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Manganese‐induced parkinsonism in methcathinone abusers: bio‐markers of exposure and follow‐up
Author(s) -
Sikk K.,
Haldre S.,
Aquilonius S.M.,
Asser A.,
Paris M.,
Roose Ä.,
Petterson J.,
Eriksson S.L.,
Bergquist J.,
Taba P.
Publication year - 2013
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12088
Subject(s) - parkinsonism , globus pallidus , medicine , magnetic resonance imaging , cohort , nuclear medicine , neuroimaging , psychiatry , radiology , basal ganglia , disease , central nervous system
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 E stonian cohort of intravenous methcathinone users. Methods During 2006–2012 we studied 38 methcathinone abusers with a mean age of 33 years. Subjects were rated by the U nified P arkinson's D isease R ating S cale ( UPDRS ), H oehn and Y ahr ( HY ), and S chwab and E ngland ( SE ) rating scales. Twenty‐four cases were reassessed 9–70 (20 ± 15) months after the initial evaluation. Manganese ( M n) in plasma and hair was analysed by i nductively c oupled p lasma‐ a tom e mission s pectrometry. 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 M n in hair (2.9 ± 3.8 ppm) than controls (0.82 ± 1.02 ppm), P = 0.02. Plasma M n concentrations were higher (11.5 ± 6.2 ppb) in active than in former users (5.6 ± 1.8 ppb), P = 0.006. Active methcathinone users had increased MRI T 1‐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 M n exposure are characteristic only of recent abuse, the syndrome is not reversible.