Amyotrophic lateral sclerosis, occupational exposure to extremely low frequency magnetic fields and electric shocks: a systematic review and meta-analysis

Jalilian, Hamed; Najafi, Kamran; Khosravi, Yahya; Röösli, Martin

doi:10.1515/reveh-2020-0041

Cited by 9 publications

(7 citation statements)

References 60 publications

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“…We also did not find that occupational exposure to electromagnetic radiation increases ALS risk, which could be due to the low number of individuals reporting this exposure in our cohort, most of whom were health care workers. A recent meta-analysis suggests that electromagnetic radiation exposure slightly increases ALS risk (Jalilian et al 2021 ), although reports included in the meta-analysis were mixed, indicating that the risk is not uniform across all studies.…”

Section: Discussionmentioning

confidence: 99%

Associations of self-reported occupational exposures and settings to ALS: a case–control study

Goutman

Boss

Godwin

et al. 2022

Int Arch Occup Environ Health

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Background Environmental exposures contribute to the pathogenesis of amyotrophic lateral sclerosis (ALS), a fatal and progressive neurological disease. Identification of these exposures is important for targeted screening and risk factor modification. Objective To identify occupational exposures that are associated with a higher risk of ALS using both survey and standard occupational classification (SOC) coding procedures, and to highlight how exposure surveys can complement SOC coding. Methods ALS participants and neurologically healthy controls recruited in Michigan completed a detailed exposure assessment on their four most recent and longest held occupations. Exposure scores were generated from the exposure survey, and occupations were assigned to SOC codes by experienced exposure scientists. Results This study included 381 ALS and 272 control participants. ALS participants reported higher duration-adjusted occupational exposure to particulate matter (OR = 1.45, 95% CI 1.19–1.78, p < 0.001), volatile organic compounds (OR = 1.22, 95% CI 1.02–1.45, p = 0.029), metals (OR = 1.48, 95% CI 1.21–1.82, p < 0.001), and combustion and diesel exhaust pollutants (OR = 1.20, 95% CI 1.01–1.43, p = 0.041) prior to ALS diagnosis, when adjusted for sex, age, and military service compared to controls. In multivariable models, only occupational exposure to metals remained significant risk (OR = 1.56, 95% CI 1.11–2.20, p = 0.011), although in an adaptive elastic net model, particulate matter (OR = 1.203), pesticides (OR = 1.015), and metals (1.334) were all selected as risk factors. Work in SOC code “Production Occupations” was associated with a higher ALS risk. SOC codes “Building and Grounds Cleaning and Maintenance Occupations”, “Construction and Extraction Occupations”, “Installation, Maintenance, and Repair Occupations”, and “Production Occupations” were all associated with a higher exposure to metals as determined using survey data. Discussion Occupational exposure to particulate matter, volatile organic compounds, metals, pesticides, and combustion and diesel exhaust and employment in “Production Occupations” was associated with an increased ALS risk in this cohort.

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Section: Discussionmentioning

confidence: 99%

Associations of self-reported occupational exposures and settings to ALS: a case–control study

Goutman

Boss

Godwin

et al. 2022

Int Arch Occup Environ Health

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“…Thus, it seems most plausible that the results we found are coincidental, and not signs of a causal link. Recent reviews and meta-analyses have come to conflicting conclusions, where some conclude that ALS is associated with occupational exposure to magnetic fields, but not to electric shock [ 35 , 36 ] whereas another highlights a history of electric shock as a risk factor for ALS [ 37 ]. Our data set did not include enough cases to shed further light on this question.…”

Section: Discussionmentioning

confidence: 99%

Neurological symptoms and disorders following electrical injury: A register-based matched cohort study

