The term “Gulf War syndrome” is applied to a variety of symptoms and signs in veterans of the Persian Gulf War of 1991. Controversy regarding the nature of this syndrome and relation to various exposures in the war zone continues. This article reviews some of the possible pathomechanisms and the evidence for, as well as against, this syndrome. Most of the studies conducted by independent academic centers show evidence for organic damage to the nervous system in patients with Gulf War syndrome exhibiting neurologic symptoms. Further investigations are still going on to resolve the controversy and to develop a strategy for management of patients with this syndrome.
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• Gulf War syndrome with symptoms such as fatigue, headache, joint pain, skin rash, shortness of breath, sleep disturbances, difficulty in concentrating, and forgetfulness was reported in soldiers following the Gulf War of 1991.
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• Controversy regarding the organic basis of this syndrome has persisted.
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• Although no firm basis has been established, the syndrome cannot be dismissed and further studies continue.
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• More recent studies are focusing on chronic medical problems in veterans of other wars.
Historical note and terminology
The military operation known as Desert Shield/Desert Storm was initiated by the United States, in conjunction with several other countries, in 1991 as a response to Iraqi invasion of Kuwait. Following the completion of the Persian Gulf War in February 1991, 25% to 32% of 693,826 returning veterans have experienced a variety of unexplained symptoms, referred to as Gulf war syndrome (GWS). The most common symptoms are fatigue, headache, joint pains, skin rash, shortness of breath, sleep disturbances, difficulty in concentrating, and forgetfulness. An earlier publication described a condition called "Desert Storm pneumonitis" or "Al-Eskan disease," which was named after a village in Saudi Arabia. The condition was attributed to fine desert sand that caused a pulmonary reaction and various systemic effects due to opportunistic infections (33). The term "Gulf War syndrome" appeared in medical literature in 1994 (36). It is also referred to as “Gulf War illness.” Since then, more than 1000 publications have referred to Gulf War syndrome with various theories of its etiology and pathogenesis. Of the 697,000 military personnel deployed in Operation Desert Storm, 15% to 20% are reportedly sick and nearly 25,000 have died. Findings suggest that active-duty Gulf War veterans did not have excess unexplained illnesses compared to the 1,479,751 Gulf War-era military personnel not deployed, as determined by hospitalization in the 4.67-year period following deployment (31). No consensus about the nature of this disease and its validity as a medical entity exists. A proportion of patients with Gulf War syndrome can be identified as having chronic fatigue syndrome, myalgic encephalomyelitis, or fibromyalgia syndrome. The controversy has been sustained by different interest groups including those representing the war veterans in an environment of public media, but it has yet to be scientifically resolved.
All modern wars have been associated with a syndrome characterized by unexplained medical symptoms. A somatic syndrome was related primarily to the First World War, whereas a neuropsychiatric syndrome was associated with the Second World War. Several war syndromes, not due to the injuries caused by conventional weapons, have also been reported. The Balkan syndrome, was reported by United Nations and North Atlantic Treaty Organization forces in Kosovo. The Balkan syndrome has been attributed to radioactive waste product used in weapons. The focus of this article is on the controversy surrounding the neurologic aspects of Gulf War syndrome. Numerous publications since 2001 related to the topic of Gulf War syndrome have not resolved the controversy raised in the original article, although this syndrome was officially recognized in the United Kingdom in 2005.