Screening occupational populations for asymptomatic or early peripheral neuropathy

Traditional quantitative methods for evaluating neuropathy may be problematic or insufficiently sensitive as screening tools; standard eleotrophysiological techniques (nerve conduction velocities and electromyography) are often no more sensitive or reproducible, and in some cases are less sensitive, than the clinical neurological examination. Several promising methods for the evaluation of subclinical neurotoxic effects, including somatosensory and visual evoked potentials, quantitative sensory testing of temperature and vibration, and specialized nerve conduction testing, will be discussed. The crucial issues of sensitivity, standardized test procedures, reproducibility, and practical application in the field setting are currently being examined for these and other techniques. It should be recognized, however, that a brief, directed clinical examination may currently serve as the best screening battery for certain neurotoxins. The most appropriate screening tests can be devised when the neurotoxin is identified and its effects known.