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Montiel M, Fasano A. Dystonia and parkinsonism: Not an easy combo. Parkinsonism Relat Disord 2024; 123:106009. [PMID: 38233325 DOI: 10.1016/j.parkreldis.2024.106009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Marcela Montiel
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Neuroscience, Toronto, Ontario, Canada.
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2
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Atteinte neurologique définitive dans un contexte de consommation intraveineuse de méthcathinone (éphédrone). TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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3
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Habrat B, Silczuk A, Klimkiewicz A. Manganese Encephalopathy Caused by Homemade Methcathinone (Ephedrone) Prevalence in Poland. Nutrients 2021; 13:nu13103496. [PMID: 34684497 PMCID: PMC8539983 DOI: 10.3390/nu13103496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/24/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
Manganese encephalopathy is a known disorder in occupational medicine. A serious phenomenon has been the emergence of manganese encephalopathy in intravenous users of homemade methcathinone (ephedrone). A short survey was developed for clinical environments dealing with people who use psychoactive substances. The data were obtained from 72 rehabilitation therapy centers. Surveys carried out in about a third of Polish centers dealing with providing medical assistance to people addicted to substances other than alcohol and tobacco have shown that over 4% of people treated there had symptoms of manganese encephalopathy, of which more than half are people in whom the probability of a clinical diagnosis of this disorder is significant. It has been shown that knowledge of manganese encephalopathy is none or minimal in more than 70% of the surveyed institutions. An urgent need for personnel training in this field was pointed out. Attention was paid to the importance of disseminating good review articles on new and dynamically developing problem phenomena.
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Affiliation(s)
- Bogusław Habrat
- Department of Prevention and Treatment of Addictions, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland; (B.H.); (A.S.)
| | - Andrzej Silczuk
- Department of Prevention and Treatment of Addictions, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland; (B.H.); (A.S.)
- Department of Public Health, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Anna Klimkiewicz
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland
- Correspondence:
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4
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Ordak M, Sloniewicz N, Nasierowski T, Muszynska E, Bujalska-Zadrozny M. Manganese concentration in patients with encephalopathy following ephedrone use: a narrative review and analysis of case reports. Clin Toxicol (Phila) 2021; 60:10-17. [PMID: 34521308 DOI: 10.1080/15563650.2021.1973488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Numerous case reports describe manganese encephalopathy in patients using ephedrone (methcathinone). The aim of this narrative review of case reports was to relate manganese ion concentrations in peripheral blood to the reported neurological deficits. METHODS International databases, including Thomson (Web of Knowledge), PubMed/Medline, Science Direct, Scopus and Google Scholar were searched for literature items published between 2007 and 2020, in which the authors measured the manganese concentration in patients taking ephedrone. RESULTS We identified 39 patients in two case series comprising of twenty-three and twelve patients, respectively, and four case reports meeting inclusion criteria. The study showed that 93% of them had elevated blood manganese concentration in relation to the accepted norm (>219 nmol/L), and the median was 364 nmol/L. The median duration of ephedrone use in individual groups of patients was approximately 48 months, and it did not show a relationship with the manganese concentration in the blood. A greater percentage of the people with manganese concentration higher than 250 nmol/L exhibited more severe gait, speech and handwriting disorders. The median duration of ephedrone withdrawal was a month in the group of people with the highest level of manganese ions (>500 nmol/L). CONCLUSION Manganese concentrations did not vary with the duration of ephedrone use.
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Affiliation(s)
- Michal Ordak
- Department of Pharmacodynamics, Centre for Preclinical, Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
| | - Natalia Sloniewicz
- Department of Pharmacodynamics, Centre for Preclinical, Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
| | | | - Elzbieta Muszynska
- Department of Medical Biology, Medical University of Bialystok, Bialystok, Poland
| | - Magdalena Bujalska-Zadrozny
- Department of Pharmacodynamics, Centre for Preclinical, Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
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Behavioral and neurochemical studies of inherited manganese-induced dystonia-parkinsonism in Slc39a14-knockout mice. Neurobiol Dis 2021; 158:105467. [PMID: 34358615 DOI: 10.1016/j.nbd.2021.105467] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/14/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
Inherited autosomal recessive mutations of the manganese (Mn) transporter gene SLC39A14 in humans, results in elevated blood and brain Mn concentrations and childhood-onset dystonia-parkinsonism. The pathophysiology of this disease is unknown, but the nigrostriatal dopaminergic system of the basal ganglia has been implicated. Here, we describe pathophysiological studies in Slc39a14-knockout (KO) mice as a preclinical model of dystonia-parkinsonism in SLC39A14 mutation carriers. Blood and brain metal concentrations in Slc39a14-KO mice exhibited a pattern similar to the human disease with highly elevated Mn concentrations. We observed an early-onset backward-walking behavior at postnatal day (PN) 21 which was also noted in PN60 Slc39a14-KO mice as well as dystonia-like movements. Locomotor activity and motor coordination were also impaired in Slc39a14-KO relative to wildtype (WT) mice. From a neurochemical perspective, striatal dopamine (DA) and metabolite concentrations and their ratio in Slc39a14-KO mice did not differ from WT. Striatal tyrosine hydroxylase (TH) immunohistochemistry did not change in Slc39a14-KO mice relative to WT. Unbiased stereological cell quantification of TH-positive and Nissl-stained estimated neuron number, neuron density, and soma volume in the substantia nigra pars compacta (SNc) was the same in Slc39a14-KO mice as in WT. However, we measured a marked inhibition (85-90%) of potassium-stimulated DA release in the striatum of Slc39a14-KO mice relative to WT. Our findings indicate that the dystonia-parkinsonism observed in this genetic animal model of the human disease is associated with a dysfunctional but structurally intact nigrostriatal dopaminergic system. The presynaptic deficit in DA release is unlikely to explain the totality of the behavioral phenotype and points to the involvement of other neuronal systems and brain regions in the pathophysiology of the disease.
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Jîtcă G, Ősz BE, Tero-Vescan A, Vari CE. Psychoactive Drugs-From Chemical Structure to Oxidative Stress Related to Dopaminergic Neurotransmission. A Review. Antioxidants (Basel) 2021; 10:381. [PMID: 33806320 PMCID: PMC8000782 DOI: 10.3390/antiox10030381] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/26/2022] Open
Abstract
Nowadays, more and more young people want to experience illegal, psychoactive substances, without knowing the risks of exposure. Besides affecting social life, psychoactive substances also have an important effect on consumer health. We summarized and analyzed the published literature data with reference to the mechanism of free radical generation and the link between chemical structure and oxidative stress related to dopaminergic neurotransmission. This review presents data on the physicochemical properties, on the ability to cross the blood brain barrier, the chemical structure activity relationship (SAR), and possible mechanisms by which neuronal injuries occur due to oxidative stress as a result of drug abuse such as "bath salts", amphetamines, or cocaine. The mechanisms of action of ingested compounds or their metabolites involve intermediate steps in which free radicals are generated. The brain is strongly affected by the consumption of such substances, facilitating the induction of neurodegenerative diseases. It can be concluded that neurotoxicity is associated with drug abuse. Dependence and oxidative stress are linked to inhibition of neurogenesis and the onset of neuronal death. Understanding the pathological mechanisms following oxidative attack can be a starting point in the development of new therapeutic targets.
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Affiliation(s)
- George Jîtcă
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (G.J.); (C.E.V.)
| | - Bianca E. Ősz
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (G.J.); (C.E.V.)
| | - Amelia Tero-Vescan
- Department of Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania;
| | - Camil E. Vari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania; (G.J.); (C.E.V.)
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7
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Sanotsky Y, Selikhova M, Fedoryshyn L, Kuzyk P, Matviyenko Y, Semeryak O, Dziewulska D, Holton JL, Lees AJ. Neuropathological Findings in Ephedrone Encephalopathy. Mov Disord 2020; 35:1858-1863. [PMID: 32542919 DOI: 10.1002/mds.28125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A number of cases of severe parkinsonism-dystonia have been recognized and reported following the illicit use of ephedrone prepared from pseudoephedrine and potassium permanganate. The pathology associated with ephedrone neurotoxicity has not been described yet in the scientific literature. OBJECTIVES To report the first neuropathological study of ephedrone toxicity. METHODS The brain of a 33-year-old Ukrainian female ex-ephedrone addict with a long history of l-dopa-unresponsive parkinsonism with dysarthria, dystonia, profound postural instability, cock-gait, and frequent falls, and on antiretroviral treatment, was examined using routine stains and immunohistochemistry. RESULTS Neuropathological findings included diffuse pallidal astrogliosis without neuronal depletion. There was also widespread vascular pathology with small vessels occluded by foreign material, associated with giant cell response without any evidence of consequent focal infarction and a cerebellar abscess. CONCLUSIONS Clinical findings of l-dopa-unresponsive parkinsonism with dystonia, caused by illicit use of ephedrone, are fully consistent with neuropathological changes in the pallidum, lack of change in the SN, and preserved tyrosine hydroxylase activity. The findings in the basal ganglia are compatible with manganese toxicity. The vascular pathology is likely a joint effect of infection and the ephedrone toxicity on the vessels. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Yanosh Sanotsky
- Department of Neurology, Lviv Regional Clinical Hospital, Lviv, Ukraine
| | - Marianna Selikhova
- Queen Square Brain Bank, UCL Queen Square Institute of Neurology, London, United Kingdom
| | | | - Petro Kuzyk
- Department of Pathological Anatomy #2, Bogomolets National Medical University, Kyiv, Ukraine
| | - Yuriy Matviyenko
- Department of Neurology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Orest Semeryak
- Department of Neurology, Lviv Regional Clinical Hospital, Lviv, Ukraine
| | - Dorota Dziewulska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Janice L Holton
- Queen Square Brain Bank, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Andrew J Lees
- Queen Square Brain Bank, UCL Queen Square Institute of Neurology, London, United Kingdom
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8
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Balachandran RC, Mukhopadhyay S, McBride D, Veevers J, Harrison FE, Aschner M, Haynes EN, Bowman AB. Brain manganese and the balance between essential roles and neurotoxicity. J Biol Chem 2020; 295:6312-6329. [PMID: 32188696 PMCID: PMC7212623 DOI: 10.1074/jbc.rev119.009453] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Manganese (Mn) is an essential micronutrient required for the normal development of many organs, including the brain. Although its roles as a cofactor in several enzymes and in maintaining optimal physiology are well-known, the overall biological functions of Mn are rather poorly understood. Alterations in body Mn status are associated with altered neuronal physiology and cognition in humans, and either overexposure or (more rarely) insufficiency can cause neurological dysfunction. The resultant balancing act can be viewed as a hormetic U-shaped relationship for biological Mn status and optimal brain health, with changes in the brain leading to physiological effects throughout the body and vice versa. This review discusses Mn homeostasis, biomarkers, molecular mechanisms of cellular transport, and neuropathological changes associated with disruptions of Mn homeostasis, especially in its excess, and identifies gaps in our understanding of the molecular and biochemical mechanisms underlying Mn homeostasis and neurotoxicity.
