Survivors from  -fluoroethyl acetate poisoning show a selective cerebellar syndrome

Kim, Jong Min; Jeon, Beomseok

doi:10.1136/jnnp.2008.151605

Cited by 10 publications

(7 citation statements)

References 31 publications

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“…Neurological damage manifested as neuropsychological abnormality, motor dysfunction and cerebellar ataxia after the acute phase that persisted for months have been reported. 6 Acetamide has been manufactured in China under a special antidote programme by Chinese Center for Disease Control and Prevention (China CDC) for more than 10 years after large SMFA poisoning outbreaks. It is currently stocked as a level III antidote in HA.…”

Section: Case 2 Andmentioning

confidence: 99%

Hong Kong Poison Information Centre: Annual Report 2015

Chan¹,

Tse²,

Lau³

2016

Hong Kong Journal of Emergency Medicine

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Objective:To report and analyse the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2015. Methods: In 2015, all poisoning cases received by HKPIC were retrieved from its database [Poison Information and Clinical Management System (PICMS)] for analysis. Results: A total of 3,960 poisoned cases were analysed. There were 1,770 male patients (44.7%), 2,176 female patients (55.0%) and 14 sex unspecified patients (0.4%). The majority of the cases (63.5%) were between 20 and 59 years old. Common causes for poisoning were suspected self-harm/suicidal attempt (38.4%), unintentional exposure (17.4%) and abusive substances use (11.6%). Excluding the common co-ingestant ethanol, the five commonest types of poison were paracetamol, benzodiazepine, household products, zopiclone and Chinese herbal medicine. Most patients were managed with supportive measures, while 16.4% and 16.2% of them were treated by decontamination and antidotes respectively. Majority of the cases had uneventful recovery; 1% resulted in death and 4.3% had major outcomes. Seven interesting cases and one outbreak were discussed. Conclusions: This 10th annual report provided updated epidemiological information on poisoning pattern in Hong Kong and highlighted important changes in comparing with our previous reports. (Hong Kong j.emerg.med. 2016;23:358-370) 10

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Section: Case 2 Andmentioning

confidence: 99%

Hong Kong Poison Information Centre: Annual Report 2015

Chan¹,

Tse²,

Lau³

2016

Hong Kong Journal of Emergency Medicine

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“…Given the finding that MSA-C is more frequent than MSA-P in Asian populations, environmental exposures related to cerebellar dysfunction should be carefully reviewed. Recently, beta-fluoroethyl acetate (ethyl fluoroacetate, FEA), a highly potent toxic chemical that has been used against rats and wild animals, was reported to cause selective cerebellar dysfunction [94]. This is a unique finding reported from South Korea.…”

Section: Environmental Toxins Associated With Parkinsonism or Cerebelmentioning

confidence: 99%

“…This is a unique finding reported from South Korea. In South Korea, FEA had been available to the general public as an effective pest control agent with less than optimal regulation until 2005 [94]. In Japan, FEA has been designated as a Type II Monitoring Chemical Substance, indicating that the use of this compound is under government surveillance.…”

Section: Environmental Toxins Associated With Parkinsonism or Cerebelmentioning

confidence: 99%

“…In Japan, FEA has been designated as a Type II Monitoring Chemical Substance, indicating that the use of this compound is under government surveillance. On the whole, FEA is banned or severely restricted in most countries, and so cases of FEA poisoning are very rare [94]. Whether FEA is likely to be an environmental toxin in South Korea and Japan warrants further investigation.…”

Section: Environmental Toxins Associated With Parkinsonism or Cerebelmentioning

confidence: 99%

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Difference in MSA Phenotype Distribution between Populations: Genetics or Environment?

Ozawa

Révész

Paviour

et al. 2012

Journal of Parkinson's Disease

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The reasons for the differences in emphasis on striatonigral or olivopontocerebellar involvement in multiple system atrophy (MSA) remain to be determined. Semi-quantitative pathological analyses carried out in the United Kingdom and Japan demonstrated that olivopontocerebellar-predominant pathology was more frequent in Japanese MSA than British MSA. This observation provides evidence for a difference in phenotype distribution between British and Japanese patients with definite MSA. Studies of the natural history and epidemiology of MSA carried out in various populations have revealed that the relative prevalences of clinical subtypes of MSA probably differ among populations; the majority of MSA patients diagnosed in Europe have predominant parkinsonism (MSA-P), while the majority of MSA patients diagnosed in Asia have predominant cerebellar ataxia (MSA-C). Although potential drawbacks to the published frequencies of clinical subtypes and pathological subtypes should be considered because of selection biases, the difference demonstrated in pathological subtype is also consistent with the differences in clinical subtype of MSA demonstrated between Europe and Asia. Modest alterations in susceptibility factors may contribute to the difference in MSA phenotype distribution between populations. Synergistic interactions between genetic risk variants and environmental toxins responsible for parkinsonism or cerebellar dysfunction should therefore be explored. Further investigations are needed to determine the environmental, genetic, and epigenetic factors that account for the differences in clinicopathological phenotype of MSA among different populations.

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“…Beta-fluoroethyl acetate is a derivative of sodium fluoroacetate. Cases of suicide attempts with the compound have been reported (Kim and Jeon 2009). Mean ingestion dose was 1200 mg, in the range of lethal dose of sodium fluoroacetate.…”

Section: Insecticides/herbicides/pesticidesmentioning

confidence: 99%

Cerebellotoxic Agents

Manto

2021

Handbook of the Cerebellum and Cerebellar Disorders

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The cerebellum is particularly vulnerable to neurotoxic agents and poisoning. People of all ages can be affected by cerebellar damage due to neurotoxicity, ranging from fetuses to the elderly. Elderly patients are more vulnerable to injury, as well as patients with silent cerebellar lesions, such as preexisting structural lesions. Purkinje neurons are a main target of cerebellotoxic substances. The main causes of TOICS (toxic-induced cerebellar syndrome) are acute and chronic ethanol ingestion, drugs, and environmental exposure. Cerebellar structures are among the most sensitive targets of the central nervous system (CNS) to ethanol intake. In addition to ethanol, drugs such as phenytoin, antineoplastics, lithium salts, and heroin can cause an irreversible cerebellar syndrome. Environmental causes of TOICS include chronic exposure to metals, benzene derivatives, and hyperthermia. Recently, deposits of Gadolinium, a heavy metal of the lanthanide group, have been reported in the cerebellum (dentate nuclei) and globus pallidus following repeated administration of linear Gd-based contrast agents (GBCAs). Both the mechanism of these deposits and their fate are unknown. As a general rule, cerebellar syndromes associated with toxic insults should not be underestimated. In particular, since patients may develop life-threatening edema of the posterior fossa in several circumstances, urgent management may be required. Preventative measures should be considered. The clinical significance of deposits of Gadolinium in the cerebellum is currently undetermined.

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Survivors from -fluoroethyl acetate poisoning show a selective cerebellar syndrome

Abstract: In summary, FEA poisoning causes a selective cerebellar syndrome in its survivors. The pathomechanism underlying the selective cerebellar toxicity of FEA remains to be elucidated. The selective involvement of the cerebellum might provide a useful model for cerebellar degeneration.

Cited by 10 publications

References 31 publications

Hong Kong Poison Information Centre: Annual Report 2015

Hong Kong Poison Information Centre: Annual Report 2015

Difference in MSA Phenotype Distribution between Populations: Genetics or Environment?

Cerebellotoxic Agents

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