The Neurotoxicity of the Halogenated Hydroxyquinolines

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Abstract
An epidemic of 10,000 cases of a new gastrointestinal-neurologic syndrome—subacute myelo-optic neuropathy (SMON)—occurred in Japan between 1956 and 1970. Although the epidemic was recognized promptly and a multidisciplinary search for the etiologic agent was begun, investigators did not identify the agent for more than a decade. An astute clinical observation led to careful retrospective case-control and cohort studies that strongly implicated a halogenated hydroxyquinoline, iodochlorhydroxyquin, as the etiologic agent. These findings were announced publicly on Aug 7, 1970. On Sept 8, the Japanese government removed all the halogenated hydroxyquinolines from the market. Kono reported1that the epidemic had ended precipitously and, in a personal communication (June 16, 1972), reported that the epidemic had not recurred. There is little reason to doubt that the halogenated hydroxyquinolines were responsible for the epidemic of SMON. As reported by theWall Street Journalof April 11, 1972, there are those, however, who think