Correspondence

MDMA and Parkinsonism

N Engl J Med 2003; 349:96-97July 3, 2003

Article

To the Editor:

Recreational use of 3,4-methylenedioxymethamphetamine (MDMA), or “ecstasy,” has been increasing. MDMA has classically been associated with serotonergic neurotoxicity in humans and in animal models. Recent investigations in nonhuman primates, at doses modeled after those used by humans, revealed severe dopaminergic neurotoxicity with less serotonergic neurotoxicity.1 We report a case of juvenile Parkinson's disease after repeated use of MDMA.

A 19-year-old man was observed to have a resting tremor in his right hand on going to sleep and waking from a nap in March 2002. The tremor progressed to affect the right leg. Magnetic resonance imaging of the head was normal. He was given a diagnosis of Parkinson's disease, and selegiline was prescribed, but since his symptoms did not improve, he discontinued treatment. Trihexyphenidyl was then prescribed; it reduced his tremor, but because of nausea the patient takes it only once a week. Within the past four months, he has reported progressive difficulty in rising from bed. In the morning, he says, his “muscles don't want to move.” He has also noticed that his typing proficiency has deteriorated.

The patient's father, who is 62 years old, has a 13-year history of rest tremor that was diagnosed as Parkinson's disease 10 years ago. The Parkinson's symptoms have improved with levodopa–carbidopa, but he has motor fluctuations. The father's half brother, who is 55 years old, also has Parkinson's disease and has had symptoms including bradykinesia and asymmetric rest tremor for four to five years. There is no other family history of Parkinson's disease or other movement disorders.

The patient had ingested MDMA twice a month for six months before the onset of symptoms of Parkinson's disease. His last ingestion was in January 2002. He had trismus, diaphoresis, and a sense of euphoria after taking MDMA. He said he did not use other illicit drugs. He drinks six or seven beers per week and has a smoking history of one to two pack-years. There is no history of use of neuroleptic drugs.

There has been controversy surrounding the case of MDMA-induced parkinsonism that was reported in 1999.2-5 In the case we report here, juvenile Parkinson's disease occurred in a man with a family history of Parkinson's disease. Ricaurte et al.1 have speculated that cases of MDMA-induced parkinsonism are not commonly reported because Parkinson's disease is not clinically apparent until 70 to 80 percent of striatal–nigral dopamine is depleted. This patient may have had a genetic predisposition to Parkinson's disease, and symptoms may have developed earlier than they otherwise would have because of this environmental insult to his dopaminergic system.

Sandra M. Kuniyoshi, M.D., Ph.D.
Joseph Jankovic, M.D.
Baylor College of Medicine, Houston, TX 77030
sandrak@bcm.tmc.edu

5 References

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Citing Articles (9)

Citing Articles

1. 1

   Yen F Tai, Rosa Hoshi, Catherine M Brignell, Lisa Cohen, David J Brooks, H Valerie Curran, Paola Piccini. (2011) Persistent Nigrostriatal Dopaminergic Abnormalities in Ex-Users of MDMA (‘Ecstasy’): An 18F-Dopa PET Study. Neuropsychopharmacology 36:4, 735-743
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2. 2

   John C.M. Brust. (2010) Substance abuse and movement disorders. Movement Disorders 25:13, 2010-2020
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3. 3

   John C.M. Brust. 2007. Amphétamine et autres psychostimulants. , 129-170.
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4. 4

   Ryan M. Smith, Madalina Tivarus, Heather L. Campbell, Ashleigh Hillier, David Q. Beversdorf. (2006) Apparent Transient Effects of Recent ???Ecstasy??? Use on Cognitive Performance and Extrapyramidal Signs in Human Subjects. Cognitive and Behavioral Neurology 19:3, 157-164
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5. 5

   Brian J. Dew, Kirk W. Elifson, Claire E. Sterk. (2006) Treatment Implications for Young Adult Users of MDMA. Journal of Addictions & Offender Counseling 26:2, 84-98
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6. 6

   Maartje M.L. De Win, Gerry Jager, Hylke K.E. Vervaeke, Thelma Schilt, Liesbeth Reneman, Jan Booij, Frank C. Verhulst, Gerard J. Den Heeten, Nick F. Ramsey, Dirk J. Korf, Wim Van Den Brink. (2005) The Netherlands XTC Toxicity (NeXT) study: objectives and methods of a study investigating causality, course, and clinical relevance. International Journal of Methods in Psychiatric Research 14:4, 167-185
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7. 7

   Lisa Jerome, Rick Doblin, Michael Mithoefer. (2004) Ecstasy use-Parkinson's disease link tenuous. Movement Disorders 19:11, 1386-1386
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8. 8

   M. Isabel Colado, Esther O’Shea, A. Richard Green. (2004) Acute and long-term effects of MDMA on cerebral dopamine biochemistry and function. Psychopharmacology 173:3-4, 249-263
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9. 9

   Stephen J. Kish. (2003) What is the evidence that Ecstasy (MDMA) can cause Parkinson's disease?. Movement Disorders 18:11, 1219-1223
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