Brain & Nervous System Health Center

Gulf War Syndrome Still a Mystery

From the WebMD Archives

June 16, 2000 -- They suffer from recurrent headaches, joint stiffness, nausea, anxiety, and depression. Their symptoms have been the focus of numerous studies over the last decade, including one recent report of brain cell damage similar to that seen in the early stages of Parkinson's disease. Yet for Gulf War veterans, there still is no researcher who can pinpoint a truly unique set of symptoms that they can label as Gulf War syndrome.

A new, large study once again finds that those deployed to the Persian Gulf "do not demonstrate the existence of a unique Gulf War syndrome," says author Bradley N. Doebbeling, MD, MSc, an epidemiologist and associate professor of internal medicine with the University of Iowa College of Medicine in Iowa City. The study was funded by the CDC and the U.S. Department of Defense (DOD).

"What [our study] argues for, I think, is dismissing this idea of a Gulf War syndrome or mystery illness," he tells WebMD. "I think it does show there's an illness occurring in the group, probably not something that's entirely unique, something that we've seen before. It's either a series of medical conditions occurring in that population at an increased rate, or it's what we often call 'medically unexplained symptoms.'"

Doebbeling's study involved more than 3,600 veterans -- all living in Iowa, with approximately half of them having been deployed to the Persian Gulf.

Researchers conducted one-hour telephone interviews with each veteran, asking about symptoms and the degree to which they were bothered by them. To develop their 137-symptom checklist, researchers first talked with numerous veterans and doctors. "We looked at probably the broadest set of symptoms that has been studied so far," says Doebbeling.

Researchers identified three symptom patterns. One set of symptoms included joint stiffness, muscles aches, joint pain, numbness or tingling, headaches, and nausea. Psychological distress symptoms included feeling nervous, worrying, feeling distant or cut off, and depression. Panic-type symptoms included panic and anxiety attacks; a racing, pounding, or skipping heart; attacks of chest pain or pressure; and attacks of sweating.

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Deployed veterans reported the same symptoms as nondeployed military. However, significantly more deployed vets reported symptoms -- 90% more, says Doebbeling. And their symptoms covered many areas of the body, as noted in previous studies.

"This high level of such diverse symptoms is difficult to explain as a single illness and fails to support the hypothesis that there is a Gulf War syndrome," Doebbeling tells WebMD. "It would be uncharacteristic of any single illness. But that also doesn't mean that something isn't going on."

However, the symptoms are similar to hard-to-diagnose conditions like chronic fatigue syndrome and fibromyalgia. "Those symptoms are kind of indistinguishable," Doebbeling tells WebMD.

Doebbeling's findings ring true with other studies, Drue Barrett, PhD, tells WebMD. Also one of the Iowa study's authors, Barrett says, "Most studies have found that Gulf War veterans do report more symptoms than those who were not deployed to the Gulf. In most studies, they reported nearly every symptom more often, but when you start to do more objective, physiologic measures, then the differences are not so obvious." Barrett is a research scientist in the CDC's division of environmental hazards and health effects.

One CDC-funded study of Air Force veterans also found no unique patterns, she says. "About 50% of Gulf War veterans had this clustering of symptoms, as did about 15% of non-Gulf War veterans. It's saying that these are symptoms that may cluster together in a variety of different situations, but it's not something that is unique to what happened in the Gulf.

"There are a number of theories regarding illness among combat war veterans. Some people have raised the issue that perhaps it's due to types of vaccines they received. Mostly people are concerned about anthrax vaccine," Barrett says. However, there's also concern about contact with pesticides and a chemical used for exposure to nerve gas, she adds.

From the Veterans Affairs (VA) Office, Kelley Brix, MD, assistant chief of research and development, tells WebMD that 150 research projects currently devoted to Gulf War syndrome are being conducted by either the Department of Defense or the VA.

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"I think that there are a couple of consistent findings," Brix tells WebMD. "In each of these [previous] studies, Gulf War veterans do report higher frequency of symptoms ... On the other hand, when you look at very serious health outcomes, like [death] or hospitalization or defects in offspring, there are no differences between Gulf War veterans and [other people]."

She calls Doebbeling's study "very strong ... a very comprehensive survey. They made an effort to choose these groups so they would be representative of everyone in combat. The people came from hundreds of units so the results could be extrapolated to the entire population of Gulf War veterans."

The Institute of Medicine has called Doebbeling's study "perhaps the strongest study on Gulf War veterans," Brix tells WebMD. "I would agree with that."

In studies of past wars, veterans have reported similar patterns of chronic symptoms, says researcher Kenneth C. Hyams, MD, MPH, director of epidemiology at the U.S. Naval Research Center in Bethesda, Md.

"We found the same difficult-to-explain symptoms among veterans of all major wars going back to the Civil War, both world wars, and Vietnam. These were big issues in the past, just as they are now. After World War I, there was soldier's heart ... We saw very similar symptoms to what we're seeing now. There was a huge controversy, just like we're seeing now, whether it was a physical or psychological illness. Referral centers were established to evaluate veterans, just as we have now," Hyams tells WebMD.

"I don't think you can characterize all of them as psychological, but certainly that is one of the major causes," Hyams says. "They all had problems with headache, fatigue, joint pain. We all have those symptoms at one time. But they certainly are more common after major wartime conflicts."

The issue of Gulf War syndrome is by no means dead, Michael Kilpatrick, MD, of the DOD's Office for Gulf War Illnesses, tells WebMD. "We need to take a look at what does cause medically unexplained symptoms in people, whether deployed or not. We're 10 years out from war and we still have people who are very sick. The longer we go, the more difficult it becomes to do a medical intervention to help them with their symptoms."

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Kilpatrick adds, "There are a lot of vets who have serious health concerns, and although nothing ties their health problems to the Gulf War, that doesn't make them any less real."

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