eMedicine Specialties > Neurology > Neurotoxicology

Toxic Neuropathy: 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: Feb 24, 2009

Follow-up

Further Outpatient Care

  • Consistent follow-up care with a neurologist is necessary to monitor the progress of neurological findings.
  • Follow-up with an occupational medicine specialist may be important to assist with return to work and reduction of exposure. This clinician may be able to work with the company supervisors or management to improve the work environment. This may occur if the company chooses to substitute the neuropathy-causing agent with a less-toxic agent in the workplace, to change the schedules of workers so that their exposure is less during a period of time, or to promote safer personal protective equipment. Communication between health care provider and management is essential for this individual's health as well as his or her status for disability or ability return to work.

Prognosis

Each patient's prognosis depends on the severity of the neuropathy when exposure is ceased or reduced to levels that will not affect health negatively.

Patient Education

  • Inform patients about aspects of dose, diet, and nutrition that may increase risk of toxicity when taking a medication. Since many solvents are metabolized in the liver, concomitant use of medications with similar metabolism may lead to increased toxicity.
  • Workers, by law, need to be informed of chemicals in the workplace and their potential health hazards. Material safety data sheets (MSDS), per order of Occupational Safety and Health Administration (OSHA), are available to all workers in the workplace.
  • The Emergency Planning and Community Right to Know Act (EPCRA) requires that facilities using, storing, or manufacturing hazardous chemicals make public inventory and report every release to public officials and health personnel. These facilities must cooperate with health personnel who are treating victims of exposure.

Miscellaneous

Medicolegal Pitfalls

  • Consider the following algorithm to assess whether a toxic etiology satisfies a rigorous method of scrutiny.
  • Algorithm for clinical assessment of neurotoxic disease
    • Begin the evaluation by noting chief complaint or complaints. Consider when they began and how they relate to an exposure.
    • Take a thorough medical history that includes an occupational and environmental history to consider all sources of exposure to all possible agents. List details of all jobs and job tasks within the jobs and what symptoms and medical problems began when.
    • Consider review of systems and how eating, bowel movements, sexual activity, sleep, and emotional status varied during exposure incidents.
    • List medical complaints on a timeline and relate each to exposure dates, duration, and intensity. Consider other occupational, environmental, and drug exposures. Include vitamin supplements, hobbies, and traditional practices.
    • Include birth history, pregnancy, and extensive family history to uncover any genetic or congenital diseases.
    • Consider how symptoms change as they relate to exposures. How often do flare-ups occur? Are the symptoms persistent or do they improve?
    • Do colleagues or co-workers have similar complaints?
    • List all potential sources of exposure: from where, what form, and how they are used.
    • Obtain MSDSs and scientific data on each chemical agent.
    • Perform neurologic examination. A general medical examination including an assessment of the autonomic system, hair, teeth, nails, skin color, and lymph system is important. Are any objective neurological signs or other systemic findings noted?
    • Arrange for confirmatory neurophysiological, neuropsychological, and imaging tests.
    • Arrange for serum and biological monitoring when appropriate (see Table 2).
    • Review regulatory information for this chemical. What have OSHA, EPA, NIOSH, American Conference of Governmental Industrial Hygienists (ACGIH), and other international organizations published as a safe level? See Table 1.
    • Consider contacting an industrial hygienist for air and water sampling.
    • Consider removal from exposure.
    • Consider whether exposure and medical problem may be consistent chronologically. First, did the exposure precede the complaint or dysfunction?
    • Exclude all other common causes of the diagnosis. Are the findings consistent with a primary neurological or other medical condition? Are the findings explained by other historical or familial factors? Other exposures, illnesses, or stressors?
    • Search literature for epidemiologic and case studies and series that describe an association between exposure and dysfunction.
    • Is dose and duration of exposure consistent with the described dysfunction? Focus on details of the literature.
    • What is the proposed mechanism for this exposure-induced dysfunction?
    • Estimate functional status and medical treatment options and consultation necessary for support.
    • Reevaluate by examination and neurological and neuropsychological tests. Do the results remain consistent?
 


More on Toxic Neuropathy

Overview: Toxic Neuropathy
Differential Diagnoses & Workup: Toxic Neuropathy
Treatment & Medication: Toxic Neuropathy
Follow-up: Toxic Neuropathy
References
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Further Reading

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Keywords

drug neuropathy, chemical neuropathy, toxins, industrial chemicals, organic solvents, occupational exposure, environmental exposure, pollutants

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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

Milind J Kothari, DO, Professor and Vice-Chair, Department of Neurology, Pennsylvania State University College of Medicine; Consulting Staff, Department of Neurology, Penn State Milton S Hershey Medical Center
Milind J Kothari, DO is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Neurological Association
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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