n-Hexane-induced changes in nerve conduction velocities and somatosensory evoked potentials

Exposure to volatile hydrocarbons and neurologic function among oil spill workers up to 6 years after the Deepwater Horizon disaster

BACKGROUND

During the 2010 Deepwater Horizon (DWH) disaster, oil spill response and cleanup (OSRC) workers were exposed to toxic volatile components of crude oil. Few studies have examined exposure to individual volatile hydrocarbon chemicals below occupational exposure limits in relation to neurologic function among OSRC workers.

OBJECTIVES

To investigate the association of several spill-related chemicals (benzene, toluene, ethylbenzene, xylene, n-hexane, i.e., BTEX-H) and total petroleum hydrocarbons (THC) with neurologic function among DWH spill workers enrolled in the Gulf Long-term Follow-up Study.

METHODS

Cumulative exposure to THC and BTEX-H across the oil spill cleanup period were estimated using a job-exposure matrix that linked air measurement data to detailed self-reported DWH OSRC work histories. We ascertained quantitative neurologic function data via a comprehensive test battery at a clinical examination that occurred 4-6 years after the DWH disaster. We used multivariable linear regression and modified Poisson regression to evaluate relationships of exposures (quartiles (Q)) with 4 neurologic function measures. We examined modification of the associations by age at enrollment (<50 vs. ≥50 years).

RESULTS

We did not find evidence of adverse neurologic effects from crude oil exposures among the overall study population. However, among workers ≥50 years of age, several individual chemical exposures were associated with poorer vibrotactile acuity of the great toe, with statistically significant effects observed in Q3 or Q4 of exposures (range of log mean difference in Q4 across exposures: 0.13-0.26 μm). We also observed suggestive adverse associations among those ≥ age 50 years for tests of postural stability and single-leg stance, although most effect estimates did not reach thresholds of statistical significance (p < 0.05).

CONCLUSIONS

Higher exposures to volatile components of crude oil were associated with modest deficits in neurologic function among OSRC workers who were age 50 years or older at study enrollment.

O monitoramento comportamental como medida de exposição ocupacional e ambiental de agentes tóxicos

Resumo Introdução: o comportamento, como uma função biológica do organismo, pode ser tomado como objeto de estudo da neuropsicologia, já que parte do propósito dessa ciência é identificar, caracterizar e compreender as variáveis que o afetam, como a exposição crônica a agentes tóxicos. Objetivo: sustentar a ideia de que o comportamento humano pode ser utilizado como medida de identificação e avaliação da exposição ambiental e ocupacional de toxicantes. Métodos: este ensaio se apoia em revisão assistemática de literatura da área de toxicologia comportamental. Resultados: buscou-se caracterizar a abordagem comportamental como uma alternativa de mensuração em estudos epidemiológicos e apresentar algumas medidas e técnicas de avaliação neurocomportamentais. Discute-se a importância da padronização das baterias neurocomportamentais e suas limitações, além de exemplificar o seu uso potencial na triagem toxicológica com solventes (hexano). Conclusão: argumentou-se em favor da importância da toxicologia comportamental como área de interesse da saúde ocupacional, assim como da utilização de avaliações comportamentais na detecção precoce e prevenção de agravos à saúde dos trabalhadores, de modo a oferecer subsídios para o desenvolvimento de processos de produção mais seguros.

Peripheral and central conduction in n-hexane polyneuropathy

Electrophysiological findings of 27 males with industrial n-hexane polyneuropathy (HPNP) are presented. The results of needle electromyography and nerve conduction studies were compatible with primarily axonal polyneuropathy with secondary segmental demyelination. Motor conduction velocities were the slowest in distal regions of the nerves. In the proximal nerve segments, which were partly tested by magnetic stimulation of the nerve roots, this slowing was much less pronounced. The reduction in mean motor conduction velocities in the forearm segments of ulnar nerves was more than 30% in comparison to the control group means. This reduction was only 10% in the neck-axilla segments. We think that this finding is a reflection of the distal axonopathy process. Central motor conduction times calculated by transcranial magnetic stimulation and spinal nerve root stimulation were found to be prolonged in HPNP patients, indicating that descending motor pathways are affected in human HPNP.

