Can a manganese deficiency cause movement type symptoms, such as twitching, jerky movements, hyperexcitable movements, or strange movements?

Manganese Deficiency and Movement Disorders

Manganese deficiency is extremely rare in humans and is not typically associated with movement disorders such as twitching, jerky movements, or hyperexcitable movements; these symptoms are more characteristic of manganese toxicity rather than deficiency.

Understanding Manganese in Human Health

Manganese is an essential trace element that serves important functions in the human body:

• It acts as a cofactor for multiple enzymes including oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases 1
• It plays roles in bone formation, metabolism, antioxidant defense, and neurological function 1
• The recommended daily intake is approximately 2 mg/day for adults (2.3 mg for men and 1.8 mg for women) 1

Manganese Deficiency vs. Toxicity

Manganese Deficiency

Manganese deficiency is exceptionally rare in humans 1. When experimentally induced or observed, it manifests as:

• Transient skin rash
• Decreased serum cholesterol
• Elevated alkaline phosphatase, calcium, and phosphorus levels
• In women: altered mood and increased premenstrual pain 1

Notably absent from documented manganese deficiency symptoms are movement disorders or neurological symptoms resembling twitching, jerky movements, or hyperexcitability.

Manganese Toxicity

In contrast, manganese toxicity (manganism) is well-documented and specifically affects the brain's basal ganglia, causing movement disorders that can include:

• Parkinsonian-like tremors and movement abnormalities 1, 2
• Dystonic movements 2
• Neuropsychiatric symptoms including irritability 1
• Halting gait, dysarthria, and mask-face 2
• Action tremor and increased variability in movement patterns 3

Diagnostic Considerations

If a patient presents with movement disorders such as twitching, jerky movements, or hyperexcitable movements:

1. Consider manganese toxicity rather than deficiency 1, 2, 4

2. Evaluate potential sources of excess manganese:

   • Occupational exposure (mining, welding, alloy production) 4
   • Long-term parenteral nutrition 2, 5
   • Environmental exposure 6
   • Impaired manganese elimination due to liver disease 2, 5

3. Diagnostic tests to consider:

   • Whole blood manganese levels 1, 2
   • Brain MRI (characteristic T1 hyperintensities in globus pallidus) 1, 2, 5
   • Liver function tests 2

Clinical Pitfalls and Caveats

• Movement disorders are almost exclusively associated with manganese excess, not deficiency 1, 6, 4
• Manganese toxicity can be misdiagnosed as Parkinson's disease or other movement disorders 4
• Genetic disorders of manganese metabolism (SLC30A10 or SLC39A14 mutations) can cause hypermanganesemia with dystonia 7
• Symptoms of manganese toxicity may persist for weeks to months after exposure cessation 5, 3
• Patients with cholestasis or liver dysfunction are at higher risk for manganese accumulation due to impaired biliary excretion 2

In summary, if a patient presents with movement disorders such as twitching, jerky movements, or hyperexcitability, clinicians should investigate manganese toxicity rather than deficiency as the potential cause, as deficiency states have not been documented to produce these neurological manifestations.