Recently, Movement Disorders published the third case report of Parkinson's symptoms in an individual who reported prior (ϩ/Ϫ) 3,4-methylenedioxymethamphetamine (MDMA or "Ecstasy") use, 1 and an excellent accompanying editorial that critically examined claims of causality made in case reports. 2 We have contacted the authors of both previous case reports and learned that the amount of Ecstasy consumed by both cases was below that required for enrollment in studies that were designed to look for but failed to find dopamine toxicity in Ecstasy users. Amounts consumed were also below doses (3 doses in 3-hour intervals of up to 8.6 mg/kg p.o., 25.8 mg/kg in total; 4.0 mg/kg s.c. injections, 12 mg/kg in total) that failed to produce dopamine toxicity in nonhuman primates. 3,4 One case report was of an individual who took Ecstasy on 10 occasions over a year. 5 Although precise data on the amount consumed each time are not available, 6 based on data collected in Ecstasy users around this period (see for example Gerra et al. 7 and Wareing et al. 8 ), estimated consumption probably ranged from 1 to 3.5 tablets per use. Another case report 9,10 was of an individual who took just 1 to 2 tablets twice monthly for approximately 6 months. Assuming a 75-kg body weight and 80 mg tablets, a dose at or above typical Ecstasy pills of the times, 11,12 neither case is likely to have consumed more than 3.7 mg/kg per occasion.
Based on the available evidence, the link between Ecstasy use and Parkinson's disease seems especially tenuous.