You can find out more about NPF's National Medical Director, Dr. Michael S. Okun, by also visiting the NPF Center of Excellence, University of Florida Center for Movement Disorders & Neurorestoration.
Pesticides, Agent Orange, and potential environmental risk factors for the development of Parkinson’s disease continue to make the news. Patients and families may be comforted by headlines on chemicals and Parkinson’s disease, most of which they may never be exposed to. The recent report by Goldman and colleagues from the Parkinson’s Institute, a National Parkinson Foundation Center of Excellence in Sunnyvale, CA, may open some eyes to environmental exposures and Parkinson’s disease risk.
Goldman and colleagues cleverly chose to study twins from the WWII Veterans Cohort. By utilizing twin pairs (half were identical twins) researchers limited the potential effects of genetics on the development of Parkinson’s disease. One person from each twin pair was required to have been diagnosed with Parkinson’s disease. A very careful occupational and hobby history was then extracted, with the chief weakness of this study lying in how the histories were obtained. First hand histories from patients were sparse with spouses and siblings providing second hand proxy histories in most cases. The main study weakness was somewhat balanced by the employment of an occupational hygienist. An occupational hygienist is a carefully trained professional that can independently determine exposures, hazards, or risks in a workplace environment. The hygienist and the researchers examined six solvents, and determined that only trichloroethylene (TCE) was associated with an increased risk (6.1X) of developing Parkinson’s disease in men. Additionally men exposed to TCE or to another chemical called PERC (tetrachloroethylene) had an 8.9 times increased risk of developing Parkinson’s disease. Interestingly n-hexane, xylene, and toluene, which have all been thought to be potentially associated with the development of Parkinson’s disease, did not show an increased risk in this cohort. All of the studies of environmental exposures should be interpreted with caution, and patients and families should look for common themes among multiple research reports, as the potential for error in these types of population based studies can be high. TCE exposure will therefore require more study, and also study within the female population of Parkinson’s disease patients.
The next question a patient or family member should ask about TCE is what kind of work might lead to an exposure. The following is a list of potential places one might come in contact with TCE:
- Grease remover
- Typewriter fluid
- Paints and strippers
- Carpet cleaners and spot removers
- Computer part cleaners
- Decaffeinated coffees
- Textile plants
- Anaesthetics in an operating room setting
The following is a list of the highest risk of occupations associated with TCE exposure:
- Dry cleaners
- Industrial machinists and repair crews
- Health care workers
Patients and families should appreciate that there is a difference between acute TCE exposure and chronic TCE exposure. Acute high dose exposure seems to depress the central nervous system, and may lead to breathing problems, heart arrhythmias, coma, and a host of other problems. Acute TCE may also prove to be a nasty skin irritant. When we talk about TCE exposure and Parkinson’s disease, we are referring to chronic long-term exposure. Chronic exposure has also been associated with unsteadiness, dizziness, headaches, memory loss and many other symptoms. The current study presented at the American Academy of Neurology by Goldman and colleagues suggests that Parkinson’s disease risk may need to be added to the potential sequalae of chronic TCE exposure.
Patients and families should be aware that the risk factors for Parkinson’s disease seem to now be extending beyond genetics, and may be inclusive of environmental exposures. Hancock and colleagues recently reported that insecticides and herbicides, especially organochlorines and organophosphorus compounds, increased the risk of Parkinson’s disease even in those without a family history. Pesticides and environmental risk factors therefore have emerged as important considerations in the development of Parkinson’s disease. Patients, families and physicians should all be aware of these chemicals, and should assess their risks for exposure.
Additionally, we are pleased to announce the launch of the new National Parkinson Foundation Helpline! People with Parkinson's, their families, friends and health care providers are invited to call 1-800-4PD-INFO (473-4636) to receive current and up-to-date information about Parkinson's disease generally, emotional support, and referrals to health professionals and community resources.
Goldman SM. Trichloroethylene and Parkinson's disease: dissolving the puzzle. Expert Rev Neurother. 2010 Jun;10(6):835-7.
Frigerio R, Sanft KR, Grossardt BR, Peterson BJ, Elbaz A, Bower JH, Ahlskog JE, de Andrade M, Maraganore DM, Rocca WA. Chemical exposures and Parkinson's disease: a population-based case-control study. Mov Disord. 2006 Oct;21(10):1688-92. PubMed PMID: 16773614.
