Burst spinal artery aneurysm linked to Ecstasy use

Taking the street drug Ecstasy could lead to a potentially fatal weakening and rupture of the spinal cord artery, doctors have warned in the Journal of NeuroInterventional Surgery.

Posterior spinal artery aneurysms - a blood-filled swelling of the spinal cord artery, caused by a weakening and distension of the vessel wall - are rare, with only 12 cases reported to date. But all of them caused spinal bleeding which affected the function of the spinal cord.

Doctors discovered one of these aneurysms in a previously healthy teenager who had taken Ecstasy or MDMA.

The morning after the night before, he woke up with headache, neck pain and muscle spasms. After a week these symptoms suddenly took a turn for the worse, accompanied by nausea, prompting him to seek help at his local emergency department.

A week later the teen was transferred to a specialist neurosurgical unit for further investigations, which revealed an aneurysm, measuring 2 x 1 mm, on the left side of the spinal cord artery at the back of his neck.

The aneurysm was successfully removed, along with the weakened portion of the artery. The teen made a full recovery, with no lasting nerve damage.

But the authors reiterate that Ecstasy use has already been linked to severe systemic and neurological complications, including stroke, inflammation of the arteries in the brain (vasculitis) and internal brain bleeds.

And now, posterior spinal artery aneurysm can be added to the list, they say.

The drug acts on the sympathetic nervous system, sparking a sudden hike in blood pressure, as a result of the surge in serotonin it releases. And this could make any pre-existing aneurysms or other arterial abnormalities prone to rupture, they warn.

Study reveals how ecstasy acts on the brain and hints at therapeutic uses

Brain imaging experiments have revealed for the first time how ecstasy produces feelings of euphoria in users.

Results of the study at Imperial College London, parts of which were televised in Drugs Live on Channel 4 in 2012, have now been published in the journal Biological Psychiatry.

The findings hint at ways that ecstasy, or MDMA, might be useful in the treatment of anxiety and post-traumatic stress disorder (PTSD).

MDMA has been a popular recreational drug since the 1980s, but there has been little research on which areas of the brain it affects. The new study is the first to use functional magnetic resonance imaging (fMRI) on resting subjects under its influence.

Twenty-five volunteers underwent brain scans on two occasions, one after taking the drug and one after taking a placebo, without knowing which they had been given.

The results show that MDMA decreases activity in the limbic system – a set of structures involved in emotional responses. These effects were stronger in subjects who reported stronger subjective experiences, suggesting that they are related.

Communication between the medial temporal lobe and medial prefrontal cortex, which is involved in emotional control, was reduced. This effect, and the drop in activity in the limbic system, are opposite to patterns seen in patients who suffer from anxiety.

MDMA also increased communication between the amygdala and the hippocampus. Studies on patients with PTSD have found a reduction in communication between these areas.

The project was led by David Nutt, the Edmond J. Safra Professor of Neuropsychopharmacology at Imperial College London, and Professor Val Curran at UCL.

Dr Robin Carhart-Harris from the Department of Medicine at Imperial, who performed the research, said: “We found that MDMA caused reduced blood flow in regions of the brain linked to emotion and memory. These effects may be related to the feelings of euphoria that people experience on the drug.”

Professor Nutt added: “The findings suggest possible clinical uses of MDMA in treating anxiety and PTSD, but we need to be careful about drawing too many conclusions from a study in healthy volunteers. We would have to do studies in patients to see if we find the same effects.”

MDMA has been investigated as an adjunct to psychotherapy in the treatment of PTSD, with a recent pilot study in the US reporting positive preliminary results.

As part of the Imperial study, the volunteers were asked to recall their favourite and worst memories while inside the scanner. They rated their favourite memories as more vivid, emotionally intense and positive after MDMA than placebo, and they rated their worst memories less negatively. This was reflected in the way that parts of the brain were activated more or less strongly under MDMA. These results were published in the International Journal of Neuropsychopharmacology.

Dr Carhart-Harris said: “In healthy volunteers, MDMA seems to lessen the impact of painful memories. This fits with the idea that it could help patients with PTSD revisit their traumatic experiences in psychotherapy without being overwhelmed by negative emotions, but we need to do studies in PTSD patients to see if the drug affects them in the same way.”

Follow-up study finds lasting benefit from MDMA for people with PTSD

The follow-up study was based on an original trial held in 2010 where 20 patients suffering from long term PTSD were given MDMA (the main ingredient in the party drug ecstasy) as part of their psychotherapy sessions. The researchers reported at the time that 83% of the participants showed improvements in their condition two months later.

In this new work, the researchers revisited the original patients three and a half years later (one refused to participate leaving just 19) to see how well they were doing. They found that just two of the patients had suffered a relapse – the rest they say maintained the relief they had found in the original trial.

The research was sponsored by the group Multidisciplinary Association for Psychedelic Studies (MAPS), whose mission is to seek out treatments for a variety of mental ailments using non-traditional drug therapies. In addition to providing funds for the trials they also worked out agreements with the government to allow for legal testing of the drug (it currently has as a Schedule I status.)

Study leads Michael and Ann Mithoefer conducted the original trial out of their private practice office. Each trial was conducted with a single patient at a time and involved a non-pharmaceutical therapy session followed by one where the patient was given a dose of MDMA. Another traditional session was held later – the sessions that included use of the drug lasted up to eight hours because the effects of the drugs last that long.

The researchers believe that MDMA helps PTSD sufferers by allowing them to relive the emotionally traumatic experience that led to their condition in a more relaxed and receptive way. Because of the promising results, MAPS is calling on the government to relax its rules on the testing and use of MDMA for medical applications.

I’ve been up since 6 am. I’ve had a breath test for alcohol, a urine test for drugs and a psychological test for mental health. Then I’m handed a red pill and a glass of water. I swallow it… and I’m told to relax. Which is easier said than done when you don’t know if you’ve just taken vitamin C or 83 milligrams of pure MDMA.

I’m taking part in a groundbreaking study on MDMA, the drug commonly known as ecstasy. The research is run by David Nutt of Imperial College London, a former government adviser and one of the few UK researchers licensed to study class-A drugs.

His main aim is to discover what MDMA does to the human brain, something that, remarkably, has never been done before. A second goal is to study MDMA as a therapy for post-traumatic stress disorder. The experiment is also being filmed for a Channel 4 documentary called Drugs Live: The Ecstasy Trial, which will be broadcast in the UK next week.