1/12. Psychogenic chemical sensitivity: psychogenic pseudoseizures elicited by provocation challenges with fragrances.A middle-aged woman with a 10-year history of disability attributed to chemical sensitivities complained that exposure to specific fragrances immediately elicited seizures. Video-EEG monitoring was performed in a hospital neurodiagnostic laboratory during provocative challenge studies employing fragrances identified by the patient as reliably inducing symptoms. The baseline clinical EEG was normal. Immediately after each provocation with air deodorant and perfume, she consistently showed both generalized tonic/clonic and multifocal myoclonic jerking, at times was nonresponsive, spoke with slurred speech, and complained of right-sided paralysis and lethargy. None of these events were associated with any EEG abnormalities. Psychological assessment (mmpi-2, MCMI-II) revealed personality traits that predisposed her to somatization and beliefs about environmental sensitivities. The convulsions were a manifestation of psychogenic pseudoseizures that had been iatrogenically reinforced.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/12. A 37-year-old mechanic with multiple chemical sensitivities.A 37-year-old heating, ventilation, and air-conditioning mechanic developed respiratory, musculoskeletal, and central nervous system symptoms associated with a variety of odorous environmental chemicals. Organic disease was not evident, but the patient was distressed by these symptoms and was at risk for becoming disabled by them. His symptoms fit broadly into the condition recognized as multiple chemical sensitivity. multiple chemical sensitivity is a diagnostic term for a group of symptoms without demonstrated organic basis. The symptoms are characteristic of dysfunction in multiple organ systems, they increase and decrease according to exposure to low levels of chemical agents in the patient's environment, and they sometimes occur after a distinct environmental change or insult such as an industrial accident or remodeling. Although traditional medical organizations have not agreed on a definition for this syndrome, it is being increasingly recognized and makes up an increasing percentage of the caseload at occupational and environmental medicine clinics. Although there is often dispute about whether the symptoms have a functional or organic basis, an informed approach to evaluation, diagnosis, and management and a careful assessment of impairment, disability, and work relatedness are necessary. Careful exclusion of organic causes is critical, and this should be followed by a judicious approach to coping with symptoms.- - - - - - - - - - ranking = 4keywords = environment (Clic here for more details about this article) |
3/12. sick building syndrome.Dr. Hodgson summarizes what is known about human symptoms and discomfort in the built environment, and formulates several critical hypotheses that show striking parallels to the questions arising from discussions of the IEI/MCS syndrome.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/12. multiple chemical sensitivity (MCS)--differential diagnosis in clinical neurotoxicology: a German perspective.The multiple chemical sensitivity syndrome (MCS) is a new cluster of environmental symptoms which have been described and commented on for more than 15 years now in the USA. In the meantime it has also been observed in European countries. The main features of this syndrome are: multiple symptoms in multiple organ systems, precipitated by a variety of chemical substances with relapses and exacerbation under certain conditions when exposed to very low levels which do not affect the population at large. There are no lab markers or specific investigative findings. In our view, MCS is not a separate clinical syndrome but a collective term. A very small part of the patients in question may actually exhibit a somatic or psychosomatic response to low levels of a variety of chemicals in the environment. For another part, even if the MCS symptoms are induced by chemical substances in the environment, the basic hypersensitivity is a psychological stress reaction. In the third and largest group, the patients have been misdiagnosed, i.e. a somatic or psychiatric disease has been overlooked. There is a fourth group of patients in whom there is no evidence of any exposure at all but instead a belief system installed by certain physicians, the media and other groups in society. This paper tries to describe the neurological and neurotoxic aspects of MCS problems and to illustrate it with examples of an alleged outbreak of chronic neurotoxic disease caused by pyrethroids in germany. research strategy should establish clearly determined diagnostic criteria, agreement on the use of specific questionnaires as well as clinical and technical diagnostic procedures, prospective clinical studies of MCS patients and comparative groups as well as experimental approaches.- - - - - - - - - - ranking = 3keywords = environment (Clic here for more details about this article) |
5/12. A 4-year-old girl with manifestations of multiple chemical sensitivities.Multiple chemical sensitivities (MCS) syndrome, also known as idiopathic environmental intolerance, is a controversial diagnosis that encompasses a wide range of waxing and waning, subjective symptoms referable to more than one body system and provoked by exposure to low levels of chemicals, foods, or other agents in the environment. Although MCS has been studied extensively, a unifying mechanism explaining the illness remains obscure, and clinicians are divided as to whether such a medical entity exists separately from psychosomatic syndromes. MCS is an adult diagnosis; there is little reference to pediatric cases in the scientific literature. In this case from the Pediatric environmental health Subspecialty Unit at boston's Children's Hospital, I present the case of a preschool child who had suffered from milk allergy and poor weight gain as an infant, and then later developed asthma, allergic symptoms, sinusitis, headaches, fatigue, and rashes precipitated by an expanding variety of chemicals, foods, and allergens. I review definitions, mechanisms, diagnostic strategies, and management, and discuss some uniquely pediatric features of MCS as illustrated by this case.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
