Journal
ACTA NEUROLOGICA SCANDINAVICA
Volume 121, Issue 4, Pages 237-243Publisher
WILEY
DOI: 10.1111/j.1600-0404.2009.01189.x
Keywords
drug addiction; ephedrone; manganism; methcathinone; neuroimaging; neurophysiology; parkinsonism
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Funding
- Swedish Research Council [621-2005-5279]
- Estonian Science Foundation [5680, 7433]
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Objective - To identify biomarkers supporting the clinical diagnosis of manganism in patients several years after exposure to manganese (Mn). Methods - Neurophysiological examinations, magnetic resonance imaging (MRI), single-photon emission computed tomography and fluorodeoxyglycose (FDG) positron emission tomography were performed in four former ephedrone addicts with extrapyramidal symptoms. Results - Peripheral nervous system was not affected. No patients had reduced uptake of 123I Ioflupane in the striatum. MRI signal intensities were slightly changed in the basal ganglia. All patients showed a widespread, but not uniform, pathological pattern of FDG uptake with changes mainly located to the central part of the brain including the basal ganglia and the surrounding white matter. Conclusions - Presynaptic neurons in the nigrostriatal pathway are intact in Mn-induced parkinsonism after prolonged abstinence from ephedrone. The diagnosis is principally based on clinical signs and the history of drug abuse.
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