The course of chronic solvent induced encephalopathy: a systematic review.
BACKGROUND
Worldwide millions of workers are exposed to organic solvents. Long term exposure leads in some workers to the development of Chronic Solvent induced Encephalopathy (CSE). The first reports about CSE came from the European Nordic countries in the 1970s. In spite of decades of experience with this disease, little is known about the course and prognostic factors of CSE.


OBJECTIVE
To provide an overview of the evidence about the course and prognostic factors of CSE.


METHODS
A systematic review was conducted. Databases PubMed, PsycINFO (1970-2008) and EMBASE (1980-2008) were searched with the search strategy: solvent AND follow up AND (encephalopathy OR chronic intoxication). Inclusion criteria were: written in English, study population of CSE patients, follow-up time of at least 1 year. Included articles were assessed on methodological quality.


RESULTS
Sixty unique articles were retrieved of which sixteen met the inclusion criteria. Data extraction provided information about domains of neurology, neuropsychology, physical and mental health perceptions, and social consequences. In a number of studies no significant changes, and in other studies improvement of functioning could be measured. Prognostic factors resulting from included studies were summarized for each domain indicating a potential positive influence of younger age and lower exposure variables.


CONCLUSIONS
Due to the large heterogeneity of methodology no levels of evidence could be obtained. This review shows that there is a need for future research that addresses a variety of domains of functioning, hopefully resulting in an overall prognostic model for CSE.


CONCLUSIONS
Studies in this review are in agreement about CSE being a non-progressive disease in which no severe deterioration of functioning occurs after diagnosis. In a number of studies no significant changes, and in other studies improvement of functioning could be measured. Presumably cessation of exposure might be one of the causal factors for the non-progressive character of the disease as has been found. Future studies are needed to clarify the role of various prognostic factors on the course of CSE.
van Valen
Evelien
E
Netherlands Center for Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, The Netherlands. e.vanvalen@amc.uva.nl
Wekking
Ellie
E
van der Laan
Gert
G
Sprangers
Mirjam
M
van Dijk
Frank
F
D000328:Adult; D001925:Brain Damage, Chronic / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology*; D016208:Databases, Factual / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D020258:Neurotoxicity Syndromes / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012997:Solvents / Q000633:toxicity*; D055815:Young Adult
D012997:Solvents