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Affiliation(s)
| | - Somshuvra Mukhopadhyay
- Division of Pharmacology and Toxicology, College of Pharmacy, Institute for Cellular and Molecular Biology, and Institute for Neuroscience, University of Texas, Austin, Texas 78712
| | - Danielle McBride
- College of Medicine, University of Cincinnati, Cincinnati, Ohio 45267
| | - Jennifer Veevers
- College of Medicine, University of Cincinnati, Cincinnati, Ohio 45267
| | - Fiona E Harrison
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | | | - Erin N Haynes
- College of Public Health, University of Kentucky, Lexington, Kentucky 40536
| | - Aaron B Bowman
- School of Health Sciences, Purdue University, West Lafayette, Indiana 47907
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Ennok M, Sikk K, Haldre S, Taba P. Cognitive profile of patients with manganese-methcathinone encephalopathy. Neurotoxicology 2019; 76:138-143. [PMID: 31678058 DOI: 10.1016/j.neuro.2019.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
Manganese-methcathinone encephalopathy (MME) is a rare parkinsonian syndrome described in drug addicts who have self-injected a home-made mixture containing methcathinone and manganese. We assessed 14 patients with MME and compared their results with 14 matched control subjects. The patients had a parkinsonian syndrome with symmetrical bradykinesia, dystonias, and postural, gait and speech impairment, with moderate restrictions in activities of daily living. Their cognitive status was assessed with the Russian version of the Wechsler Adult Intelligence Scale (WAIS) and with tests of attention (Trail Making Test, Bourdon-Wiersma Dot Cancellation Test), memory (Auditory Verbal Learning Test, Rey-Osterrieth Complex Figure), motor skills (Grooved Pegboard), visuospatial skills (Money Road Map Test, Benton Judgment of Line Orientation), and executive abilities (Verbal Fluency, 5-Point Test, Wisconsin Card Sorting Test). Only a few significant differences emerged. After controlling for multiple comparisons, the results in the WAIS Object Assembly subtest, the Grooved Pegboard test (dominant and nondominant hand) and the Verbal Fluency test remained significant.
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Affiliation(s)
- Margus Ennok
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia; Neurology Clinic, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia.
| | - Katrin Sikk
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia; Department of Neurology, Internal Medicine Clinic, North Estonia Medical Centre Foundation, J. Sütiste 19, 13419 Tallinn, Estonia
| | - Sulev Haldre
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia; Neurology Clinic, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia
| | - Pille Taba
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia; Neurology Clinic, Tartu University Hospital, L. Puusepa 8, 50406 Tartu, Estonia
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Ebrahimi‐Fakhari D, Van Karnebeek C, Münchau A. Movement Disorders in Treatable Inborn Errors of Metabolism. Mov Disord 2018; 34:598-613. [DOI: 10.1002/mds.27568] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/30/2018] [Accepted: 10/25/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Darius Ebrahimi‐Fakhari
- Department of Neurology, Boston Children's HospitalHarvard Medical School Boston Massachusetts USA
| | - Clara Van Karnebeek
- Departments of Pediatrics and Clinical GeneticsAmsterdam University Medical Centres Amsterdam The Netherlands
| | - Alexander Münchau
- Department of Pediatric and Adult Movement Disorders and Neuropsychiatry, Institute of NeurogeneticsUniversity of Lübeck Lübeck Germany
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11
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Bahar E, Kim JY, Yoon H. Quercetin Attenuates Manganese-Induced Neuroinflammation by Alleviating Oxidative Stress through Regulation of Apoptosis, iNOS/NF-κB and HO-1/Nrf2 Pathways. Int J Mol Sci 2017; 18:ijms18091989. [PMID: 28914791 PMCID: PMC5618638 DOI: 10.3390/ijms18091989] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/29/2017] [Accepted: 09/13/2017] [Indexed: 12/16/2022] Open
Abstract
Manganese (Mn) is an essential trace element required for the development of human body and acts as an enzyme co-factor or activator for various reactions of metabolism. While essential in trace amounts, excessive Mn exposure can result in toxic accumulations in human brain tissue and resulting extrapyramidal symptoms called manganism similar to idiopathic Parkinson’s disease (PD). Quercetin (QCT) has been demonstrated to play an important role in altering the progression of neurodegenerative diseases by protecting against oxidative stress. This study aimed to investigate the protective effect of QCT on Mn-induced neurotoxicity and the underlying mechanism in SK-N-MC human neuroblastoma cell line and Sprague-Dawley (SD) male rat brain. The results showed that Mn treatment significantly decreased the cell viability of SK-N-MC cell and increased the release of lactate dehydrogenase (LDH), which was attenuated by QCT pretreatment at 10 and 20 µg/mL. Compared to the Mn alone group, QCT pretreatment significantly attenuated Mn-induced oxidative stress, mitochondrial dysfunction and apoptosis. Meanwhile, QCT pretreatment markedly downregulated the NF-κB but upregulated the heme oxygenase-1 (HO-1) and Nrf2 proteins, compared to the Mn alone group. Our result showed the beneficial effect of QCT on hematological parameters against Mn in rat brain. QCT decrease reactive oxygen species (ROS) and protein carbonyl levels and increased Cu/Zn-superoxide dismutase (SOD) activity induced in Mn-treated rats. QCT administration caused a significant reduction in the Mn-induced neuroinflammation by inhibiting the expression of inflammatory markers such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6) cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS). QCT lowered the Mn elevated levels of various downstream apoptotic markers, including Bax, cytochrome c, cleaved caspase-3 and polymerase-1 (PARP-1), while QCT treatment upregulated anti-apoptotic Bcl-2 proteins and prevented Mn-induced neurodegeneration. Furthermore, administration of QCT (25 and 50 mg/kg) to Mn-exposed rats showed improvement of histopathological alteration in comparison to Mn-treated rats. Moreover, administration of QCT to Mn-exposed rats showed significant reduction of 8-hydroxy-2′-deoxyguanosine (8-OHdG), Bax, activated caspase-3 and PARP-1 immunoreactivity. These results indicate that QCT could effectively inhibit Mn induced apoptosis and inflammatory response in SK-N-MC cells and SD rats, which may involve the activation of HO-1/Nrf2 and inhibition of NF-κB pathway.
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Affiliation(s)
- Entaz Bahar
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Gyeongsang National University, Jinju 52828, Gyeongnam, Korea.
| | - Ji-Ye Kim
- Department of Pathology, College of Medicine, Yonsei University, Seoul 03722, Korea.
- Department of Pathology and Translational Genomics, School of Medicine, Samsung Medical Center, Seoul 06351, Korea.
| | - Hyonok Yoon
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Gyeongsang National University, Jinju 52828, Gyeongnam, Korea.
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12
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Levin OS, Chimagomedova AS, Skripkina NA, Lyashenko EA, Babkina OV. Nonmotor Symptoms in Vascular and Other Secondary Parkinsonism. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1303-1334. [PMID: 28805574 DOI: 10.1016/bs.irn.2017.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Vascular parkinsonism (VP) is a relatively frequent variant of secondary parkinsonism caused by ischemic or hemorrhagic lesions of basal ganglia, midbrain, or their links with frontal cortex. According to different investigations, various forms of cerebrovascular disease cause 1%-15% of parkinsonism cases. Nonmotor symptoms are frequently found in VP and may negatively influence on quality of life. However, nonmotor symptoms such as hallucinations, orthostatic hypotension, REM-sleep behavior disorder, and anosmia are rarely revealed in VP, which may be noted to another diagnosis or mixed pathology. Clinical value of nonmotor symptoms in normal pressure hydrocephalus, toxic, and drug-induced parkinsonism is also discussed.
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Affiliation(s)
- Oleg S Levin
- Russian Medical Academy of Professional Continuous Education, Centre of Extrapyramidal Disorders, Moscow, Russia.
| | - Achcha Sh Chimagomedova
- Russian Medical Academy of Professional Continuous Education, Centre of Extrapyramidal Disorders, Moscow, Russia
| | - Natalia A Skripkina
- Russian Medical Academy of Professional Continuous Education, Centre of Extrapyramidal Disorders, Moscow, Russia
| | - Elena A Lyashenko
- Russian Medical Academy of Professional Continuous Education, Centre of Extrapyramidal Disorders, Moscow, Russia
| | - Olga V Babkina
- Russian Medical Academy of Professional Continuous Education, Centre of Extrapyramidal Disorders, Moscow, Russia
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13
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Yang HJ, Park SH, Seo M, Weon YC, Kim Y. 18F-FP-CIT dopamine transporter PET findings in cirrhotic patients with parkinsonism. Neurotoxicology 2017; 64:78-84. [PMID: 28259768 DOI: 10.1016/j.neuro.2017.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 02/07/2023]
Abstract
We report the clinical features and imaging findings of presynaptic dopamine transporter (DAT) positron emission tomography (PET) in four of patients with liver cirrhosis and concurrent parkinsonism. We also reviewed previously reported cases of cirrhosis-related parkinsonism using dopaminergic molecular imaging. Our results using 18F-radiolabeled N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane (FP-CIT) DAT PET in four patients with cirrhosis and parkinsonism showed two different molecular imaging patterns well related to their neurological symptoms. 18F-FP-CIT PET imaging of two patients showed normal DAT density in the striatum. Their clinical features included symmetric parkinsonism, early gait disturbances and postural instability, and the absence of resting tremor. The other two patients showed reduced striatal DAT uptake asymmetrically with a rostrocaudal gradient similar to idiopathic Parkinson's disease (IPD). They had clinical findings of hemiparkinsonism, resting tremor, without early gait disturbance or postural instability. They also showed sustained response to levodopa treatment. Based on the structured review of 21 cases with cirrhosis-related parkinsonism in the literature including the present cases, we categorized cirrhotic parkinsonism into three groups. Eleven of the twenty-one cases were categorized into group 1; levodopa-resistant atypical parkinsonism without a dopaminergic deficit in molecular imaging similar to primary manganism. Another 6 cases were categorized into group 2; coincidental IPD with superimposed cirrhosis with sustained good response to levodopa and presynaptic dopaminergic deficit with rostrocaudal gradient typical of IPD. The other undetermined 4 cases were categorized into group 3. They showed symmetric parkinsonism with variable response to levodopa therapy. Their molecular imaging showed a global diffuse dopaminergic deficit in the presynaptic molecular imaging distinct to group 1 (normal uptake) or 2 (asymmetric rostrocaudal deficit). In conclusion, cirrhosis-related parkinsonism is a heterogeneous disorder.
