Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T20:44:21.218Z Has data issue: false hasContentIssue false
  • English
  • Français

Late Onset Polyneuropathy due to Organophosphate (DDVP) Intoxication

Published online by Cambridge University Press:  02 December 2014

Serhan Sevim ,
Mustafa Aktekin ,
Okan Dogu ,
Hakan Ozturk  and
Mustafa Ertas
Serhan Sevim
Affiliation:
Department of Neurology, Mersin University, Faculty of Medicine, Mersin, Turkey
Mustafa Aktekin
Affiliation:
Department of Anatomy, Mersin University, Faculty of Medicine, Mersin, Turkey
Okan Dogu
Affiliation:
Department of Neurology, Mersin University, Faculty of Medicine, Mersin, Turkey
Hakan Ozturk
Affiliation:
Department of Anatomy, Mersin University, Faculty of Medicine, Mersin, Turkey
Mustafa Ertas
Affiliation:
Department of Neurology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Organophosphate intoxication can cause some well-known life threatening acute neurological complications such as seizures, paralysis, neuromuscular and cardiac conduction disorders. Less often, a predominantly motor and delayed axonal neuropathy can occur. This syndrome is due to inhibition of neuropathy target esterase.

Case Report:

A 30-year-old woman attempted suicide by drinking approximately 1000mg/kg dimethyl-2,2-dichloro vinyl phosphate (DDVP). After a muscarinic and cholinergic syndrome lasting four days, she developed a purely motor distal axonal polyneuropathy on the fifth week after ingestion confirmed by electroneuromyography and sural nerve biopsy. Neurological examination and electroneuromyography revealed a slight recovery at the end of the 21st month.

Conclusion:

This case of late onset polyneuropathy caused by organophosphate intoxication had unusual features such as intact sensory nerves and worse prognosis when compared to previously reported cases.

Résumé:

RÉSUMÉ: Contexte:

L’intoxication par les organophosphorés peut causer des complications neurologiques aiguës pouvant mettre la vie en danger, tells des convulsions, une paralysie, des troubles de conduction neuromusculaires et cardiaques. Plus rarement, une neuropathie à prédominance motrice et axonale peut survenir. Ce syndrome est dû à l’inhibition de la neuropathy target esterase. Observation clinique: Une femme âgée de 30 ans a fait une tentative de suicide par ingestion d’à peu près 1 000mg/kg de 2,2 dichlorovinyl diméthyl phosphate. Suite à un syndrome muscarinique et cholinergique de quatre jours, elle a développé une polyneuropathie axonale distale purement motrice la cinquième semaine après l’ingestion, neuropathie confirmée par électroneuromyographie et biopsie du nerf sural. L’examen neurologique et l’électroneuromyographie ont montré une légère récupération après 21 mois.

Conclusion:

Ce cas de polyneuropathie à début tardif causée par une intoxication par un organophosphoré était caractérisé par des nerfs sensitifs intacts et un pronostic plus sombre que les cas rapportés antérieurement.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 1 , February 2003 , pp. 75 - 78
Copyright
Copyright © The Canadian Journal of Neurological 2003

