Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by CHEN, C.-S. Articles by CHONG, M.-Y. Search for Related Content PubMed Citation Articles by CHEN, C.-S. Articles by CHONG, M.-Y. Schizophrenia Spectrum Disorders Syndromes Secondary to General Medical Disorders

Charles Bonnet Syndrome and Multiple Sclerosis

To the Editor: Charles Bonnet syndrome refers to formal, complex, persistent, stereotypical visual hallucinations that are not accompanied by any other psychotic symptoms in cognitively unimpaired individuals (1). Although multiple sclerosis can produce diverse neuropsychiatric manifestations, we know of no reports of Charles Bonnet syndrome in patients with this illness.

Ms. A, a 56-year-old woman with no cognitive impairment, claimed to see vivid and complicated images after losing her vision for 4 months as a result of optic neuritis. These images changed in shape, color, and size and included Chinese and English characters, vegetables, and small animals that could penetrate into her abdomen. She recognized them as unreal, but they existed at all times, whether she had her eyes open or closed.

She had suffered from multiple sclerosis for about 20 years and had no comorbid psychiatric disorders. Besides her temporary loss of vision, she experienced effects on her cervical and thoracic spinal cord. She became bedridden and completely dependent on the care of others. In an assessment of cognitive functioning, she scored 25 out of 30 points on the Mini-Mental State Examination, excluding the items that require vision (5 points). Magnetic resonance imaging of her brain revealed high signal intensity in both periventricular and white matter regions of the parietal lobes. Carbamazepine treatment, 200 mg t.i.d., was initiated, and Ms. A’s visual hallucinations were significantly reduced. However, after she stopped taking carbamazepine, the visual hallucinations returned, but they disappeared after she resumed taking carbamazepine.

A literature search revealed that a greater risk of Charles Bonnet syndrome has been found with advanced age, cerebral impairment, and ocular pathology (2). It is therefore not unusual that Charles Bonnet syndrome has been found in younger people with certain diseases involving the eyes and brain. Therapy targeting the underlying ocular or cerebral diseases might alleviate the hallucinations. In addition, anticonvulsants such as carbamazepine and valproate are effective for treatment because their antiseizure properties can reduce "irritable cortex," a condition that has been hypothesized to cause a "phantom visual phenomenon" (3). Despite prevalent ocular and cerebral involvement in multiple sclerosis, to our knowledge, there have been no reports of hallucinations that are consistent with the Charles Bonnet syndrome. Plausible explanations are 1) that visual hallucinations seldom occur without cognitive impairment and other psychotic symptoms in multiple sclerosis, 2) that there are few voluntary expressions of visual hallucinations, and 3) that physicians are unfamiliar with this syndrome. The last two explanations might account for an underestimation of Charles Bonnet syndrome in multiple sclerosis. It is suggested that psychiatrists, neurologists, and ophthalmologists pay more attention to the nature of hallucinations in order to diagnose Charles Bonnet syndrome, which can be treated effectively with anticonvulsants.

References

1. Gold K, Rabins PV: Isolated visual hallucination and the Charles Bonnet syndrome: a review of the literature and presentation of six cases. Compr Psychiatry 1989; 30:90-98[CrossRef][Medline]
2. Schultz G, Melzack R: The Charles Bonnet syndrome: phantom visual images. Perception 1991; 20:809-825[Medline]
3. Rosenbaum F, Harati Y, Rolak L, Freedman M: Visual hallucinations in sane people: Charles Bonnet syndrome. J Am Geriatr Soc 1987; 35:66-68[Medline]

This article has been cited by other articles:

				E.-J. Choi, J.-K. Lee, J.-K. Kang, and S.-A. Lee Complex Visual Hallucinations After Occipital Cortical Resection in a Patient With Epilepsy Due to Cortical Dysplasia Arch Neurol, March 1, 2005; 62(3): 481 - 484. [Abstract] [Full Text] [PDF]

				G. J. Menon Complex Visual Hallucinations in the Visually Impaired: A Structured History-Taking Approach Arch Ophthalmol, March 1, 2005; 123(3): 349 - 355. [Abstract] [Full Text] [PDF]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by CHEN, C.-S. Articles by CHONG, M.-Y. Search for Related Content PubMed Citation Articles by CHEN, C.-S. Articles by CHONG, M.-Y. Schizophrenia Spectrum Disorders Syndromes Secondary to General Medical Disorders

Get information about faster international access.

Privacy Policy

Copyright © 2001 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us