Environmental Risks for PD: Manganese, Welding, Mining, and Parkinsonism

You can find out more about NPF's National Medical Director, Dr. Michael S. Okun, by also visiting the NPF Center of Excellence, University of Florida Center for Movement Disorders & Neurorestoration.

The recent publication, in the American Journal of Epidemiology, addressing metal emission and urban incidence of Parkinson’s disease underscores the public’s growing concern that manganese, copper, and other metals may play a role as an environmental cause of Parkinson’s disease.  Willis et. al. in the investigated the relationship between copper, lead, or manganese emissions and Parkinson’s disease.  The study covered nearly 30 million Medicare beneficiaries, and ultimately concluded that urban Parkinson’s disease incidence was greater “in counties with higher reported industrial releases with copper or manganese.”  The authors cited several weaknesses of their own study including other unaccounted for risk factors, and no direct environmental metal measurements.  Furthermore, there was no way to determine whether patients had actual Parkinson’s disease or just symptoms similar to Parkinson’s (i.e. parkinsonism).

The dramatic rescue of thirty-three Chilean miners was all over the news last month.  Miners have been known to have an increased risk of exposure to manganese, and this has led to the question as to whether miners and welders carry a higher risk of developing Parkinson’s disease.  Controversy has swirled around this issue in both medical and in legal circles, with several class action lawsuits,  and one paper reporting the results of exposures in patients pursuing litigation (Racette, 2005)).  It is therefore important to inform the public about the differences between typical (also known as “idiopathic”) Parkinson’s disease and parkinsonism due to manganese exposure.

Parkinson’s disease is an entity that is usually diagnosed by an experienced neurologist following a detailed clinical history and examination that may reveal motor (tremor, stiffness, slowness, gait, balance difficulties, etc.) and also possibly non-motor dysfunction (loss of smell, depression, anxiety, cognitive decline, sleep disorder, bladder and bowel symptoms, sexual dysfunction etc.).  Patients with idiopathic Parkinson’s disease usually respond well to levodopa or dopamine agonists.  Brain MRI scans in Parkinson’s disease are usually normal.  Manganese exposure (in welders or in miners), in contrast, is known to have a largely different acute and chronic presentation. 

Manganese toxicity and Parkinson’s disease has been reviewed in an article published by Dr. Joseph Jankovic who is at the NPF Center of Excellence at Baylor College of Medicine, Houston TX (Jankovic, 2005). Dr. Jankovic points out that in acute manganese intoxication “cough and shortness of breath, as well as headaches occur early. 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 behavior, hallucinations, and other psychiatric symptoms (“manganese madness”). Other psychiatric abnormalities may include pseudobulbar affect with emotional incontinence which is manifested by inappropriate laughing and possibly crying. Later, hypomimia (decreased facial expression), action tremors, dystonia, myoclonus, speech, gait and balance problems, and other parkinsonian features may emerge. A variety of neuropsychological abnormalities have been reported, even in early stages of manganese poisoning, but no consistent pattern of behavioral or cognitive abnormalities has emerged.” 

Patients with manganese toxicity usually have normal blood manganese levels unless acutely exposed, and they usually do not respond to dopamine replacement therapy (levodopa) or agonists.  Additionally, manganese toxicity patients, unlike idiopathic Parkinson’s disease, usually have characteristic MRI abnormalities.

The most important thing for patients who have worked as miners or welders to be aware of is the differences in clinical presentations, imaging studies, and response to medications.  These differences usually help in the differentiation of manganese parkinsonism from Parkinson’s disease.  It is currently unknown and unexplored as to whether manganese exposure imparts a greater risk of the development of Parkinson’s disease (“second hit environmental hypothesis”), and we hope more research will focus on this area in the future.

For more information, read the 11/11/10 article in Medscape Today: Urban Exposure to Manganese, Copper May Raise Parkinson's Risk

Selected References

Willis AW, Evanoff BA, Lian M, Galarza A, Wegrzyn A, Schootman M, Racette BA. Metal Emissions and Urban Incident Parkinson Disease: A Community Health Study of Medicare Beneficiaries by Using Geographic Information Systems. Am J Epidemiol. 2010 Oct 19. Epub.

Racette BA, Tabbal SD, Jennings D, Good L, Perlmutter JS, Evanoff B. Prevalence of parkinsonism and relationship to exposure in a large sample of
Alabama welders. Neurology. 2005 Jan 25;64(2):230-5.

Jankovic J. Searching for a relationship between manganese and welding and
Parkinson's disease. Neurology. 2005 Jun 28;64(12):2021-8.

