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

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 (1963–1984). 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.

[1]  M. Trenerry,et al.  Neurologic manifestations in welders with pallidal MRI T1 hyperintensity , 2005, Neurology.

[2]  D. Jennings,et al.  Prevalence of parkinsonism and relationship to exposure in a large sample of Alabama welders , 2005, Neurology.

[3]  P. Fisher,et al.  β-Lactam antibiotics offer neuroprotection by increasing glutamate transporter expression , 2005, Nature.

[4]  K. Ericson,et al.  Positron emission tomography with 68-Ga-EDTA and computed tomography in patients with subarachnoid haemorrhage , 2005, Acta Neurochirurgica.

[5]  Wei Zheng,et al.  Manganese toxicity upon overexposure , 2004, NMR in biomedicine.

[6]  C. Olanow,et al.  Manganese‐Induced Parkinsonism and Parkinson's Disease , 2004, Annals of the New York Academy of Sciences.

[7]  M. Asanuma,et al.  Neuroprotective effects of nonsteroidal anti-inflammatory drugs on neurodegenerative diseases. , 2004, Current pharmaceutical design.

[8]  H. Hefter,et al.  Secondary progressive chronic manganism associated with markedly decreased striatal D2 receptor density , 2003, Movement disorders : official journal of the Movement Disorder Society.

[9]  K. Ono,et al.  Myoclonic involuntary movement associated with chronic manganese poisoning , 2002, Journal of the Neurological Sciences.

[10]  C. Yoo,et al.  Dopamine transporter density is decreased in parkinsonian patients with a history of manganese exposure: What does it mean? , 2002, Movement disorders : official journal of the Movement Disorder Society.

[11]  J. Mink,et al.  Welding-related parkinsonism , 2001, Neurology.

[12]  G. Xiao.  Compared Observation of the Therapeutic Effect of PAS-Na and EDTA on Chronic Manganisnm , 2001 .

[13]  E. Pira,et al.  Occupational Mn parkinsonism: magnetic resonance imaging and clinical patterns following CaNa2-EDTA chelation. , 2000, Neurotoxicology.

[14]  M Aschner,et al.  Manganese uptake and distribution in the central nervous system (CNS). , 1999, Neurotoxicology.

[15]  D B Calne,et al.  Manganese neurotoxicity: a review of clinical features, imaging and pathology. , 1999, Neurotoxicology.

[16]  R Sprung,et al.  Chronic manganism: fourteen years of follow-up. , 1999, The Journal of neuropsychiatry and clinical neurosciences.

[17]  N. Chu,et al.  Long-term progression in chronic manganism , 1998, Neurology.

[18]  N. Chu,et al.  Manganism and idiopathic parkinsonism , 1994, Neurology.

[19]  N. Chu,et al.  Levodopa failure in chronic manganism , 1994, Neurology.

[20]  D B Calne,et al.  Progression after chronic manganese exposure , 1993, Neurology.

[21]  C. Angle,et al.  Manganese encephalopathy: utility of early magnetic resonance imaging. , 1993, British journal of industrial medicine.

[22]  P. Xie,et al.  A report of two cases of chronic serious manganese poisoning treated with sodium para-aminosalicylic acid. , 1992, British journal of industrial medicine.

[23]  Y. Hwang,et al.  Manganese induced parkinsonism: an outbreak due to an unrepaired ventilation control system in a ferromanganese smelter. , 1989, British journal of industrial medicine.

[24]  J Fenstermacher,et al.  Drug “Diffusion” within the Brain a , 1988, Annals of the New York Academy of Sciences.

[25]  S. Rapoport,et al.  Examination of Blood — Brain Barrier Permeability in Dementia of the Alzheimer Type with [68Ga]EDTA and Positron Emission Tomography , 1987, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[26]  S. Tandon,et al.  Chelation in metal intoxication. VI. Influence of PAS and CDTA on the excretion of manganese in rabbits given MnO2. , 1978, Toxicology.

[27]  P. Seth,et al.  Chelation in metal intoxication. I. In vivo effect of chelating agents on liver and testis of manganese administered rats. , 1975, Environmental research.