SUSPECTED MPTP-INDUCED PARKINSONISM

The case of an intravenous heroin user who developed parkinsonian symp toms from the age of 28 years is presented, Neuropathologic examinatio n revealed a marked loss of neurons and gliosis with the presence of L ewy bodies in the substantia nigra and locus ceruleus; they stained va riably with antibody to ubiquitin and negatively with antibodies to ta u and neurofibrillary tangles, Pseudo-Lewy bodies were also seen, Elec tron microscopy showed features in keeping with other electron microsc opic studies of Lewy bodies in idiopathic Parkinson's disease and 1-me thyl-4-phenyl-1-,2,3,6-tetrahydropyridine (MPTP)-induced inclusion bod ies in monkeys, Given that the deceased was a known heroin user, the r arity of the early age of onset, that MPTP is a recognized cause of pa rkinsonism in the drug abusing population, the absence of history of e xposure to neuroleptics and the neuropathologic features, the parkinso nism was considered to be due to MPTP contamination of heroin, However , given the onset of parkinsonism 11 years prior to death it was not p ossible to obtain samples of the heroin injected to test for the prese nce of MPTP. Therefore it could not be absolutely excluded that this w as a case of idiopathic Parkinson's disease occurring at a very young age in a heroin abuser, The immunohistochemical and electron microscop ic features of Lewy bodies in such a case have not been previously des cribed, The similarity of the neuropathological features to these of i diopathic Parkinson's disease and MPTP-induced parkinsonism further st rengthens the hypothesis of MPTP or an MPTP-like agent being a cause o f idiopathic Parkinson's disease. (C) Pearson Professional Ltd 1997.