Clinical aspects of ALS in Gulf War Veterans

Edward J. Kasarskis, Jennifer H. Lindquist, Cynthia J. Coffman, Steven C. Grambow, John R. Feussner, Kelli D. Allen, Eugene Z. Oddone, Kimberly A. Kamins, Ronnie D. Horner

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


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.

Original languageEnglish
Pages (from-to)35-41
Number of pages7
JournalAmyotrophic Lateral Sclerosis
Issue number1
StatePublished - 2009

Bibliographical note

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.


  • ALS
  • Cohort studies
  • Epidemiology
  • Risk factors

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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