{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:58:44Z","timestamp":1784829524168,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,1,24]],"date-time":"2013-01-24T00:00:00Z","timestamp":1358985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2013,6]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Methcathinone abuse is a new cause of manganism. The psychostimulant is prepared from pseudoephedrine using potassium permanganate as an oxidant. We describe the clinical, biological, neuroimaging characteristics and follow\u2010up results in a large <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>stonian cohort of intravenous methcathinone users.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>During 2006\u20132012 we studied 38 methcathinone abusers with a mean age of 33\u2005years. Subjects were rated by the <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>nified <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>arkinson's <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>isease <jats:styled-content style=\"fixed-case\">R<\/jats:styled-content>ating <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>cale (<jats:styled-content style=\"fixed-case\">UPDRS<\/jats:styled-content>), <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>oehn and <jats:styled-content style=\"fixed-case\">Y<\/jats:styled-content>ahr (<jats:styled-content style=\"fixed-case\">HY<\/jats:styled-content>), and <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>chwab and <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>ngland (<jats:styled-content style=\"fixed-case\">SE<\/jats:styled-content>) rating scales. Twenty\u2010four cases were reassessed 9\u201370 (20\u2005\u00b1\u200515)\u2005months after the initial evaluation. Manganese (<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>n) in plasma and hair was analysed by <jats:styled-content style=\"fixed-case\">i<\/jats:styled-content>nductively <jats:styled-content style=\"fixed-case\">c<\/jats:styled-content>oupled <jats:styled-content style=\"fixed-case\">p<\/jats:styled-content>lasma\u2010<jats:styled-content style=\"fixed-case\">a<\/jats:styled-content>tom <jats:styled-content style=\"fixed-case\">e<\/jats:styled-content>mission <jats:styled-content style=\"fixed-case\">s<\/jats:styled-content>pectrometry. Magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>) was performed in 11, and single\u2010photon emission computed tomography (<jats:styled-content style=\"fixed-case\">SPECT<\/jats:styled-content>) with iodobenzamide (<jats:styled-content style=\"fixed-case\">IBZM<\/jats:styled-content>) in eight subjects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average total <jats:styled-content style=\"fixed-case\">UPDRS<\/jats:styled-content> score was 43\u2005\u00b1\u200521. The most severely affected domains in <jats:styled-content style=\"fixed-case\">UPDRS<\/jats:styled-content> Part <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> were speech and postural stability, the least affected domain was resting tremor. At follow\u2010up there was worsening of <jats:styled-content style=\"fixed-case\">HY<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">SE<\/jats:styled-content> rating scales. Subjects had a higher mean level of <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>n in hair (2.9\u2005\u00b1\u20053.8\u2005ppm) than controls (0.82\u2005\u00b1\u20051.02\u2005ppm), <jats:italic>P\u2005<\/jats:italic>=\u20050.02. Plasma <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>n concentrations were higher (11.5\u2005\u00b1\u20056.2\u2005ppb) in active than in former users (5.6\u2005\u00b1\u20051.8\u2005ppb), <jats:italic>P\u2005<\/jats:italic>=\u20050.006. Active methcathinone users had increased <jats:styled-content style=\"fixed-case\">MRI T<\/jats:styled-content>1\u2010signal intensity in the globus pallidus, substantia nigra and periaquaductal gray matter. <jats:styled-content style=\"fixed-case\">IBZM<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">SPECT<\/jats:styled-content> showed normal symmetric tracer uptake in striatum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Methcathinone abusers develop a distinctive hypokinetic syndrome. Though the biomarkers of <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>n exposure are characteristic only of recent abuse, the syndrome is not reversible.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.12088","type":"journal-article","created":{"date-parts":[[2013,1,24]],"date-time":"2013-01-24T18:32:03Z","timestamp":1359052323000},"page":"915-920","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Manganese\u2010induced parkinsonism in methcathinone abusers: bio\u2010markers of exposure and follow\u2010up"],"prefix":"10.1111","volume":"20","author":[{"given":"K.","family":"Sikk","sequence":"first","affiliation":[{"name":"Department of Neurology and Neurosurgery University of Tartu Tartu Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Haldre","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery University of Tartu Tartu 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