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Affiliation(s)
- Hui-Jun Yang
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Seol Hoon Park
- Department of Nuclear Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Minjung Seo
- Department of Nuclear Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Young Cheol Weon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Yangho Kim
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan 44033, South Korea.
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14
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Hoggard N, Roditi GH. T 1 hyperintensity on brain imaging subsequent to gadolinium-based contrast agent administration: what do we know about intracranial gadolinium deposition? Br J Radiol 2017; 90:20160590. [PMID: 27653560 PMCID: PMC5605029 DOI: 10.1259/bjr.20160590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 11/05/2022] Open
Abstract
There is growing evidence for the accumulation of gadolinium (Gd) in patients administered with intravenous Gd-based contrast agents, even in the absence of renal impairment. This review of the literature will discuss what has been found to date in cadaveric human studies, clinical studies of patients and from animal models. Evidence for the potential route of entry into the brain will be examined. The current state of knowledge of effects of Gd accumulation in the brain is discussed. We will then discuss what the possible implications may be for the choice of Gd-based contrast agents in clinical practice.
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Affiliation(s)
- Nigel Hoggard
- Academic Unit of Radiology, INSIGNEO, University of Sheffield, Sheffield, UK
| | - Giles H Roditi
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
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15
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Racette BA, Searles Nielsen S, Criswell SR, Sheppard L, Seixas N, Warden MN, Checkoway H. Dose-dependent progression of parkinsonism in manganese-exposed welders. Neurology 2016; 88:344-351. [PMID: 28031394 DOI: 10.1212/wnl.0000000000003533] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 09/12/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether the parkinsonian phenotype prevalent in welders is progressive, and whether progression is related to degree of exposure to manganese (Mn)-containing welding fume. METHODS This was a trade union-based longitudinal cohort study of 886 American welding-exposed workers with 1,492 examinations by a movement disorders specialist, including 398 workers with 606 follow-up examinations up to 9.9 years after baseline. We performed linear mixed model regression with cumulative Mn exposure as the independent variable and annual change in Unified Parkinson Disease Rating Scale motor subsection part 3 (UPDRS3) as the primary outcome, and subcategories of the UPDRS3 as secondary outcomes. The primary exposure metric was cumulative Mn exposure in mg Mn/m3-year estimated from detailed work histories. RESULTS Progression of parkinsonism increased with cumulative Mn exposure. Specifically, we observed an annual change in UPDRS3 of 0.24 (95% confidence interval 0.10-0.38) for each mg Mn/m3-year of exposure. Exposure was most strongly associated with progression of upper limb bradykinesia, upper and lower limb rigidity, and impairment of speech and facial expression. The association between welding exposure and progression appeared particularly marked in welders who did flux core arc welding in a confined space or workers whose baseline examination was within 5 years of first welding exposure. CONCLUSIONS Exposure to Mn-containing welding fume may cause a dose-dependent progression of parkinsonism, especially upper limb bradykinesia, limb rigidity, and impairment of speech and facial expression.
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Affiliation(s)
- Brad A Racette
- From the Department of Neurology (B.A.R., S.S.N., S.R.C., M.N.W.), Washington University School of Medicine, St. Louis, MO; School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa; Department of Environmental and Occupational Health Sciences (L.S., N.S.), University of Washington, Seattle; and Department of Family Medicine and Public Health (H.C.), University of California, San Diego.
| | - Susan Searles Nielsen
- From the Department of Neurology (B.A.R., S.S.N., S.R.C., M.N.W.), Washington University School of Medicine, St. Louis, MO; School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa; Department of Environmental and Occupational Health Sciences (L.S., N.S.), University of Washington, Seattle; and Department of Family Medicine and Public Health (H.C.), University of California, San Diego
| | - Susan R Criswell
- From the Department of Neurology (B.A.R., S.S.N., S.R.C., M.N.W.), Washington University School of Medicine, St. Louis, MO; School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa; Department of Environmental and Occupational Health Sciences (L.S., N.S.), University of Washington, Seattle; and Department of Family Medicine and Public Health (H.C.), University of California, San Diego
| | - Lianne Sheppard
- From the Department of Neurology (B.A.R., S.S.N., S.R.C., M.N.W.), Washington University School of Medicine, St. Louis, MO; School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa; Department of Environmental and Occupational Health Sciences (L.S., N.S.), University of Washington, Seattle; and Department of Family Medicine and Public Health (H.C.), University of California, San Diego
| | - Noah Seixas
- From the Department of Neurology (B.A.R., S.S.N., S.R.C., M.N.W.), Washington University School of Medicine, St. Louis, MO; School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa; Department of Environmental and Occupational Health Sciences (L.S., N.S.), University of Washington, Seattle; and Department of Family Medicine and Public Health (H.C.), University of California, San Diego
| | - Mark N Warden
- From the Department of Neurology (B.A.R., S.S.N., S.R.C., M.N.W.), Washington University School of Medicine, St. Louis, MO; School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa; Department of Environmental and Occupational Health Sciences (L.S., N.S.), University of Washington, Seattle; and Department of Family Medicine and Public Health (H.C.), University of California, San Diego
| | - Harvey Checkoway
- From the Department of Neurology (B.A.R., S.S.N., S.R.C., M.N.W.), Washington University School of Medicine, St. Louis, MO; School of Public Health, Faculty of Health Sciences (B.A.R.), University of the Witwatersrand, Johannesburg, South Africa; Department of Environmental and Occupational Health Sciences (L.S., N.S.), University of Washington, Seattle; and Department of Family Medicine and Public Health (H.C.), University of California, San Diego
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Juurmaa J, Menke RAL, Vila P, Müürsepp A, Tomberg T, Ilves P, Nigul M, Johansen-Berg H, Donaghy M, Stagg CJ, Stepens A, Taba P. Grey matter abnormalities in methcathinone abusers with a Parkinsonian syndrome. Brain Behav 2016; 6:e00539. [PMID: 27843694 PMCID: PMC5102639 DOI: 10.1002/brb3.539] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/29/2016] [Accepted: 07/02/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A permanent Parkinsonian syndrome occurs in intravenous abusers of the designer psychostimulant methcathinone (ephedrone). It is attributed to deposition of contaminant manganese, as reflected by characteristic globus pallidus hyperintensity on T1-weighted MRI. METHODS We have investigated brain structure and function in methcathinone abusers (n = 12) compared to matched control subjects (n = 12) using T1-weighted structural and resting-state functional MRI. RESULTS Segmentation analysis revealed significant (p < .05) subcortical grey matter atrophy in methcathinone abusers within putamen and thalamus bilaterally, and the left caudate nucleus. The volume of the caudate nuclei correlated inversely with duration of methcathinone abuse. Voxel-based morphometry showed patients to have significant grey matter loss (p < .05) bilaterally in the putamina and caudate nucleus. Surface-based analysis demonstrated nine clusters of cerebral cortical thinning in methcathinone abusers, with relative sparing of prefrontal, parieto-occipital, and temporal regions. Resting-state functional MRI analysis showed increased functional connectivity within the motor network of patients (p < .05), particularly within the right primary motor cortex. CONCLUSION Taken together, these results suggest that the manganese exposure associated with prolonged methcathinone abuse results in widespread structural and functional changes affecting both subcortical and cortical grey matter and their connections. Underlying the distinctive movement disorder caused by methcathinone abuse, there is a more widespread pattern of brain involvement than is evident from the hyperintensity restricted to the basal ganglia as shown by T1-weighted structural MRI.
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Affiliation(s)
- Julius Juurmaa
- Department of Neurology and Neurosurgery University of Tartu Tartu Estonia
| | - Ricarda A L Menke
- Nuffield Department of Clinical Neurosciences (NDCN) Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) University of Oxford Oxford UK; Department of Psychiatry University of Oxford Oxford UK
| | - Pierre Vila
- Nuffield Department of Clinical Neurosciences (NDCN) Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) University of Oxford Oxford UK
| | | | - Tiiu Tomberg
- Radiology Clinic Tartu University Hospital Tartu Estonia
| | - Pilvi Ilves
- Radiology Clinic Tartu University Hospital Tartu Estonia
| | - Mait Nigul
- Radiology Clinic Tartu University Hospital Tartu Estonia
| | - Heidi Johansen-Berg
- Nuffield Department of Clinical Neurosciences (NDCN) Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) University of Oxford Oxford UK
| | | | - Charlotte J Stagg
- Nuffield Department of Clinical Neurosciences (NDCN) Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) University of Oxford Oxford UK; Department of Psychiatry University of Oxford Oxford UK
| | - Ainārs Stepens
- Laboratory for Research in Rehabilitation Riga Stradins University Riga Latvia
| | - Pille Taba
- Department of Neurology and Neurosurgery University of Tartu Tartu Estonia
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Noyce AJ, Lees AJ, Schrag AE. The prediagnostic phase of Parkinson's disease. J Neurol Neurosurg Psychiatry 2016; 87:871-8. [PMID: 26848171 PMCID: PMC4975823 DOI: 10.1136/jnnp-2015-311890] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/11/2015] [Indexed: 12/14/2022]
Abstract
The field of prediagnostic Parkinson's disease (PD) is fast moving with an expanding range of clinical and laboratory biomarkers, and multiple strategies seeking to discover those in the earliest stages or those 'at risk'. It is widely believed that the highest likelihood of securing neuroprotective benefit from drugs will be in these subjects, preceding current point of diagnosis of PD. In this review, we outline current knowledge of the prediagnostic phase of PD, including an up-to-date review of risk factors (genetic and environmental), their relative influence, and clinical features that occur prior to diagnosis. We discuss imaging markers across a range of modalities, and the emerging literature on fluid and peripheral tissue biomarkers. We then explore current initiatives to identify individuals at risk or in the earliest stages that might be candidates for future clinical trials, what we are learning from these initiatives, and how these studies will bring the field closer to realistically commencing primary or secondary preventive trials for PD. Further progress in this field hinges on greater clinical and biological description, and understanding of the prediagnostic, peridiagnostic and immediate postdiagnostic stages of PD. Identifying subjects 3-5 years before they are currently diagnosed may be an ideal group for neuroprotective trials. At the very least, these initiatives will help clarify the stage before and around diagnosis, enabling the field to push into unchartered territory at the earliest stages of disease.
