Paresthesias Among Community Members Exposed to the World Trade Center Disaster

Marmor, Michael; Shao, Yongzhao; Bhatt, Dimple H.; Stecker, Mark M.; Berger, Kenneth I.; Goldring, Roberta M.; Rosen, Rebecca; Caplan-Shaw, Caralee; Kazeros, Angeliki; Pradhan, Deepak; Wilkenfeld, Marc; Reibman, Joan

doi:10.1097/jom.0000000000000966

Cited by 13 publications

(14 citation statements)

References 32 publications

(31 reference statements)

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“…Results of a previous analysis of risk factors for paresthesia among WTC EHC patients that did not take into account times to events were similar to those of one of the present models in finding significant associations of paresthesias with both working in jobs that required cleaning of WTC dust in the workplace and heavy exposure to WTC dust on September 11, 2001 after adjusting for potential confounders [13]. Of these two risk factors, only work in a job that required cleaning of WTC dust was significant in our initial Cox regression model that counted subjects with “occasional” paresthesia as paresthesia-free.…”

Section: Discussionsupporting

confidence: 76%

“…An earlier analysis of patients from the WTC EHC found that many reported paresthesias at enrollment 7–15 years after 9/11 [13]. These symptoms were associated with the severity of exposure to WTC dust on 9/11 and cleaning of workplaces after adjusting for known risk factors for paresthesia, including preexisting paresthesias, anxiety, and diagnoses of diabetes and cancer [3,12].…”

Section: Introductionmentioning

confidence: 99%

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Time to Onset of Paresthesia Among Community Members Exposed to the World Trade Center Disaster

Thawani

Wang

Shao

et al. 2019

IJERPH

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We examined whether time to onset of paresthesia was associated with indicators of severity of World Trade Center (WTC) exposure. We analyzed data from 3411 patients from the Bellevue Hospital—WTC Environmental Health Center. Paresthesia was defined as present if the symptom occurred in the lower extremities with frequency “often” or “almost continuous.” We plotted hazard functions and used the log-rank test to compare time to onset of paresthesia between different exposure groups. We also used Cox regression analysis to examine risk factors for time-to-paresthesia after 9/11/2001 and calculate hazard ratios adjusted for potential confounders. We found significantly elevated hazard ratios for paresthesia for (a) working in a job that required cleaning of WTC dust in the workplace; and (b) being heavily exposed to WTC dust on September 11, 2001, after adjusting for age, race/ethnicity, depression, anxiety, post-traumatic stress disorder, and body mass index. These observational data are consistent with the hypothesis that exposure to WTC dust or some other aspect of cleaning WTC dust in the workplace, is associated with neuropathy and paresthesia. Further neurological evaluations of this and other WTC-exposed populations is warranted.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Time to Onset of Paresthesia Among Community Members Exposed to the World Trade Center Disaster

Thawani

Wang

Shao

et al. 2019

IJERPH

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“…NHANES prevalence data from this period suggested that any WTC exposure, whether the most or the least exposed, increased by two-fold the likelihood of reporting neuropathic symptoms. This standardization to NHANES bolsters the connection between WTC exposure and paresthesia symptoms also found in previous neuropathy symptom studies [15,16,17]. Moreover, we used a validated screening questionnaire, the DNS, in addition to questions on paresthesias of the upper and lower extremities, similar to the questions used by Marmor et al [16], to examine prevalence in our population using multiple measures; therefore, giving our findings a more robust framework.…”

Section: Discussionmentioning

confidence: 80%

“…This standardization to NHANES bolsters the connection between WTC exposure and paresthesia symptoms also found in previous neuropathy symptom studies [15,16,17]. Moreover, we used a validated screening questionnaire, the DNS, in addition to questions on paresthesias of the upper and lower extremities, similar to the questions used by Marmor et al [16], to examine prevalence in our population using multiple measures; therefore, giving our findings a more robust framework. Further support for our findings can also be found in a 2016 study of 16 WTC-exposed responders and survivors, which concluded that there was a higher probability of a neuropathy diagnosis in patients who were WTC-exposed as compared with others referred for electromyography (EMG) testing [31].…”

Section: Discussionmentioning

confidence: 80%

“…To date, three previous questionnaire-based studies have investigated the prevalence and risk factors for peripheral neuropathy in smaller WTC-exposed populations and reported that neuropathy symptoms were commonly associated with WTC-related exposure or WTC cleaning work [15,16,17]. The purpose of the current study is to investigate the prevalence of self-reported peripheral neuropathic symptoms and paresthesias among more than 9000 WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical workers (EMS) between 7 June 2017, when the Diabetic Neuropathy Symptom (DNS) score was added to FDNY monitoring questionnaires, and 6 April 2019.…”

Section: Introductionmentioning

confidence: 99%

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Post-9/11 Peripheral Neuropathy Symptoms among World Trade Center-Exposed Firefighters and Emergency Medical Service Workers

Colbeth

Zeig‐Owens

Webber

et al. 2019

IJERPH

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Peripheral neuropathy can result from numerous conditions including metabolic disorders, inflammatory disease, or exposure to environmental or biological toxins. We analyzed questionnaire data from 9239 Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed firefighters and emergency medical service workers (EMS) to evaluate the association between work at the WTC site and subsequent peripheral neuropathy symptoms using the validated Diabetic Neuropathy Symptom (DNS) score. We grouped the population into an “Indicated” group with conditions known to be associated with paresthesia (N = 2059) and a “Non-Indicated” group without conditions known to be associated (N = 7180). The level of WTC exposure was categorized by time of arrival to the WTC. Overall, 25% of workers aged 40 and older reported peripheral neuropathy symptoms: 30.6% in the Indicated and 23.8% in the Non-Indicated groups, respectively. Multivariable logistic models performed on the Non-Indicated group, and on the Non-Indicated in comparison with non-WTC exposed National Health and Nutrition Examination Survey (NHANES), found that the highest level of WTC-exposure was significantly associated with DNS positive outcomes, after controlling for potential confounders. In conclusion, this study suggests that symptoms of peripheral neuropathy and paresthesias are common and are associated with WTC-exposure intensity.

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Neurological disease in the aftermath of terrorism: a review

Cauwer

Somville

2018

Acta Neurol Belg

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The purpose of our review is to discuss current knowledge on long-term sequelae and neurological disorders in the aftermath of a terrorist attack. The specific aspects of both psychological and physical effects are mentioned in more detail in this review. Also, the outcomes such as stress-related disorders, cardiovascular disease, and neurodegenerative disease are explained. Moreover, PTSD and posttraumatic structural brain changes are a topic for further investigations of the patients suffering from these attacks. Not only the direct victims are prone to the after effects of the terroristic attacks, but the rescue workers, physicians, witnesses and worldwide citizens may also be affected by PTSD and other neurological diseases as well. The determination of a whole series of risk factors for developing neurological disorders can be a means to set up early detection, preventative measures, to refine treatment and thus to gain better outcome in the future.

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Paresthesias Among Community Members Exposed to the World Trade Center Disaster

Cited by 13 publications

References 32 publications

Time to Onset of Paresthesia Among Community Members Exposed to the World Trade Center Disaster

Time to Onset of Paresthesia Among Community Members Exposed to the World Trade Center Disaster

Post-9/11 Peripheral Neuropathy Symptoms among World Trade Center-Exposed Firefighters and Emergency Medical Service Workers

Neurological disease in the aftermath of terrorism: a review

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