Pesticide Exposure Symptoms Report

Conclusion: People with "single" non-occupational exposure to pesticides can be severely hurt by their exposure. 

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Subject:     Pesticide Exposure Symptoms Report----
 Date:        Sat, 09 Dec 2000 10:33:51 -0500
From:        Stephen Tvedten <steve@getipm.com>
Organization:     Get Set Inc. (www.getipm.com)

To:     Paul Helliker <phelliker@cdpr.ca.gov>
          Director, State of California, Department of Pesticide Regulation 

Dear Mr. Helliker,  I thought you might like to read a Pesticide Exposure Symptoms Report.

Keywords: Pesticide, Dursban, organophosphates, illness, neurological, neurobehavioral, forensic, expert, witness, toxic, chemicals, neuropsychology, neurotoxicology

Neuropsychological Evaluation of Bystander Exposure to Pesticides(1) By  Raymond M. Singer -  Independent Practice Santa Fe, New Mexico and  New York, New York

ABSTRACT

Background: There are reports in the literature of long-term neurobehavioral dysfunction in persons with pesticide exposure, primarily in occupational settings. This report presents data concerning a subject with non-occupational and apparently single-incident exposure.

A home with open windows and a property were sprayed by helicopter with a mixture of pesticides, including chlorpyrifos, a carbamate (carbofuran) and an organophosphate. Three dogs on the property, fed from separate cans of food, were vomiting and listless, and were diagnosed by their veterinarian with pesticide poisoning.

The subject reported initial symptoms of anxiety, itching on face which spread over her body, dizziness and forgetfulness, with sleep frequently interrupted around 2-3 AM with symptoms of breathlessness, followed by numb hands and feet and a feeling of "blacking out".

She continued to reside in the home during the time when the pesticides were still potent. Her primary symptoms at the time of this examination, three years later, were disabling chemical sensitivity, along with sleep apnea-like episodes, and memory problems. She was in litigation.

Methods: Physical examination which ruled out other causes of the symptoms, medical record review, brain MRI and neuropsychological testing.

Results: Brain MRI showed diffuse scattered foci of increased signal intensity in the subcortical and periventricular white matter tracts. Organophosphate pesticides are known to cause degeneration of the myelin.

From normal or better pre-exposure function, declines in function included arithmetic (5th %); Digit Symbol and Symbol Search (9th %); visual memory (BVRT, 11 errors); Embedded Figures (1st %); Paired Associates Learning (1st %) and logical memory (1st %). Personality testing showed no personality disorder.

Conclusion: Doctors need to be aware that pesticide exposure can lead to permanent neuropsychological deficits, even with a "single" exposure. Brain dysfunctions from neurotoxicity can be revealed with appropriate neuropsychological testing.

    TEXT

Introduction: Pesticides are one of the most significant sources of neurotoxicity in our society. Most pesticides indiscriminately attack the nervous system of both insects and humans. Unfortunately, due to a lack of knowledge of the significant and permanent danger that such substances pose to humans, pesticides are applied without adequate precautions. Many people are hurt by pesticides and do not get an appropriate diagnosis and treatment. Some are misdiagnosed with psychiatric disorders such as depression, anxiety or psychosis, which can then lead to iatrogenic illness.

Although there have been a number of neurobehavioral studies of workers with chronic exposures to pesticide, acute (single) exposure reports are more rare (See Singer (1990); Singer, R. & Scott, N.E. (1987); Hartman, (1995)).

This case involved a woman with a single exposure to Lorsban (chlorpyrifos, a type of organophosphate insecticide, a trade name includes Dursban (OP's)); Furadan (carbofuran; a carbamate insecticide; causes cholinestaer-ase inhibition), and Dimate (organophosphate). The exposure occurred while she was sleeping in her home with windows open. Her home was adjacent to a field being sprayed by helicopter. Within minutes of being awakened by the sound of the helicopter, the smell of pesticides was strong, even after closing the windows. The pilot continued to circle around and made numerous passes over and near the residence, spraying in close proximity to the home.

Immediate symptoms were lacking or undetermined. Within a day of exposure, the following symptoms occurred: Itching, night time respiratory attacks, gastrointestinal problems, and anxiety.  Three dogs at the residence were diagnosed with acute pesticide poisoning. The subject did not evacuate the premises, and continued to live in the residence for several months. Carbaryl has long-term persistence indoors (Branch and Jacqz, 1985). Multiple chemical sensitivity developed in the subject over the next few months.

