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Occipital lobe epilepsy presenting with visual hallucinations

Charles Bonnet syndrome
Published:February 04, 2013DOI:https://doi.org/10.1016/j.ajem.2012.11.031
      Thank you for your letter and commentary. Indeed, we did not clearly define the fact that the hallucinations were in the area of visual field loss. The patient did not perceive hallucinations as occurring in the areas of vision loss but described the hallucinations as peoples' faces that appeared on the edges of objects that he did see. The hallucinations were in fact on the side of visual loss. He also said that they often started small and grew larger. Our mention that elementary hallucinations may occur was based on our review of the literature. Indeed, Charles Bonnet is most often characterized by complex hallucination, but some sources relate that elementary hallucinations may occur. In one reference, some hallucinations have been described as a solitary constant solid object in the central visual field, most commonly a flash, but often a complex grid or a branching structure [
      • Menon G.J.
      • Rahman I.
      • Menon S.J.
      • Dutton G.N.
      Complex visual hallucinations in the visually impaired: the Charles Bonnet Syndrome.
      ]. In addition, a series on Charles Bonnet in patients who received photodynamic therapy as treatment for choroidal neovascularization, 15% reported seeing flashing lights, and only 5% described complex hallucinations [
      • Cohen S.Y.
      • Bulik A.
      • Tadayoni R.
      • Quetel G.
      Visual hallucinations and Charles Bonnet syndrome after photodynamic therapy for age related macular degeneration.
      ].
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      References

        • Menon G.J.
        • Rahman I.
        • Menon S.J.
        • Dutton G.N.
        Complex visual hallucinations in the visually impaired: the Charles Bonnet Syndrome.
        Surv Ophthalmol. 2003; 48: 58-72
        • Cohen S.Y.
        • Bulik A.
        • Tadayoni R.
        • Quetel G.
        Visual hallucinations and Charles Bonnet syndrome after photodynamic therapy for age related macular degeneration.
        Br J Ophthalmol. 2003; 87: 977-979