A Parkinsonian Syndrome in Methcathinone Users and the Role of Manganese

In this case series of 23 adults in Latvia who were injection users of methcathinone (a drug manufactured by users from readily available pharmaceutical agents such as pseudoephedrine), patients had an extrapyramidal syndrome, elevated serum manganese levels, and MRI abnormalities in the basal ganglia. These findings suggest that methcathinone use can result in neurologic toxic effects from manganese contained in the methcathinone solution. In this case series of 23 adults in Latvia who were injection users of methcathinone, patients had an extrapyramidal syndrome, elevated serum manganese levels, and MRI abnormalities in the basal ganglia. A parkinsonian syndrome has been noted in methcathinone users in Russia 1 and in the Baltic states. Methcathinone is a stimulant with euphoric effects, known in Russia as ephedrone and by the street names cat, mul'ka , and jeff . Cathinone, originally derived from the plant khat ( Catha edulis ), has long been used as a psychostimulant; it is known to cause psychoses but not parkinsonism. 2 , 3 Methcathinone is manufactured by oxidation of the ephedrine and pseudoephedrine contained in various readily available pharmaceutical agents. 3 , 4 This oxidation process is often performed under home conditions. In Russia and Eastern Europe, an . . .