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Affiliation(s)
- Alastair John Noyce
- Department of Molecular Neuroscience, Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, London, UK
| | - Andrew John Lees
- Department of Molecular Neuroscience, Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, London, UK
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Selikhova M, Tripoliti E, Fedoryshyn L, Matvienko Y, Stanetska H, Boychuk M, Komnatska I, Lees A, Sanotsky Y. Analysis of a distinct speech disorder seen in chronic manganese toxicity following Ephedrone abuse. Clin Neurol Neurosurg 2016; 147:71-7. [DOI: 10.1016/j.clineuro.2016.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 03/11/2016] [Accepted: 05/29/2016] [Indexed: 11/17/2022]
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Guilarte TR, Gonzales KK. Manganese-Induced Parkinsonism Is Not Idiopathic Parkinson's Disease: Environmental and Genetic Evidence. Toxicol Sci 2016. [PMID: 26220508 DOI: 10.1093/toxsci/kfv099] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Movement abnormalities caused by chronic manganese (Mn) intoxication clinically resemble but are not identical to those in idiopathic Parkinson's disease. In fact, the most successful parkinsonian drug treatment, the dopamine precursor levodopa, is ineffective in alleviating Mn-induced motor symptoms, implying that parkinsonism in Mn-exposed individuals may not be linked to midbrain dopaminergic neuron cell loss. Over the last decade, supporting evidence from human and nonhuman primates has emerged that Mn-induced parkinsonism partially results from damage to basal ganglia nuclei of the striatal "direct pathway" (ie, the caudate/putamen, internal globus pallidus, and substantia nigra pars reticulata) and a marked inhibition of striatal dopamine release in the absence of nigrostriatal dopamine terminal degeneration. Recent neuroimaging studies have revealed similar findings in a particular group of young drug users intravenously injecting the Mn-containing psychostimulant ephedron and in individuals with inherited mutations of the Mn transporter gene SLC30A10. This review will provide a detailed discussion about the aforementioned studies, followed by a comparison with their rodent analogs and idiopathic parkinsonism. Together, these findings in combination with a limited knowledge about the underlying neuropathology of Mn-induced parkinsonism strongly support the need for a more complete understanding of the neurotoxic effects of Mn on basal ganglia function to uncover the appropriate cellular and molecular therapeutic targets for this disorder.
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Affiliation(s)
- Tomás R Guilarte
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York 10032
| | - Kalynda K Gonzales
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York 10032
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20
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Miranda M, Bustamante ML, Mena F, Lees A. Original footage of the Chilean miners with manganism published in Neurology in 1967. Neurology 2016; 85:2166-9. [PMID: 26668239 DOI: 10.1212/wnl.0000000000002223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Manganism has captured the imagination of neurologists for more than a century because of its similarities to Parkinson disease and its indirect but seminal role in the "l-dopa miracle." We present unpublished footage of the original case series reported in Neurology® in 1967 by Mena and Cotzias depicting the typical neurologic signs of manganism in 4 Chilean miners and their response to high doses of l-dopa.
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Affiliation(s)
- Marcelo Miranda
- From the Departments of Neurology (M.M.) and Radiology (F.M.), Clinica Las Condes; the Program of Human Genetics, Biomedical Sciences Institute, and Department of Psychiatry and Mental Health, North Division, Faculty of Medicine (M.L.B.), and Biomedical Neurosciences Institute, Faculty of Medicine (M.L.B.), Universidad de Chile, Santiago; and Reta Lila Weston Institute of Neurological Sciences (A.L.), Institute of Neurology, University College London, UK.
| | - M Leonor Bustamante
- From the Departments of Neurology (M.M.) and Radiology (F.M.), Clinica Las Condes; the Program of Human Genetics, Biomedical Sciences Institute, and Department of Psychiatry and Mental Health, North Division, Faculty of Medicine (M.L.B.), and Biomedical Neurosciences Institute, Faculty of Medicine (M.L.B.), Universidad de Chile, Santiago; and Reta Lila Weston Institute of Neurological Sciences (A.L.), Institute of Neurology, University College London, UK
| | - Francisco Mena
- From the Departments of Neurology (M.M.) and Radiology (F.M.), Clinica Las Condes; the Program of Human Genetics, Biomedical Sciences Institute, and Department of Psychiatry and Mental Health, North Division, Faculty of Medicine (M.L.B.), and Biomedical Neurosciences Institute, Faculty of Medicine (M.L.B.), Universidad de Chile, Santiago; and Reta Lila Weston Institute of Neurological Sciences (A.L.), Institute of Neurology, University College London, UK
| | - Andrew Lees
- From the Departments of Neurology (M.M.) and Radiology (F.M.), Clinica Las Condes; the Program of Human Genetics, Biomedical Sciences Institute, and Department of Psychiatry and Mental Health, North Division, Faculty of Medicine (M.L.B.), and Biomedical Neurosciences Institute, Faculty of Medicine (M.L.B.), Universidad de Chile, Santiago; and Reta Lila Weston Institute of Neurological Sciences (A.L.), Institute of Neurology, University College London, UK
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21
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Improvement in Ephedrone Parkinsonism After Global Pallidus Pars Interna Deep Brain Stimulation Implantation. Mov Disord Clin Pract 2016; 3:191-193. [DOI: 10.1002/mdc3.12248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/21/2015] [Accepted: 07/29/2015] [Indexed: 11/07/2022] Open
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22
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Lotti M, Aminoff MJ. Evaluating suspected work-related neurologic disorders (clinical diagnosis). HANDBOOK OF CLINICAL NEUROLOGY 2015; 131:9-21. [PMID: 26563780 DOI: 10.1016/b978-0-444-62627-1.00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
The clinical diagnosis of work-related neurologic disorders is essentially one of exclusion because symptoms and signs are often nonspecific. The clinical reasoning requires a three-step approach: (1) establish the characteristics of the presenting disease; (2) ascertain that observed clinical features are consistent with those caused by the suspected agent(s); and (3) assess occupational exposures. A detailed history is of paramount importance in evaluating patients with suspected work-related neurologic disorders as it is in other clinical contexts, especially because in some circumstances it may represent the only criterion to establish causality. Thus, besides characterization of neurologic symptoms, including their location, quality, timecourse, and possible other associated symptoms, the work environment of the patient should be understood in full detail. In this respect, when a neurotoxin is suspected, then the history collection can be guided by the knowledge of the likely syndromes it produces. Similarly, physical examination should be directed to the target of toxicity/entrapment based on information from the work history. Although specific sites and elements of the nervous system may be affected depending on the offending agent, most neurotoxic disorders are characterized by generalized rather than focal neurologic abnormalities. Laboratory toxicologic tests have limited application for the etiologic diagnosis of neurotoxic disorders, except in cases of acute poisoning and in patients exposed to neurotoxic chemicals with prolonged half-life. In most cases examination takes place after the end of exposure, when the offending chemical is no longer detectable in body fluids. Electrophysiologic studies, in particular evoked potentials, electromyography, and conduction velocities, are important to confirm the organic basis of symptoms, particularly to detect subclinical or early neurologic involvement and to reduce the number of disorders to be considered in the differential diagnoses. In general, imaging studies with computed tomography and magnetic resonance are of limited utility in the evaluation of suspected neurotoxic disorders, except for helping to exclude other causes of the patient's clinical state. Improved conditions and safer practices in the workplace have led to a gradual shift in application of neuropsychologic evaluation from the assessment of severe neurotoxic damage to the evaluation of mild subclinical disturbances, and these tests are nowadays extensively used in screening workers exposed to neurotoxicants. Tools used in the screening of large groups of workers exposed to neurotoxicants may differ from those used in the clinic. Whereas some are obviously impractical, such as physical examination, others, such as, for instance, toxicologic tests, are used for biologic monitoring of exposure to ascertain compliance with occupational exposure limits.
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Affiliation(s)
- Marcello Lotti
- Department of Cardiology, Thoracic and Vascular Sciences, School of Medicine, University of Padua, Padua, Italy.
| | - Michael J Aminoff
- Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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Rusz J, Hlavnička J, Čmejla R, Růžička E. Automatic Evaluation of Speech Rhythm Instability and Acceleration in Dysarthrias Associated with Basal Ganglia Dysfunction. Front Bioeng Biotechnol 2015; 3:104. [PMID: 26258122 PMCID: PMC4513571 DOI: 10.3389/fbioe.2015.00104] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/10/2015] [Indexed: 11/13/2022] Open
Abstract
Speech rhythm abnormalities are commonly present in patients with different neurodegenerative disorders. These alterations are hypothesized to be a consequence of disruption to the basal ganglia circuitry involving dysfunction of motor planning, programing, and execution, which can be detected by a syllable repetition paradigm. Therefore, the aim of the present study was to design a robust signal processing technique that allows the automatic detection of spectrally distinctive nuclei of syllable vocalizations and to determine speech features that represent rhythm instability (RI) and rhythm acceleration (RA). A further aim was to elucidate specific patterns of dysrhythmia across various neurodegenerative disorders that share disruption of basal ganglia function. Speech samples based on repetition of the syllable /pa/ at a self-determined steady pace were acquired from 109 subjects, including 22 with Parkinson's disease (PD), 11 progressive supranuclear palsy (PSP), 9 multiple system atrophy (MSA), 24 ephedrone-induced parkinsonism (EP), 20 Huntington's disease (HD), and 23 healthy controls. Subsequently, an algorithm for the automatic detection of syllables as well as features representing RI and RA were designed. The proposed detection algorithm was able to correctly identify syllables and remove erroneous detections due to excessive inspiration and non-speech sounds with a very high accuracy of 99.6%. Instability of vocal pace performance was observed in PSP, MSA, EP, and HD groups. Significantly increased pace acceleration was observed only in the PD group. Although not significant, a tendency for pace acceleration was observed also in the PSP and MSA groups. Our findings underline the crucial role of the basal ganglia in the execution and maintenance of automatic speech motor sequences. We envisage the current approach to become the first step toward the development of acoustic technologies allowing automated assessment of rhythm in dysarthrias.
