Subclinical neurophysiological effects of lead: A review on peripheral, central, and autonomic nervous system effects in lead workers

Abstract

Background The peripheral nerve conduction velocity (NCV), distribution of nerve conduction velocities (DCV), somatosensory, visual, and brainstem auditory evoked potentials (SEP, VEP, and BAEP, respectively), event-related potential (P300), computerized static posturography with spectral analysis (postural balance), and electrocardiographic R–R interval variability (CVRR) with spectral analysis appear to be promising techniques for assessing subclinical effects of lead on the peripheral, central and autonomic nervous systems. This article presents an overview of research addressing subclinical neurophysiological effects of lead in workers exposed to lead. Methods We reviewed 102 articles to examine the effects and dose–effects relationships of lead on peripheral, central, and autonomic nervous system function together with reversibility of the effects, interaction between lead and other metals, and relative sensitivity and specificity of each technique. Background and methodology were also reviewed. Results and Conclusion Available data suggest that, on a group basis, the reduction in the NCV, together with the effects on the P300 latency, postural balance, and CVRR, occurs at a mean blood lead concentration (BPb) as low as 30–40 μg/dL; the effects on the latencies of the short-latency SEP, VEP, and BAEP, as well as the DCV, start at a BPb as low as 40–50 μg/dL. Further cross-sectional and preferably prospective studies by using each of those methods are needed to establish more precise dose–effects (and response) relationships of lead. Am. J. Ind. Med. 37:193–204, 2000. © 2000 Wiley-Liss, Inc.