title: Amnesic syndrome and severe ataxia following the recreational use of 3,4-methylene-dioxymethamphetamine (MDMA, 'ecstasy') and other substances.
abstract: A 26-year-old woman suffered disseminated intravascular coagulation (DIC) and a brief respiratory arrest following recreational use of 3,4-methylene-dioxymethamphetamine (MDMA; 'ecstasy'), together with amyl nitrate, lysergic acid (LSD), cannabis and alcohol. She was left with residual cognitive and physical deficits, particularly severe anterograde memory disorder, mental slowness, severe ataxia and dysarthria. Follow-up investigations have shown that these have persisted, although there has been some improvement in verbal recognition memory and in social functioning. Magnetic resonance imaging and quantified positron emission tomography investigations have revealed: (i) severe cerebellar atrophy and hypometabolism accounting for the ataxia and dysarthria; (ii) thalamic, retrosplenial and left medial temporal hypometabolism to which the anterograde amnesia can be attributed; and (iii) some degree of fronto-temporal-parietal hypometabolism, possibly accounting for the cognitive slowness. The putative relationship of these abnormalities to the direct and indirect effects of MDMA toxicity, hypoxia and ischaemia is considered.
authors.affiliation: Neuropsychiatry and Memory Disorders Clinic, University Department of Psychiatry and Psychology, King's College, St Thomas's Campus, London SE1 7EH, UK. michael.kopelman@kcl.a.cuk
authors.forename: M D
authors.initials: MD
authors.lastname: Kopelman
authors.forename: L J
authors.initials: LJ
authors.lastname: Reed
authors.forename: P
authors.initials: P
authors.lastname: Marsden
authors.forename: A R
authors.initials: AR
authors.lastname: Mayes
authors.forename: E
authors.initials: E
authors.lastname: Jaldow
authors.forename: H
authors.initials: H
authors.lastname: Laing
authors.forename: C
authors.initials: C
authors.lastname: Isaac
mesh_terms: D000328:Adult; D000647:Amnesia / Q000139:chemically induced* / Q000175:diagnosis; D001931:Brain Mapping; D002524:Cerebellar Ataxia / Q000139:chemically induced* / Q000175:diagnosis; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced / Q000175:diagnosis; D004347:Drug Interactions; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced / Q000175:diagnosis; D006801:Humans; D002534:Hypoxia, Brain / Q000139:chemically induced / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D009483:Neuropsychological Tests; D019966:Substance-Related Disorders / Q000150:complications*; D014055:Tomography, Emission-Computed
chemical_list: D018817:N-Methyl-3,4-methylenedioxyamphetamine