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Affiliation(s)
- Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague , Prague , Czech Republic ; Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague , Prague , Czech Republic
| | - Jan Hlavnička
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague , Prague , Czech Republic
| | - Roman Čmejla
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague , Prague , Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague , Prague , Czech Republic
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Abstract
Movement disorders, classically involving dysfunction of the basal ganglia commonly occur in neurodegenerative and structural brain disorders. At times, however, movement disorders can be the initial manifestation of a systemic disease. In this article we discuss the most common movement disorders which may present in infectious, autoimmune, paraneoplastic, metabolic and endocrine diseases. Management often has to be multidisciplinary involving primary care physicians, neurologists, allied health professionals including nurses, occupational therapists and less frequently neurosurgeons. Recognizing and treating the underlying systemic disease is important in order to improve the neurological symptoms.
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Affiliation(s)
- Werner Poewe
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, Innsbruck A-6020, Austria.
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Seo YA, Wessling-Resnick M. Ferroportin deficiency impairs manganese metabolism in flatiron mice. FASEB J 2015; 29:2726-33. [PMID: 25782988 DOI: 10.1096/fj.14-262592] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/27/2015] [Indexed: 02/07/2023]
Abstract
We examined the physiologic role of ferroportin (Fpn) in manganese (Mn) export using flatiron (ffe/+) mice, a genetic model of Fpn deficiency. Blood (0.0123 vs. 0.0107 mg/kg; P = 0.0003), hepatic (1.06 vs. 0.96 mg/kg; P = 0.0125), and bile Mn levels (79 vs. 38 mg/kg; P = 0.0204) were reduced in ffe/+ mice compared to +/+ controls. Erythrocyte Mn-superoxide dismutase was also reduced at 6 (0.154 vs. 0.096, P = 0.0101), 9 (0.131 vs. 0.089, P = 0.0162), and 16 weeks of age (0.170 vs. 0.090 units/mg protein/min; P < 0.0001). (54)Mn uptake after intragastric gavage was markedly reduced in ffe/+ mice (0.0187 vs. 0.0066% dose; P = 0.0243), while clearance of injected isotope was similar in ffe/+ and +/+ mice. These values were compared to intestinal absorption of (59)Fe, which was significantly reduced in ffe/+ mice (8.751 vs. 3.978% dose; P = 0.0458). The influence of the ffe mutation was examined in dopaminergic SH-SY5Y cells and human embryonic HEK293T cells. While expression of wild-type Fpn reversed Mn-induced cytotoxicity, ffe mutant H32R failed to confer protection. These combined results demonstrate that Fpn plays a central role in Mn transport and that flatiron mice provide an excellent genetic model to explore the role of this exporter in Mn homeostasis. -
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Affiliation(s)
- Young Ah Seo
- Departments of Genetics and Complex Diseases and Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Marianne Wessling-Resnick
- Departments of Genetics and Complex Diseases and Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
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26
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Sikk K, Taba P. Methcathinone "Kitchen Chemistry" and Permanent Neurological Damage. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 120:257-71. [PMID: 26070761 DOI: 10.1016/bs.irn.2015.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Methcathinone abuse is a significant cause of parkinsonism among young patients in the Eastern European countries. The drug is synthesized from over-the-counter cold remedies containing ephedrine or pseudoephedrine. The final mixture contains a high concentration of manganese if potassium permanganate is used as the oxidant agent. Though manganese is an essential trace element and its homeostasis is well maintained, exposure to a high level of manganese is neurotoxic. The use of manganese-contaminated methcathinone may cause permanent neurological damage and severe disability. Drug users develop a distinctive extrapyramidal syndrome that resembles classic manganese intoxication. Methcathinone could have additive neurotoxic effect to the progression of parkinsonism. The most prevalent symptoms are symmetrical bradykinesia, dystonias, and early postural, gait, and speech impairment. After cessation of exposure, the syndrome is generally irreversible and can even progress.
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Affiliation(s)
- Katrin Sikk
- Department of Neurology, North-Estonian Regional Hospital, Tallinn, Estonia
| | - Pille Taba
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.
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Villalobos V, Hernández-Fonseca JP, Bonilla E, Medina-Leendertz S, Mora M, Mosquera J. Ultrastructural Changes of Caudate Nucleus in Mice Chronically Treated with Manganese. Ultrastruct Pathol 2015; 39:217-25. [PMID: 25569534 DOI: 10.3109/01913123.2014.991885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Manganese (Mn) is able to cross the blood-brain barrier and induces functional and structural alterations during the intoxication by this metal. Therefore, the effects of chronic administration of Mn in the caudate nucleus of mice were evaluated by electron microscopy. Male albino mice were injected intraperitoneally with MnCl2 (5 mg/kg/d) 5 d per week during 9 weeks. The control group received only 0.9% of NaCl solution. The caudate nuclei were extracted and subsequently processed to be observed on a conventional transmission electron microscope at 2, 4, 6, and 9 weeks after treatment. A high percentage of vacuolated and swollen mitochondria were found throughout all the analyzed periods. Myelin disarrangement and ultrastructural alterations related to edema were observed increased in Mn-treated mice at week 9. Granular degeneration of myelin at week 9 accompanied with deposition of electron dense granules in the neuropil was also observed. Edema in neuropil and glial cells was detected from week 2 to week 9 accompanied by swollen mitochondria. Neuronal bodies, synaptic terminals, and perivascular cells were found swollen. Decreased electron density in postsynaptic areas and decreased and dispersed synaptic vesicles in presynaptic areas were noted in Mn-treated animals. Some neurons from Mn-treated mice showed cisternae dilation of the Golgi apparatus. These results suggest that Mn-treatment produces structural alterations in the caudate nucleus that could be responsible for some of the neurotoxic effects of this metal.
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Affiliation(s)
- Virginia Villalobos
- Departamento de Biología, Facultad Experimental de Ciencias, Universidad del Zulia , Maracaibo , Venezuela
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Racette BA. Manganism in the 21st century: the Hanninen lecture. Neurotoxicology 2014; 45:201-7. [PMID: 24148923 PMCID: PMC3992192 DOI: 10.1016/j.neuro.2013.09.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/27/2013] [Accepted: 09/22/2013] [Indexed: 11/24/2022]
Abstract
Since the original description of the health effects of inhaled occupational manganese (Mn) by Couper in 1837, an extensive literature details the clinical syndrome and pathophysiology of what was thought to be a rare condition. In the last decade, conventional wisdom regarding the clinicopathological effects of Mn has been challenged. Past exposures to Mn were an order of magnitude higher than modern exposures in developed countries; therefore, the clinical syndrome seen in the time of Couper is no longer typical of modern Mn exposed workers. Parkinsonism (rigidity, bradykinesia, rest tremor, and postural instability) is present in 15% of Mn-exposed workers in welding industries, and these parkinsonian signs are associated with reduced health status and quality of life. These parkinsonian signs also overlap considerably with the clinical findings seen in early stages of Parkinson's disease (PD); although, molecular imaging suggests that Mn-exposed workers have dopaminergic dysfunction in a pattern unique from PD. Furthermore, geographic information system studies demonstrate that regions of the US with high industrial Mn emissions have an increased incidence of PD and increased PD associated mortality. This review will contrast historical, descriptive human studies in Mn-exposed subjects with more recent data and will suggest a research agenda for the 21st century.
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Affiliation(s)
- Brad A Racette
- Department of Neurology, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8111, St. Louis, MO 63110, USA; University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa.
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Bonnet C, Rusz J, Megrelishvili M, Sieger T, Matoušková O, Okujava M, Brožová H, Nikolai T, Hanuška J, Kapianidze M, Mikeladze N, Botchorishvili N, Khatiashvili I, Janelidze M, Serranová T, Fiala O, Roth J, Bergquist J, Jech R, Rivaud-Péchoux S, Gaymard B, Růžička E. Eye movements in ephedrone-induced parkinsonism. PLoS One 2014; 9:e104784. [PMID: 25117825 PMCID: PMC4130591 DOI: 10.1371/journal.pone.0104784] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/16/2014] [Indexed: 12/02/2022] Open
Abstract
Patients with ephedrone parkinsonism (EP) show a complex, rapidly progressive, irreversible, and levodopa non-responsive parkinsonian and dystonic syndrome due to manganese intoxication. Eye movements may help to differentiate parkinsonian syndromes providing insights into which brain networks are affected in the underlying disease, but they have never been systematically studied in EP. Horizontal and vertical eye movements were recorded in 28 EP and compared to 21 Parkinson's disease (PD) patients, and 27 age- and gender-matched healthy subjects using standardized oculomotor tasks with infrared videooculography. EP patients showed slow and hypometric horizontal saccades, an increased occurrence of square wave jerks, long latencies of vertical antisaccades, a high error rate in the horizontal antisaccade task, and made more errors than controls when pro- and antisaccades were mixed. Based on oculomotor performance, a direct differentiation between EP and PD was possible only by the velocity of horizontal saccades. All remaining metrics were similar between both patient groups. EP patients present extensive oculomotor disturbances probably due to manganese-induced damage to the basal ganglia, reflecting their role in oculomotor system.
