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Personalized Prevention in Mercury-Induced Amyotrophic Lateral Sclerosis: A Case Report. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10217839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic exposure to low levels of mercury is involved in the development of motor neuron diseases (MND). Genetic alterations may have a crucial role in the onset and progression. We presented a case of a TANK-binding kinase 1 (TBK1)-mutated 54-year-old male worker who developed a MND due to chronic mercury exposure at work. He was employed in a chlor-alkali plant in Central Italy. After two years of employment he had acute mercury intoxication with suggestive neurological symptoms and a high urinary level of the metal. Through years, many episodes of intoxication occurred, but he continued to perform the same job and be exposed to mercury. After yet another episode of intoxication in 2013, he showed fasciculations of the upper limbs and trunk, and electromyographic activity patterns were consistent with amyotrophic lateral sclerosis (ALS). In 2016, a genetic test revealed a mutation of TBK1, an ALS-related gene. This case highlights the important role of genetics in personalized occupational medicine. Occupational physicians should use genetic tests to identify conditions of individual susceptibility in workers with documented frequent episodes of mercury intoxication recorded during health surveillance programs to customize prevention measures in the workplace and act before damage appears.
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Fields CA, Borak J, Louis ED. Mercury-induced motor and sensory neurotoxicity: systematic review of workers currently exposed to mercury vapor. Crit Rev Toxicol 2017; 47:811-844. [PMID: 28718354 PMCID: PMC5931703 DOI: 10.1080/10408444.2017.1342598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/12/2017] [Accepted: 06/11/2017] [Indexed: 01/08/2023]
Abstract
The neurotoxicity of elemental mercury (Hg0) is well-recognized, but it is uncertain whether and for how long neurotoxicity persists; among studies that evaluated previously exposed workers, only one examined workers during and also years after exposure ceased. The aim of this review is to document the type, frequency, and dose-relatedness of objective neurological effects in currently exposed mercury workers and thereby provide first approximations of the effects one would have expected in previously exposed workers evaluated during exposure. We systematically reviewed studies of neurotoxicity in currently exposed mercury workers identified by searching MEDLINE (1950-2015), government reports, textbook chapters, and references cited therein; dental cohorts were not included. Outcomes on physical examination (PE), neurobehavioral (NB) tests, and electrophysiological studies were extracted and evaluated for consistency and dose-relatedness. Forty-five eligible studies were identified, comprising over 3000 workers chronically exposed to a range of Hg0 concentrations (0.002-1.7 mg/m3). Effects that demonstrated consistency across studies and increased frequency across urine mercury levels (<50; 50-99; 100-199; ≥200 μg/L) included tremor, impaired coordination, and abnormal reflexes on PE, and reduced performance on NB tests of tremor, manual dexterity and motor speed. The data suggest response thresholds of UHg ≈275 μg/L for PE findings and ≈20 μg/L for NB outcomes. These results indicate that PE is of particular value for assessing workers with UHg >200 μg/L, while NB testing is more appropriate for those with lower UHg levels. They also provide benchmarks to which findings in workers with historical exposure can be compared.
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Affiliation(s)
- Cheryl A. Fields
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jonathan Borak
- Departments of Medicine and Epidemiology & Public Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elan D. Louis
- Department of Neurology, Yale School of Medicine, and Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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Ohlander J, Huber SM, Schomaker M, Heumann C, Schierl R, Michalke B, Jenni OG, Caflisch J, Muñoz DM, von Ehrenstein OS, Radon K. Mercury and neuromotor function among children in a rural town in Chile. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:27-35. [PMID: 27078174 DOI: 10.1080/10773525.2015.1125585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mercury (Hg) exposure from artisanal gold mining has adverse effects on the neuromotor function in adults. However, few studies have examined this relationship in children. OBJECTIVES To investigate the impact of Hg exposure on children's neuromotor function. METHODS Cross-sectional data on Hg risk factors and demographics were collected from n = 288 children (response = 68.9%). Based on complete cases (CCs) (n = 130) and multiple imputations (n = 288), associations between fingernail Hg and four different neuromotor function components were calculated using multiple logistic regression adjusted for confounders. RESULTS Of the children, 11.1, 14.9, 63.9, and 10.4% had pathologic pure motor skills, adaptive fine motor skills, adaptive gross motor skills, and static balance, respectively. No significant association between fingernail Hg and any neuromotor component was found. However, Hg burning in the household was significantly associated with children's pathologic pure motor skills (OR 3.07 95% CI 1.03-9.18). CONCLUSION Elemental Hg exposure in the household might have adverse long-term effects on children's pure motor skills.
