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Case-Control Study of Paresthesia Among World Trade Center-Exposed Community Members
Michael Marmor1, Sujata Thawani, Maria Luisa Cotrina
1Department of Population Health, NYU Grossman School of Medicine, New York (Dr Marmor, Dr Shao, Ms Wang, Dr Alexander), Department of Environmental Medicine, NYU Grossman School of Medicine, New York, New York (Dr Marmor, Dr Shao, Ms Wang, Dr Reibman), Department of Medicine, NYU Grossman School of Medicine, New York, New York (Dr Marmor, Dr Cotrina, Dr Wilkenfeld, Dr Reibman), Department of Neurology, NYU Grossman School of Medicine, New York, New York (Dr Thawani, Dr Alexander, Dr Wong), Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (Dr Wong), UCSF/Fresno and University Neurology Associates, Fresno, California (Dr Stecker), Division of Occupational and Environmental Medicine, Department of Medicine, NYU Winthrop Hospital, Mineola, New York (Dr Wilkenfeld) and Department of Internal Medicine, Strelitz Diabetes Center, Eastern Virginia Medical School, Norfolk, Virginia (Ms Vinik, Dr Vinik).
Objective:
To investigate whether paresthesia of the lower extremities following exposure to the World Trade Center (WTC) disaster was associated with signs of neuropathy, metabolic abnormalities, or neurotoxin exposures.
Methods:
Case-control study comparing WTC-exposed paresthesia cases with "clinic controls" (WTC-exposed subjects without paresthesias), and "community controls" (WTC-unexposed persons).
Results:
Neurological histories and examination findings were significantly worse in cases than controls. Intraepidermal nerve fiber densities were below normal in 47% of cases and sural to radial sensory nerve amplitude ratios were less than 0.4 in 29.4%. Neurologic abnormalities were uncommon among WTC-unexposed community controls. Metabolic conditions and neurotoxin exposures did not differ among groups.
Conclusions:
Paresthesias among WTC-exposed individuals were associated with signs of neuropathy, small and large fiber disease. The data support WTC-related exposures as risk factors for neuropathy, and do not support non-WTC etiologies.
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