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Ronald E. Gots, MD, PhD
International Center for Toxicology and Medicine Rockville, Md

Sorell L. Schwartz, PhD; Norman Hershkowitz, MD, PhD
Georgetown University School of Medicine Washington, DC

Vinay Chaudhry, MD
The Johns Hopkins University School of Medicine Baltimore, Md

Robert L. Vogel, PhD
Mercer University Macon, Ga

JAMA. 1997;278(5):385.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—The articles by Dr Haley et al^1-3 are fraught with design and interpretive problems. Unique symptom complexes, neurologic syndromes, and toxicologic end points, contrary to established criteria, form the bases of these studies.

The clinical data presented² provide little evidence from which to conclude that these patients had any neuropathic processes. The authors point out that comprehensive evaluations found that the findings were "nonspecific and not sufficient to diagnose any known syndrome." Importantly, the authors fail to explain what these subtle, neurophysiological findings have to do with the symptoms. In addition, the problems with interpretation of neurologic testing are extensive. For instance, only 5 veterans (2 with "confusion ataxia" and 3 with "arthro-myo-neuropathy") had peripheral neurophysiological tests (nerve conduction studies, electromyography, single fiber electromyography, and quantitative sensory tests). The only abnormality detected was "borderline abnormal motor nerve conduction in the lower extremity in 2" (from syndrome 3) and . . . [Full Text PDF of this Article]

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