Dry Cleaning Solvents and Potential Environmental Risks for Developing Parkinson’s Disease

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
  • Adhesives
  • Computer part cleaners
  • Decaffeinated coffees
  • Dry-cleaning
  • Textile plants
  • Anaesthetics in an operating room setting

The following is a list of the highest risk of occupations associated with TCE exposure:

  • Electricians
  • 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. 

Selected References:

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 Cathy Whitlock

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. 

April 2015
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March 2015
Everything a Parkinson’s Disease Patient Needs to Know About the New Dopamine Pump

February 2015
Tips for Parkinson’s Disease Patients Switching from Sinemet or Madopar to Rytary (IPX066)

January 2015
More Evidence Linking Gut Bacteria to Parkinson’s Disease: A Guide for Patients

December 2014
Two New Therapies for Parkinson’s Disease Patients to get Excited About: Vaccines and Monoclonal Antibodies

November 2014
The Importance of a Monitoring Strategy When Prescribing Dopamine Agonists: Lessons from the National Parkinson Foundation Data

October 2014
Is Midlife Migraine Related to Late Life Parkinson’s Disease?

September 2014
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

August 2014
Everything You Need to Know About Medical Marijuana and Parkinson’s Disease

July 2014
The End for Levodopa Phobia: New Study Shows Sinemet is a Safe Initial Therapy for Treatment of Parkinson's Disease

June 2014
Is light therapy a potential treatment modality in Parkinson’s disease?

May 2014
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?

April 2014
An Update on DAT Scanning for Parkinson’s Disease Diagnosis

March 2014
Could Northera (Droxidopa) Be an Alternative Treatment for Low Blood Pressure and Passing Out Symptoms?

February 2014
The Dream of a Pill Free Existence and the Continuous Dopaminergic Pump for the Treatment of Parkinson's Disease

January 2014
Should I take Inosine to Raise my Uric Acid Levels and Treat my Parkinson’s Disease?

December 2013
Could Fungus and Mold be an Important Contributor to Parkinson’s Disease?

November 2013
Pimavanserin and the Hope for a Better Drug for Hallucinations and Psychosis in Parkinson’s Disease

October 2013
Halting of the Creatine Study

September 2013
The Importance of Identifying and Treating Caregiver Strain

August 2013
Putting Parkinson’s Disease Information into the Palm of Your Hand: Parkinson’s Enters the Smartphon

July 2013
What Parkinson’s Disease Patients Need to Know about H. Pylori Gastrointestinal Infections

June 2013
A2A Receptor Antagonists and Parkinson’s Disease Treatment

May 2013
Another Setback for Trophic Factor Treatment in Parkinson's Disease

April 2013
IPX066 and What Patients Really Want in New Carbidopa/Levodopa (Sinemet) Formulations

March 2013
The Weather Forecast for Parkinson’s Disease Calls for Worldwide Economic Storm

February 2013
Defeating the Barriers to Implementing Exercise Regimens in Parkinson’s Disease Patients

January 2013
When should you start medication therapy for Parkinson’s disease?

December 2012
Neurologist Care Reduces Hospitalizations in Parkinson's Disease

November 2012
A Victory in Court for Parkinson's Disease Patients who Require Ongoing Rehabilitative Therapies

October 2012
Given the recent FDA announcement about Mirapex (pramipexole), should I be worried about dopamine agonists?

September 2012
What about the new Parkinson’s Disease Vaccine? What should I know?

August 2012
Caffeine as a Potential Treatment for Parkinson’s Disease

July 2012
Time to Consider GPi DBS for Parkinson’s Disease: A Shift in the Practice of Patient Selection for DBS

June 2012
A New Treatment for Parkinson’s Disease-Related Constipation

May 2012
Too Many Pills: Improving Delivery Systems for Parkinson’s Disease Drugs

April 2012
Measuring Quality and Assessing Depression in Parkinson's Disease

March 2012
Watch out for Unexpected Obstacles if You Use a Cueing Strategy to Break Freezing of Gait in Parkinson’s Disease

February 2012
Pill Color, Generic Medications and Insurance Issues: Important Medication-Related Tips for the Parkinson’s Disease Patient

January 2012
Are Blood Tests for Parkinson’s Disease on the Horizon?

