Skip to main content
Log in

Organophosphate-Induced Delayed Polyneuropathy

  • Review Article
  • Published:
Toxicological Reviews

Abstract

Organophosphate-induced delayed polyneuropathy (OPIDP) is a rare toxicity resulting from exposure to certain organophosphorus (OP) esters. It is characterised by distal degeneration of some axons of both the peripheral and central nervous systems occurring 1–4 weeks after single or short-term exposures. Cramping muscle pain in the lower limbs, distal numbness and paraesthesiae occur, followed by progressive weakness, depression of deep tendon reflexes in the lower limbs and, in severe cases, in the upper limbs. Signs include high-stepping gait associated with bilateral foot drop and, in severe cases, quadriplegia with foot and wrist drop as well as pyramidal signs. In time, there might be significant recovery of the peripheral nerve function but, depending on the degree of pyramidal involvement, spastic ataxia may be a permanent outcome of severe OPIDP. Human and experimental data indicate that recovery is usually complete in the young. At onset, the electrophysiological changes include reduced amplitude of the compound muscle potential, increased distal latencies and normal or slightly reduced nerve conduction velocities. The progression of the disease, usually over a few days, may lead to non-excitability of the nerve with electromyographical signs of denervation. Nerve biopsies have been performed in a few cases and showed axonal degeneration with secondary demyelination. Neuropathy target esterase (NTE) is thought to be the target of OPIDP initiation. The ratio of inhibitory powers for acetylcholinesterase and NTE represents the crucial guideline for the aetiological attribution of OP-induced peripheral neuropathy. In fact, pre-marketing toxicity testing in animals selects OP insecticides with cholinergic toxicity potential much higher than that to result in OPIDP. Therefore, OPIDP may develop only after very large exposures to insecticides, causing severe cholinergic toxicity. However, this was not the case with certain triaryl phosphates that were not used as insecticides but as hydraulic fluids, lubricants and plasticisers and do not result in cholinergic toxicity. Several thousand cases of OPIDP as a result of exposure to tri-ortho-cresyl phosphate have been reported, whereas the number of cases of OPIDP as a result of OP insecticide poisoning is much lower. In this article, we mainly discuss OP pesticide poisoning, particularly when caused by chlorpyrifos, dichlorvos, isofenphos, methamidophos, mipafox, trichlorfon, trichlornat, phosphamidon/mevinphos and by certain carbamates. We also discuss case reports where neuropathies were not convincingly attributed to fenthion, malathion, omethoate/dimethoate, parathion and merphos. Finally, several observational studies on long-term, low-level exposures to OPs that sometimes reported mild, inconsistent and unexplained changes of unclear significance in peripheral nerves are briefly discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I.
Table II.

Similar content being viewed by others

References

  1. Lotti M. Organophosphorus compounds. In: Spencer PS, Schaumburg HH, editors. Experimental and clinical neurotoxicology. 2nd ed. New York: Oxford University Press, 2000: 897–925

    Google Scholar 

  2. Morgan JP. The Jamaica ginger paralysis. JAMA 1982; 248: 1864–7

    Article  PubMed  CAS  Google Scholar 

  3. Organisation for Economic Co-Operation and Development. Guideline 418: delayed neurotoxicity of organophosphorus substances following acute exposure. Paris: OECD, 1995

    Google Scholar 

  4. Mackerer CR, Barth ML, Krueger AJ. Comparison of neurotoxic effects and potential risks from oral administration or ingestion of tricresyl phosphate and jet engine oil containing tricresyl phosphate. J Toxicol Environ Health A 1999; 56: 293–383

    Google Scholar 

  5. World Health Organization. Organophosphorus insecticides. EHC 63. Geneva: WHO, 1986

    Google Scholar 

  6. Lotti M. The pathogenesis of organophosphate delayed polyneuropathy. Crit Rev Toxicol 1992; 21: 465–87

    Article  CAS  Google Scholar 

  7. Johnson MK. Organophosphates and delayed neuropathy: is NTE alive and well? Toxicol Appl Pharmacol 1990; 102: 385–99

    Article  PubMed  CAS  Google Scholar 

  8. Johnson MK. The target for initiation of delayed neurotoxicity by organophosphorus esters: biochemical studies and toxicological applications. Rev Biochem Toxicol 1982; 4: 141–212

