Organic Glue Neuropathies: Epidemiology, Clinical Investigation and Therapy of 100 Cases

Abstract

An epidemiological, clinical and therapeutic study was carried out on the toxic neuropathies produced by organic glues. 3,950 workers from the shoe and leather industry were investigated. One hundred cases of toxic polyneuropathies were identified. These showed differences of severity in their clinical manifestation. Clinical examination together with electromyography, as previously described by Malizia et al. (1981), was used for the diagnosis of the polyneuropathies. The methodology was able to disclose even subclinical changes without overt symptoms.

Analysis of the substances used in the manufacturing process showed a high content of N-Hexane in both the glues and the solvents together with phthalates, triorthocresol phosphate and triorthocresol triphosphate according to Carapella and Chiavarelli (1975). N-Hexane is a toxic substance which has been extensively studied. Perbellini et al. (1977) have attributed the neurotoxicity of N-Hexane to its two metabolites hexanole and 2-hexandione. Elevated levels of N-Hexane were found constantly in the workshop environment.

In this study the traditional therapy of Vitamins (Vitamins B₁, B₂, B₆, B₁₂ together with corticosteroids, or other immunosuppressive drugs) and physiotherapy was compared with a combination of the traditional therapy together with steroids and gangliosides (Cronassial Fidia Research Laboratories). The gangliosides were given intramuscularly at a dosage of 0.3–0.5 mg per kg of body weight.

Of the 100 patients treated 58 were given the traditional therapy and 42 received gangliosides together with the traditional therapy. The patients were grouped according to the severity of the disease (i.e., severe 32, intermediate 20, mild 29, subclinical 19). Of the severe group, 10 received the continued therapy with gangliosides as did 10 patients in the intermediate group, 13 in the mild group and 9 in the subclinical group. Comparison of the response to the treatment was made on the basis of time taken to recovery. The results showed significant (p<0.01) reduction in the time to recovery in those patients classified as having severe polyneuropathies and treated with the combined therapy.