Lucchini RG, Martin CJ, Doney BC. From manganism to manganese-induced parkinsonism: a conceptual model based on the evolution of exposure. Neuromolecular Med. 2009;11(4):311-21. Epub 2009 Dec 10. Review.

Acknowledgement: A special thanks to Joseph Jankovic, M.D. for providing critical edits to this article.

Posted: 12/1/2010 9:00:00 AM by Cathy Whitlock

Browse current and archived What's Hot in PD? articles, the National Parkinson Foundation's monthly blog for people with Parkinson's written by our National Medical Director, Dr. Michael S. Okun. 

June 2015
Short and Long-Term Problems with Anticholinergic Drugs used for Sleep, Bladder, and Tremor Symptoms

May 2015
Leaps in Deep Brain Stimulation Technology

April 2015
What to tell Parkinson’s patients about diet and taking statin drugs

March 2015
Everything a Parkinson’s Disease Patient Needs to Know About the New Dopamine Pump

February 2015
Tips for Parkinson’s Disease Patients Switching from Sinemet or Madopar to Rytary (IPX066)

January 2015
More Evidence Linking Gut Bacteria to Parkinson’s Disease: A Guide for Patients

December 2014
Two New Therapies for Parkinson’s Disease Patients to get Excited About: Vaccines and Monoclonal Antibodies

November 2014
The Importance of a Monitoring Strategy When Prescribing Dopamine Agonists: Lessons from the National Parkinson Foundation Data

October 2014
Is Midlife Migraine Related to Late Life Parkinson’s Disease?

September 2014
Deep Brain Stimulation for Parkinson’s Disease: NPF Congratulates Mahlon DeLong and Alim-Louis Benabid and Looks to a Bright Future in Human Neural-Network Modulation

August 2014
Everything You Need to Know About Medical Marijuana and Parkinson’s Disease

July 2014
The End for Levodopa Phobia: New Study Shows Sinemet is a Safe Initial Therapy for Treatment of Parkinson's Disease

June 2014
Is light therapy a potential treatment modality in Parkinson’s disease?

May 2014
How does the most common genetic cause of Parkinson’s Disease (LRRK2) cause Parkinson’s disease and could it be used to help develop a better therapy?

April 2014
An Update on DAT Scanning for Parkinson’s Disease Diagnosis

March 2014
Could Northera (Droxidopa) Be an Alternative Treatment for Low Blood Pressure and Passing Out Symptoms?

February 2014
The Dream of a Pill Free Existence and the Continuous Dopaminergic Pump for the Treatment of Parkinson's Disease

January 2014
Should I take Inosine to Raise my Uric Acid Levels and Treat my Parkinson’s Disease?

December 2013
Could Fungus and Mold be an Important Contributor to Parkinson’s Disease?

November 2013
Pimavanserin and the Hope for a Better Drug for Hallucinations and Psychosis in Parkinson’s Disease

October 2013
Halting of the Creatine Study

September 2013
The Importance of Identifying and Treating Caregiver Strain

August 2013
Putting Parkinson’s Disease Information into the Palm of Your Hand: Parkinson’s Enters the Smartphon

July 2013
What Parkinson’s Disease Patients Need to Know about H. Pylori Gastrointestinal Infections

June 2013
A2A Receptor Antagonists and Parkinson’s Disease Treatment

May 2013
Another Setback for Trophic Factor Treatment in Parkinson's Disease

April 2013
IPX066 and What Patients Really Want in New Carbidopa/Levodopa (Sinemet) Formulations

March 2013
The Weather Forecast for Parkinson’s Disease Calls for Worldwide Economic Storm

February 2013
Defeating the Barriers to Implementing Exercise Regimens in Parkinson’s Disease Patients

January 2013
When should you start medication therapy for Parkinson’s disease?

December 2012
Neurologist Care Reduces Hospitalizations in Parkinson's Disease

November 2012
A Victory in Court for Parkinson's Disease Patients who Require Ongoing Rehabilitative Therapies

October 2012
Given the recent FDA announcement about Mirapex (pramipexole), should I be worried about dopamine agonists?

September 2012
What about the new Parkinson’s Disease Vaccine? What should I know?

