Supervisors: dotsent Sulev Haldre (TÜ närvikliinik), dotsent Pille Taba (TÜ närvikliinik) ja professor Sten-Magnus Aquilonius (Uppsala Ülikool, Rootsi).
Opponent: professor Per Odin, MD, PhD (Bremerhaveni Keskhaigla, Saksamaa/ Skane Ülikooli Kliinik, Lund, Rootsi)
There are many causes of parkinsonian syndromes, among them Parkinson's disease is the most common. Neurodegenerative diseases, drugs, structural lesions, cerebrovascular diseases, infections and toxicants can all induce parkinsonism. This study describes parkinsonian syndrome in drug addicts, who had injected home-made psychostimulant mixture made of pseudoephedrine, potassium permanganate, acetic acid and boiling water. In the oxidation reaction, pseudoephedrine was converted to ephedrone (methacathinone). As a toxic by-product of the synthesis the final mixture contained high concentration of manganese. The intravenously administered daily manganese load was almost 2000 times higher than recommended. During 2006 till 2012, we examined 38 patients with a mean age of 33 years. The main motor symptoms were postural instability, gait disorder and speech impairment, limb dystonia and bradykinesia. The clinical symptomatology resembled classic manganese intoxication. There was no correlation between the duration of drug abuse and the severity of symptoms, i.e. a severe motor impairment could develop only after a short time of ephedrone abuse. The syndrome was irreversible after cessation of exposure and there was a trend of worsening. Magnetic resonance imaging showed increased signal intensity in globus pallidus and substantia nigra, these findings are specific to manganese exposure. Molecular neuroimaging studies showed the preservation of dopaminergic neurons, which are decreased in Parkinson's disease. Ephedrone abuse is an imortant cause of parkinonism in young Estonian patients. Identifying the cause of an extrapyramidal syndrome in former ephedrone abusers could be difficult, because there are no specific laboratory or imaging findings. Recognising the typical clinical picture and detailed history taking about previous drug abuse, helps to avoid further expensive and unnecessary investigations. The use of homemade manganese-contaminated ephedrone causes significant motor impairmet and decline in quality of life. Preventive measures could reduce the direct and indirect expenses on rehabilitation and social services.