Gash DM, Rutland K, Hudson NL, Sullivan PG, Bing G, Cass WA, Pandya JD, Liu M, Choi DY, Hunter RL, Gerhardt GA, Smith CD, Slevin JT, Prince TS. Trichloroethylene: Parkinsonism and complex 1 mitochondrial neurotoxicity. Ann Neurol. 2008 Feb;63(2):184-92.
Kochen W, Kohlmüller D, De Biasi P, Ramsay R. The endogeneous formation of highly chlorinated tetrahydro-beta-carbolines as a possible causative mechanism
in idiopathic Parkinson's disease. Adv Exp Med Biol. 2003;527:253-63.
Guehl D, Bezard E, Dovero S, Boraud T, Bioulac B, Gross C. Trichloroethylene and parkinsonism: a human and experimental observation. Eur J Neurol. 1999
Huber F. [Clinical aspects and neuropathology of trichloroethylene poisoning]. Z Unfallmed Berufskr. 1969;62(4):226-67. German.
Hancock DB, Martin ER, Mayhew GM, Stajich JM, Jewett R, Stacy MA, Scott BL, Vance JM, Scott WK. Pesticide exposure and risk of Parkinson's disease: a family-based case-control study. BMC Neurol. 2008 Mar 28;8:6.
Posted: 10/1/2010 10:00:00 AM by
Browse current and archived What's Hot in PD? articles, the National Parkinson Foundation's monthly blog for people with Parkinson's written by our National Medical Director, Dr. Michael S. Okun.
Short and Long-Term Problems with Anticholinergic Drugs used for Sleep, Bladder, and Tremor Symptoms
Leaps in Deep Brain Stimulation Technology
What to tell Parkinson’s patients about diet and taking statin drugs
Everything a Parkinson’s Disease Patient Needs to Know About the New Dopamine Pump
Tips for Parkinson’s Disease Patients Switching from Sinemet or Madopar to Rytary (IPX066)
More Evidence Linking Gut Bacteria to Parkinson’s Disease: A Guide for Patients
Two New Therapies for Parkinson’s Disease Patients to get Excited About: Vaccines and Monoclonal Antibodies
The Importance of a Monitoring Strategy When Prescribing Dopamine Agonists: Lessons from the National Parkinson Foundation Data
Is Midlife Migraine Related to Late Life Parkinson’s Disease?
Deep Brain Stimulation for Parkinson’s Disease: NPF Congratulates Mahlon DeLong and Alim-Louis Benabid and Looks to a Bright Future in Human Neural-Network Modulation
Everything You Need to Know About Medical Marijuana and Parkinson’s Disease
The End for Levodopa Phobia: New Study Shows Sinemet is a Safe Initial Therapy for Treatment of Parkinson's Disease
Is light therapy a potential treatment modality in Parkinson’s disease?
How does the most common genetic cause of Parkinson’s Disease (LRRK2) cause Parkinson’s disease and could it be used to help develop a better therapy?
An Update on DAT Scanning for Parkinson’s Disease Diagnosis
Could Northera (Droxidopa) Be an Alternative Treatment for Low Blood Pressure and Passing Out Symptoms?
The Dream of a Pill Free Existence and the Continuous Dopaminergic Pump for the Treatment of Parkinson's Disease
Should I take Inosine to Raise my Uric Acid Levels and Treat my Parkinson’s Disease?
Could Fungus and Mold be an Important Contributor to Parkinson’s Disease?
Pimavanserin and the Hope for a Better Drug for Hallucinations and Psychosis in Parkinson’s Disease
Halting of the Creatine Study
The Importance of Identifying and Treating Caregiver Strain
Putting Parkinson’s Disease Information into the Palm of Your Hand: Parkinson’s Enters the Smartphon
What Parkinson’s Disease Patients Need to Know about H. Pylori Gastrointestinal Infections
A2A Receptor Antagonists and Parkinson’s Disease Treatment
Another Setback for Trophic Factor Treatment in Parkinson's Disease
IPX066 and What Patients Really Want in New Carbidopa/Levodopa (Sinemet) Formulations
The Weather Forecast for Parkinson’s Disease Calls for Worldwide Economic Storm
Defeating the Barriers to Implementing Exercise Regimens in Parkinson’s Disease Patients
When should you start medication therapy for Parkinson’s disease?