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Affiliation(s)
- Johan Ohlander
- a Center for International Health Ludwig-Maximilians-University (LMU) at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine , University Hospital Munich (LMU) , Munich , Germany
| | - Stella Maria Huber
- a Center for International Health Ludwig-Maximilians-University (LMU) at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine , University Hospital Munich (LMU) , Munich , Germany
| | - Michael Schomaker
- b Centre for Infectious Disease Epidemiology and Research , University of Cape Town , Cape Town , South Africa
| | - Christian Heumann
- c Department for Statistics , Ludwig-Maximilians-University Munich , Munich , Germany
| | - Rudolf Schierl
- a Center for International Health Ludwig-Maximilians-University (LMU) at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine , University Hospital Munich (LMU) , Munich , Germany
| | - Bernhard Michalke
- d Research Unit Analytical BioGeoChemistry , Helmholtz Center Munich - German Research Center for Environmental Health GmbH , Neuherberg , Germany
| | - Oskar G Jenni
- e Department of Pediatrics, Child Development Center , University Children's Hospital Zürich , Zürich , Switzerland
| | - Jon Caflisch
- e Department of Pediatrics, Child Development Center , University Children's Hospital Zürich , Zürich , Switzerland
| | - Daniel Moraga Muñoz
- f Facultad de Medicina , Universidad Diego Portales , Santiago , Chile.,g Past staff of Facultad de Medicina, Latin American Center of the Center for International Health Ludwig-Maximilians-University , Universidad Católica del Norte , Coquimbo , Chile
| | - Ondine S von Ehrenstein
- h Department of Community Health Sciences , University of California Los Angeles , Los Angeles , CA , USA
| | - Katja Radon
- a Center for International Health Ludwig-Maximilians-University (LMU) at the Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine , University Hospital Munich (LMU) , Munich , Germany
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Anger WK. Reconsideration of the WHO NCTB strategy and test selection. Neurotoxicology 2014; 45:224-31. [PMID: 25172409 PMCID: PMC4268438 DOI: 10.1016/j.neuro.2014.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 07/16/2014] [Accepted: 08/05/2014] [Indexed: 11/20/2022]
Abstract
The World Health Organization-recommended neurobehavioral core test battery (NCTB) became the international standard for identifying adverse human behavioral effects due to neurotoxic chemical exposure when it was first proposed in 1983. Since then the WHO NCTB has been repeatedly cited as the basis for test selection in human neurotoxicology research. A discussion group was held before the International Symposium on Neurobehavioral Methods and Effects in Occupational and Environmental Health to review the NCTB and reconsider its tests. The workshop made three consensus recommendations to the International Congress on Occupational Health (ICOH) Scientific Committee on Neurotoxicology and Psychophysiology (SCNP):. 1. A 'screening' battery of broadly sensitive tests is needed as guidance to the field of human neurotoxicology 2. The SCNP should convene a panel to reconsider the functions measured and the tests in the WHO NCTB 3. Three disciplines should be represented in the panel recommending a revised NCTB: neuropsychology; experimental psychology; neurology. This recommendation will be pursued at the next meeting of the International Congress on Occupational Health (ICOH) Scientific Committee on Neurotoxicology and Psychophysiology (SCNP).
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Affiliation(s)
- W Kent Anger
- Oregon Health & Science University, Portland, OR 97034, USA.
