Chemotherapy-induced peripheral neuropathy (CIPN) is a common neurological complication of cancer treatment.  CIPN has been associated with exposure to cisplatin, proteasome inhibitors ,antitubulins, immunomodulatory agents and biologics.   As the population ages, the long-term sequelae of prior CIPN have become increasingly relevant. 

"Preexisting conditions should be taken into consideration prior to initiation of potentially neurotoxic agents. It is important that the treating physician collaborate closely with a neurologist in evaluating and managing high-risk patients."

Link to original story at CancerNetwork.com

The National Academy of Sciences is reporting on the results of congressionally mandated review of the evidence linking to exposure to herbicides used during the Vietnam War with health problems including but not limited to Parkinson's disease.  "[T]he committee was asked to address the specific question of whether various conditions with Parkinson's-like symptoms should qualify the assignment of Parkinson's disease to the limited or suggestive category of association with herbicide exposure." 

This is a rather strange question as it asks the committee to lump parkinsonism (a.k.a. conditions with Parkinson's-like symptoms) in with idiopathic Parkinson disease.  Not too surprisingly, "the committee noted that Parkinson's disease is a diagnosis of exclusion".  In fact, various conditions with Parkinson's-like symptoms must be excluded when making a differential diagnosis of idiopathic Parkinson's disease!  Oddly, rather than recommending that the VA create a new category called parkinsonism under which idiopathic Parkinson Disease and "various conditions with Parkinson's-like symptoms" would all have been logically covered, the committee instead concluded that "there is no rational basis for exclusion of individuals with Parkinson's-like symptoms from the service-related category denoted as Parkinson's disease. To exclude a claim for a condition with Parkinson's-like symptoms, the onus should be on the U.S. Department of Veterans Affairs (VA) on a case-by-case basis to definitively establish the role of a recognized factor other than the herbicides sprayed in Vietnam."

Keep in mind, that Progressive Supranuclear Palsy (PSP) is an idiopathic neurodegnerative disease with Parkinson's-like symptoms.  Although it has recently been linked to environmental factors there is no evidence that exposure to any specific chemical causes PSP.   Manganese exposure, which can occur among welders, is associated parkinsonism as well.   So we have an example of an idiopathic neurodegenerative disease and a neurotoxic effect that both produce Parkinson's-like symptoms that must logically be excluded in the differential diagnosis of idiopathic Parkinson's disease and yet, these two conditions will now be "included" in the category denoted as Parkinson's disease. 

So what does this all mean for Vets?  In short, with respect to excluding persons with various conditions with Parkinson's-like symptoms the committee has recommended that for these claims the onus "should" be on the U.S. Department of Veterans Affairs to establish the role of a recognized factor other than the herbicides sprayed in Vietnam on a case by case basis.   In other words, if you have Parkinson's-like symptoms and the government can show that you were exposed to manganese while working as a welder after you completed your tour of duty they may be able to deny your claim.   On the other hand, if you develop Parkinson's-like symptoms and there are no identifiable recognized factors other than the herbicides sprayed in Vietnam in your personal exposure history your claim may be paid.

Link to original story in EurekAlert

A new study by researchers affiliated with the National Institute of Environmental Health Sciences (NIEHS) looking at subjects from the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study (GENEVA) has found an increased risk for developing ALS among veterans with a history of exposure to herbicides, pesticides, nasopharyngeal radium, exhaust fumes, radar waves, contaminated food, being with one mile of an explosion (possible interaction with CTE and ALS?), herbicides in the field, mixing and application of burning agents, burning agents in the field, and Agent Orange. 

Although the authors are cautious about over interpreting the findings because "some of them may have been confounded by other exposures experienced during military service or civilian life" the data nevertheless add to a growing body of literature supporting the role of chemicals in neurodegenerative diseases such as ALS. 

Link to abstract in PubMed

Please watch this related video entitled "Veterans face higher risk for developing ALS" that originally appeared on the WDBJ-7 website