Missouri and applicants in four other states were awarded grants from the federal Agency for Toxic Substances and Disease Registry to determine the prevalence of the two chronic neurological diseases in communities near sources of hazardous substances.
Some residents of Herculaneum - home to a Doe Run Co. lead smelter, the nation's largest - say their Jefferson County town of 2,800 people has a higher-than-expected number of cases of Lou Gehrig's disease, formally known as amyotrophic lateral sclerosis. ALS attacks nerve cells in the brain and the spinal cord. Multiple sclerosis affects the central nervous system and the ability of nerves to conduct electrical impulses to and from the brain.
The study could begin in mid- to late March, said Eduardo Simoes, state epidemiologist for the Missouri Department of Health and Senior Services. It awaits another round of clearance from the federal health agency to ensure that protocol in each of the studies is consistent.
Missouri's grant for the three-year study is about $300,000.
Simoes said health officials don't know if Jefferson County has a high proportion of cases, but should have an indication midway through the investigation.
"If the prevalence is high, then we'll have to investigate why," he said. "That's a more complicated epidemiological study."
Unlike cancer, multiple sclerosis and ALS are not reportable diseases in Missouri, so there's no baseline of information, Simoes said. That's why the Department of Health jumped at the chance to investigate what some Herculaneum residents have suspected. Simoes said there is some "scant" evidence of a link between environment and the two diseases.
"That's the best of public health," he said. "We have to address their concerns."
Sheila McHawes of Herculaneum said she became aware of ALS when her brother-in-law was diagnosed six years ago. He died last year at age 41.
"I started looking around me," she said. "We started checking and were amazed when we started putting it on paper."
McHawes doesn't blame Doe Run, saying "we can't accuse anybody. Nobody knows what causes this."
She said she knows of two dozen cases within 10 miles of the lead smelter.
Sharon Gacki of the ALS Association's St. Louis regional chapter said the national office has not found a proven cluster of ALS.
Dr. Joseph Malone, on loan to the state from the Atlanta-based Centers for Disease Control and Prevention, said the prevalence of ALS is about six per 100,000. The prevalence of multiple sclerosis is 150 per 100,000. Prevalence is a "snapshot" number of cases at any given time. That's different from incidence, which is the number of new cases each year.
The state will attempt to learn the prevalence of cases by starting with the ALS and multiple sclerosis associations, inviting neurologists, hospitals and clinics to report cases.
The other ATSDR-funded study sites are in Illinois, Massachusetts, Washington and Texas.
On the Net:
Agency for Toxic Substances and Disease Registry, http://www.atsdr.cdc.gov
Missouri Department of Health and Senior Services, http://www.health.state.mo.us
ALS Association's St. Louis regional chapter, http://www.alsa.org/serving/stlouis-chapter.cfm
National Multiple Sclerosis Society, http://www.nmss.org