Radiologic Clinics of North America, 47(5), 833–40, vi. The long-term and cumulative effects of retained gadolinium in the brain and elsewhere are not as yet understood. What if gadolinium affected the function of cells, especially nerve cells, and triggered a cascade of adverse events, experienced by the person as decidedly abnormal and unpleasant sensations? Since the medical community believes these contrast dyes are harmless, many don’t trace their symptoms back on their timeline to their scan. Read our full post and the study here. shedding light on the effects of retained gadolinium from Contrast MRI, September 22, 2020 12:19 pm / Leave a comment. The long-term and cumulative effects of retained gadolinium in the brain and elsewhere are not as yet understood. Why should patients with normal kidney function be expected to be any different when they retain gadolinium? Die Symptome einer Gadolinium-Vergiftung sind vielfältig und häufig schwer zu deuten bzw. Most of the gadolinium toxicity affected patients I know describe their chronic pain as a dull, continuous ache, and as burning, numbness, prickling sensations, electric-like feelings, and/or deep bone pain in their hips, joints, and ribs. This study provides the first definitive evidence that GBCAs induce mitochondrial toxicity and cell death in cultured human neurons. Gadolinium toxicity Symptoms include pain in the skin, bones, joints or head. This condition is accompanied by symptoms that include severe physical pain and cognitive difficulties. The word “nephrogenic” in the name caused doctors and researchers to focus on people with severe renal disease. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2853020&tool=pmcentrez&rendertype=abstract, Williams, S. (2012). Patients with Gadolinium Deposition Disease often complain about acute and chronic symptoms that are similar but not identical to NSF. He said that it is imperative that individuals have at least 3 of the symptoms, but he prefers to see 5/6 to be certain of the diagnosis. Despite having evidence of prolonged gadolinium retention many months and even many years after their last MRI with a GBCA, those patients with only one or two chronic symptoms of gadolinium toxicity, or another disease such as MS, won’t meet the diagnostic criteria for GDD. Some sufferers of gadolinium toxicity have also reported other symptoms, including gastrointestinal issues, such as diarrhea and abdominal pain, and cardiac issues such as abnormal heart rhythms. That is not a novel idea since it was suggested by some doctors in the past, including Dr. Jonathan Kay and his colleagues who said, “NSF neither originates in the kidney nor is caused by factors originating in the kidney”. Head pain (early on after GBCA). Like what happened with NSF, all patients affected by retained gadolinium may not be properly diagnosed, and the effects of gadolinium toxicity will continue to be underreported. Brain fog is also a prominent feature of lead toxicity, which is another heavy metal toxicity. Letter to FDA about Gadolinium Toxicity from GBCAs. Georg 30. Change ), Copyright 2014-2020, All Rights Reserved. Nephrogenic systemic fibrosis can begin days to months after exposure to gadolinium-containing contrast. Gadolinium is normally excreted by the body through the kidneys, but kidneys functioning less than optimally have trouble getting rid of all of the gadolinium, so toxic levels build up in the body’s tissues and organs, including the brain. In practice, the diagnosis of NSF therefore sometimes has to be based primarily on patients’ history of GBCA-exposures, subsequent appearance of otherwise unexplained symptoms from the skin, the limbs, or other organs, and the exclusion of relevant differential diagnoses”. In 1997, when a group of patients on dialysis developed what appeared to be a new skin disorder, it was called Nephrogenic Fibrosing Dermopathy (NFD). Gadolinium levels in urine and gadolinium concentration in bone were found to have a non-significant relationship (R 2 = 0.11, p = 0.3). Journal of Magnetic Resonance Imaging : JMRI, 30(6), 1240–8. Affected patients and their loved ones may be able to file a lawsuit and recover damages. Given that Gd has been shown to induce mitochondrial toxicity, interfere with ion channels, create neuronal hyperexcitability, and affect inflammatory processes, could Gd be affecting not only the part of the brain that controls many processes, but also peripheral and autonomic nerve endings, as well as dorsal root ganglia, to produce the many and varied symptoms that patients are experiencing? 