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 (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.

Fig. 1

Handwriting of a manganism patient receiving para-aminosalicylic acid (PAS) therapy. (A) Handwriting at the time of hospital admission before PAS therapy; (B) handwriting at the end of 15-week PAS treatment; and (C) handwriting after 17 years of PAS treatment.

Fig. 2

T1-weighted magnetic resonance images (MRIs) in the globus pallidus of the patient. (A) Axial T1-weighted MRI, (B) coronal T1-weighted MRI, and (C) sagittal T1-weighted MRI.