Download PDF
Fortschr Neurol Psychiatr 2022; 90(10): 456-464
DOI: 10.1055/a-1670-7111
Übersichtsarbeit

Halluzinationen bei Patienten mit idiopathischem Parkinson-Syndrom

Hallucinations in Patients with Idiopathic Parkinsonʼs Disease
Daniel Weiss
1   Neurologische Klinik mit Schwerpunkt Neurodegenerative Erkrankungen und Hertie-Institut für Klinische Hirnforschung, Universitätsklinikum Tübingen, Deutschland
,
Günter Höglinger
2   Klinik für Neurologie mit Klinischer Neurophysiologie, Medizinisch Hochschule Hannover, Deutschland
,
Fabian Klostermann
3   Klinik für Neurologie mit Experimenteller Neurologie, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutschland
,
David Weise
4   Klinik für Neurologie, Schmerztherapie und Schlafmedizin, Asklepios Fachklinikum Stadtroda, Deutschland
,
Kirsten E. Zeuner
5   Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland
,
Heinz Reichmann
6   Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Deutschland
› Author Affiliations
› Further Information
    Permissions and Reprints

Zusammenfassung

Mehr als 20% der Patienten mit idiopathischem Parkinson-Syndrom (IPS) entwickeln Psychosen. Am häufigsten sind visuelle Halluzinationen. Bei der Entwicklung der Psychosen scheinen die Pathogenese der Parkinson-Erkrankung sowie ihre Dauer ebenso eine Rolle zu spielen wie modulierende Effekte der dopaminergen Therapie. Beim Therapiemanagement steht neben allgemeinen Maßnahmen zunächst die Anpassung der dopaminergen Therapie im Vordergrund. Dies kann zu einer Gratwanderung werden zwischen Besserung der Halluzinationen und Verschlechterung der Motorik. Bei unzureichendem Erfolg kann eine antipsychotische Therapie notwendig werden – dabei ist die Auswahl auf sehr wenige Antipsychotika beschränkt, um nicht ernsthafte motorische Verschlechterungen zu riskieren. In der vorliegenden Arbeit wurden basierend auf dem aktuellen Stand der Literatur sowie empirischen Experten-basierten Erfahrungen aus dem klinischen Alltag relevante Aspekte zu Halluzinationen bei IPS-Patienten in der Praxis zusammengefasst und Empfehlungen zum Therapiemanagement erarbeitet.

Abstract

Patients with idiopathic Parkinson’s disease develop symptoms of the hallucination-psychosis spectrum in more than 20%. Most common are visual hallucinations. The pathogenesis of hallucinations mainly depends on disease duration, the distribution and extent of alpha-synuclein pathology, and modulating effects of the dopaminergic therapy. When managing PD hallucinations both anti-delirogenic actions and medication management are important. However, decrease in dopaminergic medication may lead to critical worsening of akinesia. If appropriate neuroleptic medication – essentially quetiapin or clozapin – can be considered. Instead, anti-dopaminergic neuroleptics should not be used owing to their pro-akinetic side-effects. Here, we provide therapy recommendations to manage PD hallucinations based on an up-to-date targeted review of the literature and expert-based empirical evidence.

