Multiple sclerosis disease progression and paradichlorobenzene a tale of mothballs and toilet cleaner

Richard M. Hession, Vibhash Sharma, Daniel E. Spiegel, Christine Tat, Daniel George Hwang, Marisara Dieppa, Zakraus Mahdavi, Ellen Marder, Olaf Stüve

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

IMPORTANCE: Environmental factors are thought to be critical in the initiation and perpetuation of multiple sclerosis disease activity. OBSERVATIONS: We describe the case of a woman in her late 30s with a diagnosis of relapsing-remitting multiple sclerosis, who continued to accumulate neurological disability despite long-term natalizumab treatment. The patient continued to have visual symptoms, left leg weakness, and gait instability. In addition, she subacutely developed an encephalopathy. Our investigations revealed that the patient had a long-standing history of chewing on toilet bowl deodorizing cakes. The main ingredient in this product is 99.9% paradichlorobenzene, which is also used in mothballs. CONCLUSIONS AND RELEVANCE: This case illustrates that environmental causes for neurological deterioration should be investigated in patients with multiple sclerosis who display a rapidly progressive disease course and in whom potent pharmacotherapies fail. One possible cause is the ingestion of paradichlorobenzene-containing mothballs and toilet cleaners.

Original languageEnglish (US)
Pages (from-to)228-232
Number of pages5
JournalJAMA Neurology
Volume71
Issue number2
DOIs
StatePublished - Feb 2014

Fingerprint

Multiple Sclerosis
Disease Progression
Relapsing-Remitting Multiple Sclerosis
Mastication
Brain Diseases
Gait
Leg
Eating
Drug Therapy
4-dichlorobenzene
Progression
Toilet
Causes
Therapeutics
Natalizumab
Deterioration
History
Bowl
Pharmacotherapy

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

Cite this

Multiple sclerosis disease progression and paradichlorobenzene a tale of mothballs and toilet cleaner. / Hession, Richard M.; Sharma, Vibhash; Spiegel, Daniel E.; Tat, Christine; Hwang, Daniel George; Dieppa, Marisara; Mahdavi, Zakraus; Marder, Ellen; Stüve, Olaf.

In: JAMA Neurology, Vol. 71, No. 2, 02.2014, p. 228-232.

Research output: Contribution to journalArticle

Hession, Richard M. ; Sharma, Vibhash ; Spiegel, Daniel E. ; Tat, Christine ; Hwang, Daniel George ; Dieppa, Marisara ; Mahdavi, Zakraus ; Marder, Ellen ; Stüve, Olaf. / Multiple sclerosis disease progression and paradichlorobenzene a tale of mothballs and toilet cleaner. In: JAMA Neurology. 2014 ; Vol. 71, No. 2. pp. 228-232.
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