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Cortex. 2016 Jan;74:449-75. doi: 10.1016/j.cortex.2015.08.022. Epub 2015 Sep 25.

Recent research on Gulf War illness and other health problems in veterans of the 1991 Gulf War: Effects of toxicant exposures during deployment.

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Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States. Electronic address:
Baylor University Institute of Biomedical Studies, Waco, TX, United States. Electronic address:
Molecular Neurotoxicology, Toxicology & Molecular Biology Branch (MS-3014), Health Effects Laboratory Division, Centers for Disease Control and Prevention - NIOSH, Morgantown, WV, United States. Electronic address:
Boston University School of Public Health, Department of Environmental Health, Boston, MA, United States. Electronic address:
Research Advisory Committee on Gulf War Veterans' Illnesses, Phoenix, AZ, United States. Electronic address:
University of California, San Diego, La Jolla, CA, United States. Electronic address:
Molecular & Integrative Neuroscience Department, The Scripps Research Institute, La Jolla, CA, United States. Electronic address:
National Gulf War Resource Center, Topeka, KS, United States. Electronic address:
Director, TBI Research Program, Roskamp Institute, Sarasota, FL, United States. Electronic address: fcrawford@RFDN.ORG.
Captain, U.S. Army, Retired, Crestview, FL, United States. Electronic address:
Veterans for Common Sense, Bradenton, FL, United States. Electronic address:
Institute for Neuro-Immune Medicine, Nova Southeastern University, Miami, FL, United States. Electronic address:
McEntire Joint National Guard Base, Eastover, SC, United States. Electronic address:
Department of Emergency Medicine, 3ED311, The Brody School of Medicine, East Carolina University School of Medicine, Greenville, NC, United States. Electronic address:
U.S. Government Accountability Office, Salisbury, Wiltshire, UK. Electronic address:
School of Public Health, Ann Arbor, MI, United States. Electronic address:
Northeastern University, Department of Civil and Environmental Engineering, Boston, MA, United States. Electronic address:


Veterans of Operation Desert Storm/Desert Shield - the 1991 Gulf War (GW) - are a unique population who returned from theater with multiple health complaints and disorders. Studies in the U.S. and elsewhere have consistently concluded that approximately 25-32% of this population suffers from a disorder characterized by symptoms that vary somewhat among individuals and include fatigue, headaches, cognitive dysfunction, musculoskeletal pain, and respiratory, gastrointestinal and dermatologic complaints. Gulf War illness (GWI) is the term used to describe this disorder. In addition, brain cancer occurs at increased rates in subgroups of GW veterans, as do neuropsychological and brain imaging abnormalities. Chemical exposures have become the focus of etiologic GWI research because nervous system symptoms are prominent and many neurotoxicants were present in theater, including organophosphates (OPs), carbamates, and other pesticides; sarin/cyclosarin nerve agents, and pyridostigmine bromide (PB) medications used as prophylaxis against chemical warfare attacks. Psychiatric etiologies have been ruled out. This paper reviews the recent literature on the health of 1991 GW veterans, focusing particularly on the central nervous system and on effects of toxicant exposures. In addition, it emphasizes research published since 2008, following on an exhaustive review that was published in that year that summarizes the prior literature (RACGWI, 2008). We conclude that exposure to pesticides and/or to PB are causally associated with GWI and the neurological dysfunction in GW veterans. Exposure to sarin and cyclosarin and to oil well fire emissions are also associated with neurologically based health effects, though their contribution to development of the disorder known as GWI is less clear. Gene-environment interactions are likely to have contributed to development of GWI in deployed veterans. The health consequences of chemical exposures in the GW and other conflicts have been called "toxic wounds" by veterans. This type of injury requires further study and concentrated treatment research efforts that may also benefit other occupational groups with similar exposure-related illnesses.


Cyclosarin; Gulf War illness; Organophosphates; Pesticide; Sarin; Veterans' health

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