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.

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. 

Online Resources

Amyotrophic Lateral Sclerosis Association

Centers for Disease Control and Prevention (CDC)

Healthfinder, US Department of Health and Human Services (HHS)

National Institute of Neurological Disorders and Stroke

National Institutes of Health (NIH)

National Library of Medicine

June 2004

Male Veterans At Higher Risk For Lou Gehrig's Disease

ALS Symptoms Stand Out

Military Connection Reaches All Branches

Advances Made in ALS Diagnosis

Online Resources

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Advances Made in ALS Diagnosis

Researchers have discovered a faster way to diagnose amyotrophic lateral sclerosis (ALS), the disease commonly known as Lou Gehrig's disease, according to a presentation at the Experimental Biology 2004 meeting.

Researchers from the University of Pittsburgh and Massachusetts General Hospital found 10 protein biomarkers that are present in people who have recently been diagnosed with ALS that are not present in people without the disease.

"Hopefully, down the road we can use the discovery of these biomarkers as a tool not only for diagnosing ALS, but also to find a drug or a combination of drugs to treat this disease," said study author Dr. Robert Bowser, an associate professor of pathology at the University of Pittsburgh School of Medicine.

There is no cure for ALS, and the average survival after diagnosis is only three to five years, according to the ALS Association. There is only one drug available to treat the symptoms of Lou Gehrig's, and it's more effective if it's started early in the course of the disease.

Diagnosing ALS can be a difficult and time-consuming process. There is currently no specific test for ALS, so physicians must rule out many other disorders that share similar symptoms.

"There is an urgent need to find a faster and more reliable diagnostic process that will enable earlier treatment and improve chances that therapy will alter the course of ALS," says Dr. Lucie Bruijn, science director and vice president of the ALS Association. The association is funding a larger study of the biomarkers.

For this study, Dr. Bowser and his colleagues collected cerebrospinal fluid from 25 people who had been recently diagnosed with ALS and from 35 control subjects.

Some of the control subjects had neurologic disease with similar symptoms to ALS, but others had no neurologic symptoms.

Using a technique called proteomics, the researchers profiled all of the proteins in the spinal fluid, says Dr. Bowser. They found 10 protein biomarkers in the people with ALS that were not present in the spinal fluid of the control group.

Besides a faster way to diagnose the disease, Dr. Bowser says this discovery also gives researchers a better insight into what changes occur in the body because of ALS.

Dr. Bowser says they are currently enrolling people with the disease in a study to assess how these biomarkers change over the course of the disease.

Dr. Raina Ernstoff, a neurologist with William Beaumont Hospital in Royal Oak, Mich., says the results of this study look very promising, but that "an awful lot still needs to be done."

She says the findings need to be replicated in a larger group, and she would like to see how these biomarkers change as the disease progresses.

Dr. Ernstoff adds that a test to quickly diagnose ALS would be "extraordinarily helpful." She says currently, because there's no cure or very effective treatment for ALS, physicians must be extremely careful when making the diagnosis.

Dr. David Younger, an ALS specialist and neurologist at New York University Medical Center, says the biomarkers show "important potential," but adds that any test for these biomarkers would have to be "of great benefit to patients to have a real value."

Dr. Younger adds that any test would likely be labor-intensive and could not be done by every diagnostic center.

Always consult your physician for more information.