One study in ecstasy users, one case report, one report on ecstasy-related deaths and a paper discussing serotonin syndrome, one review and model of MDMA neuropharmacology and neurotoxicity (text not located), two in-vitro or non-human animal studies and one forensic study (not summarized) were located at this time.

Ecstasy Use and Remembering Future Plans

The effects of repeated ecstasy use on prospective memory, the ability to remember to perform a behavior in the future, were assessed in 30 ecstasy users and 31 polydrug-using controls (Heffernan et al. 2001). Ecstasy users reported a greater number of prospective memory failures, despite using the same strategies controls used. Researchers using observer-scored assessments of prospective memory have failed to find impaired prospective memory in ecstasy users (Zakzanis and Young, 2001), and findings from other reports indicate that self-reported problems do not always correlate with objectively scored measures (e.g. Fox et al. 2001; Heffernan et al. 2001, Study 2). Hence it is unclear whether these findings represent an actual or perceived difference in prospective memory.

Case Report

Hyponatremia, seizures and rhabdomyolysis were reported in a 19-year old woman who consumed "several" (potentially up to ten) ecstasy tablets, with recovery reported after six days in hospital (Sue et al. 2002).

Ecstasy-related Emergencies in Sydney, Deaths in England and Wales

Research using a newly devised program for monitoring medical emergencies occurring during large events in Australia found that 85 of 424 drug-related visits to 15 "sentinel" emergency rooms in the Sydney area during the 2000 Olympics were Ecstasy-related (Indig et al. 2003). Ecstasy-related adverse events were the second most frequently reported drug-related reason for visiting an emergency room, with heroin-related emergency room visits the most frequent. One of 2 reported deaths was ecstasy-related. However, most (73%) of drug-related cases were discharged after treatment. A survey of drug-related deaths autopsied in England and Wales in 1997-2000 located 81 deaths (Schifano et al. 2003). Fatalities were most likely to occur in White men in their middle 20s during weekends and in "holiday" months (January, July or August). Polysubstance poisoning was listed as cause of death in 62% of cases, but 7% were due to MDMA alone, and opiate or opioid coadministration was involved in over half of the fatalities (44 of 81 or 59%).

Gene Expression in Mice, Hyperthermia in Rats

Researchers examined expression of genes for synaptotagmin (protein related to synaptic activity) in wild-type and serotonin transporter knockout (KO) mice after 10 mg/kg MDMA (Peng et al. 2003). They found decreased synaptotagmin IV gene expression in frontal cortex and midbrain, and increased synaptotagmin 1 gene expression in midbrain in wild-type, but not serotonin transporter KO, mice (Peng et al. 2003). These findings suggest that synaptotagmins are involved in monoamine release and neurotransmitter trafficking, but do not offer new information on MDMA pharmacology or neurotoxicity. In a study conducted with rats, researchers investigated the role of the hypothalamus-pituitary-adrenal (HPA) axis in MDMA-induced hyperthermia (Sprague et al. 2003). Findings suggest that thyroid hormones are at least partially involved in hyperthermia after a rather high dose (40 mg/kg) of MDMA, and that activity at Beta3 adrenergic receptors might be responsible for elevating skeletal temperature. The authors also suspect sympathetic system activity is involved as well. On the basis of these findings, the authors recommend treating Ecstasy-related hyperthermia with drugs that lower sympathetic nervous system activity.