The outcome of the movement disorder in methcathinone abusers: clinical, MRI and manganesemia changes, and neuropathology.

Abstract

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: A Stepens, V Groma, S Skuja, A Platkājis, P Aldiņš, I Ekšteina, I Mārtiņsone, R Bricis, M Donaghy
• Journal: European journal of neurology (Eur J Neurol) Vol. 21 Issue 2 Pg. 199-205 (Feb 2014) ISSN: 1468-1331 [Electronic] England
• PMID: 23678867 (Publication Type: Journal Article)
• Copyright: © 2013 The Author(s) European Journal of Neurology © 2013 EFNS.

Chemical References

• Propiophenones
• monomethylpropion
• Manganese

Topics

• Adult
• Dyskinesia, Drug-Induced (blood, pathology)
• Female
• Globus Pallidus (pathology)
• Humans
• Male
• Manganese (blood)
• Manganese Poisoning (blood, pathology)
• Middle Aged
• Propiophenones (adverse effects)
• Young Adult