    CAS  Google Scholar 

  9. Lotti M, Johnson MK. Neurotoxicity of organophosphorus pesticides: predictions can be based on in vitro studies with hen and human enzymes. Arch Toxicol 1978; 41: 215–21

    Article  PubMed  CAS  Google Scholar 

  10. Moretto A. Testing for organophosphate delayed polyneuropathy. In: Maines MD, Costa LG, Reed DJ, et al., editors. Current protocols in toxicology. New York: John Wiley & Sons, 1999: 11.5.1–14

    Google Scholar 

  11. World Health Organization. Tricresyl phosphate. EHC 110. Geneva: WHO, 1990

    Google Scholar 

  12. Aldridge WN, Reiner E. Enzyme inhibitors as substrates: interactions of esterases with esters of organophosphorus and carbamic acids. Amsterdam: North Holland Publishing Co., 1972

    Google Scholar 

  13. Lotti M, Johnson MK. Repeated small doses of a neurotoxic organophosphate: monitoring of neurotoxic esterase in brain and spinal cord. Arch Toxicol 1980; 45: 263–71

    Article  PubMed  CAS  Google Scholar 

  14. Peraica M, Capodicasa E, Moretto A, et al. Organophosphate polyneuropathy in chicks. Biochem Pharmacol 1993; 45: 131–5

    Article  PubMed  CAS  Google Scholar 

  15. Lotti M, Moretto A, Capodicasa E, et al. Interactions between neuropathy target esterase and its inhibitors and the development of polyneuropathy. Toxicol Appl Pharmacol 1993; 122: 165–71

    Article  PubMed  CAS  Google Scholar 

  16. Glynn P. Neuropathy target esterase. Biochem J 1999; 344: 625–31

    Article  PubMed  CAS  Google Scholar 

  17. Lotti M, Moretto A, Zoppellari R, et al. Inhibition of pymphocytic neuropathy target esterase predicts the development of organophosphate-induced delayed polyneuropathy. Arch Toxicol 1986; 59: 176–9

    Article  PubMed  CAS  Google Scholar 

  18. Moretto A, Lotti M. Poisoning by organophosphorus insecticides and sensory neuropathy. J Neurol Neurosurg Psychiatry 1998; 64: 463–8

    Article  PubMed  CAS  Google Scholar 

  19. McConnel R, Delgado-Tellez E, Caudra R, et al. Organophosphate neuropathy due to methamidophos: biochemical and neurophysiological markers. Arch Toxicol 1999; 73: 296–300

    Article  Google Scholar 

  20. Van Tienhoven M, Atkins J, Li Y, et al. Human neuropathy target esterase catalyzes hydrolysis of membrane lipids. J Biol Chem 2002; 277: 20942–8

    Article  PubMed  CAS  Google Scholar 

  21. Zaccheo O, Dinsdale D, Meacock PA, et al. Neuropathy target esterase and its yeast homologue degrade phosphatidylcholine to glycerophosphocholine in living cells. J Biol Chem 2004; 279: 24024–33

    Article  PubMed  CAS  Google Scholar 

  22. Veronesi B, Padilla S, Blackmon K, et al. Murine susceptibility to organophosphorus-induced delayed neuropathy (OPIDN). Toxicol Appl Pharmacol 1991; 107: 311–24

    Article  PubMed  CAS  Google Scholar 

  23. Winrow CJ, Hemming ML, Allen DM, et al. Loss of neuropathy target esterase in mice links organophosphate exposure to hyperactivity. Nat Genet 2003; 33: 477–85

    Article  PubMed  CAS  Google Scholar 

  24. Moser M, Li Y, Vaupel K, et al. Placental failure and impaired vasculogenesis result in embryonic lethality for neuropathy target esterase-deficient mice. Mol Cell Biol 2004; 24: 1667–79

    Article  PubMed  CAS  Google Scholar 

  25. Akassoglou K, Malester B, Xu J, et al. Brain-specific deletion of neuropathy target esterase/swisscheese results in neurodegeneration. Proc Natl Acad Sci U S A 2004; 101: 5075–80

    Article  PubMed  CAS  Google Scholar 

  26. Lotti M, Becker CE, Aminoff MJ. Organophosphate polyneuropathy: pathogenesis and prevention. Neurology 1984; 34: 658–62

    Article  PubMed  CAS  Google Scholar 

  27. Susser M, Stein Z. An outbreak of tri-ortho-cresyl phosphate (T.O.C.P) poisoning in Durban. Br J Ind Med 1957; 14: 111–20

