Multiple Sclerosis

MULTIPLE SCLEROSIS

Oligoclonal bands are often present but are not specific for multiple sclerosis. Further, diagnosis can never be based upon laboratory findings alone.[1] Evoked potentials may or may not be present: results were inconclusive in this patient. Changes in evoked potentials can occur with toxic injury but not in all, and perhaps not most for a single evoked potential (eg., vep). In most patients, there is an interval of months or years after the initial episode before new symptoms develop or old ones recur. It is more common for symptoms to steadily progress in multiple sclerosis.1 The diagnosis of multiple sclerosis cannot be made with confidence until there is involvement of different parts of the nervous system at different times.1

Immune activation occurs in multiple sclerosis[2] although this can also be induced by toxic exposure.[3] Immune activation increases risk of exacerbation.2 Ten years after onset about half can still do employment and household activities,2 which is definitely not the pattern here. Seventy six percent of patients with chronic illness induced by toxic exposures have immune activation with elevated CD26.3 Her respiratory symptoms cannot be explained by multiple sclerosis and her fatigue, widespread aching, chemical sensitivity are classic for toxic injury3 but not typical of multiple sclerosis. There are numerous studies showing a relationship between multiple sclerosis and solvents.[4],[5],[6],[7],[8],[9],[10] Both Procide and the paint compound involved solvent exposure.

[1] L.M. Tierney et al., Editors, Current Medical Diagnosis and Treatment, 1999, Appleton and Lange,

Stanford CT.

[2] L Goldman and JC Bennett, Editors, Cecil Textbook of Medicine, WB Saunders Co., Philadelphia,

PA.

[3] Ziem G., McTamney J., “Profile of patients with chemical injury and sensitivity”, Env Health Persp

105:417-436, 1997.

[4] Landtblom AM., et al., "Multiple sclerosis and exposure to solvents, ionizing radiation and animals",

Scand J Work Env Health 19(6): 399-404, 1993.

[5] Nelson NA., et al., "Acase-control study of chronic neuropsychiatric disease and organic solvent

exposures in automobile assembly plant workers", Occup Env Med 51(5):302-307, 1994.

[6] Landtblom AM., et al., "Organic solvents and multiple sclerosis: a synthesis of the current evidence",

Epidemiology 7(4):429-433, 1996.

[7] Blisard KS., "The investigation of alleged insecticide toxicity: a case involving chlordane exposure,

multiple sclerosis, and peripheral neuropathy", J Forensic Sci 31(4): 499-504, 1986.

[8] Noseworhty JH, Rice GP., "Trichlorathylene poisoning mimicking multiple sclerosis", Can J Neurol

Sci 15(1):87-88, 1988.

[9] Amaducci L, et al., "Multiple sclerosis among shoe and leather workers: an epidemiological survey in

Florence", Acta Neurol Scand 65(2): 94-103, 1982.

[10] Amaducci L., et al., "Another possible precipitating factor in multiple sclerosis: the exposure to

organic solvents", Boll Ist Sieroter Milan 56(6):613-617, 1978.