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August 6, 1997

Identification of Gulf War Syndrome: Methodological Issues and Medical Illnesses

Author Affiliations

International Center for Toxicology and Medicine Rockville, Md
Georgetown University School of Medicine Washington, DC
The Johns Hopkins University School of Medicine Baltimore, Md
Mercer University Macon, Ga

JAMA. 1997;278(5):385. doi:10.1001/jama.1997.03550050047023

To the Editor.  —The articles by Dr Haley et al1-3 are fraught with design and interpretive problems. Unique symptom complexes, neurologic syndromes, and toxicologic end points, contrary to established criteria, form the bases of these studies.The clinical data presented2 provide little evidence from which to conclude that these patients had any neuropathic processes. The authors point out that comprehensive evaluations found that the findings were "nonspecific and not sufficient to diagnose any known syndrome." Importantly, the authors fail to explain what these subtle, neurophysiological findings have to do with the symptoms. In addition, the problems with interpretation of neurologic testing are extensive. For instance, only 5 veterans (2 with "confusion ataxia" and 3 with "arthro-myo-neuropathy") had peripheral neurophysiological tests (nerve conduction studies, electromyography, single fiber electromyography, and quantitative sensory tests). The only abnormality detected was "borderline abnormal motor nerve conduction in the lower extremity in 2" (from syndrome 3) and