MDMA ("Ecstasy") and its association with cerebrovascular accidents: Preliminary findings

BACKGROUND AND PURPOSE: Abuse of the popular recreational drug "Ecstasy" (M DMA) has been linked to the occurrence of cerebrovascular accidents, It is known that MDMA alters brain serotonin (5-HT) concentrations and that brain postsynaptic 5-HT2 receptors play a role in the regulation of brain microv asculature. Therefore, we used brain imaging to find out whether MDMA use p redisposes one to cerebrovascular accidents by altering brain 5-HT neurotra nsmission. METHODS: The effects of MDMA use on brain cortical 5-HT2A receptor densitie s were studied using [I-123]R91150 single-photon emission CT in 10 abstinen t recent MDMA users, five former MDMA users, and 10 healthy control subject s. Furthermore, to examine whether changes in brain 5-HT2A receptor densiti es are associated with alterations in blood vessel volumes, we calculated r elative cerebral blood volume maps from dynamic MR imaging sets in five MDM A users and six healthy control subjects. RESULTS: An analysis of variance revealed that mean cortical [I-123]R91150 binding ratios were significantly lower in recent MDMA users than in former MDMA users and control subjects. This finding suggests down-regulation of 5-HT2 receptors caused by MDMA-induced 5-HT release, Furthermore, in MDMA u sers, low cortical 5-HT2 receptor densities were significantly associated w ith low cerebral blood vessel volumes (implicating vasoconstriction) and hi gh cortical 5-HT2 receptor densities with high cerebral blood vessel volume s (implicating vasodilatation) in specific brain regions. CONCLUSION: These findings suggest a relationship between the serotonergic system and an altered regulation of 5-HT2 receptors in human MDMA users, MD MA users may therefore be at risk for cerebrovascular accidents resulting f rom alterations in the 5-HT neurotransmission system.