Can manganese deficiency cause movement type symptoms, such as ataxia and impaired coordination?

Manganese Deficiency Can Cause Movement Disorders Including Ataxia

Yes, manganese deficiency can cause movement disorders including ataxia and impaired coordination, though this is rare in humans and more commonly documented in animal studies. 1, 2, 3

Neurological Manifestations of Manganese Abnormalities

Manganese Deficiency Effects

• Neurological symptoms:

  • Ataxia (impaired coordination of movement) 1, 2
  • Loss of coordination 3
  • Impaired motor function 2

• Other systemic effects:

  • Impaired growth and skeletal development 1, 2
  • Abnormal glucose tolerance 2
  • Disorders in lipid and carbohydrate metabolism 2, 3
  • Transient skin rash 1
  • Altered mood and increased pain in women 1

Clinical Significance

• Manganese deficiency is exceptionally rare in humans but well-documented in animal models 1
• In critically ill patients, only about 2.1% show decreased manganese values 1
• Low neuronal manganese levels have been associated with Huntington's disease 1

Manganese Homeostasis and Neurological Function

Physiological Role

• Manganese is a cofactor for several enzymes including:
  • Mitochondrial superoxide dismutase
  • Pyruvate carboxylase
  • Arginase
  • Glutamine synthetase
  • Phosphoenolpyruvate decarboxylase 1

Genetic Disorders of Manganese Metabolism

• SLC39A8 mutations can cause manganese deficiency leading to a congenital disorder of glycosylation 4
• Conversely, SLC30A10 and SLC39A14 mutations cause hypermanganesemia with movement disorders 4

Clinical Considerations

Diagnosis

• Manganese levels can be measured in whole blood, RBC, plasma, or serum 1
• MRI brain may show characteristic findings in manganese disorders 4
• Ataxia evaluation should include careful neurological examination to determine if the cerebellum, spinal cord, peripheral nerves, or vestibular system is involved 1

Treatment Approach

• For documented manganese deficiency:
  • Ensure adequate dietary intake (2-3 mg/day for adults) 1
  • In parenteral nutrition, provide manganese at appropriate doses (no more than 1 mg/kg/day, maximum 50 μg/day) 1

Important Caveats

• Manganese toxicity is a greater concern than deficiency and can cause Parkinson-like symptoms 1, 5
• Monitoring is essential in patients receiving long-term parenteral nutrition 1
• Patients with cholestasis or liver dysfunction are at higher risk of manganese accumulation 1
• Iron deficiency can increase manganese absorption and retention, potentially leading to toxicity 1, 3

Differential Diagnosis of Movement Disorders

• When evaluating ataxia and coordination problems, consider:
  • Hypomagnesemia (can cause tremor, ataxia, and dysarthria) 6
  • Cerebellar lesions 1
  • Sensory ataxia from peripheral neuropathies 1
  • Vestibular disorders 1
  • Medication side effects
  • Other mineral deficiencies or toxicities

While manganese deficiency can theoretically cause movement disorders including ataxia, clinicians should maintain a high index of suspicion for manganese toxicity, which is more common and can present with parkinsonism and other movement disorders that may be mistaken for neurodegenerative diseases 5.