title: Clinical, neuroimaging and neurophysiological features in addicts with manganese-ephedrone exposure.
abstract: OBJECTIVE
  To identify biomarkers supporting the clinical diagnosis of manganism in patients several years after exposure to manganese (Mn).
  
  
  METHODS
  Neurophysiological examinations, magnetic resonance imaging (MRI), single-photon emission computed tomography and fluorodeoxyglycose (FDG) positron emission tomography were performed in four former ephedrone addicts with extrapyramidal symptoms.
  
  
  RESULTS
  Peripheral nervous system was not affected. No patients had reduced uptake of (123)I Ioflupane in the striatum. MRI signal intensities were slightly changed in the basal ganglia. All patients showed a widespread, but not uniform, pathological pattern of FDG uptake with changes mainly located to the central part of the brain including the basal ganglia and the surrounding white matter.
  
  
  CONCLUSIONS
  Presynaptic neurons in the nigrostriatal pathway are intact in Mn-induced parkinsonism after prolonged abstinence from ephedrone. The diagnosis is principally based on clinical signs and the history of drug abuse.
authors.affiliation: Department of Neurology and Neurosurgery, University of Tartu, Estonia. katrin.sikk@regionaalhaigla.ee <katrin.sikk@regionaalhaigla.ee>
authors.forename: K
authors.initials: K
authors.lastname: Sikk
authors.forename: P
authors.initials: P
authors.lastname: Taba
authors.forename: S
authors.initials: S
authors.lastname: Haldre
authors.forename: J
authors.initials: J
authors.lastname: Bergquist
authors.forename: D
authors.initials: D
authors.lastname: Nyholm
authors.forename: H
authors.initials: H
authors.lastname: Askmark
authors.forename: T
authors.initials: T
authors.lastname: Danfors
authors.forename: J
authors.initials: J
authors.lastname: Sörensen
authors.forename: L
authors.initials: L
authors.lastname: Thurfjell
authors.forename: R
authors.initials: R
authors.lastname: Raininko
authors.forename: R
authors.initials: R
authors.lastname: Eriksson
authors.forename: R
authors.initials: R
authors.lastname: Flink
authors.forename: C
authors.initials: C
authors.lastname: Färnstrand
authors.forename: S-M
authors.initials: SM
authors.lastname: Aquilonius
mesh_terms: D000328:Adult; D001480:Basal Ganglia Diseases / Q000139:chemically induced / Q000378:metabolism / Q000503:physiopathology; D003342:Corpus Striatum / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008345:Manganese / Q000009:adverse effects*; D020149:Manganese Poisoning / Q000175:diagnosis*; D009434:Neural Pathways / Q000503:physiopathology; D020734:Parkinsonian Disorders / Q000139:chemically induced*; D017933:Peripheral Nervous System / Q000378:metabolism / Q000503:physiopathology; D049268:Positron-Emission Tomography; D011427:Propiophenones / Q000009:adverse effects*; D019966:Substance-Related Disorders; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D011427:Propiophenones; C047806:monomethylpropion; D008345:Manganese