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Isolated reports of parkinsonism, developing after acute paraquat (37,53,54) and glyphosate (55) exposure, suggest a role of these pesticides as a risk factor for PD. However, PD is a common disease, and sporadic cases are substantial confounders to case reports. Ferraz et al. (56) performed a case-control study of parkinsonian features in a group of agricultural workers exposed to the manganese containing fungicide maneb. They found that the exposed workers (n = 50) were significantly more likely to have rigidity and a variety of constitutional symptoms than nonexposed workers (n = 19). There was no significant difference in other parkinsonian signs but the number of subjects was small. Of studies reporting a relationship between pesticide exposure and PD, the odds ratios ranged from 1.77 to 7.0 with relatively wide confidence intervals in many studies reflecting small sample sizes (51,57). Only one peer-reviewed study reported a significant odds ratio less than one for herbicides (58), and numerous studies found no relationship (22,25,59). If pesticide and herbicide exposures cause PD, those applying or working directly with the substances might be at higher risk. Few studies investigate the relative frequency of PD in pesticide/herbicide workers compared to those living (but not working) in rural environments. Gorell et al. (60) performed a population-based case-control study of 144 PD subjects with occupational exposure to pesticides and herbicides in Michigan, U.S.A. They found that occupational exposure to insecticides (OR=3.55) and herbicides (OR=4.10) were significant risk factors for PD; fungicide use was not associated with PD. Table 2 summarizes the positive case-control studies implicating pesticides as a risk factor for PD.

TABLE 2 Positive Parkinson's Disease Case Control Studies for Pesticides3

Study

Exposure

Cases

Controls

Odds ratio (95%CI)

Golbe et al. (57)

Pesticidesa

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