Neurol Clin. 2005 May;23(2):523-40.

Gulf war syndrome: a toxic exposure? A systematic review.

Gronseth GS .

Department of Neurology, The University of Kansas Medical Center,
3599 Rainbow Boulevard, Kansas City, KS 66160, USA. gronseth@...

Using the strength-of-conclusion scheme enumerated in Box 2, based on
two class II studies, there is probably a causal link between
deployment to the Persian Gulf theater of operation and the
development of the poorly defined multisymptom illness known as GWS
(level B). Based on class IV studies, there is insufficient evidence
to determine if exposure to toxins encountered during the Persian
Gulf war caused GWS (level U). A major limitation of the literature
regarding the GWS is the reliance on self-reporting to measure
exposure to putative causal toxins. Although objective measures of
toxin exposure in GWV generally is unavailable, modeling techniques
to estimate exposure levels to low-level nerve agents and smoke from
oil well fires have been developed. It would be useful to determine
if exposure levels determined by these techniques are associated with
GWS. The lack of a clear case definition GWS also hampers research.
Some go even further, claiming that the absence of such a definition
renders the condition illegitimate. Although an objective marker to
GWS would be useful for studies, the absence of such a marker does
not make the syndrome any less legitimate. in essence, GWS merely is
a convenient descriptive term that describes a phenomenon: GWV
reporting suffering from medically unexplained health-related
symptoms. In this sense, it shares much with the other medically
unexplained syndromes encountered in practice. The real debate
surrounding medically unexplained conditions is not whether or not
they exist, but defining their cause. In this regard, investigators
fall into two camps. One camp insists that the conditions are caused
by a yet-to-be-discovered medical problem, rejecting out of hand the
possibility of a psychologic origin. The other camp insists the
conditions are fundamentally psychogenic rejecting the possibility of
an undiscovered medical condition. The evidence shows, however, that
the conditions exists, the suffering is real, and the causes are
unknown.

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PMID: 15757795 [PubMed - indexed for MEDLINE]