Delayed Neurological Complications of Sulphur Mustard and Tabun Poisoning in 43 Iranian Veterans

Abstract

Delayed neurotoxic complications of chemical warfare agents (CWA), such as sulphur mustard (SM) and tabun, in human beings have not been reported in detail. We thus aimed to investigate possible neurotoxic complications of these agents in Iranian veterans 22-27 years after exposure. After co-ordination with the veteran foundation and obtaining the approval of the medical research ethics committee, 43 Iranian veterans with late complications of CWA exposure during the Iran-Iraq conflict were studied after obtaining signed written informed consent. Demographic and clinical findings were recorded on pre-designed forms. Neurological examination was performed by a neurologist. Routine biochemical tests were performed for all the patients. Electromyography (EMG), nerve conduction velocity (NCV) and electroencephalography (EEG) were carried out as clinically indicated. The majority of the patients (38) had been exposed to SM and only five patients to tabun. Hyperaesthesia was the most objective finding (72.1%). Fatigue (93%), paraesthesia (88.3%) and headache (83.7%) were the most common subjective findings in the patients. Sensory nerve impairments, including paraesthesia (88.3%), hyperaesthesia (72.1%) and hypoesthesia (11.6%), were the most common observed clinical complications. EMG and NCV were impaired in seven patients (16.3%) who were all SM-exposed patients but did not show any significant correlation with organ complications. EEG was negative even in the seized patients. Cholesterol, LDL and triglyceride levels were significantly above the normal ranges. Late neurological complications of CWA, particularly SM poisoning, are considerable even after three decades of exposure and require medical attention.

Sulfur Mustard Exposure and Cardiovascular Effects: A Review

“…The recognition that epigenetic modifications of DNA and histones regulate inflammatory gene expression and play a role in diverse functions such as DNA repair, proliferation, and RNA interference indicates the global importance of these effects in several diseases (60,61). For example, studies have shown that levels of histone deacetylases (HDACs) and acetyltransferase (HATs) are important biomarkers for regulating inflammation and oxidative stress (62). Therefore, the expression of inflammatory cytokines and oxidative stress in cardiac muscle impels us to investigate histone modifications in cardiac muscle and immune cells of SM exposed patients.…”

Advances in toxicology and medical treatment of chemical warfare nerve agents

“…Neurological assessment of 43 Iranian veterans 22–27 years post exposure revealed fatigue, paraesthesia and headache as the most common symptoms and sensory nerve impairments as the most common observed clinical complication. The authors concluded that late neurological complications of CWAs poisoning are notable [93]. Sensory nerve dysfunction is more prevalent than motor nerves, which predominantly was a distal sensory deficit [94].…”

Self-Care Strategy in Chemically-Injured Veterans: A Content Analysis

“…During the last century, chemical weapons caused significant damage to the society and are still considered as a matter of great concern worldwide. According to WHO reports, chemical warfare caused injuries to 1 300,000 victims and 90,000 deaths (11).…”

“…Iraq was the biggest consumer of mustard gas as a chemical weapon against Iran in 1983 -1988, which caused the death of 25,000 people. This chemical weapon caused over 100,000 casualties among military and non-military individuals in Iran (11,12). cancer (15).…”