et al. 2022

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Introduction Electric shocks may have neurological consequences for the victims. Although the literature on the neurological consequences of electric shocks is limited by retrospective designs, case studies and studies of selected patient groups, previous research provides some evidence of a link between electric shocks, and diseases and symptoms of the central nervous system (CNS)(e.g. epilepsy, migraine and vertigo) and the peripheral nervous system (PNS)(e.g. loss of sensation, neuropathy and muscle weakness). This study aims to employ a register-based, matched cohort study, to investigate whether individuals demonstrate a greater risk of neurological diseases and symptoms of the CNS or PNS in the years following an electrical injury. Materials and methods We identified 14,112 electrical injuries over a period of 19 years in two Danish registries, and matched these with three different groups of persons in a prospective matched cohort study: (1) patients with dislocation/sprain injuries, (2) patients with eye injuries and (3) persons employed in the same occupation. Year of injury, sex and age were used as matching variables. The outcomes we identified comprised neurological disorders and central or peripheral nervous system symptoms that covered a range of diagnoses in the Danish National Patient Register. The associations were analysed using conditional logistic regression for a range of time periods (six months to five years) and conditional Cox regression for analyses of the complete follow-up period (up to 20 years). Results For victims of electric shock, the CNS sequelae we identified included an increased risk of epilepsy, convulsions, abnormal involuntary movements, headache, migraine and vertigo. We also identified an uncertain, increased risk of spinal muscular atrophy and dystonia, whereas we identified no increased risk of Parkinson’s disease, essential tremor, multiple sclerosis or other degenerative diseases of the nervous system. For victims of electric shock, the PNS sequelae we identified included an increased risk of disturbances of skin sensation, mononeuropathy in the arm or leg and nerve root and plexus disorders. We also identified an uncertain, increased risk of facial nerve disorders, other mononeuropathy, and polyneuropathy. Conclusion Our results confirm that electrical injuries increase the risk of several neurological diseases and symptoms of the CNS or PNS in the years following the injury. Most often the diseases and symptoms are diagnosed within the first six months of the injury, but delayed onset of up to 5 years cannot be ruled out for some symptoms and diagnoses. Some of the conditions were rare in our population, which limited our ability to identify associations, and this warrants cautious interpretation. Therefore, further studies are needed to confirm our findings, as are studies that examine the mechanisms underlying these associations.

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“…A recent study from New Zealand reported an association between occupational exposure to electric shocks and ALS but did not show associations with exposure to work-related ELF-MF [Chen et al, 2021]. A more recent meta-analysis reported a weak association between occupational exposure to ELF-MF and the risk of ALS and reported no association between occupational exposure to electric shocks and risk of ALS; however, there was substantial heterogeneity in the results of the included studies [Jalilian et al, 2020].…”

Section: Introductionmentioning

confidence: 97%

Receipt of Electroconvulsive Therapy and Subsequent Development of Amyotrophic Lateral Sclerosis: A Cohort Study

Mezei

Lau

Pace³

et al. 2022

Bioelectromagnetics

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We investigated the potential relationship between receipt of electroconvulsive therapy (ECT) and development of amyotrophic lateral sclerosis (ALS). We conducted a cohort study using a sample of more than one million beneficiaries enrolled in the U.S. Medicare health insurance program from 1997 to 2017. Using time-varying proportional hazard modeling, we compared ALS occurrence among patients diagnosed with psychiatric conditions who received ECT to ALS occurrence among patients diagnosed with psychiatric conditions but who did not receive ECT. We observed moderately increased, but imprecise, hazard ratios (HR) for ALS following ECT (HR = 1.39, 95% confidence interval [CI]: 0.69-2.80). A statistically significant increase in the HR of ALS was observed among those who received more than 10 ECT treatments (>10 treatments, HR = 2.24, 95% CI: 1.00-5.01), compared to those receiving no ECT, with an even stronger association observed among subjects older than 65 years (HR = 3.03, 95% CI: 1.13-8.10). No monotonic exposure-response relationship was detected in categorical analyses. Our results provide weak support for the hypothesis that receipt of ECT increases the risk of developing ALS. Additional studies in larger populations, or in populations where ECT is more common, will be needed to refute or confirm an association between receipt of ECT and subsequent development of ALS.

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Amyotrophic lateral sclerosis, occupational exposure to extremely low frequency magnetic fields and electric shocks: a systematic review and meta-analysis

Cited by 9 publications

References 60 publications

Associations of self-reported occupational exposures and settings to ALS: a case–control study

Associations of self-reported occupational exposures and settings to ALS: a case–control study

Neurological symptoms and disorders following electrical injury: A register-based matched cohort study

Receipt of Electroconvulsive Therapy and Subsequent Development of Amyotrophic Lateral Sclerosis: A Cohort Study

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