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The antemortem neurobehavior in fatal paramethoxymethamphetamine usage
Wei-Hsi Chen1, Chi Chui, Hsin-Ling Yin
1Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Abstract:
Paramethoxymethamphetamine (PMMA) is an emerging and prevalent psychoactive drug with a structure analogous to amphetamine and related psychostimulants. However, the neurobehavioral effect is only studied in experimental animals and is barely mentioned in human. The authors report the antemortem neurobehavioral manifestations in 8 patients with PMMA use. There were 2 different antemortem presentations. The first group of patients showed delirium, hypertalkativity, and incoherence speech and then turned into convulsion and death. They did not exhibit the typical hyperdopaminergic movement disorder. The second group of patients gradually fell asleep and then suffered respiratory or cardiovascular collapse. The heart blood PMMA level was higher in the second group than in the first group of patients. Forensic autopsy showed variable findings, ranging from no remarkable change to significant pathological damage similar to serotonin syndrome in both groups of patients. PMMA seems to enhance serotoninergism than dopaminergism, and exerts a concentration-related dual effect on human.
Insights
Paramethoxymethamphetamine (PMMA) is a psychoactive drug causing varied human neurobehavioral effects. Higher PMMA concentrations correlate with severe outcomes, suggesting a concentration-dependent dual action.
Area of Science:
- Forensic Toxicology
- Neuropharmacology
- Clinical Toxicology
Background:
- Paramethoxymethamphetamine (PMMA) is an emerging psychoactive substance structurally related to amphetamines.
- Limited human data exists on PMMA's neurobehavioral effects, contrasting with animal studies.
Observation:
- This study details antemortem neurobehavioral manifestations in 8 patients with confirmed PMMA use.
- Two distinct clinical presentations were observed: one with delirium and convulsions, the other with sedation and collapse.
Findings:
- Patients exhibited varied presentations, from hyperactive delirium to somnolence and collapse.
- Higher PMMA blood levels were associated with the more severe, sedative presentation.
- Autopsies revealed variable findings, some consistent with serotonin syndrome, suggesting PMMA enhances serotonergic activity.
Implications:
- PMMA appears to exert a concentration-dependent dual effect on human neurobiology, primarily through serotonergic pathways.
- Understanding these distinct clinical patterns is crucial for emergency medical response and forensic investigations involving PMMA.
- Further research is needed to fully elucidate PMMA's toxicological profile and long-term effects.
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