title: Methoxetamine associated reversible cerebellar toxicity: three cases with analytical confirmation.
abstract: BACKGROUND
  There have been recent concerns about increasing use and accessibility of methoxetamine, a ketamine derivative. Few data are available to describe the clinical features associated with methoxetamine exposure. We report three cases that presented to hospital with acute neurological toxicity associated with analytically confirmed methoxetamine exposure.
  
  
  METHODS
  A 19-year-old male presented with severe truncal ataxia, nystagmus, incoordination and reduced conscious level several hours after nasal insufflation of what was initially thought to be ketamine. Features of cerebellar toxicity persisted for 3-4 days before gradual recovery. Two more patients aged 17 and 18 years presented with severe cerebellar ataxia, imbalance and reduced conscious level 40 minutes after nasal insufflation of methoxetamine (MXE). Both had slurred speech, incoordination and cerebellar ataxia that resolved within 24 hours. Serum methoxetamine concentrations were 0.24 mg/L, 0.45 mg/L and 0.16 mg/L, respectively, and no other drugs were identified on an extended toxicological screen.
  
  
  CONCLUSIONS
  Methoxetamine may cause rapid onset of neurological impairment, characterised by acute cerebellar toxicity. Spontaneous recovery was observed, but the duration of recovery may extend to several days. Presentation with an acute cerebellar toxidrome should alert clinicians to the possibility of methoxetamine exposure.
authors.affiliation: Acute Medical Unit, York Teaching Hospital NHS Foundation Trust, York, UK.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Shields
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
authors.forename: David M
authors.initials: DM
authors.lastname: Wood
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Puchnarewicz
authors.forename: Susannah
authors.initials: S
authors.lastname: Davies
authors.forename: W Stephen
authors.initials: WS
authors.lastname: Waring
mesh_terms: D000293:Adolescent; D002524:Cerebellar Ataxia / Q000139:chemically induced*; D003244:Consciousness Disorders / Q000139:chemically induced; D003512:Cyclohexanones / Q000493:pharmacokinetics / Q000506:poisoning*; D003514:Cyclohexylamines / Q000493:pharmacokinetics / Q000506:poisoning*; D006801:Humans; D013287:Illicit Drugs / Q000493:pharmacokinetics / Q000506:poisoning*; D008297:Male; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D004856:Postural Balance / Q000187:drug effects; D013064:Speech Disorders / Q000139:chemically induced; D055815:Young Adult
chemical_list: D003512:Cyclohexanones; D003514:Cyclohexylamines; D013287:Illicit Drugs; C569113:2-(3-methoxyphenyl)-2-(ethylamino)cyclohexanone