Tremor frequency patterns in mercury vapor exposure, compared with early Parkinson's disease and essential tremor.

A new portable tremometer allows determination of tremor intensities at different tremor frequencies. Based on past studies, two tremor frequency windows of similar size were chosen at 3.0-6.5 Hz and 6.6-10.0 Hz to reflect major tremor intensities in Parkinson's disease and mercury vapor poisoning, respectively. In 81 healthy controls, total tremor intensity was higher for the preferred hand and depended on age. Ten patients treated for Parkinson's disease showed substantially increased tremor intensity, especially within the low-frequency window. This pattern was also apparent in 14 patients with de novo Parkinson's disease whose overall tremor intensity was only mildly elevated. In contrast, ten patients with essential tremor had peak frequencies in both windows, and some patients had increased tremor on one side only. Sixty-three Brazilian gold traders exposed to mercury vapor showed increased tremor predominantly in the high-frequency window. Three of the gold traders had a narrower tremor peak at frequencies of 7-8 Hz. While the urine-mercury concentration was significantly associated with the current number of burning sessions per week, it did not correlate with tremor intensities. However, eight traders had a urinary mercury excretion level above 50 microg and at the same time a greatly increased average tremor intensity within the high-frequency window. These patterns were statistically significant for relative tremor intensities, but were less clear when total intensities were used. These observations suggest that the relative distribution of tremor intensities in specific frequency bands may be a valuable supplement to current diagnostic methods for subjects with mercury vapor exposure.

Threshold effect in lead-induced peripheral neuropathy.

We previously demonstrated a negative correlation between blood lead level and motor nerve conduction velocity in 202 asymptomatic 5 to 9-year-old children living near a lead smelter in Idaho. Blood lead levels ranged from 13 to 97 micrograms/dL. To determine whether a threshold exists between blood lead level and maximal motor nerve conduction velocity, we conducted three regression analyses on these data: a "hockey stick" regression, a logistic regression, and a quadratic regression. We found evidence for a threshold in all three analyses: at a blood level of 30 micrograms/dL in the "hockey stick" regression, at 20 micrograms/dL in the logistic, and at 25 to 30 micrograms/dL in the quadratic. Neither age, sex, socioeconomic status, nor duration of residence near the smelter significantly modified the relationship. These analyses confirm that asymptomatic increased lead absorption causes slowing of nerve conduction, but they also indicate that measurement of maximal motor nerve conduction velocity is an insensitive screen for low-level lead toxicity.

Increased lead absorption with anemia and slowed nerve conduction in children near a lead smelter.

Studies to evaluate the prevalence, sources, and health consequences of lead absorption were conducted among children living near a primary lead smelter. Lead levels in air, soil, and dust were highest at the smelter and decreased with distance. Ninety-nine percent of one- to nine-year-old children living within 1.6 kilometers had blood lead levels greater than or equal 40 mug/dl, indicating increased absorption, and 22% had levels greater than or equal 80 mug/dl. The prevalence of lead levels greater than or equal 40 mug/dl decreased with distance; at 72 kilometers from the smelter it was 1%. Erythrocyte protoporphyrin levels increased with blood lead levels: 17% of children with lead levels of greater than or equal 80 mug/dl were anemic. There was no overt neurologic toxicity. Significant negative correlation was found in 202 five- to nine-year-old children between blood lead levels and motor nerve conduction velocity (r = 0.38, p less than 0.02).