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Affiliation(s)
- Cecilia Bonnet
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Jan Rusz
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic
| | - Marika Megrelishvili
- Department of Neurology, S. Khechinashvili University Clinic, Tbilisi, Georgia; Institute of Medical Research, Ilia State University, Tbilisi, Georgia
| | - Tomáš Sieger
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic
| | - Olga Matoušková
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic; Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | | | - Hana Brožová
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Tomáš Nikolai
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Jaromír Hanuška
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Mariam Kapianidze
- Department of Neurology, S. Khechinashvili University Clinic, Tbilisi, Georgia
| | - Nina Mikeladze
- Department of Neurology, S. Khechinashvili University Clinic, Tbilisi, Georgia
| | - Nazi Botchorishvili
- Department of Neurology, S. Khechinashvili University Clinic, Tbilisi, Georgia
| | - Irine Khatiashvili
- Department of Neurology, S. Khechinashvili University Clinic, Tbilisi, Georgia
| | - Marina Janelidze
- Department of Neurology, S. Khechinashvili University Clinic, Tbilisi, Georgia
| | - Tereza Serranová
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Ondřej Fiala
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Jan Roth
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Jonas Bergquist
- Analytical Chemistry and Neurochemistry, Department of Chemistry, Biomedical Center and SciLife Lab, Uppsala University, Uppsala, Sweden
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Sophie Rivaud-Péchoux
- CRICM UPMC/INSERM UMR_S975, CNRS UMR7225, ICM, Pitié-Salpêtrière Hospital, Paris, France; Pierre et Marie Curie Paris-6 University, Paris, France
| | - Bertrand Gaymard
- CRICM UPMC/INSERM UMR_S975, CNRS UMR7225, ICM, Pitié-Salpêtrière Hospital, Paris, France; Pierre et Marie Curie Paris-6 University, Paris, France
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
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Golasik M, Wodowski G, Gomółka E, Herman M, Piekoszewski W. Urine as a material for evaluation of exposure to manganese in methcathinone users. J Trace Elem Med Biol 2014; 28:338-43. [PMID: 24867657 DOI: 10.1016/j.jtemb.2014.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/03/2014] [Accepted: 04/25/2014] [Indexed: 11/19/2022]
Abstract
Chronic exposure even to low doses of manganese may lead to development of neurological syndrome similar to parkinsonism. The aim of this research is to assess the possibility of manganese poisoning based on the level of metal in the urine of long-term methcathinone users from Poland. Graphite furnace atomic absorption spectroscopy (GFAAS) was used to determine manganese in urine, while the detection of the psychoactive drugs was performed by high-performance liquid chromatography (HPLC). Results of survey on longitudinal patterns of drug use showed that users of traditional illicit drugs now turn to cheaper alternatives, such as methcathinone. Parkinsonian features were observed in almost half of methcathinone users. The subjects had a higher mean level of Mn in their urine (8.68±9.27 μg L(-1)) than the controls (4.27±1.91 μg L(-1)). The presence of numerous psychoactive substances (in unchanged forms and their metabolites) was confirmed in all of the samples, with only one exception. The elevated level of manganese in urine (in 29.2% of patients) can be used as a primary marker of recent methcathinone administration, especially in the case of long time intravenous drug users where blood sampling is complicated.
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Affiliation(s)
- Magdalena Golasik
- Department of Analytical Chemistry, Faculty of Chemistry, Jagiellonian University, Ingardena 3, 30-060 Krakow, Poland
| | - Grzegorz Wodowski
- Outpatients Clinic for Drug Prevention and Treatment of Addicts, Św. Katarzyny 3, 31-063 Krakow, Poland
| | - Ewa Gomółka
- Laboratory of Analytical Toxicology and Therapeutic Drug Monitoring, Faculty of Medicine Jagiellonian University, Kopernika 15b, 31-501 Krakow, Poland
| | - Małgorzata Herman
- Department of Analytical Chemistry, Faculty of Chemistry, Jagiellonian University, Ingardena 3, 30-060 Krakow, Poland
| | - Wojciech Piekoszewski
- Department of Analytical Chemistry, Faculty of Chemistry, Jagiellonian University, Ingardena 3, 30-060 Krakow, Poland; Laboratory of High Resolution Mass Spectrometry, Regional Laboratory of Physicochemical Analysis and Structural Research, Faculty of Chemistry, Jagiellonian University, Ingardena 3, 30-060 Krakow, Poland.
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Golasik M, Herman M, Piekoszewski W, Gomółka E, Wodowski G, Walas S. Trace Determination of Manganese in Urine by Graphite Furnace Atomic Absorption Spectrometry and Inductively Coupled Plasma–Mass Spectrometry. ANAL LETT 2014. [DOI: 10.1080/00032719.2014.888729] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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A distinct variant of mixed dysarthria reflects parkinsonism and dystonia due to ephedrone abuse. J Neural Transm (Vienna) 2014; 121:655-64. [PMID: 24445755 DOI: 10.1007/s00702-014-1158-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 01/09/2014] [Indexed: 01/24/2023]
Abstract
A distinctive alteration of speech has been reported in patients suffering from ephedrone-induced parkinsonism. However, an objective assessment of dysarthria has not been performed in ephedrone users. We studied 28 young Caucasian men from Georgia with a previous history of ephedrone abuse and compared them to 25 age-matched healthy controls. Speech examination, brain MRI, and NNIPPS-Parkinson plus scale were performed in all patients. The accurate differential diagnosis of dysarthria subtypes was based on the quantitative acoustic analyses of 15 speech dimensions. We revealed a distinct variant of mixed dysarthria with a combination of hyperkinetic and hypokinetic components representing the altered motor programming of dystonia and bradykinesia in ephedrone-induced parkinsonism. According to acoustic analyses, all patients presented at least one affected speech dimension, whereas dysarthria was moderate in 43% and severe in 36% of patients. Further findings indicated relationships between motor subscores of dystonia and bradykinesia and speech components of loudness (r = -0.54, p < 0.01), articulation (r = 0.40, p < 0.05), and timing (r = -0.53, p < 0.01). In ephedrone-induced parkinsonism a prominent mixed hyperkinetic-hypokinetic dysarthria occurs that appears related to marked dystonia and bradykinesia and probably reflects manganese induced toxic and neurodegenerative damage to the globus pallidus internus and substantia nigra.
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Koksal A, Keskinkilic C, Sozmen MV, Dirican AC, Aysal F, Altunkaynak Y, Baybas S. Evaluation of Cognitive Characteristics of Patients Developing Manifestations of Parkinsonism Secondary to Long-Term Ephedrone Use. Eur Neurol 2014; 71:208-12. [DOI: 10.1159/000356509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/20/2013] [Indexed: 11/19/2022]
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Brain deposition and neurotoxicity of manganese in adult mice exposed via the drinking water. Arch Toxicol 2013; 88:47-64. [PMID: 23832297 DOI: 10.1007/s00204-013-1088-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 06/20/2013] [Indexed: 12/27/2022]
Abstract
Natural leaching processes and/or anthropogenic contamination can result in ground water concentrations of the essential metal manganese (Mn) that far exceed the current regulatory standards. Neurological consequences of Mn drinking water (DW) overexposure to experimental animals, i.e., mice, including its brain deposition/distribution and behavioral effects are understudied. Adult male C57BL/6 mice were exposed to Mn via the DW for 8 weeks. After 5 weeks of Mn exposure, magnetic resonance imaging revealed significant Mn deposition in all examined brain regions; the degree of Mn deposition did not increase further a week later. Behaviorally, early hyperactivity and more time spent in the center of the arenas in an open field test, decreased forelimb grip strength and less time swimming in a forced swim test were observed after 6 weeks of Mn DW exposure. Eight-week Mn DW exposure did not alter striatal dopamine, its metabolites, or the expression of key dopamine homeostatic proteins, but it significantly increased striatal 5-hydroxyindoleacetic acid (a serotonin metabolite) levels, without affecting the levels of serotonin itself. Increased expression (mRNA) of glial fibrillary acidic protein (GFAP, an astrocyte activation marker), heme oxygenase-1 and inducible nitric oxide synthase (oxidative and nitrosative stress markers, respectively) were observed 8 weeks post-Mn DW exposure in the substantia nigra. Besides mRNA increases, GFAP protein expression was increased in the substantia nigra pars reticulata. In summary, the neurobehavioral deficits, characterized by locomotor and emotional perturbations, and nigral glial activation associated with significant brain Mn deposition are among the early signs of Mn neurotoxicity caused by DW overexposure.
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Guilarte TR. Manganese neurotoxicity: new perspectives from behavioral, neuroimaging, and neuropathological studies in humans and non-human primates. Front Aging Neurosci 2013; 5:23. [PMID: 23805100 PMCID: PMC3690350 DOI: 10.3389/fnagi.2013.00023] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/05/2013] [Indexed: 01/10/2023] Open
Abstract
Manganese (Mn) is an essential metal and has important physiological functions for human health. However, exposure to excess levels of Mn in occupational settings or from environmental sources has been associated with a neurological syndrome comprising cognitive deficits, neuropsychological abnormalities and parkinsonism. Historically, studies on the effects of Mn in humans and experimental animals have been concerned with effects on the basal ganglia and the dopaminergic system as it relates to movement abnormalities. However, emerging studies are beginning to provide significant evidence of Mn effects on cortical structures and cognitive function at lower levels than previously recognized. This review advances new knowledge of putative mechanisms by which exposure to excess levels of Mn alters neurobiological systems and produces neurological deficits not only in the basal ganglia but also in the cerebral cortex. The emerging evidence suggests that working memory is significantly affected by chronic Mn exposure and this may be mediated by alterations in brain structures associated with the working memory network including the caudate nucleus in the striatum, frontal cortex and parietal cortex. Dysregulation of the dopaminergic system may play an important role in both the movement abnormalities as well as the neuropsychiatric and cognitive function deficits that have been described in humans and non-human primates exposed to Mn.
