“…Ephedron users consequentially have increased blood Mn levels due to their intravenous injection of this homemade mixture (Fudalej et al, 2013;Janocha-Litwin et al, 2014;Poniatowska et al, 2014;Selikhova et al, 2008;Sikk et al, 2010Sikk et al, , 2013Stepens et al, 2008). As observed with occupational exposures to Mn toxicity, these individuals are levodopa-resistant (Colosimo and Guidi, 2009;Fudalej et al, 2013;Janocha-Litwin et al, 2014;Poniatowska et al, 2014;Sanotsky et al, 2007;Selikhova et al, 2008;Sikk et al, 2013;Stepens et al, 2008) and displayed abnormally high Mn concentrations in T1-weighted MRI images of the globus pallidus, striatum, and midbrain (Fudalej et al, 2013;Janocha-Litwin et al, 2014;Poniatowska et al, 2014;Selikhova et al, 2008;Sikk et al, 2010Sikk et al, , 2013Stepens et al, 2008). Furthermore, SPECT neuroimaging studies revealed normal striatal DAT uptake in ephedron users despite their expression of moderate to severe parkinsonism (Colosimo and Guidi, 2009;Sanotsky et al, 2007;Selikhova et al, 2008), in contrast to that observed after methamphetamine use (Volkow et al, 2001) and in iPD (Blesa et al, 2012;Chen et al, 2008;Criswell et al, 2011;Huang, 2007;Huang et al, 2007;Pavese and Brooks, 2009;Stoessl, 2012).…”