Evaluation of neurologic function in Gulf War veterans

A blinded case- control study

Robert W. Haley, Jim Hom, Peter S. Roland, Wilson W. Bryan, Paul C. Van Ness, Frederick J. Bonte, Michael D. Devous, Dana Mathews, James L. Fleckenstein, Frank H. Wians, Gil I. Wolfe, Thomas L. Kurt

Research output: Contribution to journalArticle

175 Citations (Scopus)

Abstract

Objective. - To determine whether Gulf War-related illnesses are associated with central or peripheral nervous system dysfunction. Design. - Nested case-control study. Participants. - Twenty-three veterans with factor analysis-derived syndromes (the cases), 10 well veterans deployed to the Gulf War (the deployed controls), and 10 well veterans not deployed to the Gulf War (the nondeployed controls). Method. - With investigators blinded to group identities, participants underwent objective neurophysiological, audiovestibular, neuroradiological, neuropsychological, and blood tests. Main Outcome Measures. - Evidence of neurologic dysfunction. Results. - Compared with the 20 controls, the 23 cases had significantly more neuropsychological evidence of brain dysfunction on the Halstead Impairment Index (P=.01), greater interside asymmetry of the wave I to wave III interpeak latency of brain stem auditory evoked potentials (P=.02), greater interocular asymmetry of nystagmic velocity on rotational testing, increased asymmetry of saccadic velocity (P=.04), more prolonged interpeak latency of the lumbar-to-cerebral peaks on posterior tibial somatosensory evoked potentials (on right side, P=.03, and on the left side, P=.005), and diminished nystagmic velocity after caloric stimulation bilaterally (P values range from .02 to .04). Cases (n=5) with syndrome 1 ('impaired cognition') were the most impaired on brain stem auditory evoked potentials (P=.005); those (n=13) with syndrome 2 ('confusion-ataxia') were the most impaired on the Halstead Impairment Index (P=.006), rotational testing (P=.01), asymmetry of saccadic velocity (P=.03), and somatosensory evoked potentials (P≤.01); and those (n=5) with syndrome 3 ('arthro-myo-neuropathy') were the most impaired on caloric stimulation (P≤.01). Conclusions. - The 3 factor-derived syndromes identified among Gulf War veterans appear to represent variants of a generalized injury to the nervous system.

Original languageEnglish (US)
Pages (from-to)223-230
Number of pages8
JournalJournal of the American Medical Association
Volume277
Issue number3
StatePublished - Jan 15 1997

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Gulf War
Veterans
Nervous System
Case-Control Studies
Somatosensory Evoked Potentials
Brain Stem Auditory Evoked Potentials
Nervous System Trauma
Confusion
Neuropsychological Tests
Peripheral Nervous System
Hematologic Tests
Ataxia
Neurologic Manifestations
Cognition
Statistical Factor Analysis
Central Nervous System
Research Personnel
Outcome Assessment (Health Care)
Brain

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Haley, R. W., Hom, J., Roland, P. S., Bryan, W. W., Van Ness, P. C., Bonte, F. J., ... Kurt, T. L. (1997). Evaluation of neurologic function in Gulf War veterans: A blinded case- control study. Journal of the American Medical Association, 277(3), 223-230.

Evaluation of neurologic function in Gulf War veterans : A blinded case- control study. / Haley, Robert W.; Hom, Jim; Roland, Peter S.; Bryan, Wilson W.; Van Ness, Paul C.; Bonte, Frederick J.; Devous, Michael D.; Mathews, Dana; Fleckenstein, James L.; Wians, Frank H.; Wolfe, Gil I.; Kurt, Thomas L.

In: Journal of the American Medical Association, Vol. 277, No. 3, 15.01.1997, p. 223-230.

