Acute and reversible parkinsonism reported after brief
exposure to pesticides
WESTPORT, May 12, 1999 (Reuters Health) - Five case studies
documenting acute and reversible parkinsonism after brief
exposure to organophosphate pesticides are reported by
researchers in India in the second April issue of Neurology.
Dr. Mohit H. Bhatt and colleagues from the Jaslok Hospital and
Research Centre in Mumbai report that exposure to
organophosphate pesticides in patient 1 resulted from ingestion. In
patients 2 and 3, exposure resulted from household fumigation.
Patients 4 and 5 were the sister and daughter of patient 3, and
their exposure resulted from entry into the previously fumigated
home of patient 3.
All five patients exhibited classic parkinsonian symptoms including
"...bradykinesia, postural instability, and resting tremor, although
rigidity was less prominent," the authors write. These patients also
had a "...poor response to levodopa."
Parkinsonian symptoms ranged from moderately disabling in
patient 2 to severely disabling in Patients 1 and 3. Patients 4 and 5,
who had the briefest exposure, experienced the mildest symptoms.
According to the report, the "[t]hree genetically related patients
were exposed to pesticides in a common environment before onset
of parkinsonism," but the authors note that "...other family
members remained unaffected."
Patients 1, 3, 4 and 5 "...recovered completely without
treatment..." and patient 2 was lost to follow-up. Patient 3
"...experienced repeated episodes of parkinsonism with
inadvertent exposure to [the]...pesticide-contaminated
environment."
The investigators conclude that "[t]he clinical course of these five
patients suggests their syndrome represents a heretofore
undescribed toxic effect of [organophosphate] pesticides," adding
that their "...observations strengthen epidemiologic studies
implicating [organophosphate] pesticides in the etiology of
[Parkinson's disease]."
"A genetic susceptibility to [organophosphate] pesticide-induced
parkinsonism may account for three family members developing
this syndrome," they write.
Dr. Bhatt's team concludes that these pesticides "...should be
included in the list of neurotoxic agents causing parkinsonism."
Neurology 1999;52:1467-1471.
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Judith Richards, London, Ontario, Canada
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