Somatosensory evoked potentials in workers exposed to toluene and styrene

Somatosensory evoked potentials (SEPs) were used to evaluate possible subclinical impairment of the nervous system due to occupational exposure to toluene and styrene. A group of 36 rotogravure printers with severe exposure to toluene, 20 workers with severe exposure to styrene in a glass laminate manufacturing plant, and a comparison group of healthy subjects were studied. The severity of exposure was documented by measurements of toluene and styrene concentrations in breathing zone air, by hippuric acid concentration in urine in the group exposed to toluene, and by urinary mandelic acid concentration in the group exposed to styrene. Somatosensory evoked potentials were measured by stimulation of the median nerve at the wrist and the tibial nerve at the ankle. Peripheral conduction velocities (CVs) in both extremities and central conduction time (CCT) after tibial nerve stimulation were significantly decreased in both exposed groups. Significantly prolonged latencies of peripheral and cortical SEPs to median nerve stimulation as well as cortical SEPs to tibial nerve stimulation were found in workers exposed to styrene. Some abnormalities in SEPs at peripheral or spinal and cortical levels were found in eight workers exposed to toluene and six workers exposed to styrene. Of these, in three workers exposed to toluene and two to styrene increased CCT and delayed latencies of cortical responses at normal conduction values in the periphery were found. A trend for increased frequency of abnormal SEPs with duration of exposure to toluene and styrene and alcohol abuse was found. Abnormalities in SEPs in the exposed groups are most probably of multifactorial origin. Central SEP abnormalities in both exposed groups could indicate early signs of subclinical dysfunction at spinal and cortical levels and could be due to toluene or styrene exposure probably potentiated by alcohol consumption in the group exposed to toluene.

N-hexane neuropathy in offset printers

In an offset printing factory with 56 workers, 20 (36%) developed symptomatic peripheral neuropathy due to exposure to n-hexane. Another 26 workers (46%) were found to have subclinical neuropathy. The initial change in the nerve conduction study was reduced amplitude of the sensory action potentials, followed by reduced amplitude of the motor action potentials, reduction in motor conduction velocities and increase in distal latencies. These changes indicate primary axonal degeneration with secondary demyelination. Sural nerve biopsy in a severe case showed giant axonal swellings due to accumulation of 10nm neurofilaments, myelin sheath attenuation and widening of nodal gaps. The development of neuropathy bore no direct relationship to the duration of exposure, hence factors such as individual susceptibility may be important. Optic neuropathy and CNS involvement were uncommon and autonomic neuropathy was not encountered.

Evoked potentials and cerebral blood flow in solvent induced psycho-organic syndrome

Epidemiological studies have provided evidence that neuropsychiatric symptoms are induced by long term exposure to solvents; individual diagnosis with psychometric tests, however, is not always possible (for example, when the patient has linguistic difficulties). Therefore evoked potentials and cerebral blood flow were studied in 50 patients occupationally exposed to solvents who were referred to our department and for whom a solvent induced psycho-organic syndrome was suspected. Degree of exposure was evaluated by its duration (mean 13.9, range 1 to 37 years) and its intensity (from an interview). At the group level, P22 and N35 latencies and amplitude N20-P22 of somatosensory evoked potentials were higher in cases than in controls (p < 0.05), whereas there was no difference for brainstem and visual evoked potentials, nor for hemispheric cerebral blood flow (but a higher distribution in the left occipital region was seen in patients, p < 0.05). Some parameters were linked to degree of exposure (amplitude N20-P22 of somatosensory evoked potentials, interpeak latency I-V of brainstem evoked potentials, distribution of cerebral blood flow in the internal frontal left region). At the individual level, these examinations were not of diagnostic value because sensitivity was low.

Autonomic and peripheral nervous system dysfunction in workers exposed to mixed organic solvents

To assess possible solvent-induced dysfunction of the autonomic and peripheral nervous systems, 11 solvent-exposed workers and 11 age-matched unexposed controls were examined using the coefficient of variation in electrocardiographic R-R intervals (CVRR) and the distribution of nerve conduction velocities (DCV). Two components of CVRR, i.e., the C-CVRSA and C-CVMWSA, were also examined, which are considered to reflect parasympathetic and sympathetic activities, respectively. The workers had been occupationally exposed to toluene and/or solvent mixtures such as thinners, for 35-360 months. In the solvent-exposed workers, the CVRR and C-CVRSA were significantly reduced compared with unexposed controls. Similarly, the faster velocities of the DCV and median nerve conduction velocities were significantly slowed. The reduction in the CVRR was significantly correlated with duration of exposure in the solvent-exposed workers. These data, despite the small sample size and the variety of organic solvents, suggest that organic solvents may affect both the faster myelinated nerve fibers and autonomic nervous activity (principally, parasympathetic component).

Sensory and cognitive event related potentials in workers chronically exposed to solvents

To obtain objective measures of possible impairment due to organic solvents, auditory, visual and somatosensory evoked potentials and cognitive event related potentials were recorded in a group of 13 workers occupationally exposed to a mixture of various solvents. The patients were compared to healthy subjects and to chronic alcoholics seen during post-alcohol withdrawal. Auditory and visual evoked potentials were almost normal but somatosensory evoked potentials showed a slight decrease of peripheral conduction velocities and an increase of central conduction times more marked in the solvent exposed workers who were also alcoholics. The late "cognitive" components reflecting attention processes (N2 and P3) were normal. Solvent-exposed workers and alcoholics were both characterized by some difficulty in modulating their attentional resources according to task demands, as reflected by a tendency to responses (N1, N2 and P3) of similar amplitudes whether the stimulus was or was not the target. These findings support the presence, in solvent exposed workers, of minor dysfunction of the nervous system at both peripheral and cortical levels potentiated by alcohol as well as of mild cognitive impairments concerning attention processes.

