Toxic neuropathy--an overview.

The involvement of the nervous system in systemic intoxication offers diagnostic and investigative challenges to the occupational health team. Often early evidence of neurotoxicity is vague, of a highly subjective nature and may be complicated by the presence of neuropathies due to other causes such as diabetes mellitus or exposure to multiple neurotoxins such as lead and solvents. The variety of agents producing neurotoxicity is wide, including heavy metals, organophosphates, acrylamide and its analogs, industrial solvents, therapeutic agents and plant alkaloids. The identification of neurotoxic substances requires well controlled epidemiologic studies of humans, including electrodiagnostic testing and well planned experimental animal studies. The latter include consideration of choice of animal species, routes of administration, duration of exposure, clinical evaluation, electrodiagnostic testing, morphologic description of the damage produced and its distribution, and the recognition of the potential for intercurrent naturally occurring neuropathologic processes. The aim of this discussion is to give an overview of these and other factors involved in the assessment of a neurotoxic potential.