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Clinical and laboratory assessment of distal peripheral nerves in Gulf War veterans and spouses

From Neurology Service (Drs. Davis and King), New Mexico VA Health Care System, Albuquerque; Department of Neurology (Drs. Davis and King), University of New Mexico School of Medicine; Medical (Drs. Eisen and Blanchard), Research (Dr. Eisen), and Neurology Service (Dr. Mithen), St. Louis Department of Veterans Affairs Medical Center; Department of Neurology (Dr. Mithen), St. Louis University; Departments of Internal Medicine (Drs. Eisen and Blanchard) and Neurology (Dr. Parks), Washington University School of Medicine, St. Louis, MO; Deputy Under Secretary for Health for Health Policy Coordination (Dr. Murphy) and Environmental Epidemiology Service (Dr. Kang), Veterans Health Administration, Department of Veterans Affairs, Washington, DC; and Cooperative Studies Program Coordinating Center (R. Alpern and Dr. Reda), Hines VA Hospital, Hines, IL.

Address correspondence and reprint requests to Dr. Larry E. Davis, Neurology Service, New Mexico VA Health Care System, 1501 San Pedro Dr. SE, Albuquerque, NM 87108; e-mail: LEDavis{at}unm.edu

Background: The prevalence of symptoms suggesting distal symmetric polyneuropathy (DSP) was reported to be higher among deployed veterans (DV) to the Persian Gulf in 1990–1991 than to control non-deployed veterans (NDV). The authors therefore compared the prevalence of DSP by direct examination of DV and their spouses to control NDV and spouses.

Methods: The authors performed standardized neurologic examinations on 1,061 DV and 1,128 NDV selected from a cohort of veterans who previously participated in a national mail and telephone survey. Presence of DSP was evaluated by history, physical examination, and standardized electrophysiologic assessment of motor and sensory nerves. Similar examinations were performed without electrophysiologic tests in 484 DV spouses and 533 NDV spouses. Statistical analyses were performed with appropriate adjustments for the stratified sampling scheme.

Results: No differences between adjusted population prevalence of DSP in DV and NDV were found by electrophysiology (3.7% vs 6.3%, p = 0.07), by neurologic examination (3.1% vs 2.6%, p = 0.60), or by the methods combined (6.3% vs 7.3%, p = 0.47). Excluding veterans with non-military service related diseases that may cause DSP did not alter outcomes. DV potentially exposed to neurotoxins from the Khamisiyah ammunition depot explosion did not significantly differ in DSP prevalence compared to non-exposed DV. The prevalence of DSP in DV spouses did not differ from NDV spouses (2.7% vs 3.2%, p = 0.64).

Conclusions: Neither veterans deployed during the Gulf War era nor their spouses had a higher prevalence of DSP compared to NDV and spouses.

Received December 9, 2003. Accepted in final form May 25, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the September 28 issue to find the title link for this article.

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September 28 Highlights

Neurology 2004 63: 946-947. [Full Text]  

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