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Screening occupational populations for asymptomatic or early peripheral neuropathy.

Moody L; Arezzo J; Otto D
J Occup Med 1986 Oct; 28(10):975-986
Tools useful in assessing occupational peripheral nervous system disease are reviewed. It is noted that the majority of occupational neurotoxic chemicals injure the distal axon. The clinical picture of toxic axonopathy is described. Difficulties in screening for early neuropathy are addressed; this is a reversible, dose dependent, agent specific intoxication for which no clear standard of disease exists. Desirable properties of screening tests for asymptomatic populations are given; however, the relative importance of these factors is seen to vary with the real circumstances of the study or screening. Available techniques for screening workers at risk for peripheral neuropathy from exposure to neurotoxins are of three types: those based on neurological history, those based on neurological examination, and those based on neurophysiological or electrodiagnostic testing. Suggestions are made for the development of adequate history and physical examinations. Methods of quantitative sensory testing are described including vibratory testing and temperature threshold testing. Neurophysiological testing is also examined including nerve conduction velocity testing, electromyography, and evoked potentials. Auditory evoked potentials, visual evoked potentials, and somatosensory evoked potentials are described, and their differential usefulness discussed. Because of the time and expensive equipment required to administer evoked potentials, the expertise required to interpret them and their status as relative newcomers, evoked potentials are considered research tools at present, although they are a promising instrument in clinical neurotoxicology. The authors conclude that for work site screening, simplicity of administration, brevity, and acceptability to the subjects are among the most desirable attributes. Quantitative tests should have little intrasubject variability.
JOCMA7; NIOSH-Author; Occupational-health; Occupational-health-programs; Peripheral-nervous-system; Nervous-system-disorders; Occupational-medicine; Medical-monitoring; Medical-examinations; Medical-screening
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Journal Article
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Journal of Occupational Medicine
Page last reviewed: September 2, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division