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Effective Treatment of Manganese-Induced Occupational Parkinsonism With p-Aminosalicylic Acid: A Case of 17-Year Follow-Up Study

Jiang, Yue-Ming MD, MPH; Mo, Xue-An MD, MMS; Du, Feng-Qi MD; Fu, Xue MD; Zhu, Xia-Yan MD; Gao, Hong-Yu MD; Xie, Jin-Lan MD; Liao, Feng-Ling MD; Pira, Enrico MD; Zheng, Wei PhD

Journal of Occupational and Environmental Medicine: June 2006 - Volume 48 - Issue 6 - p 644-649
doi: 10.1097/01.jom.0000204114.01893.3e
Original Articles

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.

From the Department of Occupational Health and Toxicology (Dr Jiang, Dr Fu, Dr Zhu) and the Department of Neurology in 1st Affiliated Hospital (Dr Mo, Dr Du), Guangxi Medical University, China; the Wuzhou Center for Disease Prevention and Control (Dr Gao, Dr Liao), China; Wuzhou Worker’s Hospital (Dr Xie), China; the Department of T. O. and Occupational Health (Dr Pira), University of Turin, Turin, Italy; and the School of Health Sciences (Dr Zheng), Purdue University, West Lafayette, Indiana, U.S.A.

Address correspondence to: Wei Zheng, PhD, Purdue University School of Health Sciences, 550 Stadium Mall Drive, Room 1163D, West Lafayette, IN 47907, U.S.A; E-mail:

©2006The American College of Occupational and Environmental Medicine