Do you remember the case of the 'frozen addict' from recreational drug use (MPTP). Is there a 'new frozen addict syndrome' caused by methcathione (ephedrone). YES. This psychostimulant leads to release of brain catecholamines. Check out this case and video by Thayler and Gurevitch which responded to amantadine and check out the link to manganese. Key points: - Methcathione (ephedrone) can be used as a recreational drug and use has been documented in Eastern Europe and other world locations. - This chemical is synthesized by oxidation of ephedrine or pseudoephedrine w/potassium permanganate. - It is usually given IV and the 'parkinsonism' is thought to be caused by manganese. - It is unlike the MPTP frozen addict as in this case levodopa does not work to treat. - The authors point out that the syndrome tends to be more symmetrical than in idiopathic PD; the clinician should look for bradykinesia, dystonia, and gait impairment. - Check out this 41 year old case w/ a normal flurodopa PET and an abnormal MRI. - He was treated with a 5-day course of IV amantadine followed by oral amantadine. My take: It is humbling to think about the history of a recreational drug which provided one of our best overall animal models of PD (the MPTP model). Now we are observing another form of recreational drug induced parkinsonism, and this one seems to be related to manganese. It is interesting in this case to observe the response to IV and oral amantadine; which as a therapy has multiple mechanisms of action including on dopamine, acetlycholine and glutamate pathways. In the USA, we have not used IV amantadine so this will be a new trick for us. One important aspect of this case was that the clinicians resisted the urge to 'dismiss the person' as an addict or as functional case. Similar to Bill Langston's experience with the MPTP frozen addict, these authors persisted, made the diagnosis and designed and implemented a treatment. BRAVO. Remember, we will all (one day) come down with a disease or diseases and Fortuna est caeca; Fortune is blind. movementdisorders.onlinelibr… jamanetwork.com/journals/jam… #Parkinsons #manganese #methcathione #ephedrone