Case presentation: We report a 30-year-old Eastern European man who presented with a two-year history of gait disturbance. [drugsandalcohol.ie]

We describe the case of a man who presented with recurrent episodes of confusion, psychosis, dystonic limb movement and cognitive impairment and was initially diagnosed with anti-voltage-gated potassium channel (VGKC) complex limbic encephalitis in view [ncbi.nlm.nih.gov]

It is a trace mineral present in the human body in small quantities, primarily in the bones, liver, kidneys and pancreas. [watertechonline.com]

• Fatigue

  Headaches, muscle cramps, fatigue, and aggressiveness are early signs of manganese toxicity, which can then proceed into Parkinson’s disease-like symptoms such as tremors ( 6 ). [veganhealth.org]

  Chronic manganese intoxication has an insidious and progressive course and usually starts with complaints of headache, fatigue, sleep disturbances, irritability and emotional instability. [jmedicalcasereports.biomedcentral.com]

  Heat, fatigue, stress, driving aggravate. These were changes in my life-long patterns of feeling and behavior. Other people might be affected differently or not as severely. [digitalfire.com]

• Falling

  In addition to these symptoms, choreic movements, ataxia presenting as backward falls and dystonia were also seen. Serum and urine samples revealed high levels of manganese. [ncbi.nlm.nih.gov]

  People with manganese toxicity have more of a tendency to fall backwards than do those with Parkinson’s ( 6 ). [veganhealth.org]

  These findings correspond with the neurological syndrome of atypical parkinsonism that comprises, apart from general bradykinesia, rigidity and kinetic tremor, frequent dystonias and a specific cock-walk gait with a tendency to fall forward [ 9 ]. [jmedicalcasereports.biomedcentral.com]

• Cough

  Anxiety Impotence Late manifestations Tremor Impaired speech Loss of facial expressions Gait disturbances Low volume speech Can mimic Parkinson’s disease Pulmonary Acute / Metal fume fever Fever Nausea Headache Myalgia Arthralgia Chronic Persistent dry cough [wikem.org]

  Jankovic points out that in acute manganese intoxication “cough and shortness of breath, as well as headaches occur early. [parkinson.org]

• Nausea

  Manganese madness” Visual hallucinations Behavioral changes Anxiety Impotence Late manifestations Tremor Impaired speech Loss of facial expressions Gait disturbances Low volume speech Can mimic Parkinson’s disease Pulmonary Acute / Metal fume fever Fever Nausea [wikem.org]

  I blamed my violent nausea after each raku firing on carbon monoxide and tried to avoid inhaling any smoke. [digitalfire.com]

• Sweating

  […] slurred speech, mask-like face, and a general clumsiness. 3) FINAL STAGE : is characterized by more acute and incapacitating neurological impairment including limb rigidity, mild tremors, dystonic, gait disturbance, cock-like walk, excessive salivation, sweating [flipper.diff.org]

  It is important to sweat. The essential tremor is much better after hot exercise. Carbon monoxide and other minerals cause manganese toxicity to have a worse tremor, according to the library work. [digitalfire.com]

• Compulsive Behavior

  This early phase is also manifested by nonspecific symptoms such as asthenia, somnolence, insomnia, anorexia, and loss of sexual drive, as well as behavioral manifestations, characterized by irritability, impulsiveness, belligerence, obsessive-compulsive [parkinson.org]

  Later, a neurodegenerative syndrome with psychiatric symptoms, called manganism, may develop that is characterized by speech, gait and balance problems on the one hand, and obsessive-compulsive behaviors, hostility, mood changes, psychotic experiences [jmedicalcasereports.biomedcentral.com]

  behavior and intellectual deficits. [flipper.diff.org]

  behaviors. [4] Upon protracted exposure symptoms are more prominent and resemble those of idiopathic Parkinson's disease, as which it is often misdiagnosed, although there are particular differences in both the symptoms (nature of tremors, for example [en.wikipedia.org]

• Mood Swings

  During the early phase, the patient exhibits symptoms such as psychosis, mood swings, depression, and compulsiveness. [worldatlas.com]

  Early research shows that taking manganese along with calcium helps improve symptoms of PMS, including pain, crying, loneliness, anxiety, restlessness, irritability, mood swings, depression, and tension. [webmd.com]

• Dystonia

  In addition to these symptoms, choreic movements, ataxia presenting as backward falls and dystonia were also seen. Serum and urine samples revealed high levels of manganese. [ncbi.nlm.nih.gov]

  Two patients with severe dystonia from chronic manganese poisoning were markedly improved by L-dopa. Most of the effects of L-dopa disappeared a few days after substitution of placebo for the drug. [nejm.org]

  Our cases and those in the literature indicate that, in the absence of rigidity or dystonia or both, levodopa is ineffective in chronic manganese intoxication. [jamanetwork.com]

  Syndrome of hepatic cirrhosis, dystonia, polycythemia, and hypermanganesemia caused by mutations in SLC30A10, a manganese transporter in man. Am J Hum Genet 2012; 90:457-66. [action.org.uk]

• Confusion

  Possible confusion with other symptoms The necrotic lesions caused by manganese toxicity may be confused with those of salinity or boron toxicity. [keys.lucidcentral.org]

  We describe the case of a man who presented with recurrent episodes of confusion, psychosis, dystonic limb movement and cognitive impairment and was initially diagnosed with anti-voltage-gated potassium channel (VGKC) complex limbic encephalitis in view [ncbi.nlm.nih.gov]

  Signs, symptoms & indicators of Manganese toxicity Symptoms - Food - General Weak appetite Symptoms - Mind - General Hallucinations Short-term memory failure Periods of confusion/disorientation Long-term memory failure Conditions that suggest Manganese [digitalnaturopath.com]