6/12. Central neurological abnormalities and multiple chemical sensitivity caused by chronic toluene exposure.multiple chemical sensitivity (MCS) is a syndrome in which multiple symptoms occur with low-level chemical exposure; whether it is an organic disease initiated by environmental exposure or a psychological disorder is still controversial. We report a 38-year-old male worker with chronic toluene exposure who developed symptoms such as palpitation, insomnia, dizziness with headache, memory impairment, euphoria while working, and depression during the weekend. Upon cessation of exposure, follow-up neurobehavioural tests, including the cognitive ability screening instrument and the mini-mental state examination, gradually improved and eventually became normal. Although no further toluene exposure was noted, non-specific symptoms reappeared whenever the subject smelled automotive exhaust fumes or paint, or visited a petrol station, followed by anxiety with sleep disturbance. During hospitalization for a toluene provocation test, there was no difference between pre-challenge and post-challenge PaCO(2), PaO(2), SaO(2) or pulmonary function tests, except some elevation of pulse rate. The clinical manifestations suggested that MCS was more relevant to psychophysiological than pathophysiological factors.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/12. The sensitive individual and the indoor environment: case study.This case study describes an indoor environment investigation initiated in response to numerous health and comfort complaints suspected of being associated with a two-story office building. Conventional indoor environment investigation techniques were applied in an attempt to identify one or several contributing factors, such as inadequate outdoor air ventilation and the presence of a respiratory irritant. The air quality satisfaction percentage in the building was well above 80%; however, at least one individual was experiencing a fairly severe reaction only upon entering the subject building. Evaluating the building indoor conditions as acceptable without attempting to address all possible building-related causes and communicating findings to interested occupants would likely have resulted in more occupant complaints and increased the potential for hysteria conditions. This investigation necessarily addressed a sensitive individual and involved an occupational physician as a constructive participant in the investigation.- - - - - - - - - - ranking = 6keywords = environment (Clic here for more details about this article) |
8/12. Neurasthenic fatigue, chemical sensitivity and GABAa receptor toxins.Following observation of fatigue syndromes in people who have been occupationally exposed to pesticides and insecticides which exert their toxicity through the GABAa receptor, we have formulated the hypothesis that fatigue syndromes in general may be secondary to altered sensitivity of the GABAa receptor. We discuss the possible involvement of organochlorine compounds which are widespread in the environment. Organophosphate compounds may have similar toxic effects through damaged cholinergic input to the dentate gyrus of the hippocampus where cholinergic and GABAergic transmission are closely linked.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/12. Behavioral treatment of phobic avoidance in multiple chemical sensitivity.The clinical ecology model of environmental illness, or multiple chemical sensitivity (MCS), and particularly the theoretical assumptions, diagnostic procedures, and therapeutic recommendations promulgated by clinical ecologists are reviewed. No scientific evidence is found for their claims. MCS is conceptualized, instead, as a phobic disorder explicable in terms of the two-factor model of avoidance. Three cases of MCS are discussed in light of this model, and a comprehensive behavioral treatment package that includes biofeedback-assisted in vivo desensitization and cognitive restructuring is proposed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/12. Provocative challenges in patients with multiple chemical sensitivity.Whether multiple chemical sensitivity (MCS) is an organic disease initiated by environmental exposure or a psychologic disorder is a subject of controversy. The identification of pathophysiologic or psychophysiologic mechanisms occurring in patients with MCS after provocative challenges should be illuminating. Fifteen patients with MCS were challenged with their trigger substances and observed clinically. Prechallenge and postchallenge pulmonary function tests and PCO2, PO2, and oxygen saturation were measured. All of the patients whose symptoms were reproduced by the challenge (11 of 15) showed clinical evidence of acute hyperventilation with a rapid fall in PCO2 and no change or a rise in oxygen saturation. The symptoms and signs were consistent with an anxiety reaction with hyperventilation. Pulmonary function was unchanged; and recovery was rapid, aided in two cases by rebreathing into a paper bag. The most logical conclusion is that in these patients the MCS disorder is a manifestation of an anxiety syndrome triggered by their perception of an environmental insult, with at least some of their symptoms induced by hyperventilation.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
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