Manganese exposure and the neuropsychological effect on children and adolescents: a review / Exposición al manganeso y su efecto neurosicológico en niños y adolescentes: una revisión

OBJECTIVES: Manganese (Mn) is an essential element, but overexposure can have neurotoxic effects. METHODS: In this article, we review and summarize studies on exposure to Mn and nervous system impairments in children. RESULTS: We identified 12 original articles published between 1977 and 2007. Overexposure to Mn was suspected to occur through diverse sources: infant milk formula, drinking water, industrial pollution, and mining wastes. The most common bioindicator of exposure to Mn was hair Mn content, but some studies measured Mn in blood, urine, or dentin; one study on prenatal exposure measured Mn content in cord blood. Most studies indicate that higher postnatal exposure to Mn is associated with poorer cognitive functions and hyperactive behavior. CONCLUSIONS: The limitations of the existing studies are numerous: most were cross-sectional, had a modest sample size, and lacked adjustment for important confounders. Future investigations should be performed on a larger sample size and include a more detailed exposure assessment, addressing multiple sources of exposure such as food, water, and airborne particulates.

OBJETIVO: El manganeso (Mn) es un elemento esencial, pero la sobreexposición puede tener efectos neurotóxicos. MÉTODOS: En este artículo se hace una revisión y un compendio de los estudios publicados sobre la exposición al Mn y los trastornos del sistema nervioso en niños. RESULTADOS: Se identificaron 12 artículos originales publicados entre 1977 y 2007. La sobreexposición al Mn puede haber ocurrido a partir de diversas fuentes: leche en polvo o maternizada, agua de beber, polución industrial y desechos de la producción minera. El bioindicador de exposición utilizado con mayor frecuencia fue el contenido de Mn en el pelo, aunque algunos estudios lo midieron en la sangre, la orina o la dentina; un estudio sobre exposición prenatal midió su contenido en la sangre del cordón umbilical. La mayoría de los estudios indican que una mayor exposición posnatal al Mn se asocia con deficiencias en las funciones cognitivas y el comportamiento hiperactivo. CONCLUSIONES: Las limitaciones de los estudios publicados son numerosas: la mayoría de ellos eran transversales, se basaban en muestras pequeñas y en ellos no se ajustaron los resultados por importantes factores de confusión. Se requieren investigaciones adicionales con muestras mayores y que hagan una evaluación más detallada de la exposición, tomando en cuenta múltiples fuentes, como los alimentos, el agua y las partículas suspendidas en el aire.

Liver transplantion in a patient with rapid onset parkinsonism-dementia complex induced by manganism secondary to liver failure

Bilateral and symmetric globus-pallidus hyperintensities are observed on T1-weighted MRI in most of the patients with chronic liver failure, due to manganese accumulation. We report a 53-year-old man, with rapid onset parkinsonism-dementia complex associated with accumulation of manganese in the brain, secondary to liver failure. A brain MRI was performed and a high signal on T1-weighted images was seen on globus-pallidus, as well as on T2-weighted images on the hemispheric white-matter. He was referred to a liver-transplantation. The patient passed away on the seventh postoperative day. Our findings support the concept of the toxic effects of manganese on the globus-pallidus. The treatment of this form of parkinsonism is controversial and liver-transplantation should not be considered as first line treatment but as an alternative one.

Hiperintesidades simétricas e bilaterais dos gânglios da base são observadas em imagens de ressonância magnética encefálica (RM) ponderadas em T1 na maioria dos pacientes com insuficiência hepática crônica devidas ao acúmulo de manganês. Nós relatamos o caso de um homem, com 53 anos de idade, com um complexo parkinsonismo-demência rapidamente progressivo associado com o acúmulo de manganês no cérebro, secundariamente a insuficiência hepática. Uma RM encefálica foi realizada e foram observadas imagens hiperintensas/hipersinal nas imagens ponderadas em T1 no globo pálido e, também, na substância branca dos hemisférios cerebrais ponderadas em T2. Devido à falta de resposta ao tratamento clinico optamos pelo transplante hepático. O paciente faleceu no 7° dia de PO. Nossos achados corroboram o conceito dos efeitos tóxicos do manganês nos gânglios da base/globo pálido. O tratamento desta forma de parkinsonismo é controverso e o transplante hepático não deverá ser considerada uma opção terapêutica de primeira linha, porém como um tratamento alternativo considerando-se os riscos-benefícios dessa escolha.

Effects of manganese ions in the neuromuscular junction

The neurotoxic effects of manganese occured mainly from its inhalation are well described in the literature. In this study we have been demonstrated the potent and reversible effect of manganese ions (Mn²+) on neuromuscular transmission using conventional myographic. The Mn²+ mechanism wich causes reversible blockade at neuromuscular junction was investigated in isolated mouse phrenic nerve-diaphragm (PND) preparations. As much Mn²+ 0.9 mM as Mn²+ 1.8 mM produced rapid neuromuscular blockade (50% in < 4 min), but only the lower concentration reversed spontaneously. The use of d-tubocurarine (5.8 µM), 3,4-diaminopyridine 3,4-DAP, 0.09 mM) and dantrolene (10 µM) excluded the involvment of nicotinic receptors, K+ channels and ryanodine receptors, respectively, as the potential target for this ion. Manganese acts an early competitive antagonist and after as an agonist of Ca²+, indicating that this ion may probably act via Ca²+ cannels...