Effective Treatment of Manganese-Induced Occupational Parkinsonism With p-Aminosalicylic Acid: A Case of 17-Year Follow-Up Study

Abstract

Objective-Chronic manganese (Mn) intoxication induces syndromes resembling Parkinson disease. The clinical intervention has largely been unsuccessful. We report a 17-year follow-up study of effective treatment of occupational Mn parkinsonism with sodium para-aminosalicylic acid (PAS).Methods-The patient, female and aged 50 at the time of treatment, was exposed to airborne Mn for 21 years . The patient had palpitations, hand tremor, lower limb myalgia, hypermyotonia, and a distinct festinating gait. She received 6 g PAS per day through an intravenous drip infusion for 4 days and rested for 3 days as one therapeutic course. Fifteen such courses were carried out between March and June 1987.Results-At the end of PAS treatment, her symptoms were significantly alleviated, and handwriting recovered to normal. Recent follow-up examination at age 67 years (in 2004) showed a general normal presentation in clinical, neurologic, brain magnetic resonance imaging, and handwriting examinations with a minor yet passable gait.Conclusions-This case study suggests that PAS appears to be an effective drug for treatment of severe chronic Mn poisoning with a promising prognosis.Occupational exposure to manganese (Mn) takes place in ore extraction and processing, steel and alloy production, welding, chemical synthesis, ceramic production, and dry battery fabrication. Mn is also used in water purification, as bactericidal and fungicide agents, and recently used as an antiknock agent in gasoline. Neurotoxicities resulting from occupational

Brain magnetic resonance imaging and manganese concentrations in red blood cells of smelting workers: Search for biomarkers of manganese exposure

“…Our previous work on a manganism patient treated with paraaminosalicylic acid showed a normal T1-weighted MRI in the globus pallidus (Jiang et al, 2006). Kim and his colleagues have reported that a welder with more than 10-year Mn exposure whose clinical manifestations included masked face, asymmetric resting tremor, and bradykinesia had symmetrical high signal intensities in the globus pallidus on T1-weighted image.…”

Manganese accumulates primarily in nuclei of cultured brain cells

“…To explore the mechanism of Mn neurotoxicity and identify the potential susceptibility of cell types to Mn exposure, it is necessary to have thorough understanding of the intracellular distribution of Mn within different types of brain cells. In our recent attempt to explore the mechanism of para-aminosalicylic acid (PAS) in effective treatment of manganism patients (Jiang et al, 2006), there is a need to study whether and how this drug may mobilize the intracellular pool of Mn. Thus, the purpose of this study was to determine and compare the subcellular distribution of Mn in cell types that are important for Mn transport and toxicity.…”

Manganese and its Role in Parkinson’s Disease: From Transport to Neuropathology

“…Moreover, levodopa is contraindicated in manganism, as Mn catalyzes dopamine autooxidation to toxic quinones and semiquinones (Graham 1984;Lloyd 1995;Parenti et al 1988). According to some studies (Discalzi et al 2000;Herrero Hernández et al 2003;Herrero Hernández et al 2006;Ky et al 1992;Ono et al 2002;Penalver 1957) chelating treatment can reverse manganese poisoning with persistent clinical benefit for many years (Herrero Hernández et al 2003;Herrero Hernández et al 2006;Jiang et al 2006). However, large controlled clinical trials are lacking.…”