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Am J Ind Med. 2018 Mar;61(3):251-260. doi: 10.1002/ajim.22791. Epub 2017 Nov 10.

Amyotrophic lateral sclerosis-A case report and mechanistic review of the association with toluene and other volatile organic compounds.

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Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts.
Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Compass Environmental, Inc., Kennesaw, Georgia.
Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina.
Department of Medicine (Pulmonary and Critical Care Division), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.


Unmasking of latent neurodegenerative disease has been reported following exposure to chemicals that share one or more mechanisms of action in common with those implicated in the specific disease. For example, unmasking of latent Parkinson's disease (PD) has been associated with exposure to anti-dopaminergic agents, while the progression of pre-existing mild cognitive impairment and unmasking of latent Alzheimer's disease has been associated with exposure to general anesthetic agents which promote Aβ protein aggregation. This literature review and clinical case report about a 45-year-old man with no family history of motor neuron disease who developed overt symptoms of a neuromuscular disorder in close temporal association with his unwitting occupational exposure to volatile organic compounds (VOCs) puts forth the hypothesis that exposure to VOCs such as toluene, which disrupt motor function and increase oxidative stress, can unmask latent ALS type neuromuscular disorder in susceptible individuals.


amyotrophic lateral sclerosis; neurodegenerative disease; toluene; volatile organic compounds


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