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Louis ED, Zhao Q, Meng H, Ding D. Screening for action tremor in epidemiological field surveys: assessing the reliability of a semi-quantitative, visual, template-based scale for rating hand-drawn spirals. Tremor Other Hyperkinet Mov (N Y) 2012; 2:tre-02-46-177-2. [PMID: 23439312 PMCID: PMC3368524 DOI: 10.7916/d8qz28qp] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 07/07/2011] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Population-based epidemiological studies of essential and other tremors have need of a rapid yet accurate means to assess tremor, especially mild tremors. Handwriting is often affected by tremor, and a hand-drawn spiral can provide investigators with objective rather than self-reported data. We present a semi-quantitative, ordinal scale to rate hand-drawn spirals. The scale, which includes values for mild tremor, is accompanied by photographic examples of spirals of each rating, providing a visual template for guidance. METHODS This study, conducted within the framework of a population-based epidemiological study of 5,000 individuals aged 60 and older in Shanghai, asked enrollees to draw an Archimedes spiral with each hand. Spirals were rated using an ordinal scale (0, 0.5, 1, 1.5, 2, and 3). Three raters rated an initial set of 548 spirals. Four raters rated a subsequent set of 200 spirals using a visual template for guidance. RESULTS Initial agreement (548 spirals) was good (r values ranged from 0.49 to 0.62, all p<0.001). Subsequent agreement (200 spirals and using visual template) improved (r values ranged from 0.67 to -0.91, all p<0.001). DISCUSSION This tool will be useful to researchers who are attempting to rapidly assess action tremor in their field surveys.
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Affiliation(s)
- Elan D. Louis
- G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, United States of America
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, United States of America
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, United States of America
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, People's Republic of China
| | - Haijiao Meng
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, People's Republic of China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, People's Republic of China
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Neuromotor function in ship welders after cessation of manganese exposure. Int Arch Occup Environ Health 2011; 85:703-13. [DOI: 10.1007/s00420-011-0716-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 10/11/2011] [Indexed: 10/15/2022]
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Harari R, Harari F, Gerhardsson L, Lundh T, Skerfving S, Strömberg U, Broberg K. Exposure and toxic effects of elemental mercury in gold-mining activities in Ecuador. Toxicol Lett 2011; 213:75-82. [PMID: 21925580 DOI: 10.1016/j.toxlet.2011.09.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 08/09/2011] [Accepted: 09/03/2011] [Indexed: 10/17/2022]
Abstract
Traditional gold mining, using metallic mercury (Hg(0)) to form gold amalgam, followed by burning to remove the Hg(0), is widely used in South America, Africa and Asia. The gold is sold to merchants who burn it again to eliminate remaining Hg(0). In Ecuador, 200 gold miners, 37 gold merchants and 72 referents were studied. The median Hg concentrations in urine (U-Hg) were 3.3 (range 0.23-170), 37 (3.2-420), and 1.6 (0.2-13)μg/g creatinine, respectively, and in whole blood (B-Hg) were 5.2, 30, and 5.0 μg/L, respectively. Biomarker concentrations among merchants were statistically significantly higher than among miners and referents; also the miners differed from the referents. Burning of gold amalgam among miners was intermittent; U-Hg decreased in the burning-free period. In computerized neuromotor examinations, B-Hg and U-Hg concentrations were associated with increases in the centre frequency of the tremor, as well as in reaction time and postural stability.Retention of Hg (B-Hg), and the elimination rate (U-Hg) appears to be modified by polymorphism in a gene of an enzyme in the glutathione synthesis (GCLM), but there were no significant genetic modifications for the associations between exposure and neurotoxicity.Thus, the gold merchants have a much higher exposure and risk than the miners, in whom the exposure varies over time. The metabolism of Hg is modified by genetic traits. The present exposure to Hg had limited neurotoxic effects.
