Objective: The aim of the study was evaluation of clinical, radiological and ENMG characteristic of ephedronic encephalopathy(EE).

Background: The ephedrone abuse is widely spread among young people in some of the eastern European countries in transition. That mixtures used to be made from medicines containing pseudoephedrine and potassium permanganate (KMnO4) to produce the oxidant reaction and get methcationine. MRI picture and the clinical syndrome caused by ephedrone injections are relatively well known. It is consisted with parkinsonism-like syndrome, dystonia, gait and postural disturbances, pseudobulbar signs, neuropsychologic disorders. It is characterized by MRI picture showing manganese deposition in basal ganglia, brainstem and cerebellar nuclei. We have observed some cases clinically and radiologically different from those relatively typical features.

Methods: MRI, ENMG investigation of patients with EE.

Results: Case reports. We observed tree patients, 25, 23 and 53 years old men. All of them injected ephedrone regularly during 1-1,5 year and subsequently developed hypophonia, propulsions, bradykinesia, dystonia and emotional incontinence. Brain MRI scan in one case was performed after more than 1 year from injection’s cessation and didn’t show any hyperintense T1 signals consistent with manganese deposition in basal ganglia. Instead, the elevated T2 signals from pyramidal tracts bilaterally were found. This 23 years old patient had widespread fasciculations, muscle atrophy and ENMG signs of spinal anterior horn damage. He died from breath insufficiency. Two other patients both had T1 hyperintensity in basal ganglia as well as T2 signal elevation from corticospinal tracts. One of them also had ENMG findings of lower motoneuron dysfunction. Neither of them had fasciculations or muscle wasting.

Conclusions: Upper and lower motor neuron damage is not typical for ephedronic encephalopathy. Nevertheless, taking the cases described above, it is possible to speculate about some cause-effect relations. That needs further investigation to rule out simple coincidence with genuine ALS development, or influence of some other toxic factors (chemicals, metals etc.).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/manganese-induced-parkinsonism-and-motor-neuron-damage-can-there-be-a-relationship/