Neurophysiological Findings and Serum Aluminium in Dialysis Encephalopathy

Ladurner, G.; Wawschinek, O.; Pogglitsch, H; Petek, W.; Urlesberger, H; Holzr, H.

doi:10.1159/000115500

Cited by 11 publications

(6 citation statements)

References 6 publications

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“…17. Several reports of higher ,ug/L) serum concentrations exist, particularly in DES (68,73,89,96,955). However, most ofthese investigations also report higher normal serum values than those reported by the group referred to or being most plausible, as reported in the earlier review of the literature.…”

Section: Discussionmentioning

confidence: 79%

Metabolism and possible health effects of aluminum.

Ganrot¹

1986

Environ Health Perspect

203

150

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Literature regarding the biochemistry of aluminum and eight similar ions is reviewed. Close and hitherto unknown similarities were found. A hypothetical model is presented for the metabolism, based on documented direct observations of Al3+ and analogies from other ions. Main characteristics are low intestinal absorption, rapid urinary excretion, and slow tissue uptake, mostly in skeleton and reticuloendothelial cells. Intracellular Al3+ is probably first confined in the lysosomes but then slowly accumulates in the cell nucleus and chromatin. Large, long-lived cells, e.g., neurons, may be the most liable to this accumulation. In heterochromatin, Al3+ levels can be found comparable to those used in leather tannage. It is proposed that an accumulation may take place at a subcellular level without any significant increase in the corresponding tissue concentration. The possible effects of this accumulation are discussed. As Al3+ is neurotoxic, the brain metabolism is most interesting. The normal and the lethally toxic brain levels of Al3+ are well documented and differ only by a factor of 3-10. The normal brain uptake of Al3+ is estimated from data on intestinal uptake of Al3+ and brain uptake of radionuclides of similar ions administered intravenously. The uptake is very slow, 1 mg in 36 years, and is consistent with an assumption that Al3+ taken up by the brain cannot be eliminated and is therefore accumulated. The possibility that Al3+ may cause or contribute to some specific diseases, most of them related to aging, is discussed with the proposed metabolic picture in mind.

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Section: Discussionmentioning

confidence: 79%

Metabolism and possible health effects of aluminum.

Ganrot¹

1986

Environ Health Perspect

203

150

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“…Increased slow activity, maximally in the frontal region, and bilateral spike and slow wave complexes are typical findings among patients with dialysis encephalopathy (52)(53)(54)(55)(56). The severity of EEG abnormalities in clinical cases correlated with the S-A1 levels, which were invariably high, the mean values in 2 patient groups were 7 and 15 pmolll (53). In the QEEG, we observed more slow activity and less alpha activity among the subjects who had higher U-A1 levels.…”

Section: Aleurophysiological Effectsmentioning

confidence: 99%

Body burden of aluminum in relation to central nervous system function among metal inert-gas welders

Riihimäki¹,

Hänninen²,

Akila³

et al. 2000

Scand J Work Environ Health

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ObjectivesThe relationship between elevated internal aluminum loads and central nervous system function was studied among aluminum welders, and the threshold level for adverse effect was defined.Methods For 65 aluminum welders and 25 current mild steel welders body burden was estimated, and the aluminum concentrations in serum (S-Al) and urine (U-A1) were analyzed with graphite furnace atomic absorption spectrometry with Zeeman background correction. Referents and low-exposure and high-exposure groups were defined according to an aggregated measure of aluminum body burden, the group median S-A1 levels being 0.08, 0.14, and 0.46 pmolll, respectively, and the corresponding values for U-A1 being 0.4, 1.8, and 7.1 pmolll. Central nervous system functions were assessed with a neuropsychological test battery, symptom and mood questionnaires, a visual and quantitative analysis of electroencephalography (EEG), and P3 event-related potentials with pitch and duration paradigms.Results Subjective symptoms showed exposure-related increases in fatigue, mild depression, and memory and concentration problems. Neuropsychological testing revealed a circumscribed effect of aluminum, mainly in tasks demanding complex attention and the processing of information in the working memory system and in the analysis and recall of abstract visual patterns. The visual EEG analysis revealed pathological findings only for aluminum welders. Mild, diffuse abnormalities were found in 17% of the low-exposure group and 27% of the high-exposure group, and mild to moderate epileptiform abnormalities at a frequency of 7% and 17%, respectively. C O~C~U S~O~S Both objective neurophysiological and neuropsychological measures and subjective symptomatology indicated mild but unequivocal findings dose-dependently associated with increased aluminum body burden. The study indicates that the body burden threshold for adverse effect approximates an U-A1 value of 4-6 pmol/l and an S-A1 value of 0.25-0.35 kmol/l among aluminum welders.

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“…However, changes in visual evoked potentials are seen at serum aluminum levels of less than 60 g/L (4), suggesting that even mild aluminum accumulation is toxic to the central nervous system. When dialysis encephalopathy ensues, clear-cut electroencephalographic changes that correlate with pathologic findings are found (5). Brain aluminum accumulation in dialysis patients does not result in the formation of senile plaques and neurofibrillary tangles, typical of Alzheimer's disease (6), but tau protein, found in both plaques and tangles, is increased (7).…”

Section: Aluminummentioning

confidence: 99%