Abstract
Background:Workers chronically exposed to manganese in welding fumes may develop an extra-pyramidal syndrome with postural and action tremors.Objectives:To determine the utility of tremor analysis in distinguishing tremors among workers exposed to welding fumes, patients with Idiopathic Parkinson’s Disease (IPD) and Essential Tremor (ET).Methods:Retrospective study of recorded tremor in subjects from academic Movement Disorders Clinics and Welders. Quantitative tremor analysis was performed and associated with clinical status.Results:Postural tremor intensity was increased in Welders and ET and was associated with visibly greater amplitude of tremor with arms extended. Mean center frequencies (Cf) of welders and patients with ET were significantly higher than the mean Cf of PD subjects. Although both the welders and the ET group exhibited a higher Cf with arms extended, welders could be distinguished from the ET subjects by a significantly lower Cf of the rest tremor than that measured in ET subjects.Conclusions:In the context of an appropriate exposure history and neurological examination, tremor analysis may be useful in the diagnosis of manganese-related extra-pyramidal manifestations.
Highlights
Reports over the last 80 years have described an increasing number of cases of manganese toxicity, especially in manganese miners, smelters, welders and battery workers [1,2,3,4,5]. the clinical features vary in details, a general consensus appears to be that the illness (“manganism”) can present acutely with neuropsychiatric disturbances and more chronically with an extrapyramidal syndrome that resemblesIdiopathic Parkinson’s disease (IPD) [6]
Comparison of the mean ages of three groups at the time of this study revealed that the welders were younger than both the Idiopathic Parkinson’s Disease (IPD) patients and the Essential Tremor (ET) subjects
Group exhibited a higher center frequencies (Cf) with arms extended, welders could be distinguished from the ET subjects by a significantly lower Cf of the rest tremor than that measured in ET subjects
Summary
Reports over the last 80 years have described an increasing number of cases of manganese toxicity, especially in manganese miners, smelters, welders and battery workers (manganese dioxide) [1,2,3,4,5]. the clinical features vary in details, a general consensus appears to be that the illness (“manganism”) can present acutely with neuropsychiatric disturbances (manganese madness, or in Spanish “locura manganesa”) and more chronically with an extrapyramidal syndrome that resemblesIdiopathic Parkinson’s disease (IPD) [6]. To explore and quantify parameters of tremor in welders, a quantitative analysis of previously recorded accelerometric data was performed. The objectives of this retrospective study were (a) to characterize and analyze the tremor of welders and associated workers with a history of exposure to manganese in the workplace and (b) to compare the welders’ tremor parameters with those of de novo PD patients who had not been treated with anti-PD medications and to a group of patients with postural tremors, Essential Tremor (ET). Objectives: To determine the utility of tremor analysis in distinguishing tremors among workers exposed to welding fumes, patients with Idiopathic Parkinson’s Disease (IPD) and Essential Tremor (ET). Conclusions: In the context of an appropriate exposure history and neurological examination, tremor analysis may be useful in the diagnosis of manganese-related extra-pyramidal manifestations
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