Síndrome de Charles Bonnet. Serie de 45 casos

Abstract

Introducción. El síndrome de Charles Bonnet (SCB) es un cuadro clínico que se caracteriza por la presencia de alucinaciones visuales, principalmente complejas, en pacientes con estado cognitivo conservado e importante deterioro de la visión. El incremento del SCB se debe al aumento de la esperanza de vida y al desarrollo de patologías asociadas al envejecimiento, como la degeneración macular asociada a la edad. Aceptado tras revisión externa: 24.02.15. Cómo citar este artículo: Santos-Bueso E, Serrador-García M, Porta-Etessam J, Rodríguez-Gómez O, Martínez-de-la-Casa JM, García-Feijoo J, García-Sánchez J. Síndrome de Charles Bonnet. Serie de 45 casos. Rev Neurol 2015; 60: 337-40. © 2015 Revista de Neurología Charles Bonnet syndrome. A 45-case seriesIntroduction. Charles Bonnet Syndrome (CBS) is a condition characterised by the presence of visual hallucinations, mainly complex, in patients with significant vision loss and without cognitive impairment. The rise in CBS cases is due to an increased life expectancy and to the development of age-related pathologies such as age-related macular degeneration.Patients and methods. We herein analyse the main characteristics present in 45 patients diagnosed with CBS at the Neuroophthalmology Unit in Hospital Clínico San Carlos. The patients were referred from the macular pathology, glaucoma and ocular surface units, as well as from A&E, where they were diagnosed with CBS and later confirmed at the Multidisciplinary Unit formed by the ophthalmology, neurology and psychiatry services of the hospital.Results. Women (66.66%) over 80 constituted 68.88% of the patients and mainly had age-related macular degeneration (37.77%). The most prevalent hallucinations described by the patients were of people and faces (35.55%), in colour (66.66%), in movement (80%), had developed over a period of 6 to 12 months (26.66%), had a frequency of three episodes per day (35.55%) and lasted between 3 to 5 minutes (35.55%). Conclusions.CBS is a complex disorder that requires a multidisciplinary approach from neurologists, psychiatrists, general practitioners and ophthalmologists. New studies are needed in order to understand its clinical presentation and behaviour, and thus improve its management.

Importance of Differential Diagnosis of Charles Bonnet Syndrome in the Presence of Visual Hallucinations

“…This integrative review allowed the understanding that Charles Bonnet Syndrome fits within the framework of hallucinosis as it is associated with the patient's presence of consciousness. It is worth highlighting the importance of correctly diagnosing the condition, in order to make a differential diagnosis with other mental illnesses, and a multidisciplinary approach between ophthalmologists, neurologists and psychiatrists is essential to provide adequate treatment (2). Therefore, it is necessary to increase awareness and knowledge about CBS, effecting possible impacts on symptoms and prognosis, avoiding patient suffering.…”

“…The duration can be brief, lasting just a few seconds, or extending throughout the day, persisting for days, weeks or even years, with different degrees of frequency and detail. Furthermore, images are usually in color and can be static or animated (2,5).…”

“…In SCB, there is no evidence of cognitive deficits or other forms of sensory hallucinations, which distinguishes it from psychiatric conditions. The emergence of CBS appears to be associated with several triggering factors, such as fatigue, stress, low light and glare, in addition to being related to social isolation, cognitive deficiencies and sensory deprivation (2).…”

“…However, with the advancement of clinical understanding, it was realized that the syndrome is not exclusive to the elderly and can affect individuals of different age groups. Therefore, currently, most authors describe it as the presence of complex visual hallucinations in patients with visual deficits, in the absence of psychiatric illness or altered consciousness, regardless of age (2).…”

“…The syndrome has a benign character, in which the patient remains aware of the unreal nature of the phenomenon, and has been reported mainly in the elderly (3). Diagnostic criteria include the presence of simple or complex, persistent or repetitive visual hallucinations, loss of acuity and/or visual field, understanding of the unreal nature of hallucinations with preserved consciousness and absence of psychotic symptoms and cognitive impairment (4,2).…”