Schlüsselwörter

Parkinson - Halluzinationen - Antipsychotika

Key words

Parkinson’s disease - Hallucination - Neuroleptics


Publication History

Received: 11 June 2021

Accepted: 10 September 2021

Article published online:
29 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Levin J, Hasan A, Höglinger G. Psychosis in Parkinson’s disease: identification, prevention and treatment. J Neural Transm (Vienna) 2016; 123: 45-50
    CrossrefPubMedGoogle Scholar
  • 2 Carod-Artal FJ, Mesquita HM, Ziomkowski S. et al. Burden and health-related quality of life among caregivers of Brazilian Parkinson’s disease patients. Parkinsonism Relat Disord 2013; 19: 943-948
    CrossrefPubMedGoogle Scholar
  • 3 Goldman JG, Holden S. Treatment of psychosis and dementia in Parkinson’s disease. Curr Treat Options Neurol 2014; 16: 281
    CrossrefPubMedGoogle Scholar
  • 4 Lee AH, Weintraub D. Psychosis in Parkinson’s disease without dementia: common and comorbid with other non-motor symptoms. Mov Disord 2012; 27: 858-863
    CrossrefPubMedGoogle Scholar
  • 5 Bizzarri JV, Giupponi G, Maniscalco I. et al. Parkinson’s disease and psychoses. Neuropsychiatr 2015; 29: 1-13
    PubMedGoogle Scholar
  • 6 Goetz CG, Stebbins GT. Risk factors for nursing home placement in advanced Parkinson’s disease. Neurology 1993; 43: 2227-2229
    CrossrefPubMedGoogle Scholar
  • 7 Hassan A, Wu SS, Schmidt P. et al. High rates and the risk factors for emergency room visits and hospitalization in Parkinson’s disease. Parkinsonism Relat Disord 2013; 19: 949-954
    CrossrefPubMedGoogle Scholar
  • 8 Weiß D. Differenzialdiagnose und Therapie von Halluzinationen bei Parkinson-Syndromen. InFo Neurologie+Psychiatrie 2019; 21: 28-34
    PubMedGoogle Scholar
  • 9 Ravina B, Marder K, Fernandez HH. et al. Diagnostic criteria for psychosis in Parkinson’s disease: report of an NINDS, NIMH work group. Mov Disord 2007; 22: 1061-1068
    CrossrefPubMedGoogle Scholar
  • 10 Ekker MS, Janssen S, Seppi K. et al. Ocular and visual disorders in Parkinson’s disease: Common but frequently overlooked. Parkinsonism Relat Disord 2017; 40: 1-10
    CrossrefPubMedGoogle Scholar
  • 11 Goetz CG, Stebbins GT, Ouyang B. Visual plus nonvisual hallucinations in Parkinson’s disease: development and evolution over 10 years. Mov Disord 2011; 26: 2196-2200
    CrossrefPubMedGoogle Scholar
  • 12 Goetz CG, Fan W, Leurgans S, Bernard B, Stebbins GT. The malignant course of „benign hallucinations“ in Parkinson disease. Arch Neurol 2006; 63: 713-716
    CrossrefPubMedGoogle Scholar
  • 13 Goetz CG, Fan W, Leurgans S. et al. Antipsychotic medication treatment for mild hallucinations in Parkinson’s disease: Positive impact on long-term worsenin. Mov Disord 2008; 23: 1541-1545
    CrossrefPubMedGoogle Scholar
  • 14 Ffytche DH, Creese B, Politis M. et al. The psychosis spectrum in Parkinson disease. Nat Rev Neurol 2017; 13: 81-95
    CrossrefPubMedGoogle Scholar
  • 15 Omoto S, Murakami H, Shiraishi T. et al. Risk factors for minor hallucinations in Parkinson’s disease. Acta Neurol Scand 2021; 143: 538-544
    CrossrefPubMedGoogle Scholar
  • 16 Pagonabarraga J, Martinez-Horta S, Fernández de Bobadilla R. et al. Minor hallucinations occur in drug-naive Parkinson’s disease patients, even from the premotor phase. Mov Disord 2016; 31: 45-52
    CrossrefPubMedGoogle Scholar
  • 17 Cilia R, Akpalu A, Sarfo FS. et al. The modern pre-levodopa era of Parkinson’s disease: insights into motor complications from sub-Saharan Africa. Brain 2014; 137: 2731-2742
    CrossrefPubMedGoogle Scholar
  • 18 Bereau M, Fleury V, Bouthour W. et al. Hyperdopaminergic behavioral spectrum in Parkinson’s disease: A review. Rev Neurol (Paris) 2018; 174: 653-663
    CrossrefPubMedGoogle Scholar
  • 19 Calabresi P, Di Filippo M, Ghiglieri V. et al. Levodopa-induced dyskinesias in patients with Parkinson’s disease: filling the bench-to-bedside gap. Lancet Neurol 2010; 9: 1106-1117
    CrossrefPubMedGoogle Scholar
  • 20 Diederich NJ, Fénolon G, Stebbins G, Goetz CG. Hallucinations in Parkinson disease. Nat Rev Neurol 2009; 5: 331-342
    CrossrefPubMedGoogle Scholar
  • 21 Hoglinger GU, Respondek G, Stamelou M. et al. Clinical Diagnosis of Progressive Supranuclear Palsy: The Movement Disorder Society Criteria. Mov Disord 2017; 32: 853-864
