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From the Department of Neuroscience (Drs. Pezzoli, Canesi, Antonini, Barichella, Mariani, Tesei, Resei, and Zecchinelli), Parkinson Institute, Istituti Clinici di Perfezionamento, Milan; Paul Scherrer Institut (Drs. Antonini and Leenders), PET program, Villigen, Switzerland; Ospedale Maggiore IRCCS (Drs. Righini and Tenconi), Milan; Institute of Occupational Medicine (Dr. Perbellini), University of Verona, Italy; and Istituto Geriatrico Redaelli (Dr. Tesei), Vimodrone, Milan, Italy.
Address correspondence and reprint requests to Dr. G. Pezzoli, Director of Department of Neuroscience, Parkinson Institute—Istituti Clinici di Perfezionamento, Via Bignami, 1-20126 Milan, Italy; e-mail: pezzoli{at}parkinson.it
BACKGROUND: Single cases of parkinsonism have been associated with hydrocarbon solvents.
OBJECTIVE: To determine whether exposure to hydrocarbon solvents is related to PD.
METHODS: Cohort study of 990 patients with PD according to Core Assessment Program for Intracerebral Transplantations (CAPIT) criteria, selected from 1455 consecutive subjects presenting at a referral center; case–control study assessing Unified PD Rating Scale scores (motor score as primary endpoint) in all subjects with positive history of hydrocarbon solvent exposure (n = 188), matched for duration of disease and gender to 188 subjects selected from the remaining 802 with a negative history. Two subgroups in the case–control study included the following: 1) response to apomorphine (n = 26); 2) brain MRI (n = 15). PET imaging (n = 9) was compared with that of historic controls.
RESULTS: Exposed patients were younger (61.0 ± 9.4 versus 64.7 ± 9.4 years, p = 0.002), predominantly male (76.4% versus 45.2%, p = 0.0001), less educated (8.4 ± 4.2 versus 10.1 ± 4.4 years, p = 0.0001), and younger at onset of disease (55.2 ± 9.8 versus 58.6 ± 10 years, p = 0.014). Exposure to hydrocarbon solvents directly correlated to disease severity (r = 0.311) and inversely correlated to latency period (r = -0.252). Nine blue-collar occupations accounted for 91.1% of exposures.
CONCLUSIONS: Occupations involving the use of hydrocarbon solvents are a risk factor for earlier onset of symptoms of PD and more severe disease throughout its course. Hydrocarbon solvents may be involved in the etiopathogenesis of PD, which does not have a major genetic component.
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