2. In our Survey of Chronic Symptoms of Gadolinium Toxicity, 100% of the participants reported Pain as one of their top symptoms. Would that be easily detected on histological examination of tissue, or blood tests? I believe many symptoms of gadolinium toxicity can be explained by Gd-induced small fiber neuropathy (SFN) and long-standing neuropathic pain. We now know from the literature that every patient who has an MRI with contrast likely retains gadolinium. After all, we have been down this road before with NSF/NFD. The FDA warning that came in 2015 was the one gadolinium toxicity advocates like Marcie were fighting for. Some people also experience tingling and shaking. The authors noted that, to the best of their knowledge, the study is the first to investigate a correlation between small fiber degeneration and GBCA exposure. Symptoms are categorized as "A Symptoms" which are symptoms distinctive for GDD (also other heavy metal toxicities), and "B Symptoms" which are symptoms that are commonly observed but may also be seen in a variety of other conditions. You can absorb cesium by eating, drinking, breathing, or making skin contact with cesium or things containing its compounds. Headache is both a very common occurrence and shows tremendous variability. Pain can reorient your lifestyle, and cause you both mental and physical distress. I believe part of the problem stems from the fact that histopathological examination has not found any evidence that deposited Gd caused “harm” in the brain. Gadolinium Toxicity: If not NSF, then what is it? Here we are in 2018, 21 years after a problem first became apparent and 12 years after it was linked to gadolinium-based contrast agents. Multiple studies have shown that T1-signal intensity changes in the brain are the result of gadolinium deposition. 2019 Apr;29(4):1922-1930. doi: 10.1007/s00330-018-5737-z. Epub 2018 Oct 1. My hope is that more research will be conducted that involves evaluation and testing of patients who have retained gadolinium and are experiencing SFN-like symptoms, which, until now, have been unexplained and perplexing to clinicians who are not familiar with the potential toxic effects of retained gadolinium. _____________________________, Kay, J., & Czirjak, L. (2010). In 2016, a paper was published that provided the initial description of what is being called Gadolinium Deposition Disease or GDD in patients with normal or near normal kidney function; the description was recently updated. Gadolinium was Retained in the Spinal Cord & Peripheral Nerves of Rats Gadolinium and systemic fibrosis: guilt by association. Nephrogenic systemic fibrosis can begin days to months after exposure to gadolinium-containing contrast. symptoms of Gadolinium Toxicity. Burning, itching or severe sharp pai… If that was the case in full-blown NSF, when the patient likely retained a lot more gadolinium, think how retaining less gadolinium might impact the clinical picture of patients with normal or near-normal renal function. (A pdf of this Editorial is available for download). einzuordnen. Muscle vibrations/twitching and pins and needles skin sensations generally reflect nerve disease (neuropathy). shedding light on the effects of retained gadolinium from Contrast MRI. Gadolinium Deposition Disease (GDD) refers to patients with gadolinium accumulation having normal kidney function that show painful symptoms within few hours or weeks or two months after exposure to Gadolinium based contrast agents (GBCAs). The symptoms in Gadolinium deposition disease are similar to nephrogenic systemic fibrosis (NSF) but are less severe. For the study, neurons modeling a subset of those in the basal ganglia were tested, because the basal ganglia region is one of two brain regions that displays the greatest T1-dependent signal hyperintensity changes. A preclinical study by Bower et al. Retrieved from http://ard.bmj.com/content/69/11/1895.full.pdf, Marckmann, P., & Skov, L. (2009). A recent study by Radbruch et al. Can Symptoms of Gadolinium Toxicity be explained? As you will see, Gadolinium Toxicity is not a new problem, but just one that should be recognized for the potential harm it can cause to everyone who retains gadolinium from the gadolinium-based contrast agents administered for MRIs. The authors said that the “magnitude of the measured toxicity broadly increases as the kinetic stability of the contrast agent decreases, and the lower stability agents induce toxicity at concentrations that fall within the range detected in some autopsy patients”. So the good news is that there are relatively few commercial uses for this dangerous metal and its compounds (1). They said that the “unusual clinical presentation and nonspecific histology means that it may be very hard to come to the NSF diagnosis in some patients. 3. Interestingly, as you will see in my letter, many symptoms of SFN are the same as the clinical symptoms associated with nephrogenic systemic fibrosis (NSF), which makes sense to me since the cause is the same. Updated Gadolinium Retention test result information is also presented. What we don’t know is how much they retain. It shouldn’t matter whether the evidence comes from unenhanced brain MR images, gadolinium detected in biopsy specimens, prolonged gadolinium excretion in urine specimens, or other testing methods. Symptoms of Gadolinium Toxicity: Can their cause be explained? In my letter, I reviewed facts that we already know about Gd from the literature, in terms of both its retention after contrast administration and its effects at a cellular level. Skin tightness is a feature of GDD as well. They can be very intense soon after the MRI. Less serious side effects nausea, headache and dizziness. Coauthor of The Lighthouse Project Evidently, when you are naming a disease it can make a huge difference. Author information: (1)Department of General and Pediatric Radiology, Wroclaw Medical University, Wrocław, Poland. With the current status of understanding gadolinium toxicity by the