included analyses of possible indicators of sarin exposure on questionnaires. Self-reports indicating exposure to “chemical-warfare agents” were associated with various neurologic findings in a number of studies. The outcomes in the different studies were cognitive dysfunction, depression, and fibromyalgia; major depression and anxiety; a syndrome termed “confusion–ataxia” (problems with thinking, disorientation, balance disturbances, vertigo, and impotence); mood, memory, and cognitive deficits (profile of mood states, tension and confusion scales, three tests of recall memory, and the WMS-R backward digit span test of memory); and musculoskeletal, neurologic, neuropsychologic, and psychologic symptoms.

Some studies have not shown such effects. In a study of Danish Gulf War veterans, all of whom were involved in peacekeeping or humanitarian roles after the end of the war, self-reported exposure to “nerve gas” was not significantly associated with the neuropsychologic symptoms in the Gulf War cohort. Exposure of those troops to sarin, however, was unlikely. One study of US troops reported no association with symptoms of cognitive dysfunction, chronic fatigue, and fibromyalgia.

Posttraumatic stress disorder (PTSD) has been seen in survivors of the Matsumoto and Tokyo sarin terrorist attacks and in British veterans who reported either wearing “nuclear, biological, and chemical warfare suits”, hearing chemical alarms, or having a “chemical/nerve gas attack”. Other studies, however, found no relationship between PTSD and “wearing chemical protective gear or hearing alarms sounding”, and PTSD was not more common among Khamisiyah-exposed than nonexposed Gulf War veterans. It is not known whether PTSD would be caused by the chemical itself or by the traumatic event.

There have been some reports of persistent cardiovascular effects following the sarin attacks in Japan—sudden palpitation and electrocardiographic (ECG) changes—but other studies report that no ECG changes were evident in recovered victims 6–8 months after the Tokyo attack. A study of military personnel deployed during the time of Khamisiyah found one (cardiac dysrhythmias) of 10 specific self-reported physician cardiac diagnoses to be more frequent in the exposed versus nonexposed people. Other studies of veterans showed various cardiovascular effects, but only for deployed versus nondeployed veterans, with no analysis for exposure to sarin.

The presence of multisymptom illness, Gulf War illness, or unexplained illness and the relationship of any of them to possible indicators of exposure to chemical-warfare agents has been studied in Gulf War veterans. A case of Gulf

Front Matter (R1-R12)

Executive Summary (1-12)

1 Introduction (13-25)

2 Toxicology (26-46)

3 Human Health Outcome Studies (47-90)

4 Conclusions (91-102)

Appendix: Organophosphorus Insecticides (103-120)