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Neuropathological Findings in Ephedrone Encephalopathy
Author(s) -
Sanotsky Yanosh,
Selikhova Marianna,
Fedoryshyn Ludmyla,
Kuzyk Petro,
Matviyenko Yuriy,
Semeryak Orest,
Dziewulska Dorota,
Holton Janice L.,
Lees Andrew J.
Publication year - 2020
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.28125
Subject(s) - parkinsonism , dystonia , medicine , pathology , basal ganglia , toxic encephalopathy , encephalopathy , movement disorders , psychiatry , central nervous system , disease
Background A number of cases of severe parkinsonism‐dystonia have been recognized and reported following the illicit use of ephedrone prepared from pseudoephedrine and potassium permanganate. The pathology associated with ephedrone neurotoxicity has not been described yet in the scientific literature. Objectives To report the first neuropathological study of ephedrone toxicity. Methods The brain of a 33‐year‐old Ukrainian female ex‐ephedrone addict with a long history of l ‐dopa‐unresponsive parkinsonism with dysarthria, dystonia, profound postural instability, cock‐gait, and frequent falls, and on antiretroviral treatment, was examined using routine stains and immunohistochemistry. Results Neuropathological findings included diffuse pallidal astrogliosis without neuronal depletion. There was also widespread vascular pathology with small vessels occluded by foreign material, associated with giant cell response without any evidence of consequent focal infarction and a cerebellar abscess. Conclusions Clinical findings of l ‐dopa‐unresponsive parkinsonism with dystonia, caused by illicit use of ephedrone, are fully consistent with neuropathological changes in the pallidum, lack of change in the SN, and preserved tyrosine hydroxylase activity. The findings in the basal ganglia are compatible with manganese toxicity. The vascular pathology is likely a joint effect of infection and the ephedrone toxicity on the vessels. © 2020 International Parkinson and Movement Disorder Society

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