Parkinson syndrome-like symptoms

In workers with chronic inhalation exposure, iron deficiency and liver cirrhosis are commonly observed. Chronic inhalation exposure also affects the CNS, resulting in Parkinsonian-like symptoms. Mental aberrations are also observed. The psychiatric disturbance has been called manganese madness . Symptoms include confusion, unusual behavior, and sometimes hallucinations. Apathy, difficulty with speech, and loss of balance are most common. Other symptoms include difficulty with fine motor movement, anxiety, and pain. Manganese intoxication can result in a syndrome of parkinsonism and dystonia. If these extrapyramidal findings are present, they are likely to be irreversible... 

TOXICITY Common dose-related side effects are G1 complaints (nausea, vomiting, and anorexia) and CNS effects (drowsiness, lethargy, euphoria, dizziness, headache, and hiccups) some tolerance to these effects develops. Parkinson-like symptoms and photophobia also have occurred. Restlessness, agitation, anxiety, aggressiveness, inability to concentrate, and other behavioral effects have occurred primarily in patients with a history of psychiatric disturbance. Urticaria and other skin reactions, including Stevens-Johnson syndrome, as well as systemic lupus erythematosus, eosinophilia, leukopenia, thrombocytopenia, pancytopenia, and aplastic anemia have been attributed to the drug, and deaths have resulted from bone marrow depression. 

A woman stable on lithium for several years developed marked psychosis and parkinsonism within a week of starting to take diltiazem 30 mg three times daily. An acute parkinsonism syndrome developed in a 58-year-old man within 4 days of adding 30 mg of diltiazem three times daily to his treatment with lithium and tiotixene. However, this report has been questioned as the symptoms may have been attributable to an adverse effect of the tiotixene, and, even if the lithium toxicity was genuine, it is thought to have been more likely due to recent increases in the lithium dose, or the patient s diuretic therapy than diltiazem. ... 

In extreme cases of intoxication, a Parkinsonism-like syndrome may result, characterized by speech disturbances, muscle spasticity, tremor, memory loss, mental depression, and marked psychic symptoms permanent disability is likely. Psychosis and suicide are established risks of overexposure to carbon disulfide. ... 

One early reviewer stated that MAOIs increase the potency of phenothi-azine derivatives such that their initial dose should be reduced by three-quarters. He briefly mentions a case of a patient taking long-term perphenazine who developed a Parkinson-like syndrome with extrapyrami-dal symptoms a few hours after starting an MAOI. The US manufacturers note that, based on the increased incidence of extrapyram-idal effects reported with concurrent use of some MAOIs and phenothiazines, this possibility should be considered with promethazine."... 

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