Neurobehavioural effects of pesticides with special focus on organophosphorus compounds: which is the real size of the problem?

The risk of neurobehavioural impairment as a consequence of a prolonged, low dose exposure to neurotoxic pesticides is not clearly demonstrated despite numerous publications addressing the topic. We reviewed the 24 papers published on human neurobehavioural effects of organophosphorus and/or carbamates pesticides up to May 1st 2008. Variables evaluated were compound/s addressed, number of subjects, approach to measure or estimate exposure, characteristics of control groups and presence of confounders, methodological approach, and type of alteration, taking into account cognitive, sensory-motor, psychological, and psychomotor measures. A total of 6 papers considered the whole spectrum of functions, the studies yielding positive or uncertain results were 13 (68%) for cognitive function, 11 (69%) for psychomotor function, 11 (65%) for sensory-motor function, and 11 (65%) for psychological function impairment. In 46% of the positive studies a previous severe acute poisoning was reported. Exposure levels were measured only in 5 studies, and very often there were problems in the selection of controls, and firm conclusions on the risk of neurobehavioural effects cannot be reached yet. The main limits of the available data are: limited number of studies and compounds addressed, significant differences in the approach among studies, poor concordance of the results of different studies, and difficulties in controlling confounding factors. Nevertheless, there are sufficient data to conclude that neurobehavioural impairment might be the consequence of an acute poisoning, and possibly the consequence of relatively high and prolonged exposures.