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.
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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