Manganese‐induced parkinsonism in methcathinone abusers: bio‐markers of exposure and follow‐up. Issue 6 (24th January 2013)

• Record Type: Journal Article
• Authors: Sikk, K.; Haldre, S.; Aquilonius, S.‐M.; Asser, A.; Paris, M.; Roose, Ä.; Petterson, J.; Eriksson, S.‐L.; Bergquist, J.; Taba, P.
• Is Part Of: European journal of neurology. Volume 20:Issue 6(2013:Jun.)
• Page Start: 915
• Page End: 920
• Publication Date: 2013-01-24
• Subjects: Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.12088
• Languages: English
• ISSNs: 1351-5101

Abstract

<abstract abstract-type="main" xml:lang="en" id="ene12088-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ene12088-sec-0001" sec-type="section"> <title>Background and purpose</title> <p>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.</p> </sec> <sec id="ene12088-sec-0002" sec-type="section"> <title>Methods</title> <p>During 2006–2012 we studied 38 methcathinone abusers with a mean age of 33 years. 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 9–70 (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.</p> </sec> <sec id="ene12088-sec-0003" sec-type="section"> <title>Results</title> <p>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 ± 3.8 ppm) than controls (0.82 ± 1.02 ppm), <italic>P </italic>= 0.02. Plasma Mn concentrations were higher (11.5 ± 6.2 ppb) in active than in former users (5.6 ± 1.8 ppb), <italic>P </italic>= 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.</p> </sec> <sec id="ene12088-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Methcathinone abusers develop a distinctive hypokinetic syndrome. Though the biomarkers of Mn exposure are characteristic only of recent abuse, the syndrome is not reversible.</p> </sec> </abstract>