[Neurotoxic Occupational Substances: I. Metals and Their Compounds. A Literature Review of the Years 1970 to 1982]

The knowledge of the neurotoxicity to the peripheral nervous system of arsenic, lead, thallium and mercury as well as their compounds is reviewed according to the literature of the period 1970-1982. - First acute and chronic intoxications are described with special reference of the neurological symptoms. Then we review the results of electromyographic, neurophysiological and histological investigations. Field studies in occupationally exposed groups and evaluation of dose-response-relationships are specified in detail. Further the presented results are discussed according to aspects in occupational medicine. The following conclusions can be drawn: Neuropathies after arsenic intoxications are characterized by symmetric sensory symptoms as usually numbness and paresthesiae of the distal extremities, but the neurophysiological and histological studies showed a great variety of results. In a former study a significant dose-response-relationship between arsenic load and evidence of neuropathy in workers was demonstrated. The onset of impairments of the peripheral nervous system caused by chronic lead exposure is discussed controversially. Some reports showed a dose-response-relationship between a slowering of nerve conduction velocities and an increase of the lead body burden. Proposals of threshold values ranged between 50 to 80 micrograms lead/dl blood. Other authors did not confirm these results. Longitudinal studies are, with one exception, not available at present. Thus a relevant evaluation, particularly regarding relevance and prognosis of a mild slowering of nerve conduction velocity, can not be given now. The neurotoxicity of mercury and its compounds is well demonstrated. In case of the metal and the inorganic compounds a direct damage of the peripheral nerve is possible, whereas for organic compounds the pathophysiological mechanism is unclear. Studies concerning dose-response-relationships as well as evaluation of threshold values in chronically exposed workers are limited. It seems at present not possible to define a threshold value for the neurotoxic effects of mercury according to peripheral nervous system. Thallium caused peripheral neuropathy is described in many casuistics But to our knowledge there are no reports of neurophysiological studies in occupationally exposed groups.