[An epidemiological study of spongiform leucoencephalopathy among heorin abusers]

To understand the distribution and related risk factors of heroin spongiform leucoencephalopathy among drug users in coastland of Guangdong Province.

A cross-sectional study was conducted in four thousand four hundred and twenty eight drug users from eighteen detoxification organizations in six cities on coastland of Guangdong, using clustered random sampling methods. The six cities are Chaoyang (714), Heyuan (462), Shantou (572), Huidong (1286), Guangzhou (871) and Zhanjiang (523) and heroin abuse was considered serious in these cities. Questionnaire was used to collect the data on sex (man 3632, 82 percent; woman 795, 18 percent), age (minimum 15y, maximum 54y), duration of using heroin (minimum 1 month, maximum 150 months), daily dosage (minimum 0.02 g, maximum 6.0 g) and manner of using heroin. In addition, the neurological examination was taken in all of them and cerebral MRI was carried out in those with signs of cerebellar ataxia.

Results showed that the total incidence of heroin spongiform leucoencephalopathy in six cities is 3.16 per thousand. Poisson regression analysis showed that the incidence was related to residential areas. In comparison with other cities, there are higher incidences in Chaoyang and Heyuan. Our investigation also showed that all the patients with this disease used heroin by inhaling the pyrolysate. The incidence of heroin spongiform leucoencephalopathy was unrelated to the daily inhaling amount of heroin and the duration of inhaling heroin. No differences could be observed between the groups of different age and sex.

Spongiform leucoencephalopathy after inhalation of heroin is a rare complication and has never been reported in mainland of China before. The lesions are symmetrical and spongiform, but not necrotic and the cerebellum is invariably involved--a feature consistent with the clinical presentation that begins with ataxia. Cerebral CT showed symmetrical non-enhancing hypodense areas in both cerebellar hemispheres. Cerebral MRI showed the corresponding areas with decreased signal intensity on T1 weighted images and increased signal intensity on T2 weighted images. There was no contrast enhancement. When it occurs, several cases are affected as a small epidemic. It is suggested that the aetiology is related to the heroin batch and could perhaps be a toxic effect of a substance which came from heroin pyrolysis.