Reply to letter entitled “Comparing Bromism with methyl bromide toxicity”

To the Editor:

We offer our thanks for the comments by Armstrong and Schep¹ on our article entitled “Myoclonic jerks due to acute bromovalerylurea intoxication.”² In fact, the exact mechanism of methyl bromide-induced central nervous system toxicity is not yet clearly understood.³ Some authors suggested the toxicity is related to the disruption of enzymes involved in metabolic pathways responsible for the generation of energy.⁴ However, the role of bromide in the methyl bromide intoxication is still unclear. Not only the theory of bromide replacing chloride ion in the neuronal cell but also the effect on the regional cerebral blood flow had been proposed.⁵ Although the serum bromide level is poorly correlated with toxic effects of methyl bromide intoxication, history of exposure and high serum bromide level are still needed in the diagnosis of methyl bromide intoxication.⁶ Armstrong and Schep misunderstood our article. The references mentioning that the low serum bromide level could be lethal in acute methyl bromide intoxication were cited to explain that the serum bromide level may be different between “acute” and “chronic” intoxication containing bromide. We did not mean to compare the serum bromide level between methyl bromide and other bromide intoxication.