Office and field diagnosis of neurotoxic disease

Accurate diagnosis of neurotoxic disease requires a fundamental knowledge of the principles of neurology, epidemiology, and toxicology. The cardinal features of the office evaluation of this condition are the detailed history and meticulous clinical examination of an individual; the examination focuses on detecting naturally occurring disease that may account for or mask the principal signs and symptoms. Specialized diagnostic tests can provide an important complement to the office evaluation but are often nonspecific for neurotoxic disease. Field assessment, in contrast, rarely utilizes detailed examinations and depends heavily on quantitative screening tools, such as questionaires, tremor analysis, computer-assisted neurobehavioral tests, and quantitative sensory tests. Field studies generally have two goals: the identification of population cohort differences and the detection of individual members of a group that differ from a population or the expected norm. No single procedure is optimal for all field studies; rather, the methods and analyses should be tailored for the population and toxin under study.