Evoked potentials in chronic n-hexane intoxication

Somatosensory, brainstem auditory and pattern-reversal visual evoked potentials (SEP, BAEP and PVEP) were studied in 5 patients with n-hexane polyneuropathy to determine if the CNS was affected. In SEPs, the median central conduction (N13-to-N20) was normal but the tibial central conduction (N22-to-P40) was delayed. The central conduction time (I-to-V interval) of the BAEP was also prolonged. However, the P100 latency of the PVEP was normal. The present data indicate that the spinal cord and the brainstem are primarily affected in chronic n-hexane intoxication.

Applications of electrophysiology in a neurotoxicity battery

Electrophysiology encompasses a multifaceted group of diagnostic tests which have been validated through clinical use. These evaluate not only CNS and PNS function, but also the function of the cardiovascular system, which affects the nervous system indirectly. As the many positive attributes of these tests become more widely recognized, it seems likely that the use of electrophysiologic tests will expand in the future.

Neurophysiological approaches to the detection of early neurotoxicity in humans

Various neurophysiological methods, including electroencephalography, electromyography, nerve conduction velocities, and evoked potential techniques, have been used to detect early signs of neurotoxicity in humans. These methods have been applied to groups of occupationally exposed workers and their referents in epidemiologic studies, to patients with suspected or proven diseases after long-term work in toxic environment, and to human subjects during or after experimental exposure. The main body of knowledge arises from epidemiologic studies of occupationally exposed subjects, and several chemicals widely used in industry have been shown to be neurotoxic. Of these, e.g., lead causing peripheral neuropathy, some solvents like carbon disulfide, n-hexane, and methyl n-butyl ketone also causing neuropathy and at times central nervous system effects as well as acryl amide have been studied using neurophysiological approaches. Several other solvents including toluene, xylene, and various mixtures of organic solvents have been suspected to be neurotoxic, and nervous system effects have been ascribed to those in several neurophysiological studies. Some studies have elucidated acute nervous system effects of ethyl alcohol or industrial solvents in experimental situations applying, for example, evoked potential techniques or electroencephalography.

Effects of lead and mercury intoxications on evoked potentials

Pattern reversal, brain stem auditory and somatosensory evoked potentials (PREPs, BAEPs, SEPs) have been recorded on 13 patients occupationally exposed to inorganic lead compounds, in 9 patients occupationally or accidentally exposed to inorganic mercury compounds and in 26 chronic alcoholics. The results were compared to those of a normal control group. Peripheral conduction velocities were decreased in lead exposed workers and in alcoholics, but not modified in the mercury exposed patients. In the three exposed groups, an amplitude increase (PREPs and upper limb SEP cortical components), more important in the mercury group and an increase of central conduction time in case of lower limb stimulation, could be interpreted as early signs of nervous cortical impairment.

Neurotoxic effects of n-hexane on the human central nervous system: evoked potential abnormalities in n-hexane polyneuropathy

An outbreak of n-hexane polyneuropathy as a result of industrial exposure occurred in printing factories in Taipei area from December 1983 to February 1985. Multimodality evoked potentials study was performed on 22 of the polyneuropathy cases, five of the subclinical cases, and seven of the unaffected workers. The absolute and interpeak latencies of patterned visual evoked potential (pVEP) in both the polyneuropathy and subclinical groups were longer than in the normal controls. The pVEP interpeak amplitude was also decreased in the polyneuropathy cases. Brainstem auditory evoked potentials (BAEP), showed no difference of wave I latency between factory workers and normal controls, but prolongation of the wave I-V interpeak latencies was noted, corresponding with the severity of the polyneuropathy. In somatosensory evoked potentials (SEPs), both the absolute latencies and central conduction time (CCT) were longer in subclinical and polyneuropathy cases than in the unaffected workers and normal controls. From this evoked potentials study, chronic toxic effects of n-hexane on the central nervous system were shown.

n-Hexane metabolism in occupationally exposed workers

Lung uptake and excretion of n-hexane were studied in ten workers in a shoe factory. Simultaneous samples of inhaled and alveolar air were collected with the aid of a Rhan-Otis valve, personal samplers, and charcoal tubes. Alveolar excretion was monitored during a six hour postexposure period. Uptake was calculated from lung ventilation, the retention coefficient, and environmental concentrations. The amount of exhaled n-hexane was calculated from the decay curve. According to the experimental data, alveolar retention was about 25% of the inhaled n-hexane, corresponding to a lung uptake of about 17%. The postexposure alveolar excretion was about 10% of the total uptake. The main metabolites of n-hexane were identified and measured by capillary GC/MS in spot urine samples collected before, at the end, and 15 hours after the same working shift. Urinary concentrations were low, though related to n-hexane in the air. 2,5-Hexanedione in the end of shift samples gave the best estimate of overall exposure. About 3 mg/g creatinine of 2,5-hexanedione would correspond to about 50 ppm of n-hexane in the air (mean daily exposure).