Levodopa failure in chronic manganism

@article{Lu1994LevodopaFI,
  title={Levodopa failure in chronic manganism},
  author={C. S. Lu and C. -C. Huang and N. S. Chu and Donald B. Calne},
  journal={Neurology},
  year={1994},
  volume={44},
  pages={1600 - 1600}
}
We report a placebo-controlled study of levodopa in four patients with extrapyramidal deficits caused by chronic manganese intoxication. Their parkinsonism and dystonia had progressed slowly over a period of 5 years after they left the site of exposure. Initially the patients appeared to respond to levodopa in open observations, but this apparent benefit was not sustained. This short-term, double-blind study indicates that their parkinsonism and dystonia failed to respond to levodopa. 
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Manganism has captured the imagination of neurologists for more than a century because of its similarities to Parkinson disease and its indirect but seminal role in the “l-dopa miracle.” We present
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TLDR
It is concluded that nigrostriatal dopaminergic dysfunction is not responsible for the parkinsonism caused by chronic Mn intoxication, and the pathology is likely to be downstream of the dopaminaergic projection.
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A neurological syndrome characterized by levodopa unresponsive bradykinesia, retropulsion with falls backwards, dysarthria, gait disturbance, dystonia, and emotional lability was identified in 13
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