Occurrence of amyotrophic lateral sclerosis among Gulf War veterans

Carmel Armon

doi:10.1212/01.wnl.0000260429.80237.c0

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To the Editor:

I recently read an article¹ by authors affiliated with the United States Department of Veterans' Affairs and the United Kingdom Ministry of Defense. It provides data relevant to the first report of an excess of amyotrophic lateral sclerosis (ALS) cases in the deployed population.² The relevant text¹ is as follows:

The findings of the ALS study have had to be qualified by two considerations:

(i) the results could have been influenced by ascertainment bias because they were based on just seven additional cases of ALS among Gulf War veterans in a study of 2.5 million participants; and

(ii) the mortality rate of Gulf War veterans due to ALS has not yet been found to be elevated.³

I had not previously read or heard the statement that the entire claim of excess incidence of ALS in deployed veterans hinged on seven additional cases of ALS. This information was not shared with the …

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