eMedicine Specialties > Neurology > Neurotoxicology

Organic Solvents: Follow-up

Author: Jonathan S Rutchik, MD, MPH, Assistant Professor, Department of Occupational and Environmental Medicine, University of California at San Francisco
Contributor Information and Disclosures

Updated: Nov 9, 2009

Follow-up

Further Outpatient Care

  • Examinations and neurophysiologic and neuropsychological testing should be repeated 9 months to 1 year after the exposure is reduced or ceased.
  • Neuropsychological testing results generally stay the same or improve with time, though some authors (eg, Seppalainen) have reported that a substantial percentage worsen over time.

Deterrence/Prevention

  • Exposure is prevented with appropriate use of PPE for those who work with organic solvents.
    • Industrial hygienists are vital members of any company occupational health and safety department.
    • Engineering controls are further steps that can be taken to decrease exposure. Choosing a less-toxic chemical as an alternative to in process, increasing ventilation, and adjusting shifts so that workers are exposed to toxins for less time than before are some engineering controls.
  • Environmental exposure may be reduced by means of community education, which may lead to local, state, and national regulation and increased policing. Education may also improve epidemiologic research, which may prove or disprove the relationship between exposure to a solvent and health consequences.

Miscellaneous

Medicolegal Pitfalls

  • The clinician must be cognizant of the setting in which he or she is evaluating the patient. The clinician must perform an examination independent of the source of the referral.
  • A neurologist may be asked to determine if a case is supportable, that is, whether a diagnosis of exposure-induced neurologic sequelae can be made and be subjected to scrutiny in the legal arena. This question is complicated.
  • One may be called upon to decide if a problem is work related to determine whether a claimant is entitled to worker compensation.
  • A neurologist may be asked to determine if accidental contamination or routine toxicity caused by a pharmaceutical or food agent caused a neurologic event or deficit.
  • The best approach is a consistent one including all aspects of a clinical, neurologic, occupational, and environmental medical evaluation.

Special Concerns

  • Aged, young, and pregnant individuals are most susceptible to organic solvent–induced sequelae.
    • DNA polymorphisms may predispose some individuals more than others to specific exposures; some may not be able to metabolize nontoxic by-products normally.
    • Scientific research may elucidate these genetic differences with time.
  • The bibliography lists important review articles that provide detailed descriptions of industries, populations, and agents associated with neuropsychological dysfunction (Iregren, 198838 ; Bolla, 19948 ; Cassitto, 199412 ; Dick, 199517 ; Rosenberg, 199566 ; White, 199587 ; Fiedler, 199623 ).
 


More on Organic Solvents

Overview: Organic Solvents
Differential Diagnoses & Workup: Organic Solvents
Treatment & Medication: Organic Solvents
Follow-up: Organic Solvents
References
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References

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Further Reading

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Keywords

chemical solvents, chemical toxicity, industrial chemicals, industrial exposures, industrial solvents, toxic exposures

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Contributor Information and Disclosures

Author

Jonathan S Rutchik, MD, MPH, Assistant Professor, Department of Occupational and Environmental Medicine, University of California at San Francisco
Jonathan S Rutchik, MD, MPH is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Occupational and Environmental Medicine, and Society of Toxicology
Disclosure: Nothing to disclose.

Medical Editor

Roberta J Seidman, MD, Associate Professor of Clinical Pathology, Stony Brook University; Director of Neuropathology, Department of Pathology, Stony Brook University Medical Center
Roberta J Seidman, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuropathologists, New York Association of Neuropathologists (The Neuroplex), and Suffolk County Society of Pathologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Glenn Lopate, MD, Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Chief of Neurology, St Louis ConnectCare, Consulting Staff, Barnes Jewish Hospital
Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, FRCP(C), FACP, Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital
Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine
Disclosure: Abbott Labs  Honoraria Consulting; Teva Marion Honoraria Consulting; Boeringer-Ingelheim Honoraria Speaking and teaching

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