    PubMed  CAS  Google Scholar 

  28. Morgan JP, Petrovich P. Jamaica Ginger paralysis: forty-seven-year follow-up. Arch Neurol 1978; 35: 530–2

    Article  PubMed  CAS  Google Scholar 

  29. Senanayake N. Tri-cresyl phosphate neuropathy in Sri Lanka: a clinical and neurophysiological study with a three year follow up. J Neurol Neurosurg Psychiatry 1981; 44: 775–80

    Article  PubMed  CAS  Google Scholar 

  30. Goldenstein DA, McGuigan MA, Ripley BD. Acute tricresylphosphate intoxication in childhood. Hum Toxicol 1988; 7: 179–82

    Article  Google Scholar 

  31. Sevim S, Aktekin M, Dogu O, et al. Late onset polyneuropathy due to organphosphate (DDVP) intoxication. Can J Neurol Sci 2003; 30: 75–8

    PubMed  Google Scholar 

  32. Vasconcellos LF, Leite AC, Nascimento OM. Organophosphate-induced delayed neuropathy. Arq Neuropsiquiatr 2002; 60: 1003–7

    Article  PubMed  Google Scholar 

  33. Senanayake N, Johnson MK. Acute polyneuropathy after poisoning by a new organophosphate insecticide. N Engl J Med 1982; 306: 155–7

    Article  PubMed  CAS  Google Scholar 

  34. Wadia RS, Shinde SN, Vaidya S. Delayed neurotoxicity after an episode of poisoning with dichlorovos. Neurol India 1985; 33: 247–53

    Google Scholar 

  35. Vasilescu C, Florescu A. Clinical and electrophysiological study of neuropathy after organophosphorus compounds poisoning. Arch Toxicol 1980; 43: 305–15

    Article  PubMed  CAS  Google Scholar 

  36. Shiraishi S, Inoue N, Murai Y, et al. Dipterex (trichlorfon) poisoning: clinical and pathological studies in human and monkeys. J UOEH 1983; 5 Suppl.: 125–32

    PubMed  CAS  Google Scholar 

  37. Vasilescu C, Alexianu M, Dan A. Delayed neuropathy after organophosphorus insecticide (dipterex) poisoning: a clinical electrophysiological and nerve biopsy study. J Neurol Neurosurg Psychiatry 1984; 47: 543–8

    Article  PubMed  CAS  Google Scholar 

  38. Jedrzejowska H, Rowinska-Marcinska K, Hoppe B. Neuropathy due to phytosol (agritox) report of a case. Acta Neuropathol 1980; 49: 163–8

    Article  PubMed  CAS  Google Scholar 

  39. De Kort WLAM, Savelkoul TJF, Sindram En JW, et al. Delayed neurotoxicity’ na intoxicatie met organofosforverbindingen. Ned Tijdscher Geneesked 1986; 130: 1896–8

    Google Scholar 

  40. Chuang CC, Lin TS, Tsai MC. Delayed neuropathy and myelopathy after organphosphate intoxication. N Engl J Med 2002; 347: 1119–21

    Article  PubMed  Google Scholar 

  41. Aring CD. The systemic nervous affinità of triorthocresylphosphate (Jamaica ginger palsy). Brain 1942; 65: 34–47

    Article  CAS  Google Scholar 

  42. Inoue N, Fujishiro K, Mori K, et al. Triorthocresyl phosphate poisoning: a review of human cases. J UOEH 1988; 10: 433–42

    PubMed  CAS  Google Scholar 

  43. Smith HV, Spalding JMK. Outbreak of paralysis in Morocco due to ortho-cresyl phosphate poisoning. Lancet 1959; II: 1019–21

    Article  Google Scholar 

  44. Tosi L, Righetti C, Adami L, et al. October 1942: a strange epidemic paralysis in Saval, Verona, Italy. Revision and diagnosis 50 years later of tri-ortho-cresyl phosphate poisoning. J Neurol Neurosurg Psychiatry 1994; 57: 810–3

    Article  PubMed  CAS  Google Scholar 

  45. Tracy JA, Gallagher H. Use of glycopyrrolate and atropine in acute organophosphorus poisoning. Hum Exp Toxicol 1990; 9: 99–100

