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Mayo Clinic in Rochester
Wednesday, June 08, 2005
Risk Factors
A common factor with all eight welders studied, according to Dr. Josephs, was inadequate fume-protective measures. This provides further evidence that unprotected welding leads to neurological damage.
"An important finding from our case series analysis is that these patients were not only all welders, but all had a lack of ventilation," says Dr. Josephs. "They didn't have a mask or were welding in confined spaces."
Dr. Josephs does not advocate against welding; rather, he encourages prudent safeguards. "Protection is the key ingredient here," he says. "I think that if you have good protection and follow the U.S. Department of Labor's Occupational Safety and Health Administration guidelines for protection while welding, you're probably safe." Further information on these guidelines is available at the OSHA website.
Treatment and Long-Term Outcomes
Mayo Clinic physicians treated seven of the eight patients with low-manganese diets and one with chelation therapy with ethylene diamine tetraacetic acid, a crystalline acid therapy designed to bind the acid with the excess metal in the body -- the manganese -- and neutralize the toxic effect.
Dr. Josephs explains, however, that there is no "home run" treatment for manganese neurotoxicity. "We don't have enough evidence that diet is absolutely the way to go; while diet modifications can decrease oral intake of manganese, their manganese exposure is due to another form of intake: inhalation. Chelation therapy has the inherent risk of removing metals important to the body."
Many of the patients studied still had symptoms after they stopped exposing themselves to welding fumes, leading the Mayo neurologists to postulate that the damage invoked by manganese exposure may be permanent. "It seems to be static or progressive, not reversible," says Dr. Josephs. "I think the best option is removal from welding.
