August 6, 1997

Identification of Gulf War Syndrome: Methodological Issues and Medical Illnesses-Reply

Author Affiliations

University of Texas Southwestern Medical Center Dallas

JAMA. 1997;278(5):385-387. doi:10.1001/jama.1997.03550050047025

In Reply.  —We thank Drs Gordon, Schlesinger, and Kaires for their comments from their clinical experience with Gulf War veterans. Regarding Dr Schlesinger's suggestion to test for muscle enzymes, we measured creatine kinase levels in our case-control study, but did not find a difference between the cases with our syndrome 3 and the controls. During clinical testing of 20 veterans, Dr Amato et al1 found several patients with neuromuscular symptoms, elevated levels of creatine kinase, and abnormalities on muscle biopsy, but attributed the symptoms to psychological stress.The suggestion of Drs Engel and Jing to include a control group of veterans of the same era not deployed to the Persian Gulf region was accomplished in our case-control study; characteristics of the deployed and nondeployed control groups were shown in Table 2 of that article. We agree that repeating the study with larger number of veterans would strengthen its findings. We would welcome the formation