5-Meo-DALT-induced Cyclic Myoclonus (P3.013)

A 29-year-old man with a history of heroin and marijuana abuse developed intermittent myoclonus affecting his limbs, trunk, neck, and jaw in a cyclic pattern about every 10 minutes, along with unresponsiveness, after using the hallucinogen 5-MeO-DALT. His symptoms improved gradually over a week, and a dose of lorazepam temporarily stopped the myoclonus and partially restored consciousness. Standard urine toxicology did not detect the substance, and brain imaging and EEG were normal. This is the first reported case linking 5-MeO-DALT abuse to myoclonus, suggesting that clinicians should consider this drug in patients with unexplained cyclic myoclonus and negative toxicology screens.

Study at a glance

Abstract

Objective: To report the first case of myoclonus as neurologic presentation of 5-MeO-DALT abuse Background: 5-Meo-DALT (N,N-diallyl-5-methoxytryptamine) is a relatively new hallucinogen, initially sold online in 2004. It is a psychedelic compound from the tryptamine family which affects monoamine neurotransmitters including dopamine and serotonin. It is a psychostimulant with strong visual hallucinogenic and entheogenic effects. It can be smoked, taken orally or sniffed. It is not detected in routine toxicology screen. Typical symptoms include extreme agitation, tachycardia, and combativeness. Little is known about neurologic symptoms. Delirium was reported in one case, but myoclonus or other movement disorders have never been reported. Methods: A case report Results/Case: A 29-year old-man was admitted for markedly reduced oral intake for four days. He became unresponsive on the next day in hospital, and developed intermittent myoclonus. He had history of heroin and marijuana abuse, and was on buprenorphine. Myoclonic jerks involved all extremities, trunk, and neck with possible spread to lower jaw. The movements coalesced and recurred in cyclic pattern, approximately every 10 minutes (see Video). Somesthetic stimuli aggravated the jerks. Electrophysiologic testing was not available, but clinical examination suggested a brainstem or high spinal origin. After a dose of intravenous lorazepam, he partially regained consciousness, and myoclonus stopped, but the effects were transient. Urine toxicology screen was positive for opioid and cannabinoid. Electroencephalography did not reveal ictal or interictal epileptiform discharges. MRI brain was unremarkable. Myoclonus and encephalopathy gradually improved over a week. Once he returned back to his baseline, he reported 5-Meo-DALT use prior to this admission, and prior visual hallucinations and delusions. Conclusions: This substance abuse should be considered in patients with cyclic myoclonus and negative toxicology screen. Further studies are helpful in expanding the knowledge on neurologic features of 5-Meo-DALT abuse, and development of the screening to cover this substance.