Letter to the Editor
Treatment of Charles Bonnet syndrome
Tratamiento del síndrome de Charles Bonnet
E. Santos-Bueso
, M. Serrador-García, J. García-Sánchez
Corresponding author
Unidad de Neurooftalmología, Hospital Clínico San Carlos, Madrid, Spain
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Santos-Bueso, M. Serrador-García, J. García-Sánchez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Santos-Bueso" "email" => array:1 [ 0 => "esbueso@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Serrador-García" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "García-Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Neurooftalmología, Hospital Clínico San Carlos, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento del síndrome de Charles Bonnet" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The incidence of the Charles Bonnet syndrome (CBS) is increasing in our environment as a result of the increased life expectancy of patients and the presence of severe vision impairment mainly secondary to age-related macular degeneration and other ocular diseases such as glaucoma or cataracts.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">CBS consists in the presence of simple or complex visual pseudo-hallucinations in patients with significant vision impairment and preserved cognitive status. CBS is not a psychiatric but a neuro-ophthalmological disease which originates in the loss of vision and therefore ophthalmologists, emergency and primary care physicians must be knowledgeable of CBS in order to provide adequate diagnosis and treatment, avoiding unnecessary referrals to psychiatrists.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Even though the etiology of CBS is unknown, it is considered that the neuron deafferentation theory accounts for the development of said pseudo-hallucinations. At present, it is estimated that CBS affects up to 3.15% of patients with severe visual impairments.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">CBS must be treated comprehensively, including the causes related to the etiopathogeny of the syndrome, among them the following<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0025" class="elsevierStylePara elsevierViewall">Providing to patients adequate information about CBS, emphasizing the benign characteristics of the process and discarding psychiatric disorders. Comparing CBS with the missing limb syndrome is generally quite useful in daily practice.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Improvement of the quality of life of patients to prevent social isolation, enhance their relationship with their environment, lighting of their home, etc. as these have been associated and described as factors which give rise to CBS.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0035" class="elsevierStylePara elsevierViewall">If possible, treating the causes of the ocular disease which causes the visual impairment, mainly cataracts.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0040" class="elsevierStylePara elsevierViewall">Medical treatment of the anxiety syndrome secondary to the presence of pseudo-hallucinations.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Specific medical treatment. There is a broad range of therapies acting on various levels related to CBS pathogeny and the histological and biochemical changes that take place in the deafferent synapse (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>):<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">a)</span><p id="par0050" class="elsevierStylePara elsevierViewall">Action at the presynaptic level:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">increasing the size of the button, the number of vesicles and the neurotransmitter release area: anticonvulsant drugs such as carbamazepine, phenytoin and valproic acid.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Increasing the probability of neurotransmitter release: anticonvulsant drugs such as gabapentin.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">b)</span><p id="par0065" class="elsevierStylePara elsevierViewall">Action at the post-synaptic level:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Increasing the number of receptors (dopamine and serotonin):</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">antipsychotic drugs such as risperidone, haloperidol, sulpiride and olanzapin.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Serotonin antagonists such as ondansetron, cisapride and mirtazapine.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">c)</span><p id="par0085" class="elsevierStylePara elsevierViewall">Biochemical changes in the central nervous system:<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Diminished presence of acetylcholine in the thalamus by means of drugs such as donezepil.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Diminished GABA: anticonvulsant drugs such as clonazepam.</p></li></ul></p></li></ul></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">Management of the therapeutic options and the different response of patients to drugs enhance the importance of developing multidisciplinary neuroophthalmology units between ophthalmologists, neurologists and psychiatrists as well as communication with primary health care in order to provide adequate diagnostic and treatments and to improve the quality of life of our patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Santos-Bueso E, et al. Tratamiento del síndrome de Charles Bonnet. Arch Soc Esp Oftalmol. 2013;88:244–5.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">5HT<span class="elsevierStyleInf">3</span>: serotonin; DA: dopamin; GABA: gamma-aminobutyric acid; IACE: acetylcholine inhibitors; #: number; NRT: neurotransmitters.