TY - JOUR
T1 - Creatine phosphate kinase elevations signaling muscle damage following exposures to anticholinesterases
T2 - 2 Sentinel patients
AU - Friedman, Lee S.
AU - Brautbar, Nachman
AU - Barach, Paul
AU - Wolfe, Amir H.
AU - Richter, Elihu D.
PY - 2003/3
Y1 - 2003/3
N2 - In this study, the authors describe 2 patients who experienced confirmed exposures to anticholinesterases that commenced in the 1970s. Subsequently, elevations in creatine phosphate kinase (CPK) were initially detected more than a decade following the first acute exposure. Beginning in the early 1980s, the patients suffered from progressive generalized muscle weakness, chronic fatigue, myopathy, neuropathy, and severe neurobehavioral impairments. Previous occupational exposures included pyridostigmine, as well as isopropyl methylphosphonofluoridate (percutaneous lethal dose [LD50] < 28 mg/kg body weight), and 1 patient had exposure to agricultural organophosphates. The authors hypothesize that the workers' CPK elevations, first detected more than a decade following acute exposures to anticholinesterases, were sentinel events for impending muscle damage and necrosis. Many Gulf War veterans with Gulf War disease who reported exposures to anticholinesterases 1 decade earlier currently suffer from vague neuromuscular and cognitive impairments. Therefore, medical programs for Gulf War veterans with Gulf War Syndrome should include surveillance for elevated CPK, abnormalities of neuromuscular conduction, and genetic susceptibility, and they should promote therapeutic trials for palliation.
AB - In this study, the authors describe 2 patients who experienced confirmed exposures to anticholinesterases that commenced in the 1970s. Subsequently, elevations in creatine phosphate kinase (CPK) were initially detected more than a decade following the first acute exposure. Beginning in the early 1980s, the patients suffered from progressive generalized muscle weakness, chronic fatigue, myopathy, neuropathy, and severe neurobehavioral impairments. Previous occupational exposures included pyridostigmine, as well as isopropyl methylphosphonofluoridate (percutaneous lethal dose [LD50] < 28 mg/kg body weight), and 1 patient had exposure to agricultural organophosphates. The authors hypothesize that the workers' CPK elevations, first detected more than a decade following acute exposures to anticholinesterases, were sentinel events for impending muscle damage and necrosis. Many Gulf War veterans with Gulf War disease who reported exposures to anticholinesterases 1 decade earlier currently suffer from vague neuromuscular and cognitive impairments. Therefore, medical programs for Gulf War veterans with Gulf War Syndrome should include surveillance for elevated CPK, abnormalities of neuromuscular conduction, and genetic susceptibility, and they should promote therapeutic trials for palliation.
KW - Anticholinesterase
KW - Carbamate
KW - Cognitive dysfunction
KW - CPK
KW - Creatine phosphate kinase myopathy
KW - Gulf War Syndrome
KW - Neuropathy
KW - Organophosphate
KW - Pyridostigmine
KW - Tubular aggregate
UR - http://www.scopus.com/inward/record.url?scp=0141781122&partnerID=8YFLogxK
U2 - 10.3200/AEOH.58.3.167-171
DO - 10.3200/AEOH.58.3.167-171
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 14535577
AN - SCOPUS:0141781122
SN - 0003-9896
VL - 58
SP - 167
EP - 171
JO - Archives of Environmental Health
JF - Archives of Environmental Health
IS - 3
ER -