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Manganese-induced Parkinsonism in a patient undergoing maintenance hemodialysis

Takayasu Ohtake1, Kousuke Negishi, Kouji Okamoto

  • 1Department of Nephrology, Kidney & Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan. ohtake@shonankamakura.or.jp

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|September 27, 2005
PubMed

Insights

A rare case of manganese-induced parkinsonism occurred in a hemodialysis patient due to a Chlorella extract supplement. Chelation therapy improved brain MRI findings and neurological symptoms.

Area of Science:

  • Neurology
  • Toxicology
  • Nephrology

Background:

  • Parkinsonism is a complex neurological disorder.
  • Maintenance hemodialysis patients are at risk for toxin accumulation.
  • Long-term exposure to manganese (Mn) can cause neurological damage.

Observation:

  • A patient on maintenance hemodialysis presented with gait disturbance and dysarthria.
  • Symptoms were potentially linked to a daily health supplement containing 1.7 mg of manganese.
  • Elevated serum and cerebrospinal fluid manganese levels were observed.

Findings:

  • Brain MRI revealed abnormal signal intensities in the basal ganglia, characteristic of manganese deposition.
  • Edetic acid (EDTA) infusion therapy led to significant improvement in MRI abnormalities.
  • Neurological symptoms gradually resolved over four months following chelation therapy.

Implications:

  • This case highlights manganese toxicity from supplements as a cause of parkinsonism, even in hemodialysis patients.
  • Chelation therapy can be effective in reversing manganese-induced neurotoxicity and associated symptoms.
  • Careful review of supplement ingredients and potential toxicity is crucial for patients undergoing hemodialysis.

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