Carter Rowena, Ffytche Dominic H
Academic Clinical Fellow in General Psychiatry, King's College London, London, UK.
J Neurol. 2015 Jul;262(7):1780-90. doi: 10.1007/s00415-015-7687-6. Epub 2015 Mar 13.
Our current clinical approach to visual hallucinations is largely derived from work carried out by Georges de Morsier in the 1930s. Now, almost a century after his influential papers, we have the research tools to further explore the ideas he put forward. In this review, we address de Morsier's proposal that visual hallucinations in all clinical conditions have a similar neurological mechanism by comparing structural imaging studies of susceptibility to visual hallucinations in Parkinson's disease, Alzheimer's disease, Dementia with Lewy bodies and schizophrenia. Systematic review of the literature was undertaken using PubMed searches. A total of 18 studies across conditions were identified reporting grey matter differences between patients with and without visual hallucinations. Grey matter changes were categorised into brain regions relevant to current theories of visual hallucinations. The distribution of cortical atrophy supports de Morsier's premise that visual hallucinations are invariably linked to aberrant activity within visual thalamo-cortical networks. Further work is required to determine by what mechanism these networks become predisposed to spontaneous activation, and whether the frontal lobe and hippocampal changes identified are present in all conditions. The findings have implications for the development of effective treatments for visual hallucinations.
我们目前针对视幻觉的临床方法很大程度上源自乔治·德·莫尔西埃在20世纪30年代开展的工作。如今，在他那些具有影响力的论文发表近一个世纪后，我们拥有了研究工具来进一步探索他提出的观点。在这篇综述中，我们通过比较帕金森病、阿尔茨海默病、路易体痴呆和精神分裂症中对视幻觉易感性的结构成像研究，探讨了德·莫尔西埃提出的观点，即所有临床情况下的视幻觉都具有相似的神经机制。使用PubMed搜索对文献进行了系统综述。共确定了18项跨疾病研究，报告了有视幻觉和无视幻觉患者之间的灰质差异。灰质变化被归类到与当前视幻觉理论相关的脑区。皮质萎缩的分布支持了德·莫尔西埃的前提，即视幻觉总是与视觉丘脑 - 皮质网络内的异常活动有关。需要进一步开展工作来确定这些网络因何机制易于自发激活，以及所确定的额叶和海马体变化是否在所有情况下都存在。这些发现对开发有效的视幻觉治疗方法具有启示意义。