    CrossrefPubMedGoogle Scholar
  • 22 Berardelli A, Wenning GK, Antonini A. et al. EFNS/MDS-ES recommendations for the diagnosis of Parkinson’s disease. Eur J Neurol 2013; 20: 16-34
    CrossrefPubMedGoogle Scholar
  • 23 Ferman TJ, Arvanitakis Z, Fujishiro H. et al. Pathology and temporal onset of visual hallucinations, misperceptions and family misidentification distinguishes dementia with Lewy bodies from Alzheimer’s disease. Parkinsonism Relat Disord 2013; 19: 227-231
    CrossrefPubMedGoogle Scholar
  • 24 McKeith IG, Boeve BF, Dickson DW. et al. Diagnosis and management of dementia with Lewy bodies. Neurology 2017; 89: 88-100
    CrossrefPubMedGoogle Scholar
  • 25 Weiss D, Volkmann J, Fasano A. et al. Changing gears – DBS for dopaminergic desensitization in Parkinson’s disease?. Ann Neurol 2021; DOI: 10.1002/ana.26164. Online ahead of print.PMID: 34235776
    CrossrefPubMedGoogle Scholar
  • 26 Weintraub D, Koester J, Potenza MN. et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol 2010; 67: 589-595
    CrossrefPubMedGoogle Scholar
  • 27 Schuepbach WMM, Rau J, Knudsen K. et al. Neurostimulation for Parkinson’s Disease with Early Motor Complications. N Engl J Med 2013; 368: 610-622
    PubMedGoogle Scholar
  • 28 Mueller C, Rajkumar AP, Wan YM. et al. Assessment and Management of Neuropsychiatric Symptoms in Parkinson’s Disease. CNS Drugs 2018; 32: 621-635
    CrossrefPubMedGoogle Scholar
  • 29 Parkinson Study Group Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson’s disease. N Engl J Med 1999; 340: 757–763
    PubMed
  • 30 Ondo WG, Tintner R, Voung KD. et al. Double-blind, placebo-controlled, unforced titration parallel trial of quetiapine for dopaminergic-induced hallucinations in Parkinson’s disease. Mov Disord 2005; 20: 958-963
    CrossrefPubMedGoogle Scholar
  • 31 Emre M, Aarsland D, Albanese A. et al. Rivastigmine for dementia associated with Parkinson’s disease. N Engl J Med 2004; 351: 2509-2518
    CrossrefPubMedGoogle Scholar
  • 32 Cummings J, Isaacson S, Mills R. et al. Pimavanserin for patients with Parkinson’s disease psychosis: a randomised, placebo-controlled phase 3 trial. Lancet 2014; 383: 533-540
    CrossrefPubMedGoogle Scholar
  • 33 Espay AJ, Guskey MT, Norton JC. et al. Pimavanserin for Parkinson’s Disease psychosis: Effects stratified by baseline cognition and use of cognitive-enhancing medications. Mov Disord 2018; 33: 1769-1776
    CrossrefPubMedGoogle Scholar
  • 34 Ballard CG, Kreitzman DL, Isaacson S. et al. Long-term evaluation of open-label pimavanserin safety and tolerability in Parkinson’s disease psychosis. Parkinsonism Relat Disord 2020; 77: 100-106
    CrossrefPubMedGoogle Scholar
  • 35 Collerton D, Dudley R. A cognitive behavioural framework for the treatment of distressing visual hallucinations in older people. Behav Cogn Psychother 2004; 32: 443-455
    CrossrefPubMedGoogle Scholar
  • 36 Lhommée E, Wojtecki L, Czernecki V. et al. Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson’s disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial. Lancet Neurol 2018; 17: 223-231
    CrossrefPubMedGoogle Scholar
  • 37 Schuepbach WMM, Rau J, Knudsen K. et al. Neurostimulation for Parkinson’s Disease with Early Motor Complications. N Engl J Med 2013; 368: 610-622
    CrossrefPubMedGoogle Scholar
  • 38 Troster AI, Jankovic J, Tagliati M. et al. Neuropsychological outcomes from constant current deep brain stimulation for Parkinson’s disease. Movement disorders 2017; 32: 433-440
    CrossrefPubMedGoogle Scholar
  • 39 Witt K, Daniels C, Reiff J. et al. Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson’s disease: a randomised, multicentre study. Lancet Neurol 2008; 7: 605-614
    CrossrefPubMedGoogle Scholar
  • 40 Ferreira JJ, Lees A, Rocha JF. et al. Opicpaone as an adjunct to levodopa in patients with Parkinson’s disease and end-of-dose motor fluctuations: a randomised, double-blind, controlled trial. Lancet Neurol 2016; 15: 154-165
    CrossrefPubMedGoogle Scholar
  • 41 Expertenkonsens beim Online-Advisory-Board „Halluzinationen beim Morbus Parkinson“ am 6.11.2020, von Bial Deutschland
    PubMed