potassium-permanganate and monomethylpropion

Encephalopathy caused by manganese compounds used for illicit production of ephedrone (methcathinone) is described. The onset of disease could be observed after some months of regular intravenous use of ephedrone contaminated with manganese. In clinical picture dominate neurological signs and symptoms, mainly extrapyramidal syndromes: parkinsonism, tremor, muscle distonia, pro- and retropulsion. Some other symptoms may be observed: hypophonia or dysarthria, gain disturbances, impairment of precise movement, and micrographia. In cranial NMR often appears bilaterally an increase of an intensity of T1 signal in globus pallidus and in some other brain structures. Elimination of manganese with the use of chelating therapy as well as symptomatic treatment, mainly with the antyparkinsonic drugs, seems to be ineffective.

Topics: Brain Chemistry; Brain Diseases; Chelation Therapy; Humans; Injections, Intravenous; Magnetic Resonance Spectroscopy; Manganese Poisoning; Potassium Permanganate; Propiophenones

To examine a syndrome of chronic manganism that occurs in drug addicts in eastern Europe who use intravenous methcathinone (ephedrone) contaminated with potassium permanganate. In many cases the basal ganglia, especially the globus pallidus and the putamen, are damaged irreversibly. Routine neuropsychological assessment has revealed no cognitive deficits, despite widespread abnormalities on brain imaging studies and severe extrapyramidal motor handicap on clinical examination.. Case-control study.. Ephedrone patients and patients with opioid dependence were recruited from Lviv, Ukraine.. We tested 15 patients with ephedrone-induced toxicity, 13 opiate-dependent patients who were receiving opioid replacement therapy and 18 matched healthy volunteers.. The 'beads task', an information-gathering task to assess reflection impulsivity, was used and feedback learning, working memory and risk-taking were also assessed.. Opiate-dependent patients differed from controls on three of four tasks, whereas ephedrone patients differed from controls on only one task. More specifically, both patient groups were more impulsive and made more irrational choices on the beads task than controls (P < 0.001). However, ephedrone patients had no deficits in working memory (P > 0.1) or risk-taking (P > 0.1) compared with controls. Opioid-dependent patients had significantly worse working memory (P < 0.001) and were significantly more risk-prone than controls (P = 0.002).. Ephedrone patients may have similar deficits in information-gathering and decision-making to opiate-dependent patients, with preservation of working memory and risk-taking. This may reflect specific damage to anterior cingulate- basal ganglia loops.

Topics: Adult; Amphetamine-Related Disorders; Case-Control Studies; Decision Making; Drug Contamination; Feedback, Psychological; Female; Humans; Impulsive Behavior; Information Seeking Behavior; Male; Manganese Poisoning; Memory, Short-Term; Neuropsychological Tests; Opiate Substitution Treatment; Opioid-Related Disorders; Parkinson Disease, Secondary; Potassium Permanganate; Propiophenones; Risk-Taking; Substance Abuse, Intravenous

Parkinsonian syndrome related to intravenous use of a "designer" psychostimulant, derived from pseudoephedrine using potassium permanganate as the oxidant, has been observed in drug addicts in Estonia.. To describe the symptomatology of four young patients, history of drug administration and chemical analysis of a drug batch.. Mental and motor function and quality of life were scored and ephedrone was analyzed using electrospray mass spectrometry. Manganese content of the final synthetic mixture was analyzed using Inductively Coupled Plasma-Atomic Emission Spectrometry.. None of the four cases scored below the dementia threshold in MMSE, while other ratings (UPDRS, H&Y, PDQ-39) corresponded to disabilities seen in relatively advanced Parkinson's disease. The ephedrone yield of the reaction was approximately 44% and the mixture was found to contain 0.6 g/l of manganese.. The cases were exposed to extreme manganese load. Their symptomatology is probably identical to manganism. The role of ephedrone is presently unknown. Physicians must be aware of early signs of manganism in patients within social risk groups.

Topics: Adult; Brain; Central Nervous System Stimulants; Disability Evaluation; Disease Progression; Dyskinesia, Drug-Induced; Ephedrine; Humans; Male; Manganese Poisoning; Mass Spectrometry; Neuropsychological Tests; Parkinsonian Disorders; Potassium Permanganate; Propiophenones; Substance-Related Disorders; Sweden