August 2012
Caffeine as a Potential Treatment for Parkinson’s Disease

July 2012
Time to Consider GPi DBS for Parkinson’s Disease: A Shift in the Practice of Patient Selection for DBS

June 2012
A New Treatment for Parkinson’s Disease-Related Constipation

May 2012
Too Many Pills: Improving Delivery Systems for Parkinson’s Disease Drugs

April 2012
Measuring Quality and Assessing Depression in Parkinson's Disease

March 2012
Watch out for Unexpected Obstacles if You Use a Cueing Strategy to Break Freezing of Gait in Parkinson’s Disease

February 2012
Pill Color, Generic Medications and Insurance Issues: Important Medication-Related Tips for the Parkinson’s Disease Patient

January 2012
Are Blood Tests for Parkinson’s Disease on the Horizon?

December 2011
Placing Stem Cells in Animal Models of Parkinson’s Disease: Another Important Step

November 2011
Important News for the Parkinson’s Disease Community: More Evidence that Sinemet and Madopar are Not Toxic and do Not Accelerate Disease Progression

October 2011
The Case for All Parkinson’s Disease Patients to be Co-managed by a Primary Care-Neurologist Team

September 2011
Scientists say Research on Brain Proteins Involved in Parkinson’s Disease is “Shaping” Up

August 2011
Who Actually Takes Care of Most of the Parkinson’s Patients Worldwide: The Need for Education and the Parkinson’s Toolkit

July 2011
If you are Dizzy or Passing Out, it could be Your Parkinson’s Disease or Parkinson’s Disease Medications

June 2011
How Will Group Visits for Parkinson’s Disease Fit into the Future of Parkinson’s Disease Care?

May 2011
Why Patients Should be Wary of Chelation Therapy for Parkinson’s Disease

April 2011
Opening the Door to Gene Therapy in Parkinson’s Disease: The Need for Refinement of the Technology and Approach

March 2011
Does it Matter if I Can’t Get Brand Sinemet?

February 2011
Should I get a DaTscan or PET scan to confirm my diagnosis of Parkinson’s disease?

January 2011
A Critical Reappraisal of the Worst Drugs in Parkinson’s Disease

December 2010
Environmental Risks for PD: Manganese, Welding, Mining, and Parkinsonism

November 2010
Calling for the FDA to Revise the Eight Sinemet a Day Rule

October 2010
Dry Cleaning Solvents and Potential Environmental Risks for Developing Parkinson’s Disease

September 2010
Maintaining the Balance: Why Parkinson’s Disease Patients Need to Understand Drug Recalls, Withdrawals, and Safety Alerts

August 2010
Shining a Light on Parkinson’s Disease: Optogenetics Has a Bright Future in Research

July 2010
Poor Medication Management of Parkinson's Disease During Hospital Admissions: Patients and Families Can Improve Their Hospital-Based Management

June 2010
Why Are Patches and Continuous Release Technology a Big Deal to Parkinson's?

May 2010
Is the PD SURG Trial Another Surge Forward for DBS Therapy?

April 2010
Cycling in PD in Those Who Can’t Walk: Is it Possible?

March 2010
New iPS Stem Cells for PD: What Does it Mean?

February 2010
Time for Comprehensive Care Networks for PD

January 2010
Is Parkinson's Disease a Prion Disease?

December 2009
Parkinson's Disease Linked to Gaucher's Disease

November 2009
Brain Cells Keep Time Stamps: Implications for Parkinson's Disease Therapies

October 2009
Is it Safe to Have an MRI with a DBS in Place?

September 2009
Take Care of Your Bones as They Are Affected in Parkinson's Disease (Even in Men)

August 2009
Is it Time to Start Paying Attention to Pain Symptoms in Parkinson's Disease Patients?

July 2009
Glutathione Fails to Demonstrate Significant Improvement in PD Symptoms

June 2009
Keeping an Eye on Trials Important to the Parkinson's Disease Patient

May 2009
Increased Risk of Melanoma in Parkinson's Disease

April 2009
Finally a DBS Expert Consensus Statement Aimed at Their True Customers: The Patients

March 2009
Pesticides and Environmental Exposure in Parkinson's disease: Should We Stay Away From the Stink Truck?

February 2009
Is Exercise Effective Treatment and Protection Against PD?

January 2009
Why are Transplant Trials Struggling to Succeed in the Treatment of PD?

December 2008
Are Monoamine Oxidase Inhibitors Disease Modifying or Neuroprotective in PD?

November 2008
Update on Gene Therapy for Parkinson's Disease

Currently: 5 (1 ratings)


Each month, we will feature a new column by NPF's National Medical Director, Dr. Michael Okun, on the latest developments in Parkinson's disease research. Read the latest "What's Hot in PD?" below.

Subscribe to this blog