Objective:

To describe the available literature on Parkinsonism associated with lithium exposure

Background:

Lithium occupational and pharmacological exposure has been rising over the past years, especially for workers in lithium-ion batteries for electronics and electric vehicles. Although the association between Parkinsonism and heavy metal exposure is well described, few studies specifically analyzed its association with Lithium.

Design/Methods:

A literature review was completed using PubMed. Search terms utilized were (((Parkinsonism)) OR (Parkinson)) AND (lithium). Inclusion criteria included articles in English discussing Parkinsonism associated with lithium exposure, either pharmacological or occupational. Articles discussing neurological complications of lithium exposure, but Parkinsonism were excluded. Animal models were also excluded

Results:

We reviewed 317 manuscripts. 61 of them fulfilled the inclusion criteria. 40 of them were case reports. 31 of the case reports favored the hypothesis of lithium as a culprit on the development of Parkinsonian features, while 9 associated lithium use with improved parkinsonian features, on and off phenomenon, impulsiveness, and levodopa-induced mania. Interestingly, both acute and chronic exposure to lithium were associated with the development of parkinsonism in multiple reports. Only two studies specifically delved into the relationship of occupational lithium exposure and neurological symptoms. Both suggested that lithium levels in tobacco could reduce the risk of Parkinson's disease in smokers. No study has specifically analyzed the increased risk of parkinsonism in workers exposed to lithium.

Conclusions:

Little is known about the relationship between lithium exposure and parkinsonism. This scenario is particularly concerning considering the increased use of lithium by our society. Both observational and interventional studies are needed to better understand the complex interplay between lithium duration of exposure, dosage, associated comorbidities, and polypharmacy interactions with parkinsonism