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Manganese/Welding Fumes

Manganese is an essential element for normal body function but excess manganese in the body can disrupt neurotranmission in the brain causing a condition very similar if not identical to Parkinson's Disease. The neurotoxicity of manganese has been known since the mid 1800's as described in an elegant timeline which Dr. Parent has constructed of peer-reviewed literature publications and internal company documents. Industry chose to try to conceal the neurotoxicity of manganse in welding fumes as is described in the timeline.

Welding rods and various metals that are welded contain varying amounts of manganese. When an arc is struck, the welding rods and the metals melt and some metal vaporizes to form an extremely fine dust or fume which contains significant amounts of manganese. The particles that are produced and contain manganese are so small that they can be absorbed through the nasal membranes and travel within the olfactory neurons directly to the brain. Inhaled dust also deposits in the lungs and is slowly released into the bloodstream and is passed on directly to the brain by traversing the blood-brain barrier. Manganese concentrates in the globus pallidus area of the brain and you can actually see it in the brain of current welders via a specialized MRI technique. Once in the brain, manganese disrupts neurotranmission from one part of the brain to the others and this results in a multitude of symptoms but mainly a movement disorder which strongly resembles Parkinson’s Disease. The illness begins with disruption of cognitive function (anorexia, memory loss, headaches, hallucinations etc) and other neurobehavioral problems and then progressive to tremors and on to a variety of signs and symptoms relating to movement including postural instability and gait problems, among others.

Welding without adequate respiratory protection can result in a number of health problems. These include respiratory injury from ozone and nitrogen oxides emanating from the fumes, deposition of heavy metal oxides in the lungs, and eye/skin damage from the intense radiation emanating from the arc. One of the issues that we have studied extensively is the effect of manganese from welding fumes on the central nervous system and have clearly established a causal link between exposure to manganese from welding fumes and parkinsonism. The report that we have written on that link has passed a Daubert challenge in the Federal Court System. Dr. Parent has an extensive database on welding fumes and the effects of manganese on the central nervous system and other physiological effects that can be useful in future cases. Selected references are provided below.

Selected References

Abdel-Naby, S. and Hassanein, M., Neuropsychiatric manifestations of chronic manganese poisoning. Journal of Neurology Neurosurgery and Psychiatry, 28, 282-288 (1965).

Akbarkhanzadeh F,, Long-term effects of welding fumes upon respiratory symptoms and pulmonary function. Journal of Occupational Medicine, 22(5), 337-341 (1980).

Angervall L . Hansson G . Rockert H,, Pulmonary siderosis in electrical welder. A note on pathological appearances. Acta Pathologica et Microbiologica Scandinavica, 49, 373-380 (1960).

Antti-Poika, M., Hassi, J. and Pyy, L., Respiratory diseases in arc welders. International Archives of Occupational and Environmental Health, 40, 225-230 (1977).

Aschner, M., Manganese:  brain transport and emerging research needs. Environmental Health Perspectives, 108(Suppl 3), 429-432 (2000).

Agency for Toxic Substances and Disease Registry (ATSDR), Toxicological profile for manganese. Agency for Toxic Substances and Disease Registry (ATSDR), Public Health Service, US Department of Health and Human Services, 504 pages, September (2000).

Bast-Pettersen, R., Ellingsen, D. G., Hetland, S. M. and Thomassen, Y., Neuropsychological function in manganese alloy plant workers. International Archives of Occupational and Environmental Health, 77(4), 277-287 (2004).

Beaumont, J. J. and Weiss, N. S., Lung cancer among welders. Journal of Occupational Medicine, 23(12), 839-844 (1981).

Beuter, A., de Geoffroy, A., Mergler, D. and Hundell, K., Quantification of neuromotor function for detection of the effects of manganese. Neurotoxicology, 20, 355-366 (1999).

Bleecker, M. L., Parkinson's disease, Parkinsonism, and environmental exposure. Clinical Occupational and Environmental Medicine, 1, 655-671 (2001).

