Sequelae of Methanol Poisoning for Cognition

Česká verzia

Authors: O. Bezdíček ¹; J. Klempíř ¹; I. Lišková ¹; J. Michalec ²; M. Vaněčková ³; Z. Seidl ³; B. Janíková ⁴; M. Miovský ⁴; J. A. Hubáček ⁵; P. Diblík ⁶; P. Kuthan ⁶; A. Pilin ⁷; I. Kurcová ⁷; Z. Fenclová ⁸; V. Petrik ⁸; T. Navrátil ^9,10; D. Pelclová ⁸; E. Růžička ¹; S. Zakharov ⁸
Authors place of work: Neurologická klinika a Centrum klinických neurověd 1. LF UK a VFN v Praze ¹; Psychiatrická klinika 1. LF UK a VFN v Praze ²; Oddělení MR, Radiodiagnostická klinika 1. LF UK a VFN v Praze ³; Klinika adiktologie 1. LF UK a VFN v Praze ⁴; Centrum experimentální medicíny, IKEM, Praha ⁵; Oční klinika 1. LF UK a VFN v Praze ⁶; Ústav soudního lékařství a toxikologie 1. LF UK a VFN v Praze ⁷; Klinika pracovního lékařství 1. LF UK a VFN v Praze ⁸; Ústav lékařské biochemie a laboratorní diagnostiky 1. LF UK a VFN v Praze ⁹; Ústav fyzikální chemie J. Heyrovského AV ČR, v. v. i., Praha ¹⁰
Published in the journal: Cesk Slov Neurol N 2014; 77/110(3): 320-325
Category: Original Paper

Summary

Objective:
To identify possible cognitive deficit due to methanol intoxication.

Introduction:
Methanol poisoning leads to lesions in typical areas of the central nervous system, especially in basal ganglia (BG), to subcortical white matter lesions and to demyelination or even atrophy of the optic nerve. However, information regarding cognitive deficit on a population-based level in larger samples is lacking. Our goal was to identify whether BG dysfunction may lead to cognitive deficits.

Methods:
A sample of 50 patients 3 to 8 months after methanol intoxication (METH) and 39 controls (KS) were administered a neuropsychological battery and underwent magnetic resonance imaging (MRI). A combination of three laboratory-based metabolic markers of alcohol abuse led to selection of 28 post-methanol intoxication subjects who were unlikely to abuse alcohol (METHna). These were matched to 28 controls (KSp) for age, education, premorbid intelligence level, global cognitive performance and level of depressive symptoms.

Results:
There were significant differences in the FAB total score (METHna, Md = 16, KSp, Md = 17, p = 0.001) and in three of the FAB subscores (Conceptualization, Mental flexibility, Motor programming; all p values < 0.050). Overall, there was a positive trend towards significance and a weak association between BG lesions on MRI and Mental flexibility from the FAB (rho = –282, p = 0.054).

Conclusion:
Our findings suggest that methanol poisoning is probably associated with cognitive deficits of the frontal type due to BG dysfunction.

Key words:
methanol intoxication – cognitive deficit – neuropsychological assessment

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Lezak MD, Howieson DB, Bigler ED, Tranel D. Neuropsychological Assessment. 5th ed. Oxford: Oxford University Press 2012.

2. Jacobsen D, McMartin KE. Methanol and ethylene glycol poisonings. Mechanism of toxicity, clinical course, diagnosis and treatment. Med Toxicol 1986; 1(5): 309– 334.

3. Paasma R, Hovda KE, Jacobsen D. Methanol poisoning and long term sequelae – a six years follow‑up after a large methanol outbreak. BMC Clin Pharmacol 2009; 9: 5. doi: 10.1186/ 1472- 6904- 9- 5.

4. Vaněčková M, Zakharov S, Klempíř J, Růžička E, Bezdíček O, Lišková I et al. Intoxikace metanolem v obraze magnetické rezonance – kazuistiky. Cesk Slov Neurol N 2014; 77/ 110(2): 235– 239.

5. Airas L, Paavilainen T, Marttila RJ, Rinne J. Methanol intoxication‑induced nigrostriatal dysfunction detected using 6- [18F]fluoro‑L‑ dopa PET. Neurotoxicology 2008; 29(4): 671– 674.

6. Arora V, Nijjar IBS, Multani AS, Singh JP, Abrol R,Chopra R et al. MRI finding in metanol intoxication: a report of two cases. Br J Radiol 2007; 80(958): e243– e246.

7. Blanco M, Casado R, Vázque F, Pumar JM. CT and MR imaging findings in methanol intoxication. AJNR Am J Neuroradiol 2006; 27(2): 452– 454.

