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Case-Control Study of Paresthesia Among World Trade Center-Exposed Community Members

Marmor, Michael; Thawani, Sujata; Cotrina, Maria Luisa; Shao, Yongzhao; Wong, Ericka S; Stecker, Mark M; Wang, Bin; Allen, Alexander; Wilkenfeld, Marc; Vinik, Etta J; Vinik, Aaron I; Reibman, Joan
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.
PMID: 32049876
ISSN: 1536-5948
CID: 4304452

Paresthesias Among Community Members Exposed To The World Trade Center Disaster

Marmor, Michael; Shao, Yongzhao; Bhatt, D Harshad; Stecker, Mark M; Berger, Kenneth I; Goldring, Roberta M; Rosen, Rebecca L; Caplan-Shaw, Caralee; Kazeros, Angeliki; Pradhan, Deepak; Wilkenfeld, Marc; Reibman, Joan
OBJECTIVE: Paresthesias can result from metabolic disorders, nerve entrapment following repetitive motions, hyperventilation pursuant to anxiety, or exposure to neurotoxins. We analyzed data from community members exposed to the World Trade Center (WTC) disaster of September 11, 2001, to evaluate whether exposure to the disaster was associated with paresthesias. METHODS: Analysis of data from 3141 patients of the WTC Environmental Health Center. RESULTS: Fifty-six percent of patients reported paresthesias at enrollment 7 to 15 years following the WTC disaster. After controlling for potential confounders, paresthesias were associated with severity of exposure to the WTC dust cloud and working in a job requiring cleaning of WTC dust. CONCLUSIONS: This study suggests that paresthesias were commonly associated with WTC-related exposures or post-WTC cleaning work. Further studies should objectively characterize these paresthesias and seek to identify relevant neurotoxins or paresthesia-inducing activities.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.
PMCID:5374747
PMID: 28157767
ISSN: 1536-5948
CID: 2437202

Neurologic Evaluations of Patients Exposed to the World Trade Center Disaster

Stecker, Mark M; Yu, Huiying; Barlev, Renee; Marmor, Michael; Wilkenfeld, Marc
OBJECTIVE: The aim of this study was to describe the clinical phenotype of a limited group of responders and survivors of the World Trade Center (WTC) disaster who were referred for the evaluation of neuropathic symptoms. METHODS: Sixteen patients with WTC exposure were referred to a neurologist for evaluation. All had a neurologic examination. Most had electromyogram and nerve conduction testing/nerve conduction studies as well as appropriate imaging and blood tests. RESULTS: There was a higher probability of a neuropathy diagnosis in WTC-exposed patients than other patients referred for EMG testing. Two WTC-exposed patients had motor neuron disease and not neuropathy. CONCLUSION: This study provides objective evidence of neuropathy in a relatively high fraction of WTC-exposed patients with neuropathic symptoms. It also emphasizes that the scope of neurologic problems following WTC exposure may include other diagnoses such as motor neuron disease.
PMID: 27820766
ISSN: 1536-5948
CID: 2303662

Neuropathic Symptoms in World Trade Center Disaster Survivors and Responders

Wilkenfeld, Marc; Fazzari, Melissa; Segelnick, Jacqueline; Stecker, Mark
OBJECTIVE: The objective of this research is to determine whether responders and survivors of the World Trade Center (WTC) disaster experience symptoms of neuropathy at a rate higher than those not exposed. METHODS: A survey of neuropathic symptoms in patients who were and were not exposed at the WTC based upon the Michigan Neuropathy Screening Instrument (MNSI). RESULTS: Even after correction for medical comorbidities, age, and depression, neuropathic symptoms are much more common in those exposed to WTC dust and increase with increasing exposure. CONCLUSIONS: This study provides evidence that exposure to WTC dust is associated with neuropathic symptoms.
PMID: 26618530
ISSN: 1536-5948
CID: 2040932

Analysis of Short-Term Effects of World Trade Center Dust on Rat Sciatic Nerve

Stecker, Mark; Segelnick, Jacqueline; Wilkenfeld, Marc
OBJECTIVE:: The purpose of this study was to investigate the short-term effects of residual dust from the World Trade Center (WTC) on rat sciatic nerve. METHODS:: Nerve action potentials were recorded in nerves exposed to dust from the WTC as well as control nerves. RESULTS:: There was a reduction in the conduction velocity of nerves exposed to a high concentration of the dust from the WTC when compared with controls. CONCLUSIONS:: Although there are statistically significant reductions in conduction velocity when exposed to the WTC dust in this pilot study, additional studies both clinical and basic will be needed to further understand the significance of these results.
PMID: 25215548
ISSN: 1076-2752
CID: 1258422

9/11 and occupational/environmental medicine [Editorial]

Wilkenfeld, Marc
PMID: 21904165
ISSN: 1076-2752
CID: 302062

Characteristics Of Sarcoidosis In Residents And Workers Exposed To World Trade Center (WTC) Dust, Gas And Fumes Presenting For Medical Care [Meeting Abstract]

Parsia, SS; Yee, H; Young, S; Turetz, ML; Marmor, M; Wilkenfeld, M; Kazeros, A; Caplan-Shaw, CE; Reibman, J
ISI:000208771000740
ISSN: 1073-449x
CID: 2331682

Simple asphyxiants

Chapter by: Wilkenfeld, Marc
in: Environmental and occupational medicine by Rom WN; Markowitz S [Eds]
Philadelphia : Wolters Kluwer/Lippincott Williams & Wilkins, 2007
pp. ?-?
ISBN: 0781762995
CID: 5366

Occupational eye injury due to phototoxicity [Letter]

Wilkenfeld, Marc; Crowley, Kathleen A; Dawodu, Olugbenga
PMID: 12085469
ISSN: 1076-2752
CID: 32303