Bleich, S., Degner, D., Sprung, R., Riegel, A., Poser, W. and Ruther, E., Chronic manganism: fourteen years of follow-up. Journal of Neuropsychiatry Clinical. Neuroscience, 11(1), 117 (1999).

Bleich, S., Degner, D., Bandelow, B., Riegel, A., Maler, J. M., Ruther, E. and Kornhuber, J., Moderate hyperhomocysteinemia and neuropsychiatric symptoms in manganese-induced parkinsonism. German Journal of Psychiatry, 3, 14-20 (2000).

Bouchard, M., Mergler, D. and Baldwin, M., Manganese exposure and age: neurobehavioral performance among alloy production workers. Environmental Toxicology and Pharmacology, 19(3), 687-694 (2005).

Bouchard, M., Mergler, D., Baldwin, M., Panisset, M., Bowler, R. and Roels, H. A., Neurobehavioral functioning after cessation of manganese exposure: A follow-up after 14 years. American Journal of Industrial Medicine, 50(11), 831-840 (2006).

Bowler, R. M., Koller, W. and Schulz, P. E., Parkinsonism due to manganism in a welder:  Neurological and neuropsychological sequelae. Neurotoxicology, 27(3), 327-332 (2006).

Bowler, R. M., Gysens, S., Diamond, E., Nakagawa, S., Drezgic, M. and Roels, H. A., Manganese exposure: Neuropsychological and neurological symptoms and effects in welders. Neurotoxicology, 27(3), 315-326 (2006).

Calne, D. B., Chu, N. S., Huang, C. C., Lu, C. S. and Olanow, W., Manganism and idiopathic parkinsonism: similarities and differences. Neurology, 44(9), 1583-1586 (1994).

Cersosimo, M. G. and Koller, W. C., The diagnosis of manganese-induced parkinsonism. Neurotoxicology, 27(3), 340-346 (2006).

Chandra, S. V., Psychiatric illness due to manganese poisoning. Acta Psychiatrica Scandinavica, 303(Suppl), 49-54 (1983).

Dobson, A. W., Erikson, K. M. and Aschner, M., Manganese neurotoxicity. Annals of the New York Academy of Sciences, 1012, 115-128 (2004).

Duran, E. and Chacon, J. R., Parkinsonism probably induced by manganese. Reviews in  Neurology, 33(5), 434-436 (2001).

Fored, C. M., Fryzek, J. P., Brandt, L., Nise, G., Sjogren, B., McLaughlin, J. K., Blot, W. J. and Ekbom, A., Parkinson's disease and other basal ganglia or movement disorders in a large nationwide cohort of Swedish welders. Occupational Environmental Med.icne, 63(2), 135-140 (2006).

Gorell, J. M., Peterson, E. L., Rybicki, B. A. and Johnson, C. C., Multiple risk factors for Parkinson's disease. Journal of Neurol. Science, 217(2), 169-174 (2004).

Greiffenstein, M. F. and Lees-Haley, P. R., Neuropsychological correlates of manganese exposure: a meta-analysis. Journal of Clinical. and Experimental Neuropsychology., 29(2), 113-126 (2007).

Hua, M. S. and Huang, C. C., Chronic occupational exposure to manganese and neurobehavioral function. Journal of Clinical and Experimental Neuropsychology., 13(4), 495-507 (1991).

Huang, C. C., Chu, N. S., Lu, C. S. and Calne, D. B., Cock gait in manganese intoxication. Movement  Disorders, 12(5), 807-808 (1997).

Kim, J. W., Kim, Y., Cheong, H. K. and Ito, K., Manganese induced parkinsonism: a case report. Journal of Korean Medical Science, 13(4), 437-439 (1998).

Kim, J. W., Kim, Y. H., Cheong, H. K. et al., Three cases of manganese induced parkinsonism:  differences from idiopathic Parkinsonism. Journal of Korean Neurology Association, 16(3), 336-340 (1998).

