Charles-Bonnet-Syndrom – klinische Besonderheiten eines faszinierenden Krankheitsbilds

 

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Zusammenfassung

Auch psychisch gesunde, kognitiv völlig unauffällige Personen können visuelle Halluzinationen wahrnehmen, die als Charles-Bonnet-Syndrom (CBS) bezeichnet werden – benannt nach einem Schweizer Wissenschaftler, der solche Wahrnehmungen erstmals im 18. Jahrhundert beschrieben hat. Den Betroffenen ist der nichtreale Charakter der Halluzinationen in der Regel bewusst. Die Definitionen des CBS sind nicht einheitlich. So ist etwa eine Sehbehinderung oder Blindheit nicht in allen Definitionen gefordert, dieses Kriterium ist dennoch häufig assoziiert mit dem CBS. Weil die Prävalenz gerade bei Sehbehinderten oder Blinden hoch ist, sollten Augenärzte dieses Syndrom kennen: betroffene Patienten berichten aus Angst vor Stigmatisierung häufig nicht von sich aus von ihren Wahrnehmungen. Möglicherweise sind Frauen häufiger betroffen als Männer. Das CBS ist vor allem bei älteren Menschen gut untersucht, aber auch junge Menschen können visuelle Halluzinationen wahrnehmen. Inhalt der Wahrnehmungen sind häufig Personen, die Wahrnehmungen können unterschiedlich lang andauern. Die meisten Patienten erleben mehrere Episoden von visuellen Wahrnehmungen. Am besten untersucht ist das CBS bei Patienten mit Sehbehinderung aufgrund einer AMD. Neuroradiologische Untersuchungen haben gezeigt, dass auch zerebrale Veränderungen, vor allem im Bereich des okzipitalen Kortex, eine Rolle spielen in der Entstehung visueller Wahrnehmungen. Vielen Patienten ist allein schon durch ein aufklärendes Gespräch geholfen, eine (medikamentöse) Therapie ist in der Regel nicht erforderlich. Die zugrunde liegende Pathophysiologie ist nicht geklärt, es gibt jedoch Erklärungsmodelle.

Abstract

Even mentally and cognitively healthy people can experience visual hallucinations. These are called Charles Bonnetʼs syndrome, named after the Swiss scientist, who first described such perceptions in the 18th century. Usually patients possess insight in the unreality of their visual experiences. The definitions of CBS are not consistent. Visual impairment or blindness is not part of every definition, but often is associated with CBS. Ophthalmologists should be aware of this syndrome, since its prevalence is high among blind or visually impaired people: patients often are reluctant to admit their hallucinatory experiences, because of the fear of being stigmatised. Possibly women are affected more often than men. CBS is well investigated in the elderly, but also young people might experience visual hallucinations. Hallucinatory contents commonly are persons, with varying duration of the hallucinations. Most patients experience more than one hallucinatory episode. CBS is best investigated in patients suffering from AMD. Neuroimaging studies suggest that cerebral abnormalities, mainly in the occipital cortex, might also play a role in the pathogenesis of CBS. Many patients do not require (drug) treatment, since education itself is helpful in most cases. The pathophysiology remains unclear, but there are a couple of theories.

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