December 2011
Placing Stem Cells in Animal Models of Parkinson’s Disease: Another Important Step

November 2011
Important News for the Parkinson’s Disease Community: More Evidence that Sinemet and Madopar are Not Toxic and do Not Accelerate Disease Progression

October 2011
The Case for All Parkinson’s Disease Patients to be Co-managed by a Primary Care-Neurologist Team

September 2011
Scientists say Research on Brain Proteins Involved in Parkinson’s Disease is “Shaping” Up

August 2011
Who Actually Takes Care of Most of the Parkinson’s Patients Worldwide: The Need for Education and the Parkinson’s Toolkit

July 2011
If you are Dizzy or Passing Out, it could be Your Parkinson’s Disease or Parkinson’s Disease Medications

June 2011
How Will Group Visits for Parkinson’s Disease Fit into the Future of Parkinson’s Disease Care?

May 2011
Why Patients Should be Wary of Chelation Therapy for Parkinson’s Disease

April 2011
Opening the Door to Gene Therapy in Parkinson’s Disease: The Need for Refinement of the Technology and Approach

March 2011
Does it Matter if I Can’t Get Brand Sinemet?

February 2011
Should I get a DaTscan or PET scan to confirm my diagnosis of Parkinson’s disease?

January 2011
A Critical Reappraisal of the Worst Drugs in Parkinson’s Disease

December 2010
Environmental Risks for PD: Manganese, Welding, Mining, and Parkinsonism

November 2010
Calling for the FDA to Revise the Eight Sinemet a Day Rule

October 2010
Dry Cleaning Solvents and Potential Environmental Risks for Developing Parkinson’s Disease

September 2010
Maintaining the Balance: Why Parkinson’s Disease Patients Need to Understand Drug Recalls, Withdrawals, and Safety Alerts

August 2010
Shining a Light on Parkinson’s Disease: Optogenetics Has a Bright Future in Research

July 2010
Poor Medication Management of Parkinson's Disease During Hospital Admissions: Patients and Families Can Improve Their Hospital-Based Management

June 2010
Why Are Patches and Continuous Release Technology a Big Deal to Parkinson's?

May 2010
Is the PD SURG Trial Another Surge Forward for DBS Therapy?

April 2010
Cycling in PD in Those Who Can’t Walk: Is it Possible?

March 2010
New iPS Stem Cells for PD: What Does it Mean?

February 2010
Time for Comprehensive Care Networks for PD

January 2010
Is Parkinson's Disease a Prion Disease?

December 2009
Parkinson's Disease Linked to Gaucher's Disease

November 2009
Brain Cells Keep Time Stamps: Implications for Parkinson's Disease Therapies

October 2009
Is it Safe to Have an MRI with a DBS in Place?

September 2009
Take Care of Your Bones as They Are Affected in Parkinson's Disease (Even in Men)

August 2009
Is it Time to Start Paying Attention to Pain Symptoms in Parkinson's Disease Patients?

July 2009
Glutathione Fails to Demonstrate Significant Improvement in PD Symptoms

June 2009
Keeping an Eye on Trials Important to the Parkinson's Disease Patient

May 2009
Increased Risk of Melanoma in Parkinson's Disease

April 2009
Finally a DBS Expert Consensus Statement Aimed at Their True Customers: The Patients

March 2009
Pesticides and Environmental Exposure in Parkinson's disease: Should We Stay Away From the Stink Truck?

February 2009
Is Exercise Effective Treatment and Protection Against PD?

January 2009
Why are Transplant Trials Struggling to Succeed in the Treatment of PD?

December 2008
Are Monoamine Oxidase Inhibitors Disease Modifying or Neuroprotective in PD?

November 2008
Update on Gene Therapy for Parkinson's Disease

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Each month, we will feature a new column by NPF's National Medical Director, Dr. Michael Okun, on the latest developments in Parkinson's disease research. Read the latest "What's Hot in PD?" below.

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