TABLE 7.1 Gulf War Studies and Peripheral Neuropathy

Reference

Population

Self-Reported Exposure to Relevant Pesticides or Solvents

Health Outcome or Test Type

Results

Limitations

Military-Unit-Based Studies

Haley & Kurt, 1997

US

249 deployed veterans from Navy reserve battalion (Seabees);

Nested case-control study of 23 veterans with up to three newly defined syndromes (derived from factor analysis) vs 229 veterans without newly defined syndromes

Five of 18 related to pesticides or solvents: “DEET-containing insect repellent,” “environmental pesticides,” “pesticides in uniforms,” “pesticides in flea collars,” “CARC paint on vehicles”

Symptom questionnaire

Exposure questionnaire

Amount of insect repellent (DEET) applied to skin was associated with arthro-myo-neuropathy syndrome (RR=1.6, 95% CI=0.5–5.5 for lowest exposure; and RR=7.8, 95% CI=2.4–24.7 for greatest exposure); association held only for veterans using government-issued insect repellent, not commercial insect repellent.

Self-reported symptoms and exposure to various agents; lack of neurologic examination and electrophysiologic testing; small sample size; low participation rate

 

In a separate clinical study (Haley et al., 1997b), subset of five veterans with arthro-myoneuropathy syndrome was evaluated by blinded neurologists, who concluded that clinical and electrophysiologic findings were insufficient to diagnose any known syndrome

Lack of control group in original cohort; limited representation of entire Gulf War cohort

Proctor et al., 1998

US

300 US deployed veterans from Massachusetts (Fort Devens) and New Orleans vs 48 Germany-deployed veterans

One of eight environmental exposures related to pesticides or solvents: “pesticides”

Symptom questionnaires;

Exposure questionnaires (Clinical evaluations used for other end points but not for peripheral neuropathy)

Exposure to “pesticides” associated with neurologic symptom group (headache, numbness in arms or legs, dizziness) (p=0.007), musculoskeletal symptom group (p=0.001)

“Pesticide” exposure not significantly related to neuropsychologic symptom group (difficulty in learning and concentrating, confusion) or psychologic symptom group (inability to fall asleep, anxiety, depression)

Self-reported symptoms and exposure to various agents; moderate to low response rate; limited representation of entire Gulf War cohort



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