    Article  Google Scholar 

  46. Eray D, Kamer UM, Ozden A. Organophosphate-induced delayed polyneuropathy [letter]. J Trop Pediatr 1995; 41: 189

    PubMed  CAS  Google Scholar 

  47. Aygun D, Onar MK, Alintop BL. The clinical and electrophysiological features of a delayed polyneuropathy developing subsequently after acute organophosphate poisoning and it’s correlation with the serum acetylcholinesterase. Electromyogr Clin Neurophysiol 2003; 43: 421–7

    PubMed  CAS  Google Scholar 

  48. Bidstrup PL, Bonnel JA, Beckett AG. Paralysis following poisoning by a new organic phosphorus insecticide (mipafox) report on two cases. BMJ 1953; i: 1068–72

    Article  Google Scholar 

  49. Hierons R, Johnson MK. Clinical and toxicological investigation of a case of delayed neuropathy in man after acute poisoning by an organophosphorus pesticide. Arch Toxicol 1978; 40: 279–84

    Article  PubMed  CAS  Google Scholar 

  50. Johnson MK. Delayed neurotoxicity: do trichlorphon and/or dichlorvos cause delayed neuropathy in man or in test animals? Acta Pharmacol Toxicol (Copenh) 1981; 49: 87–98

    Article  CAS  Google Scholar 

  51. Niedziella W, Gopel W, Banzhaf E. Akute alkylphosphatintoxikation (trichlorphon) mit intervallarem polyneuropathie-syndrom. Z Gesamte Inn Med 1985; 40: 237–9

    PubMed  CAS  Google Scholar 

  52. Csik V, Motika D, Marosi GY. Delayed neuropathy after trichlorfon intoxication [letter]. J Neurol Neurosurg Psychiatry 1998; 49: 222

    Article  Google Scholar 

  53. Martinez-Chuecos J, Jurado MC, Gimenez MP, et al. Experience with hemoperfusion for organophosphate poisoning. Crit Care Med 1992; 20(11): 1538–43

    Article  PubMed  CAS  Google Scholar 

  54. De Silva HJ, Sanmugtanathan PS, Senanayake N. Isolated bilateral recurrent laryngeal nerve paralysis: a delayed complication of organophosphorus poisoning. Hum Exp Toxicol 1994; 13: 171–3

    Article  PubMed  Google Scholar 

  55. Cristopher K, Arbelaez C, Yodice PC. Bilateral vocal cord dysfunction complicating short-term intubation and the utility of heliox. Respiration 2002; 69: 366–8

    Article  Google Scholar 

  56. Sacks MD, Marsh D. Bilateral recurrent laryngeal nerve neuropraxia following laryngeal mask insertion: a rare cause of serious upper airway morbidity. Pediatr Anaesth 2000; 10: 435–7

    Article  CAS  Google Scholar 

  57. Aiuto LA, Pavlakis SG, Boxer RA. Life-threatening organophosphate-induced delayed polyneuropathy in a child after accidental chlorpyrifos ingestion. J Pediatr 1993; 122: 658–60

    Article  PubMed  CAS  Google Scholar 

  58. Gutman L, Bodensteiner JB. Organophosphate-induced delayed polyneuropathy [letter]. J Pediatr 1993; 123: 837

    Google Scholar 

  59. Chattarjee M, Sarma PSA. Unusual neurological complications in a case of organophosphate poisoning. Neurol India 2003; 51: 290–1

    Google Scholar 

  60. Kaplan JG, Kessler J, Rosenberg N, et al. Sensory neuropathy associated with dursban (chlorpyrifos) exposure. Neurology 1993; 43: 2193–6

    Article  PubMed  CAS  Google Scholar 

  61. Meggs WJ. Permanent paralysis at sites of dermal exposure to chlorpyrifos. J Toxicol Clin Toxicol 2003; 41: 883–6

    Article  PubMed  Google Scholar 

  62. Clark RF, Williams SR, Fung F, et al. A reassessment of topical organic phosphorus insecticide exposures and permanent paralysis. J Toxicol Clin Toxicol 2004; 42: 991–2

    Article  PubMed  Google Scholar 

  63. Richardson RJ. Assessment of the neurotoxic potential of chlopyrifos relative to other organophosphorus compounds: a critical review of the literature. J Toxicol Environ Health 1995; 44: 135–65

