Manganese-induced parkinsonism in methcathinone abusers: bio-markers of exposure and follow-up
2013 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 20, no 6, 915-920 p.Article in journal (Refereed) Published
Background and purpose Methcathinone abuse is a new cause of manganism. The psychostimulant is prepared from pseudoephedrine using potassium permanganate as an oxidant. We describe the clinical, biological, neuroimaging characteristics and follow-up results in a large Estonian cohort of intravenous methcathinone users. Methods During 20062012 we studied 38 methcathinone abusers with a mean age of 33years. Subjects were rated by the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr (HY), and Schwab and England (SE) rating scales. Twenty-four cases were reassessed 970 (20 +/- 15)months after the initial evaluation. Manganese (Mn) in plasma and hair was analysed by inductively coupled plasma-atom emission spectrometry. Magnetic resonance imaging (MRI) was performed in 11, and single-photon emission computed tomography (SPECT) with iodobenzamide (IBZM) in eight subjects. Results The average total UPDRS score was 43 +/- 21. The most severely affected domains in UPDRS Part III were speech and postural stability, the least affected domain was resting tremor. At follow-up there was worsening of HY and SE rating scales. Subjects had a higher mean level of Mn in hair (2.9 +/- 3.8ppm) than controls (0.82 +/- 1.02ppm), P=0.02. Plasma Mn concentrations were higher (11.5 +/- 6.2ppb) in active than in former users (5.6 +/- 1.8ppb), P=0.006. Active methcathinone users had increased MRI T1-signal intensity in the globus pallidus, substantia nigra and periaquaductal gray matter. IBZM-SPECT showed normal symmetric tracer uptake in striatum. Conclusion Methcathinone abusers develop a distinctive hypokinetic syndrome. Though the biomarkers of Mn exposure are characteristic only of recent abuse, the syndrome is not reversible.
Place, publisher, year, edition, pages
2013. Vol. 20, no 6, 915-920 p.
ephedrone, follow-up, manganism, methcathinone, MRI hyperintensities, parkinsonism
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-201779DOI: 10.1111/ene.12088ISI: 000318800600013OAI: oai:DiVA.org:uu-201779DiVA: diva2:629676