Tuesday, November 11, 2008 at 6:54 p.m.

submitted by Denise Nichols, NV&GWVC Gulf War Illness Chairwoman


BACKGROUND: Amyotrophic lateral sclerosis (ALS), often referred to as "Lou Gehrig's Disease," is a neurodegenerative disease that affects nerve cells in the brain and spinal cord. Motor neurons reach from the brain to the spinal cord and from the spinal cord to the muscles throughout the body. The progressive degeneration of the motor neurons in ALS eventually leads to a patient's death. When motor neurons die, the ability of the brain to initiate and control muscle movement is lost. As motor neurons degenerate, they can no longer send impulses to the muscle fibers that normally result in muscle movement. Early symptoms of ALS often include muscle weakness and problems speaking, swallowing or breathing. ALS is a fatal disease. The lifespan for someone diagnosed with the disease is only two to five years.

CURRENT TREATMENTS: Currently, there is only one drug approved by the FDA to specifically treat ALS. This medication is called riluzole (Rilutek). It delays the onset of ventilator-dependence in patients and may increase survival by up to 12 weeks. However, this drug costs about $1,000 per month. Other treatments may be used to relieve symptoms in patients with the disease. Medicines like baclofen or tizanidine may help spasticity. Nonsteriodal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may relieve general discomfort. Physical therapy is also an important part of treatment and helps relieve cramping and muscular pain. Speech therapy and stretching are also used.

MORE COMMON IN VETS: Veterans are at least twice as likely to develop ALS as the general population. The link exists regardless of whether one served in the Persian Gulf War, Vietnam, Korea or World War II and regardless of whether one served during a time of peace or war. A study conducted by researchers from the University of Texas Southwestern Medical Center examined Gulf War veterans and found that during 1998, the last year included in the study, more than three-times as many Gulf War veterans developed ALS as would be expected in the general population. A study published in Neurology in 2005 found men with any history of military service in the last century are at a nearly 60 percent greater risk of ALS than men who did not serve in the military.

POSSIBLE CAUSES: No one knows for sure, but there are many theories as to why ALS is more common in veterans. According to the ALS Association, environmental factors such as exposure to chemicals during military service may play a role. Also, traumatic activity or intense physical activity associated with military service is thought to be a possible cause. Others believe polluted air, radioactive wastes or high-powered vaccines may be to blame. "What I think is happening in the case of the military is there is an environmental exposure and a susceptibility," Lucie Bruijn, Ph.D., Senior Vice President of the ALS Association, told Ivanhoe. "We don't know what these environmental factors are. We think that sports might be a clue to it because many sportsmen have the disease, but we all speculate. None of this is very well proven."

A RECOGNIZED LINK: In September 2008, the Veterans Administration published regulations officially establishing ALS as a "service-connected" disease. All veterans with ALS now have access to the highest level of VA benefits without having to prove their disease was caused by service in the military.