    Article  PubMed  CAS  Google Scholar 

  64. Caroldi S, Lotti M. Delayed neurotoxicity caused by a single massive dose of dichlorvos to adult hens. Toxicol Lett 1981; 9: 157–9

    Article  PubMed  CAS  Google Scholar 

  65. Moretto A, Lotti M. The relationship between isofenphos cholinergic toxicity and the development of polyneuropathy in hens and humans. Arch Toxicol 2002; 76: 367–75

    Article  PubMed  CAS  Google Scholar 

  66. Food and Agriculture Organization/World Health Organization. Phoxim. In: Pesticides residues in food: evaluations 1984. Rome: FAO, 1985: 697–8

    Google Scholar 

  67. Catz A, Chen B, Jutrin I, et al. Late onset isofenphos neurotoxicity. J Neurol Neurosurg Psychiatry 1988; 51: 1338–40

    Article  PubMed  CAS  Google Scholar 

  68. Food and Agriculture Organization/World Health Organization. Maneb. In: Pesticide residues in food: evaluations 1993. Part II — toxicology. Geneva: WHO, 1994: 291–310

    Google Scholar 

  69. Francis BM, Metcalf RL, Hansen LG. Toxicity of organophosphorus esters to laying hens after oral and dermal administration. J Environ Sci Health B 1985; 20: 73–95

    Article  PubMed  CAS  Google Scholar 

  70. Sun DH, Zhou HD, Xue SZ. Epidemiologic survey on organophosphate-induced delayed polyneuropathy (OPIDP) among patients recovered from methamidophos poisoning. Med Lav 1998; 89Suppl. 2: S123–8

    PubMed  Google Scholar 

  71. De Haro L, Arditti J, Davide JM, et al. Intoxication au methamidophos: toxicité neurologiqué immediate et retardée; a propos de deux observations. Acta Clin Belg Suppl 1999; 1: 64–7

    PubMed  Google Scholar 

  72. Miranda J, McConnell R, Wesseling C, et al. Muscular strength and vibrations thresholds during two years after acute poisoning with organophosphate insecticides [online]. Available from URL: http://www.occenvmed.com/cgi/content/full/61/l/e4 [Accessed 2005 Jun 7]

  73. Miranda J, Lundberg I, McConnell R, et al. Onset of grip- and pinch-strength impairment after acute poisoning with organophosphate insecticides. Int J Occup Environ Health 2002; 8: 19–26

    PubMed  CAS  Google Scholar 

  74. Johnson MK, Vilanova E, Read DJ. Anomalous biochemical responses in test of the delayed neuropathic potential of methamidophos (O,S-dimethyl phosphoramidate), its resolved isomers and of some higher O-alkyl homologues. Arch Toxicol 1991; 65: 618–24

    Article  PubMed  CAS  Google Scholar 

  75. Barnes JM, Denz FA. Experimental demyelination with organophosphorus compounds. J Pathol Bacteriol 1953; 65: 597–605

    Article  PubMed  CAS  Google Scholar 

  76. De Freitas MRG, Chimelli L, Nascimento OJG, et al. Polineuropatia por triclorfon. Arq Neuropsiquiatr 1990; 48: 515–9

    Article  PubMed  Google Scholar 

  77. Johnson MK. Organophosphorus esters causing delayed neurotoxic effects: mechanisms of action and structure/activity studies. Arch Toxicol 1975; 34: 259–88

    Article  PubMed  CAS  Google Scholar 

  78. Jokanovic M, Maksimovic M, Stepanovic RM. Interaction of phosphamidon with neuropathy target esterase and acetylcholinesterase in hen brain. Arch Toxicol 1995; 69: 425–8

    Article  PubMed  CAS  Google Scholar 

  79. Hsiao CT, Yang CC, Deng CC, et al. Acute pancreatitis following organophosphate intoxication. Clin Toxicol 1996; 34: 343–7

    Article  CAS  Google Scholar 

  80. Food and Agriculture Organization/World Health Organization. Mevinphos. In: Pesticides residues in food: evaluations 1996. Part II — toxicology. Geneva: WHO, 1997: 49–74

    Google Scholar 

  81. Dickoff DJ, Gerber O, Turovsky Z. Delayed neurotoxicity after ingestion of carbamate pesticide. Neurology 1987; 37: 1229–31

