Istanbul Medipol University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
Istanbul Medipol University, Faculty of Medicine, Department of Biophysics, Istanbul, Turkey.
J Clin Neurosci. 2019 Nov;69:281-284. doi: 10.1016/j.jocn.2019.08.002. Epub 2019 Aug 30.
We have evaluated an 82 years old PD patient who has acutely developed VH secondary to acute visual loss that was associated with increased electroencephalographic activity in the gamma range over the parietal, occipital and frontal regions. In this respect, we have tested the therapeutic effect of occipital lobe oriented rTMS application and its electrophysiological correlates that led to significant improvement in the hallucinatory symptomatology of the patient after two weeks. We have revealed that the improved hallucinatory symptoms after rTMS application resolved completely after switching from the pramipexole treatment to L-Dopa indicating that there could be a combined therapeutic effect of L-Dopa and rTMS. Furthermore, Quantitative-Electroencephalography analysis has shown that the therapeutic effects of rTMS and L-Dopa were seen with the improvement of impaired gamma power spectrum. Although the main limitation of this report is that this a single case study and that these findings need to be replicated in a larger sample, e.g., as part of a controlled trial, our present findings help us to enlighten the unknown pathophysiological overlapping between the visual hallucinations in PD and Charles Bonnet Syndrome. Finally, our study revealed increased gamma coherence and power spectrum which is seen with visual hallucinations and improved after the application of 1 Hz rTMS on the occipital lobe. These findings together suggest that rTMS could be used as a therapeutic tool for parkinsonian complex VH and probably due affecting gamma coherence and power spectrum.
我们评估了一位 82 岁的 PD 患者，该患者突发 VH，伴有急性视力丧失，且顶叶、枕叶和额叶的脑电图活动增加。在这方面，我们测试了针对枕叶 rTMS 应用的治疗效果及其电生理相关性，这导致患者在两周后幻觉症状显著改善。我们发现，rTMS 应用后改善的幻觉症状在从普拉克索治疗切换为左旋多巴后完全缓解，表明左旋多巴和 rTMS 可能有联合治疗作用。此外，定量脑电图分析表明，rTMS 和左旋多巴的治疗效果与受损的伽马功率谱改善相关。尽管本报告的主要局限性是这是一项单病例研究，这些发现需要在更大的样本中复制，例如作为对照试验的一部分，但我们目前的发现有助于阐明 PD 中的视觉幻觉和 Charles Bonnet 综合征之间未知的重叠病理生理学。最后，我们的研究显示，视觉幻觉时出现的伽马相干性和功率谱增加，并在对枕叶应用 1Hz rTMS 后得到改善。这些发现共同表明 rTMS 可作为帕金森氏症复杂 VH 的治疗工具，可能是通过影响伽马相干性和功率谱来实现的。
