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Rob M. A. de Bie, MD, PhD; Richard M. Gladstone, MD; Antonio P. Strafella, MD, PhD; Ji-Hyun Ko, MSc; Anthony E. Lang, MD

Arch Neurol. 2007;64(6):886-889.

Background  Manganese intoxication may lead to a levodopa-resistant, akinetic-rigid syndrome. A new form of presumed manganese poisoning has been reported in drug-addicted persons from Russia, Ukraine, and Estonia who have intravenously injected self-prepared methcathinone hydrochloride (Ephedrone).

Patient  A 36-year-old man from Azerbaijan with hepatitis C and only modest hepatic synthetic dysfunction developed rapid-onset, levodopa-resistant parkinsonism with profound hypophonia.

Conclusion  Ephedronic encephalopathy outside the region of the former Soviet Union may become a more widespread public health problem as a result of global travel and the easy availability of the recipe for synthesis of methcathinone on the Internet.

Author Affiliations: Movement Disorders Center, Division of Neurology (Drs de Bie, Strafella, and Lang), PET Imaging Centre, Center of Addiction Mental Health (Dr Strafella), University of Toronto, Toronto, Ontario; Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands (Dr de Bie); and Montreal Neurological Institute, Brain Imaging Centre, McGill University, Montreal, Quebec (Mr Ko). Dr Gladstone is in private practice in Willowdale, Ontario.