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
(Our Organization
is not responsible for the content of Internet sites.)
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
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. |
