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NEUROLOGY 1993;43:1479
© 1993 American Academy of Neurology

Progression after chronic manganese exposure

C.-C. Huang, MD, C.-S. Lu, MD, N.-S. Chu, MD, PhD, F. Hochberg, MD, D. Lilienfeld, MD, W. Olanow, MD and D. B. Calne, DM, FRCPC

Department of Neurology (Drs. Huang, Lu, and Chu), Chang Gung Medical College and Memorial Hospital, Taipei, Taiwan; the Department of Neurology (Dr. Hochberg), Massachusetts General Hospital, Harvard Medical School, Boston, MA; the Department of Community Medicine (Dr. Lilienfeld), Mount Sinai Medical Center, New York, NY; the Department of Neurology (Dr Olanow), University of South Florida, Tampa, FL; and the Division of Neurology (Dr. Calne), Neurodegenerative Disorders Centre, University of British Columbia, Vancouver, BC, Canada

We report a longitudinal follow-up study on six patients with chronic manganese-induced parkinsonism following cessation of manganese exposure. Compared with the 1987 study, their parkinsonian symptoms showed a slow progression, particularly in gait disturbances such as freezing during turning and walking backward with retropulsion. The mean disability scores on the King's College Hospital Rating Scale were 15.0 ± 4.2 in 1987 and 28.3 ± 6.7 in 1991 (p = 0.003, paired t test). Review of the video records also confirmed a worsening of parkinsonism, especially in difficulty turning. Three of six patients receiving levodopa treatment had an initial improvement. The response decreased after 2 to 3 years. During the therapy, they did not develop on-off fluctuation or dyskinesia. We conclude that patients with manganese-induced parkinsonism may develop increasing neurologic dysfunction long after cessation of exposure and that their responses to levodopa are different from those of patients with Parkinson's disease.

Address correspondence and reprint requests to Dr. Chin-Chang Huang, Department of Neurology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan

Supported in part by a grant from the Chang Gung Memorial Hospital (CMRP #254, Drs. Chu and Huang)

Received May 12, 1992 Accepted for publication in final form December 1, 1992




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