Neurologist Care Reduces Hospitalizations in Parkinson's Disease
A Victory in Court for Parkinson's Disease Patients who Require Ongoing Rehabilitative Therapies
Given the recent FDA announcement about Mirapex (pramipexole), should I be worried about dopamine agonists?
What about the new Parkinson’s Disease Vaccine? What should I know?
Caffeine as a Potential Treatment for Parkinson’s Disease
Time to Consider GPi DBS for Parkinson’s Disease: A Shift in the Practice of Patient Selection for DBS
A New Treatment for Parkinson’s Disease-Related Constipation
Too Many Pills: Improving Delivery Systems for Parkinson’s Disease Drugs
Measuring Quality and Assessing Depression in Parkinson's Disease
Watch out for Unexpected Obstacles if You Use a Cueing Strategy to Break Freezing of Gait in Parkinson’s Disease
Pill Color, Generic Medications and Insurance Issues: Important Medication-Related Tips for the Parkinson’s Disease Patient
Are Blood Tests for Parkinson’s Disease on the Horizon?
Placing Stem Cells in Animal Models of Parkinson’s Disease: Another Important Step
Important News for the Parkinson’s Disease Community: More Evidence that Sinemet and Madopar are Not Toxic and do Not Accelerate Disease Progression
The Case for All Parkinson’s Disease Patients to be Co-managed by a Primary Care-Neurologist Team
Scientists say Research on Brain Proteins Involved in Parkinson’s Disease is “Shaping” Up
Who Actually Takes Care of Most of the Parkinson’s Patients Worldwide: The Need for Education and the Parkinson’s Toolkit
If you are Dizzy or Passing Out, it could be Your Parkinson’s Disease or Parkinson’s Disease Medications
How Will Group Visits for Parkinson’s Disease Fit into the Future of Parkinson’s Disease Care?
Why Patients Should be Wary of Chelation Therapy for Parkinson’s Disease
Opening the Door to Gene Therapy in Parkinson’s Disease: The Need for Refinement of the Technology and Approach
Does it Matter if I Can’t Get Brand Sinemet?
Should I get a DaTscan or PET scan to confirm my diagnosis of Parkinson’s disease?
A Critical Reappraisal of the Worst Drugs in Parkinson’s Disease
Environmental Risks for PD: Manganese, Welding, Mining, and Parkinsonism
Calling for the FDA to Revise the Eight Sinemet a Day Rule
Dry Cleaning Solvents and Potential Environmental Risks for Developing Parkinson’s Disease
Maintaining the Balance: Why Parkinson’s Disease Patients Need to Understand Drug Recalls, Withdrawals, and Safety Alerts
Shining a Light on Parkinson’s Disease: Optogenetics Has a Bright Future in Research
Poor Medication Management of Parkinson's Disease During Hospital Admissions: Patients and Families Can Improve Their Hospital-Based Management
Why Are Patches and Continuous Release Technology a Big Deal to Parkinson's?
Is the PD SURG Trial Another Surge Forward for DBS Therapy?
Cycling in PD in Those Who Can’t Walk: Is it Possible?
New iPS Stem Cells for PD: What Does it Mean?
Time for Comprehensive Care Networks for PD
Is Parkinson's Disease a Prion Disease?
Parkinson's Disease Linked to Gaucher's Disease
Brain Cells Keep Time Stamps: Implications for Parkinson's Disease Therapies
Is it Safe to Have an MRI with a DBS in Place?
Take Care of Your Bones as They Are Affected in Parkinson's Disease (Even in Men)
Is it Time to Start Paying Attention to Pain Symptoms in Parkinson's Disease Patients?
Glutathione Fails to Demonstrate Significant Improvement in PD Symptoms
Keeping an Eye on Trials Important to the Parkinson's Disease Patient
Increased Risk of Melanoma in Parkinson's Disease
Finally a DBS Expert Consensus Statement Aimed at Their True Customers: The Patients
Pesticides and Environmental Exposure in Parkinson's disease: Should We Stay Away From the Stink Truck?
Is Exercise Effective Treatment and Protection Against PD?
Why are Transplant Trials Struggling to Succeed in the Treatment of PD?
Are Monoamine Oxidase Inhibitors Disease Modifying or Neuroprotective in PD?
Update on Gene Therapy for Parkinson's Disease