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Amyotrophic Lateral Sclerosis (ALS) Gulf War Study

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ClinicalTrials.gov Identifier: NCT00007722
Recruitment Status : Completed
First Posted : January 1, 2001
Last Update Posted : October 9, 2009
Sponsor:
Collaborators:
United States Department of Defense
Centers for Disease Control and Prevention
Department of Health and Human Services
ALS Association
Information provided by:
VA Office of Research and Development

Brief Summary:
Recently, concern has arisen regarding a possible elevated occurrence of ALS among veterans who served in the Persian Gulf during Operations Desert Shield (August 2, 1990 - January 15, 1991), Desert Storm (January 16, 1991 - February 28, 1991) and Clean-up (March 1, 1991 - July 31, 1991). This study involves an epidemiologic investigation into the occurrence of ALS among veterans of the Gulf War. This study will further define the epidemiology of this neurological disease among younger individuals while determining whether there is a higher than expected occurrence. It will also ascertain the etiologic importance of deployment to the Persian Gulf and exposure to specific environmental factors in that geographic area. VA is leading this joint federal government epidemiologic study that also involves DoD, HHS, CDC, and academic centers of excellence in neurology, with advice from the ALS Association.

Condition or disease
Amyotrophic Lateral Sclerosis

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Detailed Description:

Primary Objectives: To develop, through nationwide ascertainment, a comprehensive descriptive epidemiology of amyotrophic lateral sclerosis (ALS) among Gulf War veterans with particular attention to whether there is a higher than expected occurrence of ALS among deployed veterans as compared to non-deployed Gulf War veterans.

Secondary Objectives: To ascertain probable/possible etiologic factors with particular focus on the role of chemical or biologic factors in the Persian Gulf area of deployment.

Primary Outcomes: Incidence of ALS among deployed and non-deployed veterans of the Gulf War.

Intervention: N/A

Study Abstract: Recently, concern has arisen regarding a possible elevated occurrence of ALS among veterans who served in the Persian Gulf during Operations Desert Shield (August 2, 1990 - January 15, 1991), Desert Storm (January 16, 1991 - February 28, 1991) and Clean-up (March 1, 1991 - July 31, 1991). In response to this concern, a nationwide epidemiological investigation was conducted to ascertain all occurrences of ALS between August, 1990 and July, 2000 among all active duty military and mobilized Reserves, including National Guard, who served during the Gulf War period (August 2, 1990-July 31, 1991). A diagnosis of ALS was confirmed by medical record review and, as necessary, neurological examination. Risk was assessed by the age-adjusted, average, annual 10-year cumulative incidence rate. VA led this joint federal government epidemiologic study that also involved DoD, HHS, CDC, and academic centers of excellence in neurology, with advice from the ALS Association.

The study population was defined as all active duty military and mobilized reserves and National Guard who served for at least one month at any time during the Gulf War period. Mobilized reservists and members of the National Guard were those who were activated and called-up, being either deployed to S.W. Asia or "back-filling" positions of military personnel who were deployed. Deployed military personnel were those who served in the S.W. Asian theater during Operations Desert Shield and Desert Storm or the period immediately after Desert Storm or received hazardous duty pay during the Gulf War. All other individuals in the study population were classified as non-deployed, although they may have been stationed outside the U.S.

This study has as its primary component a field epidemiological investigation, involving nationwide ascertainment of ALS cases among deployed and non-deployed veterans of the Gulf War to obtain a census of ALS cases among these populations. Ascertainment of cases occurred through three avenues. The first was a search of extant VA and DoD medical databases. Second, we solicited cases from the ALS Association, other related organizations, and from VA and DoD neurology clinics. And third, we identified cases through self-referrals that resulted from national media announcements. Purported cases were verified via medical record review and, as necessary, a detailed clinical examination. For all living cases, we are collecting a sample of blood and urine for determination of ALS-relevant DNA mutations and heavy metal exposure, respectively. There is also an in-home visit that includes an interview of the patient and family members with emphasis on ascertainment of unique exposures.

Results: In this large epidemiological study, researchers supported by both the Department of VA and DoD have found preliminary evidence that veterans who served in Desert Shield-Desert Storm are nearly twice as likely as their non-deployed counterparts to develop ALS. VA is exploring options for compensating veterans who served in the Gulf and who subsequently develop ALS.

Ongoing Surveillance: The study team has implemented an ongoing surveillance system to detect future cases of ALS that develop in this veteran population. This system involves maintaining the linkages created to detect current cases. New cases will be subject to the same protocols for verification, enrollment and data collection as in the original case ascertainment study.


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Study Type : Observational
Actual Enrollment : 135 participants
Observational Model: Case-Only
Time Perspective: Prospective
Official Title: CSP #500 - An Epidemiological Investigation Into the Occurrence of Amyotrophic Lateral Sclerosis (ALS) Among Gulf War Veterans
Study Start Date : July 2000
Actual Primary Completion Date : March 2003
Actual Study Completion Date : March 2003


Group/Cohort
1



Primary Outcome Measures :
  1. Probability of ALS among veterans both deployed and non-deployed to the Gulf Region(8/2/1990-7/31/1991) [ Time Frame: Ongoing ]

Biospecimen Retention:   Samples With DNA
DNA samples of blood or mouthwash were collected in veterans' homes by nurses.


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Living and deceased veterans with an ALS diagnosis who served in the military between 8/2/1990 and 7/31/1991.
Criteria

Inclusion Criteria:

Veterans who served in the Persian Gulf during Operations Desert Shield (August 2, 1990 - January 15, 1991), Desert Storm (January 16, 1991 - February 28, 1991) and Clean-up (March 1, 1991 - July 31, 1991)

Exclusion Criteria:


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00007722


Locations
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United States, North Carolina
VA Medical Center
Durham, North Carolina, United States, 27705
Sponsors and Collaborators
US Department of Veterans Affairs
United States Department of Defense
Centers for Disease Control and Prevention
Department of Health and Human Services
ALS Association
Investigators
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Study Chair: Eugene Z. Oddone, MD MHSc VA Medical Center

Publications of Results:
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Responsible Party: Oddone, Eugene - Study Chair, Department of Veterans Affairs
ClinicalTrials.gov Identifier: NCT00007722     History of Changes
Other Study ID Numbers: 500
First Posted: January 1, 2001    Key Record Dates
Last Update Posted: October 9, 2009
Last Verified: October 2009

Keywords provided by VA Office of Research and Development:
ALS
amyotrophic lateral sclerosis
Gulf War Veterans

Additional relevant MeSH terms:
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Amyotrophic Lateral Sclerosis
Sclerosis
Motor Neuron Disease
Pathologic Processes
Neurodegenerative Diseases
Nervous System Diseases
Neuromuscular Diseases
Spinal Cord Diseases
Central Nervous System Diseases
TDP-43 Proteinopathies
Proteostasis Deficiencies
Metabolic Diseases