    Article  PubMed  CAS  Google Scholar 

  82. Branch RA, Jacqz E. Subcute neurotoxicity following long-term exposure to carbaryl. Am J Med 1986; 80: 741–5

    Article  PubMed  CAS  Google Scholar 

  83. Ehrich M, Jortner BS, Padilla S. Comparison of the relative inhibition of acetylcholinesterase and neuropathy: target esterase in rats and hens given cholinesterase inhibitors. Fundam Appl Toxicol 1995; 24: 94–101

    Article  PubMed  CAS  Google Scholar 

  84. Umehara F, Izumo S, Arimura K, et al. Polyneuropathy induced by m-tolyl methyl carbamate intoxication. J Neurol 1991; 238: 47–8

    Article  PubMed  CAS  Google Scholar 

  85. Yang PY, Tsao TCY, Lin JL, et al. Carbofuran-induced delayed neuropathy. Clin Toxicol 2000; 38: 43–6

    Article  CAS  Google Scholar 

  86. Food and Agriculture Organization/World Health Organization. Fenthion. In: Pesticide residues in food: evaluations 1995. Part II — toxicological and environmental. Geneva: WHO, 1996: 123–55

    Google Scholar 

  87. Monje Argile A, Lison D, Lauwerys R, et al. Acute polyneuropathy after malathion poisoning. Acta Neurol Belg 1990; 90: 190–9

    Google Scholar 

  88. Dive A, Mahieu R, van Binst R, et al. Unusual manifestations after malathion poisoning. Hum Exp Toxicol 1994; 13: 271–4

    Article  PubMed  CAS  Google Scholar 

  89. Aldridge WN, Nemery B. Toxicology of trialkylphosphorothioates with particular reference to lung toxicity. Fundam Appl Toxicol 1984; 4: S215–23

    Article  PubMed  CAS  Google Scholar 

  90. Food and Agriculture Organization/World Health Organization. Malathion. In: Pesticide residues in food: evaluations 1997. Part II — toxicology. Geneva: WHO, 1998: 189–219

    Google Scholar 

  91. Baker EL, Zack M, Miles JW, et al. Epidemic malathion poisoning in Pakistan malaria workers. Lancet 1978; I: 31–4

    Article  Google Scholar 

  92. Rivett K, Potgieter PD. Diaphragmatic paralysis after organophosphate poisoning. S Afr Med J 1987; 72: 881–2

    PubMed  CAS  Google Scholar 

  93. Stamboulis E, Psimaras A, Vassilopoulos D, et al. Neuropathy following acute intoxication with Mecarbam (OP ester). Acta Neurol Scand 1991; 83: 198–200

    Article  PubMed  CAS  Google Scholar 

  94. Food and Agriculture Organization/World Health Organization. Mecarbam. In: Pesticides residues in food: evaluations 1986. Part II — toxicology. Rome: FAO, 1987: 89–92

    Google Scholar 

  95. Curtes JP, Develay P, Hubert JP. Late peripheral neuropathy due to an acute voluntary intoxication by organophosphorus compounds. Clin Toxicol 1981; 18: 1453–62

    Article  PubMed  CAS  Google Scholar 

  96. Solé Violàn J, Martinez Chuecos J, Molineros Somolinos F, et al. Manifestaciones neurologicas en la intoxicaciòn aguda por insecticidas organofosforados. Med Clin (Spain) 1985; 85: 217–20

    Google Scholar 

  97. Sahin M, Bernay I, Cant F, et al. Reflex sympathetic syndrome secondary to organophosphate intoxication induced neuropathy. Ann Nucl Med 1994; 8: 299–300

    Article  PubMed  CAS  Google Scholar 

  98. Lotti M, Ferrara SD, Caroldi S, et al. Enzyme studies with human and hen autopsy tissue suggest omethoate does not cause delayed neuropathy in man. Arch Toxicol 1981; 48: 265–8

    Article  PubMed  CAS  Google Scholar 

  99. De Jager AEJ, van Weerden TW, Houthoff HJ, et al. Polyneuropathy after massive exposure to parathion. Neurology 1981; 31: 603–5

    Article  PubMed  Google Scholar 

  100. Soliman SA, Farmer J, Curley A. Is delayed neurotoxicity a property of all organophosphorus compounds? A study with a model compound: parathion. Toxicology 1982; 23: 267–79

    Article  PubMed  CAS  Google Scholar 

  101. Food and Agriculture Organization/World Health Organization. Parathion. In: Pesticide residues in food: evaluations 1995. Part II — toxicological and environmental. Geneva: WHO, 1996: 243–61

