See editorial by Fasano on page 181.
The outcome of the movement disorder in methcathinone abusers: clinical, MRI and manganesemia changes, and neuropathology
Article first published online: 17 MAY 2013
© 2013 The Author(s) European Journal of Neurology © 2013 EFNS
European Journal of Neurology
Volume 21, Issue 2, pages 199–205, February 2014
How to Cite
Stepens, A., Groma, V., Skuja, S., Platkājis, A., Aldiņš, P., Ekšteina, I., Mārtiņsone, I., Bricis, R. and Donaghy, M. (2014), The outcome of the movement disorder in methcathinone abusers: clinical, MRI and manganesemia changes, and neuropathology. European Journal of Neurology, 21: 199–205. doi: 10.1111/ene.12185
- Issue published online: 13 JAN 2014
- Article first published online: 17 MAY 2013
- Manuscript Accepted: 25 MAR 2013
- Manuscript Received: 6 NOV 2012
- manganese toxicity;
- movement disorder;
Background and purpose
There is limited knowledge regarding the long-term outcome of the methcathinone/manganese-induced movement disorder. Our purpose was to define prognosis in intravenous methcathinone abusers affected by this distinctive disorder attributed to manganese (Mn) toxicity. Also, neuropathology from a globus pallidus region biopsy from a former user is reported.
Eighteen methcathinone abusers were categorized as active (five), discontinued (four) or former (nine) users. They were reassessed after a median of 32.5 months (range 3.4–59.6) clinically, on rating scales, and with MRI and blood Mn levels. The biopsy was examined ultrastructurally.
Overall the group showed a slight tendency to deterioration at follow-up on clinical assessment of motor functioning, especially the active users. No significant change occurred on parkinsonian rating scale reassessment. Significant reduction in Mn levels occurred in former users, and decreased T1-weighted hyperintensity on basal ganglia MRI occurred in 3 of 4 former and 2 of 3 discontinued users, despite lack of clinical improvement. The biopsy consisted of white matter showing decompacted myelin sheaths and frequent abnormalities of mitochondria.
No improvement in this Mn-induced movement disorder occurs after cessation of methcathinone abuse despite improvement of Mn blood levels and/or MRI abnormalities. Ultrastructural abnormalities in a former user confirm structural damage to white matter is associated with the disorder. Methcathinone/Mn toxicity is an important, disabling and permanent medical sequel of intravenous drug abuse in the former Soviet Union.