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Affiliation(s)
- Raúl Harari
- Corporación Para el Desarrollo de la Producción y el Medio Ambiente Laboral (Institute for the Development of Production and the Work Environment), P.O. Box 17-08-8386, Domingo de Brieva N38-107 y Villalengua, Urbanización Granda Centeno, Quito, Ecuador
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Evaluation of multiple neurotoxic outcomes in cancer chemotherapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010. [PMID: 20738011 DOI: 10.1007/978-1-4419-6306-2_13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Although it is now clear that cognitive dysfunction is a common accompaniment of cancer chemotherapy, its implications await further research and direction. Most of the clinical research relies on standard neuropsychological tests that were developed to diagnose stable traits. Cognitive dysfunction in patients undergoing treatment varies with time, however. Its dimensions will vary during the course of treatment, which generally consists of cycles of drug administration followed by recovery periods. To effectively determine the connection between chemotherapy and cognitive function requires neuropsychological tests based on performance, so that they can be administered repeatedly at specified times during the entire course of treatment and beyond. A number of computerized test batteries, many of which have been developed for environmental neurotoxicology, are now available that fit such criteria. Moreover, cognitive impairment is only one aspect of chemotherapy-induced neurotoxicity. A full appreciation of its scope requires assessment of sensory functions such as vision, audition and somatosensory properties and assessment of motor function. A program of research based on animal models is also essential. Only with animal models is it possible to determine dose-response relationships and to couple behavioral with mechanistic indices such as neuroplasticity. Animal behavior models play a vital role in environmental toxicology because, from them, it is possible to derive some index of exposure that limits adverse effects. However, as in human testing, it is critical to choose situations whose properties remain stable over long periods of time so as to trace the time course of neurotoxicity. Schedule-controlled operant behavior offers the most promising source of animal models.
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Grimaldi G, Manto M. Neurological tremor: sensors, signal processing and emerging applications. SENSORS (BASEL, SWITZERLAND) 2010; 10:1399-422. [PMID: 22205874 PMCID: PMC3244020 DOI: 10.3390/s100201399] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 01/22/2010] [Accepted: 02/20/2010] [Indexed: 12/02/2022]
Abstract
Neurological tremor is the most common movement disorder, affecting more than 4% of elderly people. Tremor is a non linear and non stationary phenomenon, which is increasingly recognized. The issue of selection of sensors is central in the characterization of tremor. This paper reviews the state-of-the-art instrumentation and methods of signal processing for tremor occurring in humans. We describe the advantages and disadvantages of the most commonly used sensors, as well as the emerging wearable sensors being developed to assess tremor instantaneously. We discuss the current limitations and the future applications such as the integration of tremor sensors in BCIs (brain-computer interfaces) and the need for sensor fusion approaches for wearable solutions.
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Affiliation(s)
- Giuliana Grimaldi
- FNRS, Neurologie ULB-Erasme, 808 Route de Lennik, 1070 Bruxelles, Belgium; E-Mail:
| | - Mario Manto
- FNRS, Neurologie ULB-Erasme, 808 Route de Lennik, 1070 Bruxelles, Belgium; E-Mail:
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Julvez J, Grandjean P. Neurodevelopmental toxicity risks due to occupational exposure to industrial chemicals during pregnancy. INDUSTRIAL HEALTH 2009; 47:459-468. [PMID: 19834254 DOI: 10.2486/indhealth.47.459] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Exposure to neurotoxic chemicals is of particular concern when it occurs during early development. The immature brain is highly vulnerable prenatally and is therefore at risk due to occupational exposures incurred by pregnant women. A systematic search of the literature has been performed with emphasis on epidemiological studies on female workers and the neurodevelopment of their children. The majority of recent occupational studies focused on organic solvents and pesticides, which were associated with neurobehavioral impairments in the progeny. Additional evidence on environmental exposures demonstrates the vulnerability of the developing brain to substances like lead and methylmercury. Despite the evident hazards involved, the number of occupational cohort studies carried out in this field is very low. However, the lack of evidence for assumed neurotoxicants should not divert the attention by occupational health researchers and practitioners from the need to protect pregnant workers. Due to the vulnerability of the brain during early development, a precautionary approach to neurodevelopmental toxicity needs to be applied in occupational health.
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Affiliation(s)
- Jordi Julvez
- Department of Environmental Health, Harvard School of Public Health, Landmark Building 3E-110, 401 Park Drive, Boston, MA 02215, USA.
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