Objective: To further characterize movement disorders seen in Veterans exposed to toxins at Camp Lejeune military base.

Background: Recent reports reveal that water in the Camp Lejeune military base in North Carolina was contaminated with volatile organic compounds including trichloroethylene (TCE) and tetrachloroethylene, among others, between 1953-1987. Exposure to these agents, and others such as Agent Orange (AO), is linked to the development of Parkinson’s disease (PD). For example, TCE directly causes dopamine degeneration in rodent models. However, in the clinical setting at Hines VA Hospital, Veterans displayed not only parkinsonism, but also other co-incident movement and neurologic disorders.

Method: We conducted a retrospective chart review of 25 Camp Lejeune Veterans who received care at Hines VA neurology clinic within the last year.

Results: Among the 25 Veterans, most notably we found (i) 44% had a diagnosis of PD, 32% had atypical parkinsonism (PD-ism), and 8% had essential tremor (ET). (ii) 66.7% had ET that preceded PD onset by 5-30 years, with a majority reporting exposure to both AO and Camp Lejeune toxins. (iii) overall, 56% of Veterans were dually exposed to Camp Lejeune and AO, with 100% developing a movement disorder (50% PD, 35.7% PD-ism, 14.3% ET) (iv) 66.7% also developed a combination of PD/PD-ism plus another co-incident movement disorder that was mainly hyperkinetic, and not a sequelae of PD or dopaminergic medications. (v) two Veterans (8%) that were only at Camp Lejeune had co-incident PD/PD-ism and myasthenia gravis (MG). (vi) finally, all PD-isms were synucleinopathies.

Conclusion: While we cannot imply causality, these data suggest that exposure to the toxins at Camp Lejeune are associated with a broader spectrum of neurologic symptoms than previously thought. Also, the combination of toxin exposure in those dually exposed to AO and Camp Lejeune toxins, seem to contribute to a higher number of co-incident movement and neurologic disorders compared to the general population. Transformation from ET to PD only occurs in 3.6% of the general population, as opposed to 66.7% in our cohort. The incidence of co-incident MG and PD/PD-ism is quite uncommon in general at 0.5–40/10⁹, but was 8% in our cohort, potentially suggesting a negative synergistic effect of toxins. These preliminary findings warrant further study given its implications for care management in the Veteran population.

References: Bale AS, Barone S Jr, Scott CS, Cooper GS. A review of potential neurotoxic mechanisms among three chlorinated organic solvents. Toxicol Appl Pharmacol. 2011 Aug 15;255(1):113-26. doi: 10.1016/j.taap.2011.05.008. Epub 2011 May 15. PMID: 21609728.

Danchi H, Chen RJ. Agent Orange Toxicity. [Updated 2023 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK594243/

Goldman SM, Weaver FM, Stroupe KT, Cao L, Gonzalez B, Colletta K, Brown EG, Tanner CM. Risk of Parkinson Disease Among Service Members at Marine Corps Base Camp Lejeune. JAMA Neurol. 2023 Jul 1;80(7):673-681. doi: 10.1001/jamaneurol.2023.1168. PMID: 37184848; PMCID: PMC10186205.

Louis ED, Berry D, Ghanem A, Cosentino SA. Conversion Rate of Essential Tremor to Essential Tremor Parkinson Disease: Data From a Prospective Longitudinal Study. Neurol Clin Pract. 2023 Jun;13(3):e200162. doi: 10.1212/CPJ.0000000000200162. Epub 2023 May 10. PMID: 37256209; PMCID: PMC10226077.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-impact-of-camp-lejeune-toxins-on-the-development-of-parkinsonisms-and-movement-disorders/