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Effect of levodopa treatment for parkinsonism in welders

A double-blind study

From the Department of Neurology (Dr. Koller), The Mount Sinai School of Medicine, New York, NY; Department of Neurology (Dr. Lyons), University of Kansas Medical Center, Kansas City, KS; and private practice (Dr. Truly), Canton, MS.

Address correspondence and reprint requests to Dr. William C. Koller, The Mount Sinai School of Medicine, Department of Neurology, One Gustave L. Levy Place, Box 1137, New York, NY 10029; e-mail: william.koller{at}mssm.edu

Background: Manganese is known to cause a parkinsonian syndrome similar clinically to Parkinson disease (PD). L-Dopa responsiveness is a hallmark of PD; however, L-dopa’s effect on manganese-induced parkinsonism is not well defined.

Objective: To access the efficacy and safety of L-dopa therapy in a double-blind, randomized, placebo-controlled trial.

Methods: Thirteen patients with manganese-induced parkinsonism were evaluated in a cross-over study with a modified Unified PD Rating Scale (UPDRS), timed walk test, tapping, and global clinical impression scores. Adverse reactions were assessed.

Results: There was no significant difference between placebo and L-dopa for any measure: motor UPDRS, 27.4 vs 28.8; walk time, 16.6 seconds vs 17.7 seconds; tapping right hand, 69.5 vs 64.7; and tapping left hand, 66.8 vs 64.4. There were no differences in the global impression scores. Adverse reactions occurred similarly in the two groups, including headaches, drowsiness, and diarrhea.

Conclusions: L-Dopa therapy is not effective for the management of parkinsonism in welders. L-dopa unresponsiveness may be useful to distinguish manganese-induced parkinsonism from Parkinson disease.

Received July 1, 2002. Accepted in final form November 18, 2003.

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