The Epidemiological Study Of Heroin Spongiform Leucoencephalopathy In Drug Users

Background and Objective:Heroin abuse have become a big problem in the world. It threatens social security and economic development. Heroin Spongiform Leucoencephalopathy was firstly reported by Wolters E in Holand Amsterstan in 1982. Since then there was no more than 20 cases reported in Japan,Germany,Belgium,America and Taiwan district of China. There is no cases in batches reported since 1982 and no epidemiologic data available. Due to scarce knowledge about this disease,they can not study this disease and the pathogeny about this disease is unclear,we have found cases of Heroin spongiform leukoencephalopathy by biopsy and MRI in 2000. This disease appear in coastland cities of Guang Dong province in batches,it is a good chance for us to study this special leucoencephalopathy. There are no results of etiologic study about this disease and epidemiological study is an important method to study about it. To understand the distribution and related risk factors of Heroin Spongiform Leucoencephalopathy among drug users in coastland of Guangdong Province. We launched an epidemiological research about it. Materials and Methods:We lunched an epidemic study about Heroin Spongiform Leucoencephalopathy in the south city of Guangzhou in August 2000. A cross-sectional study was conducted in five hundred and eighty one drug users from three detoxification organizations in Guangzhou city. We used clustered random sampling methods. Investigators consisted of experienced neurologists in our hospital. The neurological examination was taken to all ofthem and cerebral MRI was carried out to those with signs of cerebellar ataxia. Data obtained had been imported into computer where Poisson regression analysis was made by SPSS software. Results:Results showed that the total incidence of Heroin Spongiform Leucoencephalopathy was 5.16%0. Poisson regression analysis showed that the incidence was related to residential areas. Contrast to other cities,there was higher incidences in eastern coastland cities of Guangdong. Our investigation also showed that all patients used heroin by inhaling the pyrolysate. The incidence of Heroin Spongiform Leucoencephalopathy was unrelated to the daily inhaling amount of heroin and the duration of inhaling heroin. No differences could be observed among the groups by ages and sex. Conclusions:Heroin Spongiform Leucoencephalopathy after inhaling heroin by the method of chasing the dragon is a rare complication and have never been reported on mainland of China before. The lesions are symmetrical and spongiform,but not necrotic,and the cerebellum is invariably involved:a feature consistent with the clinical presentation that begins with ataxia. Cerebral CT showed non-enhancing hypodensity areas symmetrically in both cerebellar hemispheres. Cerebral MRI showed corresponding areas with decreased signal intensity on TI-weighted images and increased signal intensity on Tj-weighted images. There was no contrast enhancement. When it occurs,several cases are affected as a small epidemic. It suggested that the aetiology is related to the heroin batch and could perhaps be a toxic effect of a substance which came from heroin additives.