medical community, there is no known or verified methods to know with absolute certainty if you are gadolinium toxic or have symptoms that are caused by the element. GDD sufferers describe it as a head pain, and unlike any other type of head-ache they have previously experienced. With all of that published evidence of gadolinium’s toxic effects, I don’t believe it should come as a surprise to anyone that patients are reporting a wide range of symptoms after their MRIs with a gadolinium-based contrast agent – if anything, it seems it should be expected. The reason for making my letter available to the public now is to inform doctors, researchers, and affected patients about gadolinium-related facts that do not seem to be widely recognized. Allgemein / Gadolinium. Interestingly, as you will see in my letter, many symptoms of SFN are the same as the clinical symptoms associated with nephrogenic systemic fibrosis (NSF), which makes sense to me since the cause is the same. Annals of the Rheumatic Diseases, 69(11), 1895–1897. There are now 6 symptoms that stand out to Dr. Semelka as critical diagnostic findings for GDD. Arising in the subacute stage (2 weeks +): This is very much like the principal features of NSF, but generally less severe. Small fiber neuropathy (SFN) is a disorder of thinly myelinated Aδ-fibers and unmyelinated C-fibers, and it is typically associated with burning pain in the lower arms and legs. Our only advice is to consider symptom relief carefully, and do not try to be the hero who says “I … I believe the problem is Gadolinium Toxicity, and not NSF, or anything else. Instead of naming a “new” gadolinium-related disease, perhaps NSF should be renamed once again to make the name reflect the fact that impaired kidney function was not the cause of it. Reports of possible clinical symptoms experienced by patients after a contrast-enhanced MRI have been published. If you would like to learn more about the symptoms of gadolinium toxicity, read our Survey of the Chronic Effects of Retained Gadolinium from Contrast MRIs report. is available for download as a PDF and it will be posted in Our Research in the Research section of our website. When researchers later learned that the problem went well beyond the patients’ skin and caused a systemic disease process, the name was changed to Nephrogenic Systemic Fibrosis (NSF). https://gdtoxicity.files.wordpress.com/2016/10/swilliams-2012fda-letter-gdtoxicity1.pdf, Tags: Gadolinium Retention, Gadolinium Toxicity, Gadolinium-Based Contrast Agents, GBCAs, NSF. Some describe it as a burning pain and as an extreme tightness feeling (like a tight bathing cap on their head). We know that retention of Gd has been demonstrated in humans, that unexplained symptoms are occurring, and the neuronal effects of Gd have been demonstrated experimentally. I understand the logic behind that, but don’t we already have scientific evidence? The median lethal dose (LD50) of Gadolinium is roughly 100-200 mg/kg of body weight, but the dosage used for each MRI scan with contrast falls under this threshold.According to earlier studies, GBCA toxicity depends not on the presence of gadolinium, but on the strength of the chelating agent. On this page, we … Gadolinium-based CA are the most commonly used CA in clinical MRI. They divided the clinical course of “GBCA-induced NSF” into 4 phases: latent (0-14 days after GBCA exposure with a range of 0-60 days), early inflammatory (14-60 days after GBCA with a range of 0-60 days), intermediate (60-180 days after GBCA exposure), and late fibrotic (+180 days after GBCA exposure). Intraepidermal nerve fiber density (IEFND) was calculated, and the median number of terminal axonal swellings (TASs) per IEFND was determined. I believe that resulted in a gross underreporting of the health problems being caused by retained gadolinium. This symptom complex should be expected. Gadolinium(Gd)-haltige Kontrastmittel (KM) werden seit 1988 in der klinischen MRT-Routinediagnostik weltweit eingesetzt. Change ), You are commenting using your Twitter account. The authors noted that the cause of SFN remains unknown in up to 50% of cases. As Sherry et al. Skin that may feel \"woody\" and develop an orange-peel appearance and darkening (excess pigmentation) 4. Your Role in Preventing Gadolinium Poisoning Patients and families also have important roles to play to grow awareness of Gadolinium toxicity. In 2006, nine years after NSF/NFD was first diagnosed, the connection was made between NSF and gadolinium-based contrast agents (GBCAs) administered for MRIs. Symptoms. Even though retained gadolinium can cause NSF, researchers continue to say that they see no evidence that the gadolinium is having a harmful effect in patients with normal kidneys. The naming of GDD was a positive step for affected patients since it was the first time that gadolinium-related symptoms were recognized in patients with normal kidney function. Distal arm and leg skin/skin substrate thickening, discoloration, and pain. On August 25, 2020, I wrote an open letter to the FDA, Radiologists and Researchers about the symptoms of gadolinium toxicity that have not, as yet, been recognized by the FDA or medical community as being caused by retained gadolinium (Gd). This retention of gadolinium in the human body