  And I think that the chelation would only add another layer of confusion because it would essentially add another chemical exposure. Remember we are not talking about a heavy metal here. [digitalfire.com]

• Irritability

  Chronic manganese intoxication has an insidious and progressive course and usually starts with complaints of headache, fatigue, sleep disturbances, irritability and emotional instability. [jmedicalcasereports.biomedcentral.com]

  This early phase is also manifested by nonspecific symptoms such as asthenia, somnolence, insomnia, anorexia, and loss of sexual drive, as well as behavioral manifestations, characterized by irritability, impulsiveness, belligerence, obsessive-compulsive [parkinson.org]

  Early research shows that taking manganese along with calcium helps improve symptoms of PMS, including pain, crying, loneliness, anxiety, restlessness, irritability, mood swings, depression, and tension. [webmd.com]

  the syndrome associated with manganese toxicity can be divided into three stages: 1) INITIAL STAGE or ACUTE exposition (manganese madness): is marked by both emotional and cognitive disturbances characterized by excessive excitement, mood changes, irritability [flipper.diff.org]

  Generally, exposure to ambient manganese air concentrations in excess of 5 micrograms Mn/m 3 can lead to Mn-induced symptoms. [3] In initial stages of manganism, neurological symptoms consist of reduced response speed, irritability, mood changes, and [en.wikipedia.org]

• Cognitive Disorder

  Exposure to such amounts of manganese has been linked to cognitive disorders and motor skill impairment. Sources of Manganese Poisoning Sources of manganese poisoning can include drinking water, gasoline and tobacco smoke. [worldatlas.com]

• Neurologic Manifestation

  […] in the basal ganglia, particularly in the globus pallidus, with normal T2-weighted images Management Supportive care Remove source of exposure Chelation therapy with CaNa 2 EDTA or DTPA Can improve urinary excretion of manganese without affecting the neurologic [wikem.org]

Thus, the combined pharmacological actions of riluzole as both an antioxidant and inhibitor of glutamate activity may make it an ideal drug for the treatment of manganism. [ubir.buffalo.edu]

“Strikingly, treatment of one child who was severely affected led to such a dramatic improvement of her symptoms that she even regained her ability to walk.” [action.org.uk]

An useful diagnostic criterion to distinguish between manganism and Parkinson's disease consist in the fact that L-DOPA treatment is basically ineffective as treatment for manganism. [flipper.diff.org]

Then, over 3 months, she received an experimental treatment of 15 intravenous infusions of para-aminosalicylic acid (PAS), a relative of aspirin that is used to treat tuberculosis. [sciencemag.org]

[…] para -Aminosalicylic acid in the treatment of manganese toxicity. [pubs.rsc.org]

This tool can be used for prognosis after Kasai's portoenterostomy and can also be extremely useful in selecting patients who will need a liver transplant on a priority basis. [ncbi.nlm.nih.gov]

This case study suggests that PAS appears to be an effective drug for treatment of severe chronic Mn poisoning with a promising prognosis. Authors: Tommaso Pierani and Luca Rodano. [flipper.diff.org]

An extended body of literature is now available on: different exposure sources and routes of absorption; mechanistic aspects provided also by imaging assessment; dose–response relationship from epidemiological and animal studies; gender differences; genetic [oem.bmj.com]

The recent publication, in the American Journal of Epidemiology, addressing metal emission and urban incidence of Parkinson’s disease (PD) underscores the public’s growing concern that manganese, copper, and other metals may play a role as an environmental [parkinson.org]

[…] human embryonic kidney (HEK293) cells is associated with decreased intracellular manganese concentration and attenuated cytotoxicity, characterized by the reversal of Mn-reduced glutamate uptake and diminished lactate dehydrogenase (LDH) leakage. [3] Epidemiology [en.wikipedia.org]

Cikrt, Journal of Hygiene, Epidemiology, Microbiology & Immunology. 28(2):139-48. 1984. "Manganese exposure in steel smelters a health hazard to the nervous system," A. Wennberg et al. [digitalfire.com]

Mn has been also implicated in the pathophysiology of several other neurodegenerative diseases. [ncbi.nlm.nih.gov]

[…] methylcyclopentadienyl manganese tricarbonyl (MMT), [12] which on combustion becomes partially converted into manganese phosphates and sulfate that go airborne with the exhaust, [13] [14] [15] and manganese ethylene-bis-dithiocarbamate ( Maneb ), a pesticide. [16] Pathophysiology [en.wikipedia.org]

This unresponsiveness to (L-dopa) is most likely related to the difference in the pathophysiology between idiopathic and Mn-induced parkinsonism. [jmedicalcasereports.biomedcentral.com]

Prevention Prevention of soil acidity is the best control of manganese toxicity. Your best approach is to follow a planned rotation. A grass or a grass-legume sod is usually best in a tobacco rotation. [www2.ca.uky.edu]

This is supported by studies demonstrating that blocking of the glutamate receptors with the NMDA receptor antagonist, MK-801, prevents lesions produced by intrastriatal injections of Mn. [ubir.buffalo.edu]

Symptoms of Mn intoxication (""""""""manganism"""""""") resemble those in idiopathic Parkinson's disease (IPD) and usually become progressive and irreversible, making early diagnosis crucial for prevention of Mn intoxication in the occupational and environmental [grantome.com]

Characteristics and occurrence Manganese (Mn) is frequently an abundant constituent of soils, but its low solubility at neutral and alkaline pH prevents excessive uptake by plants. [keys.lucidcentral.org]