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Grey matter abnormalities in methcathinone abusers with a Parkinsonian syndrome
Julius Juurmaa1, Ricarda A L Menke2, Pierre Vila3
1Department of Neurology and Neurosurgery University of Tartu Tartu Estonia.
Background:
A permanent Parkinsonian syndrome occurs in intravenous abusers of the designer psychostimulant methcathinone (ephedrone). It is attributed to deposition of contaminant manganese, as reflected by characteristic globus pallidus hyperintensity on T1-weighted MRI.
Methods:
We have investigated brain structure and function in methcathinone abusers (n = 12) compared to matched control subjects (n = 12) using T1-weighted structural and resting-state functional MRI.
Results:
Segmentation analysis revealed significant (p < .05) subcortical grey matter atrophy in methcathinone abusers within putamen and thalamus bilaterally, and the left caudate nucleus. The volume of the caudate nuclei correlated inversely with duration of methcathinone abuse. Voxel-based morphometry showed patients to have significant grey matter loss (p < .05) bilaterally in the putamina and caudate nucleus. Surface-based analysis demonstrated nine clusters of cerebral cortical thinning in methcathinone abusers, with relative sparing of prefrontal, parieto-occipital, and temporal regions. Resting-state functional MRI analysis showed increased functional connectivity within the motor network of patients (p < .05), particularly within the right primary motor cortex.
Conclusion:
Taken together, these results suggest that the manganese exposure associated with prolonged methcathinone abuse results in widespread structural and functional changes affecting both subcortical and cortical grey matter and their connections. Underlying the distinctive movement disorder caused by methcathinone abuse, there is a more widespread pattern of brain involvement than is evident from the hyperintensity restricted to the basal ganglia as shown by T1-weighted structural MRI.
Insights
Intravenous methcathinone (ephedrone) abuse causes Parkinsonian symptoms due to manganese exposure. Brain imaging reveals widespread grey matter loss and altered motor network connectivity in abusers.
Area of Science:
- Neuroscience
- Toxicology
- Radiology
Background:
- Intravenous abuse of methcathinone (ephedrone), a designer psychostimulant, leads to a permanent Parkinsonian syndrome.
- This condition is linked to manganese deposition, evidenced by T1-weighted MRI hyperintensity in the globus pallidus.
Purpose of the Study:
- To investigate brain structure and function in methcathinone abusers compared to controls.
- To explore the neurotoxic effects of methcathinone abuse beyond basal ganglia findings.
Main Methods:
- T1-weighted structural MRI and resting-state functional MRI were used.
- 12 methcathinone abusers and 12 matched controls were included.
- Segmentation, voxel-based morphometry, and surface-based analyses were performed.
Main Results:
- Significant subcortical grey matter atrophy (putamen, thalamus, caudate nucleus) was observed in abusers.
- Grey matter loss in the putamen and caudate nucleus correlated with abuse duration.
- Cortical thinning was noted in several regions, with relative sparing of prefrontal areas.
- Increased functional connectivity within the motor network, particularly the right primary motor cortex, was found.
Conclusions:
- Prolonged methcathinone abuse causes widespread structural and functional brain changes due to manganese exposure.
- These changes affect both subcortical and cortical grey matter and their interconnections.
- The brain involvement is more extensive than suggested by T1-weighted MRI findings alone.