Stepens Ainārs, Logina Ināra, Liguts Viesturs, Aldins Pauls, Eksteina Ilze, Platkājis Ardis, Mārtinsone Inese, Tērauds Elmārs, Rozentāle Baiba, Donaghy Michael
Department of Neurology, Riga Stradins University, Riga, Latvia.
N Engl J Med. 2008 Mar 6;358(10):1009-17. doi: 10.1056/NEJMoa072488.
A distinctive extrapyramidal syndrome has been observed in intravenous methcathinone (ephedrone) users in Eastern Europe and Russia.
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).
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. T(1)-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.
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.
在东欧和俄罗斯，静脉注射甲基卡西酮（麻黄酮）的使用者中观察到一种独特的锥体外系综合征。
我们研究了拉脱维亚的23名患有锥体外系症状且平均（±标准差）注射甲基卡西酮6.7±5.1年的成年人。甲基卡西酮是在家用条件下通过高锰酸钾氧化麻黄碱或伪麻黄碱制成的。所有患者丙型肝炎病毒检测均为阳性，20名患者人类免疫缺陷病毒（HIV）检测也为阳性。
患者报告称，他们首次出现神经症状（20例步态障碍，3例声音低沉）的时间平均为使用甲基卡西酮5.8±4.5年后。在进行神经学评估时，所有23例患者均有步态障碍和向后行走困难；11例患者每天跌倒，其中1例使用轮椅。21例患者除步态障碍外还存在声音低沉，其中1例患者失音。没有患者报告认知功能下降。T（1）加权磁共振成像（MRI）显示，在所有10名现用甲基卡西酮的使用者中，苍白球、黑质和无名质均出现对称性高信号。在13名既往使用者中（自最后一次使用后已过去2至6年），MRI信号变化程度较轻。现用甲基卡西酮的使用者全血锰水平（正常水平<209纳摩尔/升）平均为831纳摩尔/升（范围为201至2102），既往使用者为346纳摩尔/升（范围为114至727）。患者停用甲基卡西酮后，神经功能缺损并未缓解。
我们观察到甲基卡西酮使用者出现独特的锥体外系综合征、基底节区MRI信号变化以及血锰水平升高，这表明甲基卡西酮溶液中的锰会导致持续性神经疾病。
