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Fortschr Neurol Psychiatr 2000; 68(3): 129-136
DOI: 10.1055/s-2000-11619
ORIGINALARBEIT
Georg Thieme Verlag Stuttgart ·New York

Die optischen Halluzinationen des Parkinson-Patienten und das Charles Bonnet-Syndrom[1]

Eine phänomenologische und pathogenetischeGegenüberstellungVisual Halluzinations in Patients with PD and the Charles-Bonnet-Syndrome - a Phenomenological and Pathogenetic Confrontation:N. J. Diederich1, 2 , V. Pieri1 , C. G. Goetz2
  • 1Abteilung für Neurologie, Centre Hospitalier de Luxembourg, Luxemburg
  • 2Department of Neurological Sciences, Rush-Presbyterian-St. Lukes Medical Center, Chicago, USA
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Publication History

Publication Date:
31 December 2000 (online)

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Zusammenfassung:

Optische Halluzinationen (OH) treten bei etwa einem Drittel der Parkinson-Patienten (PP) auf und werden als Vorboten oder Teilsymptom der Levodopa-Psychose angesehen. Ihre besondere Phänomenologie wurde bisher kaum beachtet.

Methode: Ein semistrukturiertes Interview wurde zweifach bei 62 PP durchgeführt. Zudem Anwendung diverser motorischer und kognitiver Krankheitsskalen. Die Patienten waren nicht dement, depressiv oder psychotisch. Ihre korrigierte Sehkraft betrug mindestens 0,6.

Ergebnisse: 22 Patienten (36 %) gaben in beiden Interviews komplexe optische Halluzinationen oder Illusionen an. Sie unterschieden sich nicht von den übrigen Patienten bezüglich Alter, Krankheitsdauer und -stadium, Medikamentendosis und Katarakthäufigkeit. OH traten bei 41 % der Patienten tagsüber, bei 18 % nachts und bei 41 % sowohl als auch auf. Zwei Drittel der Patienten erlebten die OH mindestens einmal wöchentlich. Die Dauer war immer kürzer als eine Stunde. Gegenstand der OH waren in absteigender Reihenfolge: Erwachsene, Kinder, Haustiere, Gegenstände. OH waren oft mobil und wiesen normale Physiognomie auf. Emotionale Betroffenheit wurde nur von 18 % der Patienten angegeben.

Diskussion: Die in unserem Parkinson-Kollektiv beobachteten OH unterscheiden sich durch fehlenden Ich-Bezug und emotionale Reaktion von OH bei exogenen und endogenen Psychosen. Sie ähneln dem Charles Bonnet-Syndrom (CBS), welches bei älteren Patienten mit unterschiedlichen visuellen Defiziten auftritt. Da auch beim Parkinson-Patienten visuelle Defizite für das Kontrast- und Farberkennungsvermögen bestehen, ist zu diskutieren, ob diese nicht wahnhaft erlebten OH zumindest anfänglich sogenannten „Release-Halluzinationen” bei partieller Visusdeprivation entsprechen. Dies wäre auch eine Erklärung für den ephemären und oft jahrelang blanden Charakter der OH. Das klare Sensorium, das Fehlen von multimodalen Halluzinationen und der nicht paranoide Charakter differenzieren von Halluzinationen anderer Genese, etwa bei toxisch induzierten Halluzinationen.

Visual hallucinations (VH) are seen in about a third of all patients with Parkinson's disease (PD) and are usually considered to be an early marker or clinical component of a dopaminergic psychosis. Their peculiar phenomenology has not yet been studied in a systematic manner.

Methods: A semi-structured interview was performed twice in 62 PD patients. Different motoric and cognitive disease scales were used. The patients were not demented or depressed and had no other psychotic features other than hallucinations. Their visions was at least 0.6.

Results: 22 patients (36 %) reported complex visual hallucinations or illusions in both interviews. These patients were not different from the non-hallucinating patients in terms of age, duration and stage of the disease, dosage and type of medication and frequency of cataracts. VH were diurnal in 41 % of the patients, nocturnal in 18 % of the patients and mixed in 41 patients. They were seen at least once weekly in 67 % and they lasted always less than an hour. VH most frequently involved adults, children and pets. They were often mobile and had normal size and physiognomy. Notable emotional reactions were only reported by 18 % of the patients.

Discussion: The phenomenology of VH in PD differs from VH in exogenous or endogenous psychoses, but is similar to the Charles Bonnet-syndrome (CBS), appearing in elderly patients with different visual deficits. As PD patients suffer regularly from visual deficits of contrast and color perception, a similar pathogenesis to CBS can be hypothesized, with these „minor” and benign VH being due to „release phenomena” in relation to partial visual deprivation. The lack of multimodality hallucinations and of secondary paranoia as well as the clear sensorium are helpful features in distinguishing them from toxic psychosis.

1 Mit Unterstützung der Stiftungen Think und Leir, Luxemburg und der Parkinson Disease Foundation, Chicago.

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1 Mit Unterstützung der Stiftungen Think und Leir, Luxemburg und der Parkinson Disease Foundation, Chicago.

Dr. med. Nico J. Diederich

Abteilung für Neurologie

Centre Hospitalier de Luxembourg

4, rue Barblé

L-1210 Luxembourg

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