The Use of British Anti-Lewisite (BAL) In The Treatment of Diabetic Neuropathy
British anti-lewisite (BAL) has been administered to 22 diabetic patients in the course of the last year, in an attempt to appraise its clinical value in the treatment of various neurologic complications of diabetes. This study was prompted in part by the report made by Furmanski1 several years ago which indicated that some peripheral neuropathies other than those associated with heavy metal intoxication might be helped by the administration of BAL. At that time he reported 3 cases of peripheral neuropathy improved by its administration. It was postulated that neuropathies might represent biochemical disorders within the neuron, consisting of impairment of enzymatic function. Since the etiology and treatment of diabetic neuropathy require both clarification and improvement, it was decided to test the virtues of BAL in such cases.
This report summarizes the results obtained in these 22 patients, discusses briefly the theoretical aspects of the action of sulfhydryl compounds, interjects a word of caution regarding its use, and emphasizes its limitations.
Before the study was undertaken a number of important considerations required critical analysis. The first of these concerns the pharmacologic properties of BAL, only the more pertinent of which will be discussed. BAL (2, 3-dimercaptopropanol) is recognized as an extremely potent compound containing two sulfhydryl radicals; these sulfhydryl radicals have a great affinity for heavy metals. Many essential enzyme systems contain heavy metals within their chemical structures. Webb and Von Heyningen2 studied the effects of BAL on enzyme systems, and showed that 7 were strongly inhibited by BAL. For. . .