From the Research
The treatment for pure sensory neuropathy due to heavy metal poisoning primarily involves chelation therapy to remove the toxic metals from the body, with the most recent and highest quality study 1 emphasizing the importance of early diagnosis and removal from the source of exposure. The specific chelating agent depends on the metal involved:
- For lead poisoning, succimer (DMSA) at 10 mg/kg orally every 8 hours for 5 days, then every 12 hours for 14 days is commonly used, or calcium disodium EDTA at 1000-1500 mg/m²/day as a continuous IV infusion for 5 days.
- For mercury poisoning, dimercaprol (BAL) at 3-5 mg/kg IM every 4 hours for 2 days, then 2-3 times daily for 7-10 days is recommended, or DMSA at similar dosing to lead treatment.
- For arsenic, BAL or DMSA are also effective. Supportive care is essential and includes:
- Pain management with medications like gabapentin (300-1200 mg three times daily), pregabalin (75-300 mg twice daily), or amitriptyline (10-100 mg at bedtime) 2.
- Physical therapy helps maintain function and prevent complications.
- Nutritional support with B-complex vitamins, particularly B1, B6, and B12, may aid nerve recovery. The effectiveness of treatment depends on early diagnosis and removal from the source of exposure, as chelation works best when initiated promptly, as noted in 1. Some nerve damage may be irreversible if treatment is delayed, though the peripheral nervous system has regenerative capacity if the toxic insult is removed in time.
Key considerations in treatment include:
- Early diagnosis and removal from the source of exposure
- Selection of the appropriate chelating agent based on the metal involved
- Supportive care to manage symptoms and prevent complications
- Nutritional support to aid nerve recovery
- Monitoring for potential side effects of chelation therapy, as noted in 3.
Overall, the goal of treatment is to remove the toxic metal from the body, manage symptoms, and prevent further damage to the nervous system, with the most recent study 1 providing guidance on the importance of early intervention.