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Review
. 2015;37(1):55-70.
doi: 10.1093/epirev/mxu001. Epub 2014 Oct 31.

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis etiology and survival

John D Beard, Freya Kamel
Review

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis etiology and survival

John D Beard et al. Epidemiol Rev. 2015.

Abstract

Rates of amyotrophic lateral sclerosis (ALS) have been reported to be higher among US military veterans, who currently number more than 21 million, but the causal factor(s) has not been identified. We conducted a review to examine the weight of evidence for associations between military service, deployments, and exposures and ALS etiology and survival. Thirty articles or abstracts published through 2013 were reviewed. Although the current evidence suggests a positive association with ALS etiology, it is too limited to draw firm conclusions regarding associations between military service and ALS etiology or survival. Some evidence suggests that deployment to the 1990-1991 Persian Gulf War may be associated with ALS etiology, but there is currently no strong evidence that any particular military exposure is associated with ALS etiology. Future studies should address the limitations of previous ones, such as reliance on mortality as a surrogate for incidence, a dearth of survival analyses, lack of clinical data, low statistical power, and limited exposure assessment. The Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis (GENEVA) Study is one such study, but additional research is needed to determine whether military-related factors are associated with ALS and to assess potential prevention strategies.

Keywords: Gulf War; amyotrophic lateral sclerosis; incidence; military personnel; mortality; motor neuron disease; occupational exposure; veterans.

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Figures

Figure 1.
Figure 1.
Article search and selection strategy employed in a review of studies on associations between military service, deployments, and exposures and amyotrophic lateral sclerosis (ALS) etiology and survival. The solid lines represent articles which remained in the review after each step shown, whereas the dashed lines represent articles which were excluded after each step shown. Only articles published through the end of 2013 were considered. MND, motor neuron disease.
See this image and copyright information in PMC

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