    Google Scholar 

  102. Johnson MK. Check your paraoxon and parathion for neurotoxic impurities. In: Crammer JM, Hixson JE, editors. Proceedings of the Delayed Neurotoxicity Workshop; 1982 Jun 27—30; Champaign (IL). Little Rock (AK): INTOX Press, 1984

  103. Alonso JL, Atalla A, Cavaliere MJ, et al. Polineuropatia por parathion. Arq Neuropsiquiatr 1983; 41: 292–308

    Article  PubMed  CAS  Google Scholar 

  104. Nisse P, Forceville X, Cezard C, et al. Intermediate syndrome with delayed distal polyneuropathy from ethylparathion poisoning. Vet Hum Toxicol 1998; 40: 349–52

    PubMed  CAS  Google Scholar 

  105. Carod-Artal FJ, Speck Martins C. Polineuropatia tardia inducida por exposicion a organofosforados. Rev Neurol (Spain) 1999; 29: 123–7

    CAS  Google Scholar 

  106. Fisher JR. Guillain-Barrè syndrome following organophosphate poisoning. JAMA 1977; 238: 1950–1

    Article  PubMed  CAS  Google Scholar 

  107. Himuro K, Murayama S, Nishiyama K, et al. Distal sensory axonopathy after sarin intoxication. Neurology 1998; 51: 1195–7

    Article  PubMed  CAS  Google Scholar 

  108. Gordon JJ, Inns RH, Johnson MK, et al. The delayed neuropathic effects of nerve agents and some other organophosphorus compounds. Arch Toxicol 1983; 52: 71–82

    Article  PubMed  CAS  Google Scholar 

  109. Pilkington A, Jamal GA, Gilham R, et al. Epidemiological study of the relationships between exposure to organophosphate pesticides and indicies of chronic peripheral neuropathy and neurophysiological abnormalities in sheep farmers and dippers. IOM Technical Memorandum Series TM/99/02c. Edinburgh: Institute of Occupational Medicine, 1999

    Google Scholar 

  110. Pilkington A, Buchanan D, Jamal GA, et al. An epidemiological study of the relations between exposure to organophosphate pesticides and indices of chronic peripheral neuropathy and neuropsychological abnormalities in sheep farmers and dippers. Occup Environ Med 2001; 58: 702–10

    Article  PubMed  CAS  Google Scholar 

  111. Haley RW, Horn J, Roland PS, et al. Evaluation of neurologic function in Gulf War Veterans: a blinded case-control study. JAMA 1997; 277: 223–30

    Article  PubMed  CAS  Google Scholar 

  112. Jamal GA, Hansen S, Apartopoulos F, et al. The ‘Gulf War Syndrome’: is there evidence of disfunction in the nervous system? J Neurol Neurosurg Psychiatry 1996; 60: 449–51

    Article  PubMed  CAS  Google Scholar 

  113. Lotti M. Low-level exposures to organophosphorus esters and peripheral nerve function. Muscle Nerve 2002; 25: 492–504

    Article  PubMed  CAS  Google Scholar 

  114. Cole DC, Carpio F, Julian J, et al. Assessment of peripheral nerve function in an Ecuadorian rural population exposed to pesticides. J Toxicol Environ Health A 1998; 55: 77–91

    Article  PubMed  CAS  Google Scholar 

  115. Drenth HJ, Ensberg IFG, Roberts DV, et al. Neuromuscular function in agricultural workers using pesticides. Arch Environ Health 1972; 25: 395–8

    PubMed  CAS  Google Scholar 

  116. Roberts DV. A longitudinal electromyographic study of six men occupationally exposed to organophosphorus compounds. Int Arch Occup Environ Health 1977; 38: 221–9

    Article  PubMed  CAS  Google Scholar 

  117. Peiris-John RJ, Ruberu AK, Wickremasinghe AR, et al. Effects of occupational exposure to organophosphate pesticides on nerve and neuromuscular function. J Occup Environ Med 2002; 44: 352–7

    Article  PubMed  CAS  Google Scholar 

  118. Burger M, Alonzo C, Heuhs L, et al. Neuropathie peripherique par pesticides organophosphores. Arch Mal Prof 1991; 52: 37–8

