Select Committee on Science and Technology Written Evidence

Letter from Dr G A Jamal, MB ChB MD PhD FRCP


  I am submitting this on a personal basis. My qualifications are MB ChB MD PhD FRCP. I am a consultant physician with specialisation in the field of clinical neurophysiology and I have a special interest in the neurological and neurophysiological assessment of the effects of neurotoxic factors on the peripheral and central nervous system. I have published extensively on the effect of organophosphate compounds on human health.

  Within the last few years I have seen many pilots, co-pilots and cabin crew members as well as passengers who have had episodes of exposure to fume incidents. I have run extensive neurological and clinical neurophysiological assessment on them.

  Aircrews have presented for testing some time after advising of exposures to aircraft contaminated air, specifically oil lubricant exposure containing organophosphates and a mixture of hydrocarbons. Given that the toxic substances involved in air fume contamination events have high affinity to lipid material and given that the bulk of the nervous system both peripheral and central is phospholipids, the nervous system is one of the prime toxic targets and is one of the most seriously affected systems in the body both in the short term and in the longer term.

  I found that the most commonly encountered manifestations include confusion, drowsiness, fogginess in the head, excessive tiredness, loss of balance and co-ordination, dizziness, clumsiness, headaches, pins and needles and numbness sensation in the extremities, generalised pain and aches. Other common manifestations include difficulty with concentration and short term memory, mood changes, disturbances of sleep and difficulty in finding words. There may be development of intolerance to alcohol and increased sensitivity to a number of chemicals. Other common manifestations include visual blurring, tinnitus, sweating disturbances, bloating, nausea, loss of sexual drive and frequency of micturition.

  We have investigated these cases systematically and thoroughly with tests looking at the function of the peripheral and central nervous system and the autonomic nervous system. The tests undertaken include EMG and Nerve Conduction Studies, Quantitative Sensory Tests (large fibre VPT and small fibre TTT), Single Fibre Jitter measurement, Multimodality Evoked Potentials (VEP, BAEP & SEP), Cognitive Evoked Potential (CEP & P300) and EEG. Other useful investigations include Neuropsychometric Tests and Autonomic Nervous System Tests. We have aspired to do Brain Functional Imaging (PET & SPECT Scan) but have not done so purely because of cost issues. We have found evidence of abnormalities in this group of patients to variable degrees including peripheral neuropathy particularly small fibre neuropathy and other central abnormalities as well as evidence of dysautonomia with a particular pattern. The findings seen are similar to those found in cases of exposure to organophosphate esters and solvents. Accurate diagnosis is essential not only to characterise the ailment but also to instigate effective management.

18 June 2007

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