Aids to the Examination of the Peripheral Nervous System by D. Riddoch

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Adjusted mean Mental Development Index scores at 4 postnatal ages of children classified by umbilical cord blood-lead level (low: <3Ilg/dL; mid: 6 to 7Ilg/dL; high: ;:::10 Ilg/dL). Error bars represent one standard error. (Reprinted by permission of the New England Journal of Medicine (vol. ) were attributable to differing levels of in utero exposure. , continuously distributed variable, natural log transform, ordered or unordered dummy variables) (Bellinger, Leviton, Waternaux, & Allred, 1985; Bellinger, Leviton, Waternaux, Needleman, & Rabinowitz, 1989).

The study by Shaheen (1984) described earlier is a rare example of an effort to look beyond IQ scores to understand how and why performance by leadexposed children on IQ tests differs from that of peers with lesser exposures. In public-health-oriented epidemiological studies, the investigation of lead tends to be viewed solely as an end in itself. It is not necessary to understand how toxicity works to justify public-health action. The pathogenesis of toxic shock syndrome was still being studied long after removal of a brand of tampon from the marketplace just about eliminated incident cases (Centers for Disease Control, 1981; Langmuir, 1982).

Because lead is not a general cytotoxin, at least at the lower body burdens of greatest worry at the population level, it does not reduce the number of neurons although it may reduce the number of synaptic connections (McCauley, Bull, Tonti, Lutkenhoff, Meister, Doerger, & Stober, 1982). Goldstein (1990, 1992) proposes that lead may disrupt the activity- or experiencedriven selective pruning of synapses that "overgrow" in the early postnatal period (Oppenheim, 1991). , without depolarization of the postsynaptic cell), lead may alter the trophic environment and thus the likelihood that "useful" synapses will survive or that incorrectly targeted neuronal projections will 32 Bellinger be eliminated.

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