Kim, K. S., Kim, Y., Jin, Y., Kim, E., Yang, J. S., Kwon, K. R., Kim, J. W., Roh, J. and Moon, Y. H., Factors associated with psychoneurobehavioral outcomes in workers exposed to manganese. Korean Journal of Occupational and Environ. Medicine, 11, 213-228 (1999).

Klos, K. J., Chandler, M., Kumar, N., Ahlskog, J. E. and Josephs, K. A., Neuropsychological profiles of manganese neurotoxicity. European Journal of Neurology, 13(10), 1139-1141 (2006).

Komaki, H., Maisawa, S., Sugai, K., Kobayashi, Y. and Hashimoto, T., Tremor and seizures associated with chronic manganese intoxication. Brain Development, 21(2), 122-124 (1999).

Lees-Haley, P. R., Rohling, M. L. and Langhinrichsen-Rohling, J., A meta-analysis of the neuropsychological effects of occupational exposure to manganese. Clinical Neuropsychol.ogy, 20(1), 90-107 (2006).

Louis, E. D., Applegate, L. M., Factor-Litvak, P., Parides, M. K. and Andrews, L., Essential tremor: occupational exposures to manganese and organic solvents. Neurology, 63(11), 2162-2164 (2004).

Mergler, D. and Baldwin, M., Early manifestations of manganese neurotoxicity in humans:  an update. Environ. Research, 73(1-2), 92-100 (1997).

Moon, D. H., Son, B. C. and Kang, D. M., Manganese exposure and its health hazards of welders. Korean Journal of Occupational and Environmental Medicine, 11(4), 476-491 (1999).

Murphy, G., Chronic poisoning by manganese. Manganic Parkinsonism. Prensa Medica Argentina, 55(13), 564-568 (1968).

Normandin, L., Panisset, M. and Zayed, J., Manganese neurotoxicity: behavioral, pathological, and biochemical effects following various routes of exposure. Reviews in Environmental Health, 17(3), 189-217 (2002).

Ohtake, T., Negishi, K., Okamoto, K., Oka, M., Maesato, K., Moriya, H. and Kobayashi, S.,  Manganese-induced parkinsonism in a patient undergoing maintenance hemodialysis. American Journal of Kidney Disease, 46(4), 749-753 (2005).

Olanow, C. W., Manganese-induced parkinsonism and Parkinson's disease. Annals of the New York Academy of Sciences, 1012, 209-223 (2004).

Pal, P. K., Samii, A. and Calne, D. B., Manganese neurotoxicity: a review of clinical features, imaging and pathology. Neurotoxicology, 20(2-3), 227-238 (1999).

Panisset, M., Lucchini, R., Belanger, S. and Mengler, D., Permanent parkinsonism in workers formerly exposed to manganese. Movement Disorders, 11, 599-600 (1996).

Park, J., Yoo, C. I., Sim, C. S., Kim, J. W., Yi, Y., Shin, Y. C., Kim, D. H. and Kim, Y., A retrospective cohort study of Parkinson's disease in Korean shipbuilders. Neurotoxicology, 27(3), 445-449 (2006).

Racette, B. A., Prevalence of parkinsonism in a large cohort of welders. Movement Disorders, 19(Suppl 9), S186 (2004).

Racette, B. A., Welding-related parkinsonism.: clinical features, treatment and pathophysiology. Neurology, 57, 936-937 (2001).

Roels, H. A., Ortega Eslava, M. I., Ceulemans, E., Robert, A. and Lison, D., Prospective study on the reversibility of neurobehavioral effects in workers exposed to manganese dioxide. Neurotoxicology, 20(2-3), 255-271 (1999).

Sadek, A. H., Rauch, R. and Schulz, P. E., Parkinsonism due to manganism in a welder. International Journal of Toxicology, 22(5), 393-401 (2003).

Stern, R. M., Assessment of risk of lung cancer for welders. Archives of Environmental Health, 38(3), 148-155 (1983).

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