Methods: Physical examination, record review, brain MRI and neuropsychological testing.  Cholinesterase testing was not performed.

Results: The subject had not complained of cognitive problems; however, The Neurotoxicity Screening Survey showed that the subject had symptoms consistent with patients with diagnosed neurotoxicity.

Brain MRI found diffuse scattered foci of increased signal intensity in the subcortical and periventricular white matter tracts, consistent with demyelination. (With OP exposure, a condition can develop that resembles the demyelination of multiple sclerosis - the primary lesion being an axonal degeneration followed by demyelination. A delay of 8 -- 12 days after a single dose occursbefore structural and functional changes occur in the nervous system (Ecobichon and Joy, 1995)).  Note that the delay of demyelination was consistent with the onset of symptoms. Other causes of  the symptoms and signs were not identified upon multiple physical examinations.

Regarding the subject's sleep apnea, although this condition may also be associated with OP poisoning, it has been reported with carbaryl poisoning (Branch and Jacqz, 1985).

Her pre-exposure GPA was 3.7, and she had been a member of Phi Theta Kappa (National Honor Society) and Sigma Tau Delta (National English Honor Society). The subject was working at home at the time of exposure.

Current neurobehavioral testing revealed a FSIQ at the 25th percentile; performance IQ at the 18th percentile; processing speed at the 8th percentile; psychomotor speed at the 9th percentile; arithmetic at the 5th percentile. A decline in overall intelligence was detected, along with specific deficits in arithmetic skills, psychomotor speed, visual perception (visual detection skills), and incidental memory. When looking at index scores, deficits can be seen in perceptual organization and processing speed.

The Benton Visual Retention Test found strong indication of acquired impairment of cognitive functioning (11 errors). An Embedded Figures Test which evaluates the ability to detect visual figure-ground relationships found performance below the 1st percentile. The Expanded Paired Associate Test, which evaluates verbal learning ability, found deficits in immediate recall (1st %) and delayed recall (11th %). Auditory information processing and tracking was below the 1st %. Logical memory ability, both immediate and delayed, was reduced by half. There was no evidence of psychoses, distortion or malingering based upon numerous tests of these variables.

Personality testing found no personality disorders, average levels of anger, and low need for succorance (sympathy and support), suggesting that personality factors did not cause this illness.

Conclusion: People with "single" non-occupational exposure to pesticides can be severely hurt by their exposure. They may be unaware of the extent of their illness, as was this subject, prior to appropriate testing and diagnosis. Mis-diagnoses of pesticide poisoning can include anxiety, depression, post-traumatic stress etc. Doctors need to be aware that pesticide exposure can lead to permanent neuropsychological deficits, even with a "single" exposure. Brain dysfunctions from neurotoxicity can be revealed with appropriate neuropsychological testing. The ill effects of pesticides on nervous system function, including permanent damage, are widely unrecognized in our society.

References: 
Branch, R.A. and Jacqz, E. (1985). Subacute neurotoxicity following long-term exposure to carbaryl. Am J Med., 80, 741, 1986.
Ecobichon, D., & Joy, R. (1994). Pesticides and Neurological Disease (2nd ed.). Boca Raton: CRC Press.
Hartman, David (1995). Neuropsychological Toxicology (2nd ed.). Plenum.
Singer, R. (1990). Neurotoxicity Guidebook. New York: Van Nostrand Reinhold.
Singer, R. & Scott, N. E. (1987). Neuropsychological evaluation of cyclodiene insecticide toxicity. The Toxicologist, 7(1), 248. 
If you have any further questions or comments, please contact the author, Dr. Raymond Singer. 
Telephone: (505) 466-1100 
E-mail: raysinger@aol.com 
Website: http://members.aol.com/neurosite/index.htm 
1. Singer, R. (1999, expected). Neuropsychological evaluation of bystander exposure to pesticides. The Journal of Neuropsychiatry and Clinical Neurosciences, 9, 1. 

Well Mr. Helliker,  the evidence that your "registered" POISONS are harming non-target species like people is increasing - almost as fast as is the pest's resistance or immunity to your "registered" POISONS!

Respectfully,  Stephen L. Tvedten

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