of the syndrome, develop effective treatment methods, and offer medical care for veterans exhibiting Gulf War syndrome symptoms.

Physicians recommend that some veterans suffering Gulf War syndrome undergo counseling to address neuropsychological symptoms and to assist in the readjustment to peacetime or civilian life and the frustration with enduring a chronic and unidentified illness. Exercise, a nutritional diet, and support groups are also helpful to many veterans suffering Gulf War syndrome. Genetic testing of veterans and their spouses is also sometimes pursued to determine causation of birth defects in some veterans’ children, which are often incorrectly attributed to Gulf War service. Complications associated with treatment of Gulf War syndrome include possible common side effects of pain relievers, such as drowsiness. Patients also risk becoming addicted to pain relievers that they use to numb the ever-present aches associated with chronic illnesses.

Perspective and Prospects

Originally identified when some American, British, and Canadian Gulf War veterans complained of various ailments after returning home in 1991, Gulf War syndrome was sensationalized in the press as a mystery illness. Physicians familiar with military medical history recognized similarities with symptoms documented in soldier populations as early as the American Civil War. This awareness suggested that the syndrome was indicative of a common wartime factor rather than a unique occurrence in the Gulf War.

Gulf War syndrome became politicized as government officials and veterans disagreed regarding the description of and funding for treatment of the syndrome. After clinical investigations of twenty thousand Gulf War veterans, the Institute of Medicine declared that no Gulf War syndrome existed, although some soldiers did suffer nonchronic illnesses, such as malaria. Five independent panels confirmed the conclusion that no unique case of an illness had been proven.

Physicians and scientists representing the Departments of Defense, Veterans Affairs, and Health and Human Services stated that the rates of incidence of Gulf War veterans’ symptoms, hospitalization, and mortality are not greater than those reported for the general population and that many veterans may have already been genetically predisposed to certain physiological conditions. They also questioned why veterans from other countries, especially Arab nations, did not report syndrome symptoms, nor were any similar reports issued after World War II soldiers returned from the Persian Gulf.

In 2002, in what veterans called a “stunning reversal,” the US Department of Defense admitted that there is increasing evidence that neural damage affects some veterans of the Gulf War and doubled research funding. The change in stance was partly in response to research emanating from the University of Texas Southwestern Medical Center in Dallas and the US Department of Veterans Affairs. Using a statistical technique called factor analysis, researchers at these facilities identified unusual clusters of symptoms that could be divided into syndromes. Syndrome 1 involved sleep and memory disturbances, syndrome 3 involved joint and muscle pain, while syndrome 2, the most serious, involved confusion and dizziness. Using magnetic resonance spectroscopy (MRS), the research team found that veterans with syndrome 2 had lost nerve cells in the brain structures that are involved with the symptoms of the syndrome. Moreover, syndrome 2 veterans were also approximately eight times more likely as healthy veterans to have had a bad reaction to the PB tablets. Researchers surmise that chemical weapons and the PB tablets that were designed to protect against them affect the same physiological pathway. The increasing scientific evidence of real physiological damage among veterans has helped spur the US government to begin more strenuous investigation into its causes. In 2002, the Department of Veterans Affairs appointed a Research Advisory Committee on Gulf War Veterans’ Illnesses.

This committee’s 2008 report provided a clearer focus for developing better treatment for Gulf War illness and a focus on how this illness may interact with other conditions. Research in this area continues through federally mandated treatment programs with the Veterans Administration (VA) and through work done independently by universities.

Bibliography:

Blanck, Ronald R., et al. “Unexplained Illnesses Among Desert Storm Veterans: A Search for Causes, Treatment, and Cooperation.” Archives of Internal Medicine 155 (February 13, 1995): 262–268.

Bloom, Saul, et al. Hidden Casualties: Environmental, Health, and Political Consequences of the Persian Gulf War. Berkeley, Calif.: Arms Control Research Center, North Atlantic Books, 1994.

Eddington, Patrick G. Gassed in the Gulf: The Inside Story of the Pentagon-CIA Cover-up of Gulf War Syndrome. Washington, D.C.: Insignia, 1997.

"Gulf War and Health: Treatment for Chronic Multisymptom Illness." Institute of Medicine of the National Academies, January 2013.

Hersh, Seymour M. Against All Enemies: Gulf War Syndrome, the War Between America’s Ailing Veterans and Their Government. New York: Ballantine Books, 1998.

Office of the Secretary of Defense. National Defense Research Institution. A Review of the Scientific Literature as It Pertains to Gulf War Illnesses. 8 vols. Santa Monica, Calif.: RAND, 1998–2001.

Rayhan, Rakib U., et al. "Increased Brain White Matter Axial Diffusivity Associated with Fatigue, Pain and Hyperalgesia in Gulf War Illness." PLoS ONE 8, no. 3 (March 20, 2013): e58493.

Research Advisory Committee on Gulf War Veterans’ Illnesses. Gulf War Illness and the Health of Gulf War Veterans: Scientific Findings and Recommendations. Washington, D.C.: Government Printing Office, 2008.

Steele, Lea, Antonio Sastre, Mary M. Gerkovich, and Mary R. Cook. "Complex Factors in the Etiology of Gulf War Illness: Wartime Exposures and Risk Factors in Veteran Subgroups." Environmental Health Perspectives 120, no. 1 (January, 2012): 112–118.

Wheelwright, Jeff. The Irritable Heart: The Medical Mystery of the Gulf War. New York: W. W. Norton, 2001.