Is there an associated risk between military service and amyotrophic lateral sclerosis (ALS)? Several studies in the last few years have suggested there is – with one Veterans Affairs study reporting a nearly two-fold risk for ALS among veterans of the first Gulf War, 1990–1991 (Neurology 2003;62:742–749), and another report finding an increased risk for ALS among men who served in the military dating back to 1906 (Neurology 2005;64:32–37).
The Department of Veterans Affairs asked the Institute of Medicine (IOM) to review the evidence, and the November IOM report offers no definite answers. The report, “Amyotrophic Lateral Sclerosis in Veterans: Review of the Scientific Literature,” concluded that while there is limited and suggestive evidence of an association between ALS and military service, more studies are needed to explore the cause of ALS among veterans.
There needs to be a more focused, collaborative effort between civilian researchers and the military to probe this issue, said Edward J. Kasarskis, MD, PhD, who led the VA study that found an elevated risk of ALS in military veterans of the first Persian Gulf War. He noted that non-military investigators do not have first-hand knowledge of the environmental exposures soldiers face, or the problems faced by soldiers in combat and on the base. He said future studies should look for data on where veterans served and what jobs they did to isolate contributing factors to ALS.
When asked if the current Gulf War conflict should be of concern, Dr. Kasarskis said it is too early to tell. Dr. Kasarskis, the Cynthia Shaw Crispen Professor of Neurology at the University of Kentucky in Lexington and Director of Neurology at the Lexington Veterans Administration Medical Center, said there are fewer soldiers in Iraq now than were in the first Gulf War. But, he added, there is concern that the longer soldiers serve in Iraq, the more risk they may have for ALS in the future.
Dr. Kasarskis noted that in the meanwhile, there are government funded projects for ALS and VA national registers specifically for veterans, and he speculated that the VA may be moving toward consideration of a policy of paying for expenses incurred by veterans with ALS. “I'm pleased with the fact that the VA acted responsibly and took the initiative to get the report from IOM,” he told Neurology Today.
• Weisskopf MG, O'Reilly EJ, Ascherio A, et al. Prospective study of military service and mortality from ALS. Neurology
• Horner RD, Kamins KG, Kasarskis EJ, et al. Occurrence of amyotrophic lateral sclerosis among Gulf War veterans. Neurology