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Male Veterans At Higher Risk For Lou Gehrig's Disease

ALS Found At All Time Periods Of Service

New evidence suggests that all men who serve in the military are at an increased risk of developing Lou Gehrig's disease, according to a presentation at the American Academy of Neurology annual meeting.Picture of a man talking on the phone

The higher odds of getting the disease, also known as amyotrophic lateral sclerosis (ALS), did not appear to be associated with a particular branch of the military or particular time period. Previous research found a similar risk for Gulf War veterans.

"In looking for some agent, we should perhaps not be focusing on the Gulf War but looking for those that are common across eras and military experiences," says study author Dr. Marc Weisskopf, a research associate at the Harvard School of Public Health. "What exactly those are is tough."

ALS Symptoms Stand Out

ALS is a progressive, fatal neurodegenerative disease that attacks nerve cells in the brain and the spinal cord.

ALS affects as many as 20,000 US adults, with about 5,000 new cases each year, according to the National Institutes of Health (NIH).

At the onset of ALS, the symptoms may be so slight that they are frequently overlooked. The initial symptoms of ALS can be quite varied in different people.

The rate at which ALS progresses can be quite variable from one person to another. Survival time with ALS ranges from three to 10 years or more.

In a small number of people, ALS is known to halt its progression, although there is no scientific understanding as to how and why this happens. Symptoms can begin in the muscles of speech, swallowing, or in the hands, arms, legs, or feet.

Not all people with ALS experience the same symptoms or the same sequences or patterns of progression. But, progressive muscle weakness and paralysis are universally experienced.

Muscle weakness is a hallmark initial sign in ALS, occurring in approximately 60 percent of patients.

Early symptoms vary with each individual, but usually include tripping, dropping things, abnormal fatigue of the arms and/or legs, slurred speech, muscle cramps and twitches, and/or uncontrollable periods of laughing or crying.

The hands and feet may be affected first, causing difficulty in lifting, walking, or using the hands for the activities of daily living such as dressing, washing, and buttoning clothes.

As the weakening and paralysis continue to spread to the muscles of the trunk of the body, the disease eventually affects speech, swallowing, chewing, and breathing. When the breathing muscles become affected, ultimately, the patient will need permanent ventilatory support in order to survive.

Military Connection Reaches All Branches

The new study appears to be the first to detect a wider association between military service and ALS, and seems to make it less likely that a military connection with the disease is an anomaly.

"Our study has its own limitations, but certainly the mounting evidence would suggest that this is not a fluke," Dr. Weisskopf adds.

"Any clue as to some environmental trigger in this disease is a helpful thing," says Dr. Stephen Scelsa, director of the neuromuscular division and the ALS Center at Beth Israel Medical Center in New York City. Yet, he says, the full significance of the finding is not yet clear.

Two recent studies had indicated an increased risk of ALS among Gulf War veterans.

Dr. Weisskopf wanted to see if that risk extended to more people. Between 1989 and 1998, he followed 268,258 men who had served in the military and 126,414 who had not. During this time, 274 men died of ALS.

All of the participants were part of the American Cancer Society's Cancer Prevention Study II, begun in 1982. Dates of entering military service ranged from 1906 to 1982.

Overall, men who had served in the military had a lower death rate, yet they were 60 percent more likely to develop ALS than men who had not served in the military. The increased risk was similar in the Army, National Guard, Navy, and Air Force.

There is no clear answer as to why this might be the case. People have variously postulated that risk might be elevated due to heavy metal exposure (particularly lead), extreme physical exertion, and electrical work (including shocks), Dr. Weisskopf said.

"This hasn't been shown with rigorous scientific data, but this disease does occur in people who are athletic, like Lou Gehrig," Dr. Scelsa added. "There may be people in the military who do a lot of physical work and strain, and that may predispose them to the disease, but I think the answer is just not in."

Always consult your physician for more information.

This article is from the Anne Arundel Medical Center Neighbors News, June 2004
 

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