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Previous Volume 358:1009-1017 March 6, 2008 Number 10 Next

Ainrs Stepens, M.D., Inra Logina, Ph.D., Viesturs Liguts, Ph.D., Pauls Aldi, M.D., Ilze Ekteina, M.D., Ardis Platkjis, Ph.D., Inese Mrtisone, M.Sci., Elmrs Trauds, M.D., Baiba Rozentle, Ph.D., and Michael Donaghy, F.R.C.P.

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ABSTRACT

Background A distinctive extrapyramidal syndrome has been observed in intravenous methcathinone (ephedrone) users in Eastern Europe and Russia.

Methods We studied 23 adults in Latvia who had extrapyramidal symptoms and who had injected methcathinone for a mean (±SD) of 6.7±5.1 years. The methcathinone was manufactured under home conditions by potassium permanganate oxidation of ephedrine or pseudoephedrine. All patients were positive for hepatitis C virus, and 20 were also positive for the human immunodeficiency virus (HIV).

Results The patients reported that the onset of their first neurologic symptoms (gait disturbance in 20 and hypophonia in 3) occurred after a mean of 5.8±4.5 years of methcathinone use. At the time of neurologic evaluation, all 23 patients had gait disturbance and difficulty walking backward; 11 patients were falling daily, and 1 of these patients used a wheelchair. Twenty-one patients had hypophonic speech in addition to gait disturbance, and one of these patients was mute. No patient reported decline in cognitive function. T₁-weighted magnetic resonance imaging (MRI) showed symmetric hyperintensity in the globus pallidus and in the substantia nigra and innominata in all 10 active methcathinone users. Among the 13 former users (2 to 6 years had passed since the last use), lesser degrees of change in the MRI signal were noted. Whole-blood manganese levels (normal level, <209 nmol per liter) averaged 831 nmol per liter (range, 201 to 2102) in the active methcathinone users and 346 nmol per liter (range, 114 to 727) in former users. The neurologic deficits did not resolve after patients discontinued methcathinone use.

Conclusions Our observation of a distinctive extrapyramidal syndrome, changes in the MRI signal in the basal ganglia, and elevated blood manganese levels in methcathinone users suggests that manganese in the methcathinone solution causes a persistent neurologic disorder.

Source Information

From the Department of Neurology (A.S., I.L.), the Department of Anesthesiology and Intensive Care (V.L.), the Department of Classical Infectology, Tuberculosis, and AIDS (P.A., I.E., B.R.), the Department of Radiology (A.P.), the Institute of Occupational and Environmental Health (I.M.), and the Department of Psychiatry and Addiction (E.T.), Riga Stradins University, Riga, Latvia; and the Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom (M.D.).

Address reprint requests to Dr. Donaghy at the Department of Clinical Neurology, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom, or at joanna.wilkinson{at}clneuro.ox.ac.uk.

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