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Long-term use of MDMA (3,4-methylenedioxymethamphetamine) has been associated with various neurotoxic effects, particularly on serotonin-producing neurons in the brain. Among the possible consequences of such neurotoxicity is the development of Parkinson's-like symptoms. These symptoms can include tremors, rigidity, and bradykinesia, which resemble the characteristics of Parkinson's disease. The underlying mechanism is thought to involve damage to the dopaminergic pathways and the serotonin system, leading to motor control issues similar to those observed in Parkinson’s disease.

Insomnia, anxiety disorders, and chronic fatigue syndrome, while potential issues for individuals using MDMA, are more commonly linked to a range of psychological and environmental factors rather than to a direct neurotoxic effect from the drug. Although they may occur, they are not primarily characterized by the neurobiological changes seen with long-term MDMA use, making Parkinson's-like symptoms a more direct and notable outcome of its prolonged use.