</p>" "tablatextoimagen" => array:3 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Synapsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Histological–biochemical changes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Drug and medication \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre-synaptic terminal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ Size of button↑ # of vesicles↑ NRT release zone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anticonvulsives (ANT-Ca<span class="elsevierStyleSup">2+</span>)Carbamazepin (Tegretol<span class="elsevierStyleSup">®</span>)Valproic acid (Depakine<span class="elsevierStyleSup">®</span>)Fenitoin (Epanutin<span class="elsevierStyleSup">®</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">↑ Probability of NRT release \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Gabapentin (Neurontin<span class="elsevierStyleSup">®</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab392969.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-synaptic terminal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↑ # of receptors (DA and 5HT<span class="elsevierStyleInf">3</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antipsychotics (ANT-DA)- Risperidone (Risperdal<span class="elsevierStyleSup">®</span>)- Haloperidol- Sulpiride (Solian<span class="elsevierStyleSup">®</span>)- Quetiapine (Seroquel<span class="elsevierStyleSup">®</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ANT-5HT<span class="elsevierStyleInf">3</span>- Ondansetron (Zofran<span class="elsevierStyleSup">®</span>)- Cisapride- Mirtazapina (Vastat<span class="elsevierStyleSup">®</span>)- Trazodone (Deprax<span class="elsevierStyleSup">®</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab392970.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Biochemical changes in the SNC</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ Acetylcholine in the thalamus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleUnderline">IACE</span>: donepezil (Arizept<span class="elsevierStyleSup">®</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">↓ GABA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleUnderline">Anticonvulsives</span>: Clonazepam (Rivotril<span class="elsevierStyleSup">®</span>) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab392968.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Medical treatment of the Charles Bonnet syndrome according to the histological changes in deafferent synapsis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Charles Bonnet plus syndrome: apropos of a case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Serrador-García" 1 => "E. Santos-Bueso" 2 => "F. Sáenz-Francés" 3 => "D. Díaz-Valle" 4 => "J.M. Martínez-de-la-Casa" 5 => "J. García-Feijoo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5301/ejo.5000130" "Revista" => array:2 [ "tituloSerie" => "Eur J Ophthalmol" "fecha" => "2012" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Charles Bonnet syndrome: case presentation and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Kester" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.optm.2008.10.017" "Revista" => array:6 [ "tituloSerie" => "Optometry" "fecha" => "2009" "volumen" => "80" "paginaInicial" => "360" "paginaFinal" => "366" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19545849" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Charles Bonnet syndrome: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Schadlu" 1 => "R. Schadlu" 2 => "J. Banks" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICU.0b013e328329b643" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Ophthalmol" "fecha" => "2009" "volumen" => "20" "paginaInicial" => "219" "paginaFinal" => "222" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19349864" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000008800000006/v1_201309060051/S2173579413000996/v1_201309060051/en/main.assets" "Apartado" => array:4 [ "identificador" => "5813" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000008800000006/v1_201309060051/S2173579413000996/v1_201309060051/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579413000996?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 1 | 2 |
| 2018 February | 21 | 1 | 22 |
| 2018 January | 13 | 1 | 14 |
| 2017 December | 19 | 3 | 22 |
| 2017 November | 12 | 4 | 16 |
| 2017 October | 21 | 8 | 29 |
| 2017 September | 8 | 2 | 10 |
| 2017 August | 10 | 4 | 14 |
| 2017 July | 9 | 4 | 13 |
| 2017 June | 19 | 7 | 26 |
| 2017 May | 20 | 1 | 21 |
| 2017 April | 21 | 1 | 22 |
| 2017 March | 27 | 33 | 60 |
| 2017 February | 30 | 5 | 35 |
| 2017 January | 22 | 0 | 22 |
| 2016 December | 41 | 5 | 46 |
| 2016 November | 27 | 8 | 35 |
| 2016 October | 31 | 4 | 35 |
| 2016 September | 24 | 9 | 33 |
| 2016 August | 17 | 1 | 18 |
| 2016 July | 15 | 2 | 17 |
| 2016 June | 14 | 5 | 19 |
| 2016 May | 8 | 1 | 9 |
| 2016 April | 26 | 5 | 31 |
| 2016 March | 11 | 5 | 16 |
| 2016 February | 13 | 11 | 24 |
| 2016 January | 14 | 6 | 20 |
| 2015 December | 22 | 8 | 30 |
| 2015 November | 15 | 4 | 19 |
| 2015 October | 26 | 5 | 31 |
| 2015 September | 23 | 2 | 25 |
| 2015 August | 9 | 3 | 12 |
| 2015 July | 13 | 5 | 18 |
| 2015 June | 6 | 2 | 8 |
| 2015 May | 13 | 6 | 19 |
| 2015 April | 17 | 8 | 25 |
| 2015 March | 32 | 4 | 36 |
| 2015 February | 13 | 4 | 17 |
| 2015 January | 24 | 1 | 25 |
| 2014 December | 42 | 8 | 50 |
| 2014 November | 39 | 4 | 43 |
| 2014 October | 35 | 8 | 43 |
| 2014 September | 45 | 14 | 59 |
| 2014 August | 30 | 4 | 34 |
| 2014 July | 41 | 8 | 49 |
| 2014 June | 33 | 5 | 38 |
| 2014 May | 15 | 7 | 22 |
| 2014 April | 20 | 3 | 23 |
| 2014 March | 26 | 4 | 30 |
| 2014 February | 15 | 7 | 22 |
| 2014 January | 29 | 4 | 33 |
| 2013 December | 26 | 3 | 29 |
| 2013 November | 1 | 0 | 1 |
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