What is it about?

This is a rare case report about early onset of Amyotrophic Lateral Sclerosis (ALS) also known as Lou Gehrig's disease in a man who was unwittingly exposed to neurotoxic volatile organic compounds (e.g. toluene) when the gym floor at his place of employment was being refinished.

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Why is it important?

This case report is important from both a clinical and a scientific perspective because it suggests that the subclinical course of ALS can be modified by exposure to neurotoxicants. Unlike most retrospective studies which rely on data derived from death records of persons at risk for exposure to chemicals based on the industry listed on their death certificate, the specific chemicals this patient was exposed were documented directly from the Material Safety Data Sheets provided by the company hired to refinish the floor. The ambient air levels of volatile organic compounds this patient was exposed to while the floor was being refinished were actually modeled by a certified industrial hygienist. In addition, the acute symptoms he experienced during his exposure (biological markers of acute effects) were reportedly experience by his exposed coworkers as well. Based on these observations, a team of clinicians and scientists that included two toxicologists, an occupational medicine specialist and a board certified neurologist concluded that this patient's exposure to volatile organic compounds modified the subclinical course of his latent disease such that he developed symptoms of ALS at a younger than expected age. Although the patient was a football coach, CTE was ruled out as a primary factor in the younger age at onset of ALS observed in this case based on the absence of behavioral symptoms and the fact that the patient did not have the bulbar form of the disease (Choi et al. 2005; Kim et al., 2017; Walt et al., 2018). This article is also important because it demonstrates how to meticulously connect the dots between the mechanisms of action of the neurotoxicants a patient was exposed to and the mechanisms implicated in the onset and progression of ALS. Clinical case reports of this type are very important because these often serve as a "canary in the coal mine" in terms of preliminary observations upon which future epidemiological studies are based.


Writing this article was a sincere pleasure as I had the chance to work with a great team of co-authors from various clinical and scientific disciplines with whom I have long standing professional collaborations.

Dr. Marcia H. Ratner
Boston University Chobanian & Avedisian School of Medicine

Read the Original

This page is a summary of: Amyotrophic lateral sclerosis-A case report and mechanistic review of the association with toluene and other volatile organic compounds, American Journal of Industrial Medicine, November 2017, Wiley, DOI: 10.1002/ajim.22791.
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