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Affiliation(s)
- Tomás R Guilarte
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University New York, NY, USA
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Stepens A, Groma V, Skuja S, Platkājis A, Aldiņš P, Ekšteina I, Mārtiņsone I, Bricis R, Donaghy M. The outcome of the movement disorder in methcathinone abusers: clinical, MRI and manganesemia changes, and neuropathology. Eur J Neurol 2013; 21:199-205. [PMID: 23678867 DOI: 10.1111/ene.12185] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 03/25/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE There is limited knowledge regarding the long-term outcome of the methcathinone/manganese-induced movement disorder. Our purpose was to define prognosis in intravenous methcathinone abusers affected by this distinctive disorder attributed to manganese (Mn) toxicity. Also, neuropathology from a globus pallidus region biopsy from a former user is reported. METHODS Eighteen methcathinone abusers were categorized as active (five), discontinued (four) or former (nine) users. They were reassessed after a median of 32.5 months (range 3.4-59.6) clinically, on rating scales, and with MRI and blood Mn levels. The biopsy was examined ultrastructurally. RESULTS Overall the group showed a slight tendency to deterioration at follow-up on clinical assessment of motor functioning, especially the active users. No significant change occurred on parkinsonian rating scale reassessment. Significant reduction in Mn levels occurred in former users, and decreased T1-weighted hyperintensity on basal ganglia MRI occurred in 3 of 4 former and 2 of 3 discontinued users, despite lack of clinical improvement. The biopsy consisted of white matter showing decompacted myelin sheaths and frequent abnormalities of mitochondria. CONCLUSIONS No improvement in this Mn-induced movement disorder occurs after cessation of methcathinone abuse despite improvement of Mn blood levels and/or MRI abnormalities. Ultrastructural abnormalities in a former user confirm structural damage to white matter is associated with the disorder. Methcathinone/Mn toxicity is an important, disabling and permanent medical sequel of intravenous drug abuse in the former Soviet Union.
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Affiliation(s)
- A Stepens
- Laboratory for Research in Rehabilitation, Riga Stradins University, Riga, Latvia
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Djamshidian A, Sanotsky Y, Matviyenko Y, O’Sullivan SS, Sharman S, Selikhova M, Fedoryshyn L, Filts Y, Bearn J, Lees AJ, Averbeck BB. Increased reflection impulsivity in patients with ephedrone-induced Parkinsonism. Addiction 2013; 108:771-9. [PMID: 23228208 PMCID: PMC3938292 DOI: 10.1111/add.12080] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/21/2012] [Accepted: 11/29/2012] [Indexed: 01/29/2023]
Abstract
AIMS To examine a syndrome of chronic manganism that occurs in drug addicts in eastern Europe who use intravenous methcathinone (ephedrone) contaminated with potassium permanganate. In many cases the basal ganglia, especially the globus pallidus and the putamen, are damaged irreversibly. Routine neuropsychological assessment has revealed no cognitive deficits, despite widespread abnormalities on brain imaging studies and severe extrapyramidal motor handicap on clinical examination. DESIGN Case-control study. SETTING Ephedrone patients and patients with opioid dependence were recruited from Lviv, Ukraine. PARTICIPANTS We tested 15 patients with ephedrone-induced toxicity, 13 opiate-dependent patients who were receiving opioid replacement therapy and 18 matched healthy volunteers. MEASUREMENTS The 'beads task', an information-gathering task to assess reflection impulsivity, was used and feedback learning, working memory and risk-taking were also assessed. FINDINGS Opiate-dependent patients differed from controls on three of four tasks, whereas ephedrone patients differed from controls on only one task. More specifically, both patient groups were more impulsive and made more irrational choices on the beads task than controls (P < 0.001). However, ephedrone patients had no deficits in working memory (P > 0.1) or risk-taking (P > 0.1) compared with controls. Opioid-dependent patients had significantly worse working memory (P < 0.001) and were significantly more risk-prone than controls (P = 0.002). CONCLUSIONS Ephedrone patients may have similar deficits in information-gathering and decision-making to opiate-dependent patients, with preservation of working memory and risk-taking. This may reflect specific damage to anterior cingulate- basal ganglia loops.
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Affiliation(s)
- Atbin Djamshidian
- Department of Molecular Neuroscience and Reta Lila Weston
Institute for Neurological Studies, University of London, London, United
Kingdom
| | | | | | - Sean S. O’Sullivan
- Department of Molecular Neuroscience and Reta Lila Weston
Institute for Neurological Studies, University of London, London, United
Kingdom
| | - Stephen Sharman
- Department of Neuropsychiatry, Institute of Neurology, UCL,
London WC1N 3BG, United Kingdom
| | - Marianna Selikhova
- Department of Molecular Neuroscience and Reta Lila Weston
Institute for Neurological Studies, University of London, London, United
Kingdom
| | | | - Yuriy Filts
- Lviv Regional Clinical Psychiatric Hospital, Lviv,
Ukraine
| | - Jenny Bearn
- Acute Assessment Unit, Maudsley Hospital, South London and
Maudsley NHS Foundation Trust, UK
| | - Andrew J. Lees
- Department of Molecular Neuroscience and Reta Lila Weston
Institute for Neurological Studies, University of London, London, United
Kingdom
| | - Bruno B. Averbeck
- Sobell Department of Motor Neuroscience and Movement
Disorders, Institute of Neurology, UCL, London WC1N 3BG, United Kingdom
- Laboratory of Neuropsychology, National Institute of Mental
Health, National Institutes of Health, Bethesda MD, 20892-4415,USA
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Abstract
Human exposure to neurotoxic metals is a global public health problem. Metals which cause neurological toxicity, such as lead (Pb) and manganese (Mn), are of particular concern due to the long-lasting and possibly irreversible nature of their effects. Pb exposure in childhood can result in cognitive and behavioural deficits in children. These effects are long-lasting and persist into adulthood even after Pb exposure has been reduced or eliminated. While Mn is an essential element of the human diet and serves many cellular functions in the human body, elevated Mn levels can result in a Parkinson's disease (PD)-like syndrome and developmental Mn exposure can adversely affect childhood neurological development. Due to the ubiquitous presence of both metals, reducing human exposure to toxic levels of Mn and Pb remains a world-wide public health challenge. In this review we summarize the toxicokinetics of Pb and Mn, describe their neurotoxic mechanisms, and discuss common themes in their neurotoxicity.
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Affiliation(s)
| | - Tomas R Guilarte
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Sikk K, Haldre S, Aquilonius SM, Asser A, Paris M, Roose Ä, Petterson J, Eriksson SL, Bergquist J, Taba P. Manganese-induced parkinsonism in methcathinone abusers: bio-markers of exposure and follow-up. Eur J Neurol 2013; 20:915-20. [PMID: 23347399 DOI: 10.1111/ene.12088] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 11/29/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Methcathinone abuse is a new cause of manganism. The psychostimulant is prepared from pseudoephedrine using potassium permanganate as an oxidant. We describe the clinical, biological, neuroimaging characteristics and follow-up results in a large Estonian cohort of intravenous methcathinone users. METHODS During 2006-2012 we studied 38 methcathinone abusers with a mean age of 33 years. Subjects were rated by the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr (HY), and Schwab and England (SE) rating scales. Twenty-four cases were reassessed 9-70 (20 ± 15) months after the initial evaluation. Manganese (Mn) in plasma and hair was analysed by inductively coupled plasma-atom emission spectrometry. Magnetic resonance imaging (MRI) was performed in 11, and single-photon emission computed tomography (SPECT) with iodobenzamide (IBZM) in eight subjects. RESULTS The average total UPDRS score was 43 ± 21. The most severely affected domains in UPDRS Part III were speech and postural stability, the least affected domain was resting tremor. At follow-up there was worsening of HY and SE rating scales. Subjects had a higher mean level of Mn in hair (2.9 ± 3.8 ppm) than controls (0.82 ± 1.02 ppm), P = 0.02. Plasma Mn concentrations were higher (11.5 ± 6.2 ppb) in active than in former users (5.6 ± 1.8 ppb), P = 0.006. Active methcathinone users had increased MRI T1-signal intensity in the globus pallidus, substantia nigra and periaquaductal gray matter. IBZM-SPECT showed normal symmetric tracer uptake in striatum. CONCLUSION Methcathinone abusers develop a distinctive hypokinetic syndrome. Though the biomarkers of Mn exposure are characteristic only of recent abuse, the syndrome is not reversible.
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Affiliation(s)
- K Sikk
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.
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Abstract
Manganese (Mn) is an essential trace metal that is pivotal for normal cell function and metabolism. Its homeostasis is tightly regulated; however, the mechanisms of Mn homeostasis are poorly characterized. While a number of proteins such as the divalent metal transporter 1, the transferrin/transferrin receptor complex, the ZIP family metal transporters ZIP-8 and ZIP-14, the secretory pathway calcium ATPases SPCA1 and SPCA2, ATP13A2, and ferroportin have been suggested to play a role in Mn transport, the degree that each of them contributes to Mn homeostasis has still to be determined. The recent discovery of SLC30A10 as a crucial Mn transporter in humans has shed further light on our understanding of Mn transport across the cell. Although essential, Mn is toxic at high concentrations. Mn neurotoxicity has been attributed to impaired dopaminergic (DAergic), glutamatergic and GABAergic transmission, mitochondrial dysfunction, oxidative stress, and neuroinflammation. As a result of preferential accumulation of Mn in the DAergic cells of the basal ganglia, particularly the globus pallidus, Mn toxicity causes extrapyramidal motor dysfunction. Firstly described as "manganism" in miners during the nineteenth century, this movement disorder resembles Parkinson's disease characterized by hypokinesia and postural instability. To date, a variety of acquired causes of brain Mn accumulation can be distinguished from an autosomal recessively inherited disorder of Mn metabolism caused by mutations in the SLC30A10 gene. Both, acquired and inherited hypermanganesemia, lead to Mn deposition in the basal ganglia associated with pathognomonic magnetic resonance imaging appearances of hyperintense basal ganglia on T1-weighted images. Current treatment strategies for Mn toxicity combine chelation therapy to reduce the body Mn load and iron (Fe) supplementation to reduce Mn binding to proteins that interact with both Mn and Fe. This chapter summarizes our current understanding of Mn homeostasis and the mechanisms of Mn toxicity and highlights the clinical disorders associated with Mn neurotoxicity.
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Affiliation(s)
- Karin Tuschl
- Clinical and Molecular Genetics Unit, UCL Institute of Child Health, London, United Kingdom.
