First Epileptic Seizure Induced by Occupational Nickel Poisoning

Abstract

Summary: Toxic causes of seizures are numerous: alcohol and other substances of abuse, drugs, and industrial and household products. However, in the absence of a clearly suggestive history and/or associated symptoms and signs, identification of the toxic origin of new-onset seizures may be extremely difficult. We report here the case of a patient admitted in our hospital after a single generalized tonic-clonic seizure. The remarkable coincidence that a colleague of his, with whom he was working to clean the same workshop, had been admitted 1 week earlier for respiratory distress, coma, and de novo nonconvulsive focal status epilepticus, led us to consider a possible toxicologic etiology. Urine analysis revealed a high nickel concentration, suggestive of acute nickel poisoning. Key Words: Seizures-PoisoningNickel.Toxic causes of seizures are numerous: alcohol and other substances of abuse, drugs, and industrial and household products. However, in the absence of a clearly suggestive history and/or associated symptoms and signs, identification of the toxic origin of new-onset seizures may be extremely difficult. We report here the case of a patient admitted in our hospital after a single generalized tonic-clonic seizure. The remarkable coincidence that a colleague of his, with whom he was working to clean the same workshop, had been admitted 1 week earlier for respiratory distress, coma, and de novo nonconvulsive focal status epilepticus, led us to suspect a possible common toxic origin. CASE REPORTThe patient was a 43-year-old man admitted to our hospital after an inaugural generalized tonic-clonic seizure. His medical and surgical history was unremarkable. The patient did not take or had not recently stopped any medication. He did not abuse alcohol or any other substance and did not recently modify his sleep or food habits. No familial history of epilepsy was known. He had worked for a couple of weeks in a car body-repair workshop where he was cleaning the ceilings of the building. On admission, physical and neurologic examinations were normal, Accepted January 27, 2005. Address correspondence and reprint requests to Dr. D. De Bels at Intensive care Unit, Salle 92, Brugmann University Hospital, Free University of Brussels, 4 Van Gehuchten Plein, B 1020 Brussels, Belgium. E-mail: david.debels@chu-brugmann.be except for a mild drowsiness attributed to a postictal state. No meningeal signs were seen. Prolactin and lactate levels were high on admission, 36.8 ng/ml (2.5-11) and 122.8 mg/dl (9-16), respectively. HbCO was normal (<5%). Glycemia and other routine blood analyses were within normal values. EEG performed a few hours later showed diffuse slow waves. Brain CT and MRI scans were normal. A diagnosis of first idiopathic generalized seizure was presumed, until we were informed that a colleague of the patient, with whom he was working to clean the same workshop, had been admitted 1 week earlier in the same hospital for respiratory distress, coma, and de novo nonconvulsant focal status epilepticus [global aphasia a...

Socioeconomic and occupational risk factors for epilepsy: A nationwide epidemiological study in Sweden

“…Some studies have found increased risks of cerebrovascular disease, brain tumors, and neurodegenerative disease among people who have occupational exposure to chemicals [4][5][6][7], but few studies have reported on the association between specific occupations and incidence of epilepsy [8,9]. One such study reported a relationship between first epileptic seizure and occupational nickel poisoning [9]. Most studies to date have been case-control studies, and most of these have used prevalent cases and relied on self-reporting for exposure assessment, which may lead to self-report and recall bias.…”

Non-convulsive status epilepticus secondary to valproic acid-induced hyperammonemic encephalopathy

“…It was thought that the automatisms were related to NCSE, although behavioral changes due to VHE were considered in the differential diagnosis, because there were EEG findings with concomitant altered states of consciousness and then oral‐alimentary automatisms that they were due to focal status epilepticus. Focal seizures, especially from the temporal lobes, have been reported exceptionally with poisonings with methanol, nickel, carbon monoxide, lithium, or domoic acid (12, 13). They suggest a higher susceptibility of the temporal cortex to potentially epileptic agents.…”

Antimony and Nickel

“…Cardiac manifestations of nickel carbonyl exposure may include myocarditis and electrocardiographic abnormalities, including QT prolongation and heart block [118]. Deaths are frequently due to acute lung injury or cerebral edema [103,114,115]. In survivors, a prolonged neurasthenic syndrome has been reported, lasting several months in some cases [118].…”

“…Few nickel exposures result in a critical care admission. The exception is nickel carbonyl, which may cause multisystem toxicity, particularly involving the pulmonary system, within hours after significant inhalational exposure [115][116][117]. The severity of toxicity of nickel carbonyl has been compared with hydrogen cyanide [117].…”