Abstract
Torsten Passie, Udo Schneider and Hinderk M. Emrich, Department of Clinical Psychiatry and Psychotherapy, Medical School Hannover (Germany):
A major drug of abuse today is 3,4-Methylenedi-oxymethamphetamine (MDMA or ‘ecstasy’). Serious medical complications and neurotoxicity are known to be caused from its uncontrolled use, but most long-term effects are still unkown. Neuropsychological studies show cognitive deficiencies in chronic users [1].
In March 1999, a 22-year-old man with a 3 year history of drug abuse was admitted to our detoxification ward. Childhood and education were without major complications. He had been taking cannabis since 1996 and ‘ecstasy’ tablets almost daily since 1997. He documented in his diary the ingestion of more than 350 ‘ecstasy’ tablets in 18 months (up to eight tablets at weekends; without dancing). He had also consumed LSD 5–7 times in total.
Since his first hospitalization in August 1998 he reported a visual perception disorder which persists continuously until today. He described it as ‘like a snowstorm on a defective TV’. Hundreds of transparent little dots moving chaotically over his whole visual field. When his eyes were open he could see everything in detail, but the whole visual field was overlaid by this disturbance. When his eyes were closed, he claimed to see ‘little coloured dots’. These phenomena were lessened in sunlight and aggravated in the dark.
A careful ophthalmologic examination showed no abnormality. The disturbances seem to be generated beyond the primary visual cortex.
Psychiatric examination showed (according to ICD-10) abuse of cannabis and hallucinogens, sociophobic anxiety disorder with derealization phenomena and a depressive disorder. Toxicological screening was negative for amphetamines, barbiturates, benzodiazepines, opiates, cocaine, phencyclidin and LSD. THC was initially positive. Physical examination, full blood count, HIV-testing, ECG, EEG, cranial CT and MRI and neuropsychological performance (attention, short- and longterm memory investigated with a standard computerized testing battery) were without abnormalities.
The described disorder remained unchanged in our 3 week treatment. When we saw him 6 weeks later there was still no change and THC-screening was negative.
Chronic administration of MDMA in animals resulted in destruction of serotonergic nerve terminals. Processes of recovery were noted, but showed region-dependent time-course and degree of recovery with compensatory re-respectively hyperinnervation [2]. Brain areas that are involved in visual perception processes were also affected [3].
We hypothesize that the neuropathological basis of this patient's visual abberations may be an altered reinnervation pattern of neurones responsible for processing visual information.
To our knowledge this is the first case described with a persisting continuously visual perception disorder induced most likely by chronic MDMA use.