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LETTER
Follow-up of Sarin Poisoning in Matsumoto
Yoshiki Sekijima, MD, PhD;
Hiroshi Morita, MD, PhD; and
Nobuo Yanagisawa, MD, PhD
1 December 1997 | Volume 127 Issue 11 | Page 1042
TO THE EDITOR:
The sarin (isopropyl methyl phosphonofluoridate) attack in Matsumoto, Japan, killed 7 residents and poisoned approximately 500 others [1]. Although widespread health hazards occurred during the acute phase [1-3], there are few data on the sequelae of sarin exposure [4, 5]. To explore the long-term effects of sarin on humans, we conducted 1-year and 2-year follow-up health examinations of all victims who showed a decrease in serum cholinesterase (ChE) activity or miosis during the acute phase.
One hundred forty-nine victims met these criteria and 85 (57.0%) had these examinations. We classified them into 3 groups according to the percentage of the minimum value for normal ChE (ChE%) in the acute phase. There were 6 persons in the severely poisoned group (ChE% < 25%), 27 in the moderately poisoned group (ChE%, 25% to <100%), and 52 in the mildly poisoned group (ChE% 
100% or not examined). All severely poisoned victims still showed abnormal findings (Table 1). We found that 4 of 6 severely poisoned persons (patients 1 to 4) still showed epileptic electroencephalographic changes, which were the most characteristic abnormality. Other abnormal findings, such as arrhythmia, hypoxia, or low-grade fever, also continued to be seen in the severely poisoned group (patients 1, 5, and 6). One of the severely poisoned victims (patient 2) developed sensory polyneuropathy 7 months after the exposure, and sensory nerve conduction velocity was reduced. In the moderately poisoned group, although 1 victim continued to have visual field defects at the 1-year follow-up health examination, he recovered completely 17 months after the exposure (patient 7). The other moderately poisoned victims and all of the mildly poisoned victims showed no objective abnormal findings. We conclude that exposure to high levels of sarin gas carries a risk for sequelae.
1. Morita H, Yanagisawa N, Nakajima T, Shimizu M, Hirabayashi H, Okudera H, et al. Sarin poisoning in Matsumoto, Japan. Lancet. 1995; 346:209-3.
2. Suzuki T, Morita H, Ono K, Maekawa K, Nagai R, Yazaki Y. Sarin poisoning in Tokyo subway [Letter]. Lancet. 1995; 345:980.
3. Nozaki H, Alkawa N, Shinozawa Y, Hori S, Fujishima S, Takuma K, et al. Sarin poisoning in Tokyo subway [Letter]. Lancet. 1995; 345:980-1.
4. Duffy FH, Burchfiel JL, Bartels PH, Gaon M, Sim VM. Long-term effects of an organophosphate upon the human electroencephalogram. Toxicol Appl Pharmacol. 1979; 47:161-76.
5. Sekijima Y, Morita H, Shindo M, Okudera H, Shibata T, Yanagisawa N. [A case of severe poisoning in the sarin attack in Matsumoto. One-year follow-up of clinical findings, and laboratory data.] Rinshoshinkeigaku. 1995; 35:1241-5.
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