Manganese-induced parkinsonism in methcathinone abusers: bio-markers of exposure and follow-up
Version of Record online: 24 JAN 2013
© 2013 The Author(s) European Journal of Neurology © 2013 EFNS
European Journal of Neurology
Volume 20, Issue 6, pages 915–920, June 2013
How to Cite
Sikk, K., Haldre, S., Aquilonius, S.-M., Asser, A., Paris, M., Roose, Ä., Petterson, J., Eriksson, S.-L., Bergquist, J. and Taba, P. (2013), Manganese-induced parkinsonism in methcathinone abusers: bio-markers of exposure and follow-up. European Journal of Neurology, 20: 915–920. doi: 10.1111/ene.12088
- Issue online: 12 MAY 2013
- Version of Record online: 24 JAN 2013
- Manuscript Accepted: 29 NOV 2012
- Manuscript Received: 4 OCT 2012
- Estonian Science Foundation
- Swedish Research Council. Grant Numbers: Grant 621-2011-4423, Grant 3.2.1001.11-0017
- EU European Regional Development Fund
- MRI hyperintensities;
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.
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.
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), P = 0.02. Plasma Mn 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 T1-signal intensity in the globus pallidus, substantia nigra and periaquaductal gray matter. IBZM-SPECT showed normal symmetric tracer uptake in striatum.
Methcathinone abusers develop a distinctive hypokinetic syndrome. Though the biomarkers of Mn exposure are characteristic only of recent abuse, the syndrome is not reversible.