Patients with painter’s disease (chronic solvent-induced encephalopathy – CSE or chronic toxic encephalopathy – CTE) have perceptible deviations in their brain as a result of the contact with organic solvents. This is the conclusion of researchers of the Academic MedicalCenter, Amsterdam in the Netherlands. They are the firsts to show a link between the symptoms, the degree of exhibition to the detrimentalsubstances and structural changes in the brain.
Diagnosis CTE or CSEwas controversial for a long time. Employees who have been exposed to organic solvents in for example paint, printing ink or detergents can suffer impaired concentration, memory problems and dysfunctional mental and motorialspeed. Although the syndrome as such has been described according to criteria of the World Health Organisation, damage to the brain was never shown indisputably in patients so far.
Research of the departments of psychiatry, radiology, nuclear medicine and the Netherlands Center for Occupational Diseases of the AMC using imaging techniques like fMRI and SPECTchanges this. They looked at ten patients with CTE/CSE, ten painters without symptoms who had been exposed to solvents, and eleven carpenters who had been exposed to solvents.
The results are published in the Annals of Neurology on April 15th, 2008. The article by Ieke Visser et al. is titled:
Cerebral impairment in chronic solvent-induced encephalopathy
Here is the abstract:
Worldwide, many workers experience occupational exposure to organic solvents, which may induce chronic solvent-induced encephalopathy (CSE) or chronic toxic encephalopathy. This disease is also reffered to as painter’s disease.
The symptomatology of CSE might be explained by disturbances within the frontostriatothalamic (FST) circuitry. A group of researchers of the Academic Medical Center, Amsterdam in the Netherlands tested the hypothesis of FST circuitry abnormalities in CSE, as well as associations with performance of psychomotorspeed, attention, and solvent exposure. To detect preclinical, solvent-related effects, we also studied the FST circuitry in solvent-exposed, but asymptomatic workers.
They compared 3 groups: 10 CSE patients, 10 asymptomatic but solvent-exposed house painters (EC), and 11 nonexposedasymptomatic carpenters with fMRI. Dopamine D2 receptor (D2R) binding, central nervous system tissue metabolites, and fractional anisotropy were measured within the FST circuitry, using single-photon emission computed tomography, magnetic resonance spectroscopy, and diffusion tensor imaging. Performance of psychomotor speed and attention, and severity of solvent exposure were assessed.
Striatal D2R binding was reduced in CSE. In the solvent-exposed asymptomatic patients, striatal D2R binding and levels of N-acetylaspartate + N-acetylaspartyl-glutamate in frontalgray matter were reduced. In both exposed groups, a trend was seen for reduced choline in frontal gray matter. In CSE, the fractional anisotropy in the thalamus, caudate nucleus, and striatal D2R binding significantly predicted reduced performance of attention and psychomotor speed. In CSE, striatal D2R binding showed a negative correlation with solvent exposure.
This is the first study in CSE showing pronounced disturbances within the FST circuitry that are related to the clinical findings and to exposure severity to solvents. The comparable, but milder, abnormalities within the FST circuitry in the exposed asymptomatic workers may imply a presymptomatic phase of CSE.
This research can not yet be used for the appraisal of individual patients. More scientific research in larger groups is necessary. At this moment it’s not yetpossible to test individual employees or patients. There is no such test available to assess individual painters to establish the diagnosis CTE/CSE. The AMC considers to set up larger scientific follow-up studies.