References

1. Fischer, JR. Gullian-Barré Syndrome following organophosphate poisoning. JAMA 1977; 238:1950–1951.Google Scholar
2. Bouldin, TW, Cavanagh, JB. Organophosphorus neuropathy. II. A fine-structural study of the early stages of axonal degeneration . Am J Pathol 1979; 94:253–270.Google Scholar
3. Moretto, A, Capodicasa, E, Lotti, M. Clinical expression of organophosphate-induced delayed polyneuropathy in rats. Toxicol Lett 1992; 63:97–102.CrossRefGoogle ScholarPubMed
4. Johnson, MK. The delayed neuropathy caused by some organophosphorus esters: mechanism and challenge. CRC Crit Rev Toxicol 1975; 3:289–316.CrossRefGoogle ScholarPubMed
5. Johnson, MK. The primary biochemical lesion leading to delayed neurotoxic effects of some organophosphorus esters. J Neurochem 1974; 23:785–789.CrossRefGoogle ScholarPubMed
6. Johnson, MK. Delayed neurotoxicity; do trichlorphon and/or dichlorvos cause delayed neuropathy in man or in test animals? Acta Pharmacol Toxicol 1981; 49:87–98.CrossRefGoogle ScholarPubMed
7. Johnson, MK. Target for initiation of delayed neurotoxicity by organophosphorus esters: biochemical studies and toxicological applications. Rev Biochem Toxicol 1982; 4:141–212.Google Scholar
8. Aiuto, AL, Pavlakis, SG, Boxer, AB. Life threatening organophosphate-induced polyneuropathy in a child after accidental chlorpyrifos ingestion. J Pediatr 1993;122:658–660.CrossRefGoogle Scholar
9. Namber, T, Nolte, CT, Jackral, J, et al. Poisoning due to organophosphate insecticides. Am J Med 1977; 50:475–492.Google Scholar
10. Lotti, M, Becker, CE, Aminoff, MJ. Organophosphate polyneuropathy: pathogenesis and prevention. Neurology 1984; 34:658–662.CrossRefGoogle Scholar
11. Lotti, M. The pathogenesis of organophosphate delayed neuropathy. Crit Rev Toxicol 1992; 21:465–487.CrossRefGoogle Scholar
12. Johnson, MK. Organophosphorus and other inhibitors of brain ‘neurotoxic esterase’ and the development of delayed polyneuropathy in hens. Biochem J 1970; 120:523–531.CrossRefGoogle Scholar
13. Besser, R, Gutmann, L, Dillmann, U, Weilmann, LS, Hopt, HC. Endplate dysfunction in acute organophosphate intoxication. Neurology 1989; 39:561–567.CrossRefGoogle ScholarPubMed
14. Hopkins, A. Toxic neuropathy due to industrial agents. In: Dyck, JP, Thomas, PK, Lambert, EH, (Eds). Peripheral Neuropathy. Philadelpia:Saunders 1975; 2:1211–1216.Google Scholar
15. Aring, CD. The systemic nervous affinity of triorthocresyl phosphate. Brain 1942; 65:34–47.CrossRefGoogle Scholar
16. Schaumburg, HH, Spencer, PS. Toxic neuropathy due to industrial agents. In: Dyck, JP, Thomas, PK, Lambert, EH, Bunge, R, eds. Peripheral neuropathy. Philadelpia: Saunders 1984; 2:2125–2128.Google Scholar
17. Bidstrup, PL, Bonnell, JA, Beckett, AG. Paralysis following poisoning by a new organic phosphorous insecticide (Mipafox): report on two cases. Br Med J 1953; 1:1068–1072.CrossRefGoogle ScholarPubMed
18. Moretto, A, Lotti, M. Poisoning by organophosphorus insecticides and sensory neuropathy. J Neurol Neurosurg Psychiatry 1998; 64:463–468.CrossRefGoogle ScholarPubMed
19. Sgarpalezos, S, Stephanis, K, Lygidakis, K, et al. Organophosphate (systox) poisoning with delayed neurological symptoms. Ann Med (Gr) 1972; 12:425–429.Google Scholar
20. Stamboulis, E, Psimaras, D, Vassilopoulos, D, et al. Neuropathy following acute intoxication with Mecarbam. Acta Neurol Scand 1991; 83:198–200.CrossRefGoogle ScholarPubMed
21. Lotti, M, Becker, CE, Aminoff, MJ. Organophosphate polyneuropathy: pathogenesis and prevention. Neurology 1984; 34:658–662.CrossRefGoogle Scholar
22. Minton, NA, Murrey, VSG. A review of organophosphate poisoning. Med Toxicol Adverse Drug Exp 1988; 3:350–375.Google ScholarPubMed
23. McConnell, R, Delgado-Tellez, E, Cuadra, R, et al. Organophosphate neuropathy due to methamidophos: biochemical and neurophysiological markers. Arch Toxicol 1999; 73:296–300.CrossRefGoogle ScholarPubMed
24. Takahashi, K, Makamura, H, Iwata, K. Ultrastructure of peripheral nerve in polyneuropathy due to diptelex. Clin Neurol (Tokyo) 1975; 15:430–435.Google Scholar
25. Pope, CN, Tanaka, DJ, Padilla, S. The role of neurotoxic esterase in the prevention and potentiation of organophosphate-induced delayed neurotoxicity. Chem Biol Interact 1993; 87:395–406.CrossRefGoogle Scholar
26. Vilanova, E, Escudero, MA, Barril, J. NTE soluble isoforms: new perspectives for targets of neuropathy inducers and promoters. Chem Biol Interact 1999; 19-20:525–540.CrossRefGoogle Scholar
27. Lotti, M, Moretto, A, Bertolazzi, M, Peraica, M, Fiorini, F. Organophosphate polyneuropathy and neuropathy target esterase: studies with methamidophos and its resolved optical isomers. Arch Toxicol 1995; 69:330–336.CrossRefGoogle ScholarPubMed
28. Johnson, MK. Symposium introduction: retrospect and prospects for neuropathy target esterase and the delayed polyneuropathy induced by some organophosphorus esters. Chem Biol Interact 1993; 87:339–346.CrossRefGoogle ScholarPubMed
29. Lotti, M, Moretto, A, Zoppellari, R, et al. Inhibition of lymphocyte neuropathy target esterase predicts the development of organophosphate-induced delayed polyneuropathy. Arch Toxicol 1986; 59:176–179.CrossRefGoogle ScholarPubMed
30. Bouldin, TW, Cavanagh, JB. Organophosphorus neuropathy. I.Teased fiber study of the spatiotemporal spread of axonal degeneration . Am J Pathol 1979; 94:241–248.Google Scholar
31. Moretto, A, Gardiman, G, Panfilo, S, et al. Effects of S-ethyl hexahydro-1H-azepine-1-carbothioate (molinate) on di-n-butyl dichlorovinyl phosphate (DBDCVP) neuropathy. Toxicol Sci 2001; 62:274–279.CrossRefGoogle ScholarPubMed
32. Moretto, A, Lotti, M, Spencer, PS. In vivo and in vitro regional differential sensitivity of neuropathy target esterase to di-n-butyl-2,2-dichlorovinyl phosphate. Arch Toxicol 1989; 63:469–473.CrossRefGoogle ScholarPubMed
33. Van den Neucker, K, Vanderstraeten, G, De Muynck, M, De Wilde, V. The neurophysiologic examination in organophosphate ester poisoning. Case report and review of the literature. Electromyogr Clin Neurophysiol 1991; 31:507–511.Google ScholarPubMed