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A Parkinsonian Syndrome in Methcathinone Users and the Role of Manganese (2008)

A Parkinsonian Syndrome in Methcathinone Users and the Role of Manganese (2008)

  1. Jatelka
    New England Journal of Medicine Volume 358:1009-1017 March 6, 2008 (http://content.nejm.org/content/vol358/issue10/index.shtml) Number 10

    Ainars Stepens, M.D., Inara Logina, Ph.D., Viesturs Liguts, Ph.D., Pauls Aldinhttp://content.nejm.org/math/large/scaron.gif, M.D., Ilze Eksteina, M.D., Ardis Platkajis, Ph.D., Inese Martinsone, M.Sci., Elmars Terauds, M.D., Baiba Rozentale, Ph.D., and Michael Donaghy, F.R.C.P.


    Background A distinctive extrapyramidal syndrome has been observed in intravenous methcathinone (ephedrone) users in Eastern Europe and Russia.
    Methods We studied 23 adults in Latvia who had extrapyramidal symptoms and who had injected methcathinone for a mean (±SD) of 6.7±5.1 years. The methcathinone was manufactured under home conditions by potassium permanganate oxidation of ephedrine or pseudoephedrine. All patients were positive for hepatitis C virus, and 20 were also positive for the human immunodeficiency virus (HIV).
    Results The patients reported that the onset of their first neurologic symptoms (gait disturbance in 20 and hypophonia in 3) occurred after a mean of 5.8±4.5 years of methcathinone use. At the time of neurologic evaluation, all 23 patients had gait disturbance and difficulty walking backward; 11 patients were falling daily, and 1 of these patients used a wheelchair. Twenty-one patients had hypophonic speech in addition to gait disturbance, and one of these patients was mute. No patient reported decline in cognitive function. T1-weighted magnetic resonance imaging (MRI) showed symmetric hyperintensity in the globus pallidus and in the substantia nigra and innominata in all 10 active methcathinone users. Among the 13 former users (2 to 6 years had passed since the last use), lesser degrees of change in the MRI signal were noted. Whole-blood manganese levels (normal level,