    Google Scholar 

  119. Horowitz S, Stark A, Marshall E, et al. A multi-modality assessment of peripheral nerve function in organophosphate-pesticide applicators. J Occup Environ Med 1999; 41: 405–8

    Article  PubMed  CAS  Google Scholar 

  120. Stokes L, Stark A, Marshall E, et al. Neurotoxicity among pesticide applicators exposed to organophosphates. Occup Environ Med 1995; 52: 648–53

    Article  PubMed  CAS  Google Scholar 

  121. Stålberg E, Hilton-Brown P, Kolmodin-Hedman B, et al. Effects of occupational exposure to organophosphorus insecticides on neuromuscular function. Scand J Work Environ Health 1978; 4: 255–61

    Article  PubMed  Google Scholar 

  122. Roberts DV. EMG voltage motor nerve conduction velocity in organophosphorus pesticide factory workers. Int Arch Occup Environ Health 1976; 36: 267–74

    Article  PubMed  CAS  Google Scholar 

  123. Ring H, Melamed S, Hellar L, et al. Evaluation of EMG examination as an indicator of worker susceptibility to organophosphate exposure. Electromyogr Clin Neurophysiol 1985; 25: 35–44

    PubMed  CAS  Google Scholar 

  124. Otto DA, Soliman S, Svendsgaard D, et al. Neurobahavioral assessment of workers exposed to organophosphorus pesticides. In: Johnson BL, editor. Advances in neurobehavioral toxicology: applications in environmental and occupational health. Chelsea: Lewis Publishers, 1990: 305–22

    Google Scholar 

  125. Jager KW, Roberts DV, Wilson A. Neuromuscular function in pesticides workers. Br J Ind Med 1970; 27: 273–8

    PubMed  CAS  Google Scholar 

  126. Ernest K, Thomas M, Paulose M, et al. Delayed effects of exposure to organophosphorus compounds. Indian J Med Res 1995; 101: 81–4

    PubMed  CAS  Google Scholar 

  127. Misra UK, Nag D, Khan WA, et al. A study of nerve conduction velocity, late responses and neuromuscular synapse functions in organophosphate workers in India. Arch Toxicol 1988; 61: 496–500

    Article  PubMed  CAS  Google Scholar 

  128. Jusic A, Jurenic D, Milić S. Electromyographical neuromuscular synaps testing and neurological findings in workers exposed to organophosphorus pesticides. Arch Environ Health 1980; 35: 168–75

    PubMed  CAS  Google Scholar 

  129. Verberk MM, Sallé HJA. Effects of nervous function in volunteers ingesting mevinphos for one month. Toxicol Appl Pharmacol 1977; 42: 351–8

    Article  PubMed  CAS  Google Scholar 

  130. Lotti M, Becker CE, Aminoff MJ, et al. Occupational exposure to the cotton defoliants DEF and Merphos: a rational approach to monitoring organophosphorus-induced delayed neurotoxicity. J Occup Med 1983; 25: 517–22

    PubMed  CAS  Google Scholar 

  131. London L, Meyers JE, Nell V, et al. An investigation into neurologic and neurobehavioral effects of long-term agrichemical use among deciduous fruit farm workers in the Western Cape, South Africa. Environ Res 1997; 73: 132–45

    Article  PubMed  CAS  Google Scholar 

  132. London L, Nell V, Thompson ML, et al. Effects of long-term organophosphate exposure on neurological symptoms, vibration sense and tremor among South African farm workers. Scand J Work Environ Health 1998; 24: 18–29

    Article  PubMed  CAS  Google Scholar 

  133. Engel LS, Keifer MC, Checkoway H, et al. Neurophysiological function in farm workers exposed to organophosphate pesticides. Arch Environ Health 1998; 53: 7–14

    Article  PubMed  CAS  Google Scholar 

  134. Albers JW, Garabrant DH, Schweitzer SJ, et al. The effects of occupational exposure to chlorpyrifos on the peripheral nervous system: a prospective cohort study. Occup Environ Med 2004; 61: 201–11

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors do not have any conflicts of interest relevant to the contents of the manuscript. Partial financial support was provided to A. Moretto by Universita di Padova, progetto di Ateneo 2004.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marcello Lotti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lotti, M., Moretto, A. Organophosphate-Induced Delayed Polyneuropathy. Toxicol Rev 24, 37–49 (2005). https://doi.org/10.2165/00139709-200524010-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00139709-200524010-00003

Keywords

Navigation