Research output: Contribution to journalArticle

Haley, RW, Hom, J, Roland, PS, Bryan, WW, Van Ness, PC, Bonte, FJ, Devous, MD, Mathews, D, Fleckenstein, JL, Wians, FH, Wolfe, GI & Kurt, TL 1997, 'Evaluation of neurologic function in Gulf War veterans: A blinded case- control study', Journal of the American Medical Association, vol. 277, no. 3, pp. 223-230.
Haley, Robert W. ; Hom, Jim ; Roland, Peter S. ; Bryan, Wilson W. ; Van Ness, Paul C. ; Bonte, Frederick J. ; Devous, Michael D. ; Mathews, Dana ; Fleckenstein, James L. ; Wians, Frank H. ; Wolfe, Gil I. ; Kurt, Thomas L. / Evaluation of neurologic function in Gulf War veterans : A blinded case- control study. In: Journal of the American Medical Association. 1997 ; Vol. 277, No. 3. pp. 223-230.
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abstract = "Objective. - To determine whether Gulf War-related illnesses are associated with central or peripheral nervous system dysfunction. Design. - Nested case-control study. Participants. - Twenty-three veterans with factor analysis-derived syndromes (the cases), 10 well veterans deployed to the Gulf War (the deployed controls), and 10 well veterans not deployed to the Gulf War (the nondeployed controls). Method. - With investigators blinded to group identities, participants underwent objective neurophysiological, audiovestibular, neuroradiological, neuropsychological, and blood tests. Main Outcome Measures. - Evidence of neurologic dysfunction. Results. - Compared with the 20 controls, the 23 cases had significantly more neuropsychological evidence of brain dysfunction on the Halstead Impairment Index (P=.01), greater interside asymmetry of the wave I to wave III interpeak latency of brain stem auditory evoked potentials (P=.02), greater interocular asymmetry of nystagmic velocity on rotational testing, increased asymmetry of saccadic velocity (P=.04), more prolonged interpeak latency of the lumbar-to-cerebral peaks on posterior tibial somatosensory evoked potentials (on right side, P=.03, and on the left side, P=.005), and diminished nystagmic velocity after caloric stimulation bilaterally (P values range from .02 to .04). Cases (n=5) with syndrome 1 ('impaired cognition') were the most impaired on brain stem auditory evoked potentials (P=.005); those (n=13) with syndrome 2 ('confusion-ataxia') were the most impaired on the Halstead Impairment Index (P=.006), rotational testing (P=.01), asymmetry of saccadic velocity (P=.03), and somatosensory evoked potentials (P≤.01); and those (n=5) with syndrome 3 ('arthro-myo-neuropathy') were the most impaired on caloric stimulation (P≤.01). Conclusions. - The 3 factor-derived syndromes identified among Gulf War veterans appear to represent variants of a generalized injury to the nervous system.",
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AU - Haley, Robert W.

AU - Hom, Jim

AU - Roland, Peter S.

AU - Bryan, Wilson W.

AU - Van Ness, Paul C.

AU - Bonte, Frederick J.

AU - Devous, Michael D.

AU - Mathews, Dana

AU - Fleckenstein, James L.

AU - Wians, Frank H.

AU - Wolfe, Gil I.

AU - Kurt, Thomas L.

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N2 - Objective. - To determine whether Gulf War-related illnesses are associated with central or peripheral nervous system dysfunction. Design. - Nested case-control study. Participants. - Twenty-three veterans with factor analysis-derived syndromes (the cases), 10 well veterans deployed to the Gulf War (the deployed controls), and 10 well veterans not deployed to the Gulf War (the nondeployed controls). Method. - With investigators blinded to group identities, participants underwent objective neurophysiological, audiovestibular, neuroradiological, neuropsychological, and blood tests. Main Outcome Measures. - Evidence of neurologic dysfunction. Results. - Compared with the 20 controls, the 23 cases had significantly more neuropsychological evidence of brain dysfunction on the Halstead Impairment Index (P=.01), greater interside asymmetry of the wave I to wave III interpeak latency of brain stem auditory evoked potentials (P=.02), greater interocular asymmetry of nystagmic velocity on rotational testing, increased asymmetry of saccadic velocity (P=.04), more prolonged interpeak latency of the lumbar-to-cerebral peaks on posterior tibial somatosensory evoked potentials (on right side, P=.03, and on the left side, P=.005), and diminished nystagmic velocity after caloric stimulation bilaterally (P values range from .02 to .04). Cases (n=5) with syndrome 1 ('impaired cognition') were the most impaired on brain stem auditory evoked potentials (P=.005); those (n=13) with syndrome 2 ('confusion-ataxia') were the most impaired on the Halstead Impairment Index (P=.006), rotational testing (P=.01), asymmetry of saccadic velocity (P=.03), and somatosensory evoked potentials (P≤.01); and those (n=5) with syndrome 3 ('arthro-myo-neuropathy') were the most impaired on caloric stimulation (P≤.01). Conclusions. - The 3 factor-derived syndromes identified among Gulf War veterans appear to represent variants of a generalized injury to the nervous system.

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