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Hallucinations Associated with Neurological Disorders and Sensory Loss

Abstract

Hallucinations occur in a great variety of neurological conditions and are facilitated by sensory loss. The common end pathway of their pathophysiology involves the activation of cortical sensory areas implicated in normal sensory ­processing. Based on the presumed pathophysiology, we here classify the hallucinations in four main groups. In migraine aura and epilepsy, hallucinations result from spontaneous intrinsic overactivity in hyperexcitable sensory cortical areas. Deafferentation, i.e. the loss or impairment of sensory input, facilitates hallucinations in the corresponding sensory modality, probably by leading to chronic hyperexcitability of the corresponding cortical areas. The archetypal example of this mechanism is the Charles Bonnet syndrome, where hallucinations are associated with visual impairment. A third mechanism relies on the dissociation of dream and sleep mechanism, as illustrated by hypnagogic and hypnopompic hallucinations. Finally, in the course of neurodegenerative diseases such as Parkinson’s disease and dementia with Lewy bodies, hallucinations are frequent and probably result from a combination of factors, including dysfunction of both bottom–up sensory processing and top–down modulatory mechanisms, as well as dream intrusion phenomena and facilitating pharmacological factors.

Keywords

  • Multiple System Atrophy
  • Dementia With Lewy Body
  • Visual Hallucination
  • Auditory Hallucination
  • Visual Aura

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Fig. 4.1
Fig 4.2

Abbreviations

CBS:

Charles Bonnet syndrome

DLB:

Dementia with Lewy bodies

fMRI:

Functional magnetic resonance imaging

PD:

Parkinson’s disease

PET:

Positron emission tomography

REM sleep:

Rapid eye movement sleep

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Fénelon, G. (2013). Hallucinations Associated with Neurological Disorders and Sensory Loss. In: Jardri, R., Cachia, A., Thomas, P., Pins, D. (eds) The Neuroscience of Hallucinations. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4121-2_4

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