US EPA

1618246 

Journal Article 

Creatine phosphate kinase elevations signaling muscle damage following exposures to anticholinesterases: 2 sentinel patients 

Friedman, LS; Brautbar, N; Barach, P; Wolfe, AH; Richter, ED 

2003 

1 

Archives of Environmental Health
ISSN: 0003-9896
EISSN: 2331-4303 

HELDREF PUBLICATIONS 

WASHINGTON 

58 

3 

167-171 

English 

14535577 

10.3200/AEOH.58.3.167-171 

WOS:000185609300007 

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. 

Anticholinesterase; Carbamate; Cognitive dysfunction; CPK; Creatine phosphate kinase myopathy; Gulf War Syndrome; Neuropathy; Organophosphate; Pyridostigmine; Tubular aggregate; cholinesterase inhibitor; creatine kinase; organophosphate; pyridostigmine; sarin; adult; agriculture; article; case report; chronic fatigue syndrome; clinical feature; cognition; cognitive defect; creatine kinase blood level; disease course; genetic susceptibility; human; human tissue; hypothesis; lethal dose; male; muscle injury; muscle weakness; myopathy; neuromuscular disease; neuropathy; occupational exposure; palliative therapy; Persian Gulf syndrome; priority journal; soldier; war; Adult; Biological Markers; Cholinesterase Inhibitors; Cognition Disorders; Creatine Kinase; Environmental Exposure; Fatigue; Humans; Male; Middle Aged; Muscle Weakness; Muscle, Skeletal; Muscular Diseases; Nervous System Diseases; Occupational Exposure; Persian Gulf Syndrome