Early onset Parkinson’s disease in the cycle of 3,4-methylenedioxymethamphetamine and substance use: a case report

BACKGROUND: Current evidence linking the development of Parkinson’s disease after the use of 3,4-methylenedioxymethamphetamine is mixed and limited, with only a few positive case reports demonstrating this. CASE PRESENTATION: We examine this interesting case of a 49-year-old Chinese gentleman who used 3,4-methylenedioxymethamphetamine and subsequently developed early onset Parkinson’s disease at age 38 years. He had a family history of Parkinson’s disease, though the onset of his symptoms was significantly earlier than those of his family members. MDMA was a likely precipitating factor for the early onset of his symptoms. He then conversely used methamphetamines to augment his treatment of Parkinson’s symptoms. In the treatment of his Parkinson’s disease, dopamine replacement therapy and deep brain stimulation could perpetuate addictive behaviors such as dopamine dysregulation syndrome, and similarly perpetuate substance use in vulnerable individuals. He had also been diagnosed with a human immunodeficiency virus infection at age 43, and his antiretroviral therapy contributed to depressive symptoms, which then complicated the management of his substance use. We examined the importance of managing his subsequent psychiatric and medical comorbidities to prevent their debilitating psychosocial impacts. CONCLUSIONS: This case implies that 3,4-methylenedioxymethamphetamine use may precipitate the early development of Parkinson’s disease in patients with genetic vulnerability. This highlights the risk in patients potentially paradoxically using substances to alleviate symptoms of Parkinson’s, which can in turn perpetuate the disease process.