Amyotrophic Lateral Sclerosis After Exposure to Manganese from Traditional Medicine Procedures in Kenya
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Amyotrophic Lateral Sclerosis After Exposure to Manganese from Traditional Medicine Procedures in Kenya Elin Roos 1 & Sebastian K.T.S. Wärmländer 2,3 & Jeremy Meyer 4 & Sabrina B. Sholts 5 & Jüri Jarvet 2,6 & Astrid Gräslund 2 & Per M Roos 7,8 Received: 25 August 2020 / Accepted: 17 November 2020 # The Author(s) 2020
Abstract Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by motor neuron loss and widespread muscular atrophy. Despite intensive investigations on genetic and environmental factors, the cause of ALS remains unknown. Recent data suggest a role for metal exposures in ALS causation. In this study we present a patient who developed ALS after a traditional medical procedure in Kenya. The procedure involved insertion of a black metal powder into several subcutaneous cuts in the lower back. Four months later, general muscle weakness developed. Clinical and electrophysiological examinations detected widespread denervation consistent with ALS. The patient died from respiratory failure less than a year after the procedure. Scanning electron microscopy and X-ray diffraction analyses identified the black powder as potassium permanganate (KMnO4). A causative relationship between the systemic exposure to KMnO4 and ALS development can be suspected, especially as manganese is a well-known neurotoxicant previously found to be elevated in cerebrospinal fluid from ALS patients. Manganese neurotoxicity and exposure routes conveying this toxicity deserve further attention. Keywords Amyotrophic lateral sclerosis . Manganese . Neurodegeneration . Potassium permanganate . Traditional medicine
Introduction
* Elin Roos [email protected] 1
Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
2
Department of Biochemistry and Biophysics, Stockholm University, 106 91 Stockholm, Sweden
3
UCLA/Getty Conservation Programme, Cotsen Institute of Archaeology, UCLA, Los Angeles, CA 90095, USA
4
Unit for Surgical Research, Medical School of Geneva, University of Geneva, 120511, 14 Genève, Switzerland
5
Department of Anthropology, National Museum of Natural History, Smithsonian Institution, 370 12, Washington D.C, USA
6
The National Institute of Chemical Physics and Biophysics, 12618 Tallinn, Estonia
7
Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
8
Department of Clinical Physiology, St. Goran Hospital, 112 81 Stockholm, Sweden
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by loss of upper and lower motor neurons and sclerosis of motor pathways in the spinal cord, leading to widespread progressive skeletal muscle atrophy [1] and death by respiratory failure. Electrophysiological examinations are necessary in the diagnostic workup of ALS, as ALS-mimicking disorders exist, most commonly in the form of myopathic conditions [2]. The ALS incidence is about 3 per 100 000 person-years [3], with a peak age of diagnosis at 54 years and a projected incidence increase in coming years [4
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