TY - JOUR
T1 - Clinical aspects of ALS in Gulf War Veterans
AU - Kasarskis, Edward J.
AU - Lindquist, Jennifer H.
AU - Coffman, Cynthia J.
AU - Grambow, Steven C.
AU - Feussner, John R.
AU - Allen, Kelli D.
AU - Oddone, Eugene Z.
AU - Kamins, Kimberly A.
AU - Horner, Ronnie D.
N1 - Funding Information:
The following neurologists comprised the ALS Gulf War Clinical Review Team: H. Mitsumoto (Columbia University) R. Pascuzzi (Indiana University) Y. Harati (Baylor University) R. Tim (Duke University) E. J. Kasarskis (VA and University of Kentucky) The authors thank the individuals who contributed to the study at various stages including: M. Lyon (formerly with the ALS Association), D. Howard, D. Barrett (Center for Disease Control), M. Dove (DMDC), M. A. K. Ryan, P. Spencer (University of Oregon), V. Palmer, T. Elza Mims, L. Dempsey-Hall, and H. Rowe. The study was supported by VA Cooperative Studies Program 500 and the Cynthia Shaw Crispen ALS Endowment.
PY - 2009
Y1 - 2009
N2 - The increased incidence of ALS in military veterans of the first Persian Gulf War raised speculation that they may have a 'Persian Gulf' variant of ALS with atypical clinical features. Medical records of military veterans with ALS, previously identified in our epidemiological study, were evaluated for clinical features (age and site of onset, race, unexplained atypical findings) and ventilator-free survival. Comparisons between deployed versus non-deployed cohorts were made with deployment status based on designation by the Department of Defense Manpower Data Center (DMDC) or by self-report. Other than the young age of onset in both cohorts (40.8 years overall mean; 40.1 years for DMDC deployed, 41.2 years for DMDC non-deployed), review of the medical records failed to document any atypical features. After adjusting for bulbar onset, median survival from symptom onset in those ≥40 years of age was 35.5 months (2.96 years) compared to 64.7 months (5.39 years) in the group <40 years of age (hazard ratio (HR)=0.47, 95% CI 0.30-0.73, p=0.0006). After adjusting for age, median survival was 45.4 months (3.78 years) and 54.8 months (4.57 years) in bulbar- versus non-bulbar onset groups, respectively (HR=1.41, 95% CI 0.83-2.39, p=0.20). After adjusting for age and site of onset, deployed veterans had significantly shorter survival than non-deployed (40.2 vs. 57.0 months, HR=0.62, 95% CI 0.40-0.96, p=0.03) using DMDC data. In conclusion, although veterans developing ALS after deployment to the Persian Gulf in 1990-1991 exhibited otherwise typical clinical features, they experienced shorter ventilator-free survival than non-deployed veterans.
AB - The increased incidence of ALS in military veterans of the first Persian Gulf War raised speculation that they may have a 'Persian Gulf' variant of ALS with atypical clinical features. Medical records of military veterans with ALS, previously identified in our epidemiological study, were evaluated for clinical features (age and site of onset, race, unexplained atypical findings) and ventilator-free survival. Comparisons between deployed versus non-deployed cohorts were made with deployment status based on designation by the Department of Defense Manpower Data Center (DMDC) or by self-report. Other than the young age of onset in both cohorts (40.8 years overall mean; 40.1 years for DMDC deployed, 41.2 years for DMDC non-deployed), review of the medical records failed to document any atypical features. After adjusting for bulbar onset, median survival from symptom onset in those ≥40 years of age was 35.5 months (2.96 years) compared to 64.7 months (5.39 years) in the group <40 years of age (hazard ratio (HR)=0.47, 95% CI 0.30-0.73, p=0.0006). After adjusting for age, median survival was 45.4 months (3.78 years) and 54.8 months (4.57 years) in bulbar- versus non-bulbar onset groups, respectively (HR=1.41, 95% CI 0.83-2.39, p=0.20). After adjusting for age and site of onset, deployed veterans had significantly shorter survival than non-deployed (40.2 vs. 57.0 months, HR=0.62, 95% CI 0.40-0.96, p=0.03) using DMDC data. In conclusion, although veterans developing ALS after deployment to the Persian Gulf in 1990-1991 exhibited otherwise typical clinical features, they experienced shorter ventilator-free survival than non-deployed veterans.
KW - ALS
KW - Cohort studies
KW - Epidemiology
KW - Risk factors
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U2 - 10.1080/17482960802351029
DO - 10.1080/17482960802351029
M3 - Article
C2 - 18792848
AN - SCOPUS:61549131259
SN - 1748-2968
VL - 10
SP - 35
EP - 41
JO - Amyotrophic Lateral Sclerosis
JF - Amyotrophic Lateral Sclerosis
IS - 1
ER -