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Verina T, Schneider JS, Guilarte TR. Manganese exposure induces α-synuclein aggregation in the frontal cortex of non-human primates. Toxicol Lett 2012; 217:177-83. [PMID: 23262390 DOI: 10.1016/j.toxlet.2012.12.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 12/07/2012] [Accepted: 12/08/2012] [Indexed: 01/01/2023]
Abstract
Aggregation of α-synuclein (α-syn) in the brain is a defining pathological feature of neurodegenerative disorders classified as synucleinopathies. They include Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). Occupational and environmental exposure to manganese (Mn) is associated with a neurological syndrome consisting of psychiatric symptoms, cognitive impairment and parkinsonism. In this study, we examined α-syn immunoreactivity in the frontal cortex of Cynomolgus macaques as part of a multidisciplinary assessment of the neurological effects produced by exposure to moderate levels of Mn. We found increased α-syn-positive cells in the gray matter of Mn-exposed animals, typically observed in pyramidal and medium-sized neurons in deep cortical layers. Some of these neurons displayed loss of Nissl staining with α-syn-positive spherical aggregates. In the white matter we also observed α-syn-positive glial cells and in some cases α-syn-positive neurites. These findings suggest that Mn exposure promotes α-syn aggregation in neuronal and glial cells that may ultimately lead to degeneration in the frontal cortex gray and white matter. To our knowledge, this is the first report of Mn-induced neuronal and glial cell α-syn accumulation and aggregation in the frontal cortex of non-human primates.
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Affiliation(s)
- Tatyana Verina
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
Neurotoxic disease can mimic many common neurologic disease states, including parkinsonism, myelopathy, neuropathy, and encephalopathy. Accurate diagnosis and appropriate treatment may result in a favorable outcome. This review highlights 5 areas of neurotoxicology for which there is an emerging understanding of disease processes or patterns of exposure, including 3 specific metal toxicities (manganism, zinc-induced copper deficiency, and cobalt-chromium neuropathy). Toxin-induced posterior reversible encephalopathy syndrome is more widely recognized and reported in association with an ever-growing list of drugs. Two new categories of street drugs, synthetic cathinones and cannabinoids, have been identified as public health threats due to their popularity, availability, and severity of toxicity.
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Affiliation(s)
- Laura M Tormoehlen
- Neurology and Emergency Medicine (LMT), Indiana University, Indianapolis; Neurology (NK), Mayo Clinic, Rochester, MN
| | - Neeraj Kumar
- Neurology and Emergency Medicine (LMT), Indiana University, Indianapolis; Neurology (NK), Mayo Clinic, Rochester, MN
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44
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Stamelou M, Tuschl K, Chong WK, Burroughs AK, Mills PB, Bhatia KP, Clayton PT. Dystonia with brain manganese accumulation resulting from SLC30A10 mutations: a new treatable disorder. Mov Disord 2012; 27:1317-22. [PMID: 22926781 PMCID: PMC3664426 DOI: 10.1002/mds.25138] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/22/2012] [Accepted: 07/03/2012] [Indexed: 11/12/2022] Open
Abstract
Background The first gene causing early-onset generalized dystonia with brain manganese accumulation has recently been identified. Mutations in the SLC30A10 gene, encoding a manganese transporter, cause a syndrome of hepatic cirrhosis, dystonia, polycythemia, and hypermanganesemia. Methods We present 10-year longitudinal clinical features, MRI data, and treatment response to chelation therapy of the originally described patient with a proven homozygous mutation in SLC30A10. Results The patient presented with early-onset generalized dystonia and mild hyperbilirubinemia accompanied by elevated whole-blood manganese levels. T1-sequences in MRI showed hyperintensities in the basal ganglia and cerebellum, characteristic of manganese deposition. Treatment with intravenous disodium calcium edetate led to clinical improvement and reduction of hyperintensities in brain imaging. Conclusions We wish to highlight this rare disorder, which, together with Wilson's disease, is the only potentially treatable inherited metal storage disorder to date, that otherwise can be fatal as a result of complications of cirrhosis. © 2012 Movement Disorder Society
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Affiliation(s)
- Maria Stamelou
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, United Kingdom
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45
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Sikk K, Kõks S, Soomets U, Schalkwyk LC, Fernandes C, Haldre S, Aquilonius SM, Taba P. Peripheral blood RNA expression profiling in illicit methcathinone users reveals effect on immune system. Front Genet 2012; 2:42. [PMID: 22303338 PMCID: PMC3268596 DOI: 10.3389/fgene.2011.00042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 06/22/2011] [Indexed: 02/05/2023] Open
Abstract
Methcathinone (ephedrone) is relatively easily accessible for abuse. Its users develop an extrapyramidal syndrome and it is not known if this is caused by methcathinone itself, by side-ingredients (manganese), or both. In the present study we aimed to clarify molecular mechanisms underlying this condition. We used microarrays to analyze whole-genome gene expression patterns of peripheral blood from 20 methcathinone users and 20 matched controls. Gene expression profile data were analyzed by Bayesian modeling and functional annotation. Of 28,869 genes on the microarrays, 326 showed statistically significant differential expression with FDR adjusted p-values below 0.05. Quantitative real-time PCR confirmed differential expression for the most of the genes selected for validation. Functional annotation and network analysis indicated activation of a gene network that included immunological disease, cellular movement, and cardiovascular disease functions (enrichment score 42). As HIV and HCV infections were confounding factors, we performed additional stratification of subjects. A similar functional activation of the “immunological disease” category was evident when we compared subjects according to injection status (past versus current users, balanced for HIV and HCV infection). However, this difference was not large therefore the major effect was related to the HIV status of the subjects. Mn–methcathinone abusers have blood RNA expression patterns that mostly reflect their HIV and HCV infections.
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Affiliation(s)
- Katrin Sikk
- Department of Neurology and Neurosurgery, University of Tartu Tartu, Estonia
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46
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Paur R, Wallner C, Hermann P, Stöllberger C, Finsterer J. Neurological Abnormalities in Opiate Addicts with and without Substitution Therapy. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:239-45. [DOI: 10.3109/00952990.2011.644001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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47
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Abstract
Manganese-induced parkinsonism has been recognized since 1837. It has been reported primarily in miners, grinders, and smelters since that time. More recently, isolated case reports involving welders have appeared in the medical literature. Manganism can be distinguished from other forms of parkinsonism by clinical presentation with support from laboratory and radiologic findings. The controversy regarding the risk of parkinsonism in welders is reviewed.
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Affiliation(s)
- Brent Furbee
- Indiana Poison Center, Indiana University School of Medicine, B408 Methodist Hospital, Indianapolis, IN 46206, USA.
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48
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Dargan PI, Sedefov R, Gallegos A, Wood DM. The pharmacology and toxicology of the synthetic cathinone mephedrone (4-methylmethcathinone). Drug Test Anal 2011; 3:454-63. [DOI: 10.1002/dta.312] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/24/2011] [Accepted: 03/24/2011] [Indexed: 11/10/2022]
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49
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Verina T, Kiihl SF, Schneider JS, Guilarte TR. Manganese exposure induces microglia activation and dystrophy in the substantia nigra of non-human primates. Neurotoxicology 2011; 32:215-26. [PMID: 21112353 PMCID: PMC3057349 DOI: 10.1016/j.neuro.2010.11.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 11/18/2010] [Accepted: 11/19/2010] [Indexed: 11/19/2022]
Abstract
Chronic manganese (Mn) exposure produces neurological deficits including a form of parkinsonism that is different from Parkinson's disease (PD). In chronic Mn exposure, dopamine neurons in the substantia nigra (SN) do not degenerate but they appear to be dysfunctional. Further, previous studies have suggested that the substantia nigra pars reticulata (SNr) is affected by Mn. In the present study, we investigated whether chronic Mn exposure induces microglia activation in the substantia nigra pars compacta (SNc) and SNr in Cynomolgus macaques. Animals were exposed to different weekly doses of Mn (3.3-5.0, 5.0-6.7, 8.3-10 mg Mn/kg body weight) and microglia were examined in the substantia nigra using LN3 immunohistochemistry. We observed that in control animals, LN3 labeled microglia were characterized by a resting phenotype. However, in Mn-treated animals, microglia increased in number and displayed reactive changes with increasing Mn exposure. This effect was more prominent in the SNr than in the SNc. In the SNr of animals administered the highest Mn dose, microglia activation was the most advanced and included dystrophic changes. Reactive microglia expressed increased iNOS, L-ferritin, and intracellular ferric iron which were particularly prominent in dystrophic compartments. Our observations indicate that moderate Mn exposure produces structural changes on microglia, which may have significant consequences on their function.
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Affiliation(s)
- Tatyana Verina
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Samara F Kiihl
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jay S Schneider
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA
| | - Tomás R Guilarte
- Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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50
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Sikk K, Haldre S, Aquilonius SM, Taba P. Manganese-Induced Parkinsonism due to Ephedrone Abuse. PARKINSON'S DISEASE 2011; 2011:865319. [PMID: 21403909 PMCID: PMC3043321 DOI: 10.4061/2011/865319] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Accepted: 01/09/2011] [Indexed: 11/20/2022]
Abstract
During recent years, a syndrome of hypokinesia, dysarthria, dystonia, and postural impairment, related to intravenous use of a "designer" psychostimulant derived from pseudoephedrine using potassium permanganate as the oxidant, has been observed in drug addicts in several countries in Eastern Europe with some cases also in Western countries. A levodopa unresponsive Parkinsonian syndrome occurs within a few months of abusing the homemade drug mixture containing ephedrone (methcathinone) and manganese. The development of this neurological syndrome has been attributed to toxic effects of manganese, but the role of the psychostimulant ephedrone is unclear. This paper describes the clinical syndrome, results of neuroimaging, and therapeutic attempts.
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Affiliation(s)
- Katrin Sikk
- Department of Neurology and Neurosurgery, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
| | - Sulev Haldre
- Department of Neurology and Neurosurgery, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
| | - Sten-Magnus Aquilonius
- Department of Neuroscience, Neurology, Uppsala University Hospital, 75185 Uppsala, Sweden
| | - Pille Taba
- Department of Neurology and Neurosurgery, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia
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