has been termed “gadolinium storage condition”. However, until this study, it was unknown whether GBCAs induce toxic effects on the cellular function of human neurons. The authors noted that there is increasing evidence that all agents (linear and macrocyclic) remain in human brain tissue for some period of time, where they may be taken up into various cell types, including glia and neurons. The development of symptoms such as headaches, bone/joint pain and skin changes appear to occur earlier, with typical onset times reported between hours and days post-contrast-enhanced MRI [ 24, 25 ]. The study, “Is Small Fiber Neuropathy Induced by Gadolinium-Based Contrast Agents?”, was published in Investigative Radiology. Those with gadolinium toxicity present symptoms shortly after a contrast MRI. These symptoms may represent part of the same process that is causing brain fog. Recently, patients who report that they suffer from chronic symptoms secondary to gadolinium exposure and retention created gadolinium-toxicity on-line support groups. Updated Gadolinium Retention test result information is also presented. 6. The updated graphs show an even stronger pattern of Gadolinium urine levels based on the number of months since the participant’s last Contrast MRI. What difference does a name make? Some have also described a persistent metallic taste or olfactory sensation. One only needs to read the NSF autopsy-based review articles to know that gadolinium can affect every organ in the body and cause extensive fibrosis and calcification of tissues. That diagnostic criteria should be applied to every patient who has evidence of gadolinium retention after their MRI with contrast and any unexplained symptoms. Intense boring pain in bones or joints. Arising in early stage (early on after GBCA): Many terms have been used for this: mental confusion sounds more scientific, but brain fog gets the point across well and succinctly. It describes “phases of NSF” and a “severity grading”, and the paper highlights the differences between early and late manifestations of the disease. ( Log Out / Can Symptoms of Gadolinium Toxicity be explained? Nephrogenic systemic fibrosis (NSF) Causes the skin and internal organs to harden. Gadolinium Toxicity – Let’s not make the same mistake again, http://ard.bmj.com/content/69/11/1895.full.pdf, http://www.ncbi.nlm.nih.gov/pubmed/19744598, https://vdocuments.mx/nsf-clinical-picture-treatment.html, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2853020&tool=pmcentrez&rendertype=abstract, https://gdtoxicity.files.wordpress.com/2016/10/swilliams-2012fda-letter-gdtoxicity1.pdf, Gadolinium Toxicity – Let’s not make the same mistake again. You may have to undergo an additional dialysis if all the gadolinium was not removed from your body, in which case gadolinium poisoning will occur on and around the access site. An expansion of described symptoms for GDD. We know from the NSF-related literature that gadolinium can cause a potentially fatal systemic disease process when it is retained in the human body. I/we knew they were wrong about that, but because of what had been said repeatedly in the published literature, patients with normal kidney function could not convince doctors that their symptoms were connected to the MRI with contrast that they had. Patients with normal kidney function were being overlooked; however, they were not unaffected by retained gadolinium from GBCAs. Copyright 2014-2020, All Rights Reserved. They don’t connect the … As Marckmann pointed out, “supporting evidence of the causal relationship between GBCA and NSF comes from ex vivo and animal studies demonstrating that Gd-salts and some GBCAs cause histologic and clinical effects resembling what is seen in NSF“. However, the lack of physical evidence and abnormal blood tests does not mean that harmful events have not taken place in patients’ bodies. These symptoms include the following: Pain and a burning sensation in the lower arms and lower limbs – patients often describe the pain as burning or cutting Pain in the bones or joints Just as Marckmann and Skov said about NSF, the clinical picture of Gadolinium Toxicity is diversified, and it varies from one patient to another and it varies over time. For a companion editorial on this topic by Hubbs Grimm, my partner on GadoliniumToxicity.com, read “Gadolinium Toxicity – Let’s not make the same mistake again”. Toxicity is rarely associated with Gd due to its poor gastrointestinal absorption (it is suspected that very little Gd is absorbed from the gastrointestinal tract (<0.05%). März 2018 22. A healthy human body should naturally eliminate Gadolinium through the kidneys. The study, Gadolinium-Based MRI Contrast Agents Induce Mitochondrial Toxicity and Cell Death in Human Neurons, and Toxicity Increases with Reduced Kinetic Stability of the Agent, was published online ahead of print in Investigative Radiology. Recently, patients who report that they suffer from chronic symptoms secondary to gadolinium exposure and retention created gadolinium-toxicity on-line support groups. Change ), You are commenting using your Facebook account. Their self-reported symptoms have recently been published. Posts about Symptoms written by Sharon Williams. 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