Irreversible motor impairment in young addicts - ephedrone, manganism or both?

Background - Parkinsonian syndrome related to intravenous. 'designer' psycho stimulant, derived from pseudoephedrine using; potassium permanganate as the oxidant, has been observed in drug addicts in Estonia. Objective - To describe the symptomatology of four young patients, history of drug administration and chemical analysis of a drug batch. Methods - 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. Results - 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. Conclusions - 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.