Neuropediatrics 2006; 37 - PS2_5_5
DOI: 10.1055/s-2006-945587

MANGANESE-INDUCED PARKINSONISM IN CHILDHOOD

P Brna 1, K Gordon 1, J Dooley 1, V Price 1, K Melanson 1
  • 1IWK Health Centre, Department of Pediatrics, Division of Pediatric Neurology, Halifax, NS, Canada

Objectives: To review the clinical presentation, routes of exposure and mechanism of manganese-induced neurotoxicity.

Methods: A previously healthy 5 year old girl presented with pica, emotional lability and marked gait abnormalities. She had severe iron deficiency anemia and polycythemia. Blood levels of manganese were extremely elevated and MRI showed increased signal in the basal ganglia on T1-weighted images consistent with manganese neurotoxicity. Chelation therapy resulted in improvement in her mobility but she continued to have significant gait impairment.

Results: Manganese neurotoxicity is rarely reported in the pediatric literature. There are a few reports with liver disease and TPN-induced toxicity. Occupational exposure is the most common source of manganism in adults. Environmental exposure is the probable source in this pediatric case as other known etiologies have been excluded. The prognosis of manganese neurotoxicity in childhood is uncertain.

Conclusion: Manganese neurotoxicity may result in devastating neurologic sequelae in both childhood and adult forms. Exposure to airborne manganese from industrial emissions and fuel-additives remains an important public health concern as the long term effects are unknown.