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

A. Stepens (Coresponding Author), V. Groma, S. Skuja, A. Platkajis, P. Aldiņš, I. Ekšteina, I. Martiņsone, R. Bricis, M. Donaghy

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


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. Click here to view the accompanying paper in this issue.

Original languageEnglish
Pages (from-to)199-205
Number of pages7
JournalEuropean Journal of Neurology
Issue number2
Publication statusPublished - Feb 2014


  • Extrapyramidal
  • Manganese toxicity
  • Methcathinone
  • Movement disorder
  • Parkinsonism

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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