Mefloquine-induced persisting perception disorder

There has been an increased incidence of malaria among travellers returning from Africa and Asia. The antimalarial drug mefloquine (Lariam) has become popular due to its efficacy in treating the wide-spread chloroquine-resistant Plasmodium falciparum. Mefloquine is used both for prophylaxis and treatment of malaria and is relatively well tolerated. However, since introduced in 1985, there have been over 100 reports of severe neurologic and psychiatric adverse effects associated with its use, the latter including acute confusional states, acute psychosis, anxiety and affective disorders, and prolonged visual illusions, i.e. mefloquine-induced persisting perception disorder (Borruat et al., 2001).

MN

"My name is MN and I am a 20 year old male from the US. I took a trip to Africa this summer, and before leaving, took the malaria preventative medication mefloquine (street name 'Lariam'). I ended up getting the fabled rare neuropsychotic side effects... it started a few days after taking the medication, when I had a panic attack at 4 a.m. in my dad's apartment, during which I had a strange paranoia that I was going crazy. I actually hallucinated (saw the wallpaper moving around) during this attack. For the next week, I woke up every day with chills and persistent anxiety. I didn't know what was wrong with me, but found out about Lariam's tendency to do things like this to people and realized that that was the cause of my symptoms. I continued to have anxiety, paranoia, and felt like I was walking around in a dream [derealisation] for a few weeks, although those symptoms have gradually faded away (very slowly... Lariam has a half life of 3-4 weeks).

I began to experience visual snow around the same time as my adverse reaction to Lariam. The 'static' has remained constant since then, although almost all of my other symptoms are decreasing... at one point, I would look up into the sky and see hundreds of floating particles (like white blood cells) swimming in and out of each other, but I do not see those with such severity anymore. I also had an effect where, upon rapidly shifting my gaze from one place to the next, it would take me some time to process the new image... I almost saw the world as a series of pictures [cinematographic vision] (doesn't sound the same as an 'afterimage', because it wasn't the old image burned onto the new one, just like a delay in processing or something).

I am looking at the visual snow simulator on the visual community website... it seems like my snow density is about a 12 with a flicker rate of maybe 3... seems relatively minor. However, it is still very disconcerting, and I do have anxiety associated with it. I am not sure whether this is caused by the snow itself or whether it reminds me of the other side effects that I was having from Lariam.

I took Klonopin and Xanex for the anxiety during the initial period of side effects. The anxiety has gone down to the point where it is almost not noticable, although a bit of it resurfaced when I found out about the existance of VS as a condition two days ago. I guess I was assuming that it would just go away, and now I am scared to death about the idea of having it permanently...

It has been a little over 3 months now since I have been experiencing these effects. As I said, the static may have gone down some (although it is really hard to tell), but the floaters seem to have gone down considerably and I am no longer having the larger delay in processing. I am really hoping that I have a transitive case of this and that it goes away... what would your advice be?

I have been to see an ophthalmologist and they said my eyes are completely normal. I have not, however, been to see any neuroophthalmologists (although I read about one in the Cleveland area on the forum), nor have I had any tests done (MRI, EEG, etc).

I am sorry I didn't post on the forum... I am new and it seemed like a vast amount of information. Instead, I found your email address and figured I would contact you directly. I am extremely worried about this and would really appreciate any advice I can get...

Do you think it will go away? Is there anything that has good results in lessening its effects? I would really like to know as much about what I can do about it as possible.

Thanks."

(MN [subject #440], Email to Klaus Podoll, September 13, 2007; additions in square brackets by Klaus Podoll)

"I should also add the following:

1) The snow is worse when I wake up in the morning.

2) The snow is a lot more noticable in the dark... I can barely see it when a surface is well lit.

3) Stress and tiredness make the snow much worse.

I also seem to be more sensitive to light and, while I don't get afterimages or trails, I do see the tiniest bit of redish stuff when I look away from a light... almost like I used to sometimes after exposure to a camera flash but much less localized or severe.

This all sounds typical but I figured I would let you know..."

(MN [subject #440], Email to Klaus Podoll, September 13, 2007)

"VS has declined since we last spoke (undoubtedly helped by cessation of caffeine drinking, taking vitamins, and sleeping 9 hrs per night), but is still present. Floaters are more noticeable, but probably because the static is lessening."

(MN [subject #440], Email to Klaus Podoll, September 27, 2007)

"Wanted to update you on the fact that I got results back from an MRI and bloodwork and there was nothing unusual. VS seems to be diminishing extremely (shall I say excruciatingly) slowly, although I guess it also could be my imagination or me getting used to it."

(MN [subject #440], Email to Klaus Podoll, October 11, 2007)

References

Borruat FX, Nater B, Robyn L, Genton B. Prolonged visual illusions induced by mefloquine (Lariam): a case report. J Travel Med 2001; 8: 148-149.
Bygbjerg IC, Rønn AM. [Long-lasting neuropsychiatric side-effects following mefloquine prophylaxis. A case after six weeks of initiating and lasting six months] [Article in Danish]. Ugeskr Laeger 1999; 161: 1422-1423.

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