Tremor and seizures associated with chronic manganese intoxication

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Functional Neuroimaging Using Ultrasonic Blood-brain Barrier Disruption and Manganese-enhanced MRI
08:36

Functional Neuroimaging Using Ultrasonic Blood-brain Barrier Disruption and Manganese-enhanced MRI

Published on: July 12, 2012

H Komaki1, S Maisawa, K Sugai

  • 1Department of Child Neurology, National Center Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.

Brain & Development
|April 17, 1999
PubMed

Insights

High manganese levels from total parenteral nutrition caused neurological issues in a child. Symptoms and brain abnormalities resolved after stopping manganese, prompting a review of recommended intake levels.

Area of Science:

  • Neurology
  • Pediatrics
  • Clinical Nutrition

Background:

  • Total parenteral nutrition (TPN) is a life-sustaining treatment for patients unable to absorb nutrients orally.
  • While essential, TPN formulations require careful monitoring of trace elements like manganese.
  • Neurological complications associated with TPN, though rare, necessitate thorough investigation.

Observation:

  • A 2-year-old girl on TPN developed tremor and seizures.
  • Magnetic resonance imaging (MRI) showed T1-weighted hyperintensities in the basal ganglia, brainstem, and cerebellum.

Findings:

  • Elevated blood manganese levels correlated with the neurological symptoms and MRI abnormalities.
  • Discontinuation of manganese administration led to the complete resolution of symptoms and imaging findings.

Implications:

  • This case highlights the potential neurotoxicity of manganese in pediatric patients receiving TPN.
  • It underscores the need to re-evaluate and potentially revise the recommended daily intake of manganese in TPN protocols.
  • Further research is warranted to establish safe and effective manganese dosing guidelines for long-term parenteral nutrition.

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