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An electrophysiological study of the skeletal muscle and the peripheral nerve in patients with lead intoxication

A comprehensive electrophysiological examination of the peripheral nervous system was carried out in 12 patients who proved to be toxicated with lead (high lead blood levels, and diminished activity of the delta-aminolevulinate dehydratase, ALA D, in erythrocytes). Maximal motor nerve conduction velocities and terminal latencies were investigated in the median, radial and deep peroneal nerves. Also the amplitude of the evoked muscle response (M wave) was measured in thenar, extensor longus and extensor digitorium brevis muscles. Sensory conduction velocity and amplitude of the nerve compound action potential were measured at the median nerve. Tibialis anterior muscle responses to deep peroneal nerve repetitive stimulation were also explored. Conventional needle electromyogram was performed in the deltoid and tibialis anterior muscles. Slight diminished motor and sensory conduction velocities were found as well as a reduction of the amplitude of the evoked muscle response of the compound sensory action potential. Four out of the 12 patients tested showed either décrémentai or incremental amplitude of the muscle response with nerve repetitive stimulation. A electromyographical diminished interference pattern was found in all patients tested. Most of the remaining motor unit potentials were fragmented or polyphasic. Just one patient disclosed potentials of enhanced duration and amplitude. No relationship was found between blood lead levels or ALA D erythrocytes concentration and the different electrophysiological tests performed, except between reduced ALA D concentration and diminished amplitudes of the M wave and of the sensory compound action potential, and also between ALA D and diminished radial motor conduction velocity. Only a slight relationship was found between timing of toxication and diminished sensory conduction velocity of the median nerve and motor conduction velocity of the radial nerve. Biochemical determination and timing of toxication did not prove to be useful tools for predicting peripheral nervous system damage. The findings suggest that the neuropathy which develops in lead intoxication is probably related mainly to individual predisposition rather than to lead blood levels and ALA D erythrocytes concentration.


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