Leo Hermle, Melanie Simon, Martin Ruchsow, Anil Batra and Martin Geppert
Background: Despite a multitude of etiological and therapeutic approaches, the exact pathophysiological mechanisms underlying Hallucinogen persisting perception disorder (HPPD) remain elusive. Rather, in each individual case, specific risk factors and different vulnerabilities form part of a multifactorial origin of this rare but highly debilitating psychiatric disorder.
Case: The following case report describes the history of a 36 year old male who has been suffering from a visual perception disorder for the last 18 years. At the age of 17 he used LSD for the first time, having consumed cannabis and alcohol on a regular basis since a year earlier.
Descriptions: After one particular LSD trip at age 18, the patient suddenly developed persistent visual disturbances including small-sized, colour-intensive, flickering, geometrical patterns; intermittent after images of objects in the visual fields, and trailing phenomena of moving objects. Results from the Early Trauma Inventory (ETI) questionnaire indicated significant mental trauma in childhood and adolescence. Brain MRI and electrophysiological investigations (median nerve SEPs) revealed a few disseminated subcortical lesions.
Conclusion: Upon experimental treatment with lamotrigine, the patient experienced partial to complete remission of the various visual disturbances. With its potentially neuroprotective and mood-stabilising properties, lamotrigine may offer a promising new therapeutic approach for the treatment of HPPD.