Clinical and epidemiological aspects of XXXX @entity4968 .

@entity1 @entity154 @entity1032 @entity227 @entity349 @entity4968 @entity772 @entity2845 @entity1432 @entity5165
An opportunity to study the effects of @entity5165 @entity4968 in @entity1 was provided by the large outbreak in Iraq in 1971-2. In adults, @entity4968 resulted from the ingestion of home-made bread prepared from @entity5165 -treated seed grain and there was a highly significant correlation between the amount of bread ingested and blood @entity349 levels. Poisoning in @entity1 resulted either from prior exposure in utero or from suckling or both. Blood @entity349 levels were higher in @entity1 and @entity1 than in adults. There was no increased incidence of @entity154 . Symptoms and signs of @entity4968 and histopathological changes were mainly confined to the CNS. Symptoms developed, on average, 1-2 months after exposure. In @entity1 there was @entity1032 with delayed onset of speech and impaired motor, sensory and autonomic function. Severely affected @entity1 were blind and deaf. In adults, the clinical picture could be classified as 1, mild (mainly of sensory symptoms) 2, moderate (sensory symptoms accompanied by cerebellar signs) and 3, severe (gross ataxia with marked @entity227 which, in some cases, progressed to @entity2845 mutism followed by @entity772 ). Grades 1 and 2 carried a better prognosis thant grade 3. Interference with transmission at the myoneural junction was found in 14% of @entity1 studied. There was no evidence of peripheral nerve involvement per se and sensory symptoms may be of central origin. The clinical differences between the Iraqi and Japanese outbreaks may be a result, in part at least, of the severe, prolonged and continuous exposure which occurred in the latter outbreak. Improvement was observed among the mild and moderate group. Treatment with chelating agents, @entity1432 resin, haemodialysis and exchange transfusion lowered blood @entity349 concentrations but produced no convincing clinical benefit. To be effective, treatment may need to be instituted soon after exposure.
