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Koszewicz M, Markowska K, Waliszewska-Prosol M, Poreba R, Gac P, Szymanska-Chabowska A, Mazur G, Wieczorek M, Ejma M, Slotwinski K, Budrewicz S. The impact of chronic co-exposure to different heavy metals on small fibers of peripheral nerves. A study of metal industry workers. J Occup Med Toxicol 2021; 16:12. [PMID: 33858451 PMCID: PMC8048227 DOI: 10.1186/s12995-021-00302-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background Chronic exposure to heavy metals affects various organs, among them the brain and peripheral nerves. Polyneuropathy is mainly length-dependent with predominantly sensory symptoms. There have been few studies on small fiber neuropathy due to heavy metal intoxication. Methods We investigated 41 metal industry workers, mean age 51.3 ± 10.5 years, with at least 5 years’ professional exposure to heavy metals, and 36 age- and sex-matched healthy controls. We performed neurological examinations, and assessed blood levels of cadmium, lead, and zinc protoporphyrin, urine levels of arsenic, standard, sensory and motor electrophysiological tests in the ulnar and peroneal nerves, sympathetic skin responses from the palm and foot, and quantitative sensation testing from dermatomes C8 and S1. Discussion The results of standard conduction tests of all nerves significantly differed between groups. The latency of sympathetic skin responses achieved from the foot was also statistically significantly prolonged in the study group. Significant differences were seen in both C8 and S1 regions for temperature and pain thresholds, and for vibratory threshold only in the S1 region, while the dispersions of low and high temperatures were important exclusively in the C8 region. Conclusions We can conclude that co-exposure to many heavy metals results in explicit impairment of peripheral nerves. The lesion is more pronounced within small fibers and is predominantly connected with greater impairment of temperature-dependent pain thresholds. The evaluation of small fiber function should be considered in the early diagnosis of toxic polyneuropathy or in low-dose exposure to heavy metals.
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Affiliation(s)
- Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Katarzyna Markowska
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | | | - Rafał Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-550, Wroclaw, Poland
| | - Paweł Gac
- Department of Hygiene, Wroclaw Medical University, J. Mikulicza-Radeckiego 7, 50-345, Wroclaw, Poland
| | - Anna Szymanska-Chabowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-550, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-550, Wroclaw, Poland
| | - Malgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wroclaw, Plac Uniwersytecki 1, 50-137, Wroclaw, Poland
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Krzysztof Slotwinski
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
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Duerden EG, Taylor MJ, Lee M, McGrath PA, Davis KD, Roberts SW. Decreased sensitivity to thermal stimuli in adolescents with autism spectrum disorder: relation to symptomatology and cognitive ability. THE JOURNAL OF PAIN 2015; 16:463-71. [PMID: 25704841 DOI: 10.1016/j.jpain.2015.02.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/21/2015] [Accepted: 02/04/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Social communication deficits and repetitive behaviors are established characteristics of autism spectrum disorder (ASD) and the focus of considerable study. Alterations in pain sensitivity have been widely noted clinically but remain understudied and poorly understood. The ASD population may be at greater risk for having their pain undermanaged, especially in children with impaired cognitive ability and limited language skills, which may affect their ability to express pain. Given that sensitivity to noxious stimuli in adolescents with ASD has not been systematically assessed, here we measured warm and cool detection thresholds and heat and cold pain thresholds in 20 high-functioning adolescents with ASD and 55 typically developing adolescents using a method-of-limits quantitative sensory testing protocol. Adolescents with ASD had a loss of sensory function for thermal detection (P < .001, both warm and cool detection thresholds) but not pain threshold (P > .05, both heat and cold pain thresholds) in comparison to controls, with no evidence for significant age or sex effects (P > .05). Intelligence quotients and symptomatology were significantly correlated with a loss of some types of thermal perception in the ASD population (ie, warm detection threshold, cool detection threshold, and heat pain threshold; P < .05). Decreased thermal sensitivity in adolescents with ASD may be associated with cognitive impairments relating to attentional deficits. Our findings are consistent with previous literature indicating an association between thermal perception and cortical thickness in brain regions involved in somatosensation, cognition, and salience detection. Further brain-imaging research is needed to determine the neural mechanisms underlying thermal perceptual deficits in adolescents with ASD. PERSPECTIVE We report quantitative evidence for altered thermal thresholds in adolescents with ASD. Reduced sensitivity to warmth, coolness, and heat pain was related to impaired cognitive ability. Caregivers and clinicians should consider cognitive ability when assessing and managing pain in adolescents with ASD.
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Affiliation(s)
- Emma G Duerden
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Margot J Taylor
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Minha Lee
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Karen D Davis
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
| | - S Wendy Roberts
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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