8. Gaul HP, Wallace CJ, Auer RN, Fong TC. MR findings in metanol intoxication. AJNR Am J Neuroradiol 1995; 16(9): 1783– 1786.

9. Singh P, Paliwal VK, Neyaz Z, Kanaujia V. Methanol toxicity presenting as haemorrhagic putaminal necrosis and optic atrophy. Pract Neurol 2013; 13(3): 204– 205. doi: 10.1136/ practneurol‑ 2012- 000500.

10. Alexander GE, Crutcher MD. Functional architecture of basal ganglia circuits: neural substrates of parallel processing. Trends Neurosci 1990; 13(7): 266– 271.

11. Růžička E. Role bazálních ganglií při řízení hybnosti a psychiky člověka (Suppl). Psychiatrie 2006; 10: 44– 45.

12. DeLong MR, Wichmann T. Circuits and circuit disorders of the basal ganglia. Arch Neurol 2007; 64(1): 20– 24.

13. Packard MG, Knowlton BJ. Learning and memory functions of the Basal Ganglia. Annu Rev Neurosci 2002; 25(1): 563– 593.

14. Ell SW, Marchant NL, Ivry RB. Focal putamen lesions impair learning in rule‑based, but not information‑ integration categorization tasks. Neuropsychologia 2006; 44(10): 1737– 1751.

15. Ell SW, Weinstein A, Ivry RB. Rule‑based categorization deficits in focal basal ganglia lesion and Parkinson’s disease patients. Neuropsychologia 201; 48(10): 2974– 2986. doi: 10.1016/ j.neuropsychologia.2010.06.006.

16. Zakharov S, Pelclová D, Navrátil T, Fenclová Z, Petrik V. Hromadná otrava metanolem v České Republice v roce 2012: srovnání s „metanolovými epidemiemi“ v jiných zemích. Urgent Med 2013; 16(2): 25– 29.

17. Zakharov S, Pelclova D, Navratil T, Belacek J, Kurcova I, Komzak O et al. Methanol and formate elimination half‑life during treatment for methanol poisoning: intermittent haemodialysis vs continuous haemodialysis/ hemodiafiltration. Kidney Int 2014. In press 2014.

18. Beirnacki P, Waldorf D. Snowball sampling: Problems and Techniques of Chain Referral Sampling. Sociol Method Res 1981; 10(2): 141– 163.

19. Krámská L, Preiss M. Určování premorbidní úrovně – možnosti zkoušky čtení slov. Psychiatrie 2007; 11(1): 4– 7.

20. Folstein MF, Folstein SE, Fanjiang G. MMSE. Mini‑Mental State Examination. Clinical Guide. Lutz Psychological Assessment Resources: 2001.

21. Beck AT, Steer RA, Brown GK. Beck Depression Inventory‑ II. (BDI– II). Manual. San Antonio: The Psychological Corporation 1996.

22. Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology 2000; 55(11): 1621– 1626.

23. Bezdicek O, Stepankova H, Moták L, Axelrod BN, Woodard JL, Preiss M et al. Czech version of Rey Auditory Verbal Learning test: Normative data. Aging Neuropsychol C. In press 2013.

24. Preiss, M, Bartoš A, Čermáková R, Nondek M, Benešová M, Rodriguez M et al. Neuropsychologická baterie Psychiatrického centra Praha. 3. vyd. Praha: Psychiatrické centrum Praha 2012.

25. Bezdicek O, Motak L, Axelrod BN, Preiss M, Nikolai T, Vyhnalek M et al. Czech Version of the Trail Making Test: Normative data and Clinical utility. Arch Clin Neuropsychol 2012; 27(8): 906– 914.

26. Troyer AK, Leach L, Strauss E. Aging and response inhibition: Normative data for the Victoria Stroop Test. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2006; 13(1): 20– 35.

27. Wechsler D. Wechslerova inteligenční škála pro dospělé. WAIS‑ III. Praha: Hogrefe Testcentrum 2010.

28. Kløve H. Clinical neuropsychology. In: Forster FM (eds). The medical clinics of North America. New York: Saunders 1963.

29. Reitan RM, Wolfson D. The Halstead‑ Reitan Neuropsychological Test Battery: Theory and clinical interpretation. 2nd ed. Tucson: Neuropsychology Press 1993.

30. Sarazin M, Pillon B, Giannakopoulos P, Rancurel G,Samson Y, Dubois B. Clinicometabolic dissociation of cognitive functions and social behavior in frontal lobe lesions. Neurology 1998; 51(1): 142– 148.

31. Guedj E, Allali G, Goetz C, Le Ber I, Volteau M, Lacomblez L et al. Frontal Assessment Battery is a marker of dorsolateral and medial frontal functions: A SPECT study in frontotemporal dementia. J Neurol Sci 2008; 273(1– 2): 84– 87.