Double vision in Parkinson’s Disease: a systematic review
Abstract
Introduction. The prevalence of diplopia in Parkinson’s disease (PD) ranges from 10% to 30%. Diplopia is usually limited to specific situations such as reading and looking around, however, it can also be constant. The aim of this review, supplemented by two case studies, was to summarise current knowledge on the frequency, possible causes, differential diagnosis, pathophysiology and treatment approaches to double vision in PD patients.
Methodology. An electronic search (PubMed, Scopus, Embase and Web of Science) to identify studies regarding diplopia in PD patients was performed in May 2020. The following search terms were used: Parkinson’s Disease and diplopia.
Results. Five articles are included in this literature review. In the literature, the number of included patients with PD who presented with symptoms of diplopia varied from a single case report to 88 patients. Diplopia was usually intermittent and binocular. The most commonly reported type of diplopia was single object diplopia, and the second most common was complete diplopia. Risk factors contributing to developing diplopia were: older age, disease duration, disease severity, cognitive decline, presence of visual hallucinations, and higher levodopa equivalent dose. Results also showed that diplopia had a significant impact on quality of life. Possible comorbidities of diplopia include myasthenia gravis and vascular disease.
Conclusion. Diplopia is relatively common in PD, but still understudied. The research shows that it has a clear impact on health-related quality of life and patient safety. The acute onset of diplopia should always result in tests to exclude other diseases. Tailored interventions should be developed, leading to improved patient safety, quality of life, and quality of care.
Keywords: Parkinson’s Diseasediplopiadouble visonmyasthenia gravis
References
- Parkinson J. AN ESSAY ON THE SHAKING PALSY. Archives of Neurology. 1969; 20(4): 441–445.
- Mueller C, Rajkumar AP, Wan YiM, et al. UK Parkinson's Pain Study Collaboration, EUROPAR and MDS Non-motor PD Study Group, National Institute for Clinical Excellence. Non-motor symptoms of Parkinson's disease: diagnosis and management. Lancet Neurol. 2006; 5(3): 235–245.
- Ekker MS, Janssen S, Seppi K, et al. Ocular and visual disorders in Parkinson's disease: Common but frequently overlooked. Parkinsonism Relat Disord. 2017; 40: 1–10.
- Archibald NK, Clarke MP, Mosimann UP, et al. The retina in Parkinson's disease. Brain. 2009; 132(Pt 5): 1128–1145.
- Nguyen-Legros J. Functional neuroarchitecture of the retina: hypothesis on the dysfunction of retinal dopaminergic circuitry in Parkinson's disease. Surg Radiol Anat. 1988; 10(2): 137–144.
- Davidsdottir S, Cronin-Golomb A, Lee A. Visual and spatial symptoms in Parkinson's disease. Vision Res. 2005; 45(10): 1285–1296.
- Djamgoz MB, Hankins MW, Hirano J, et al. Neurobiology of retinal dopamine in relation to degenerative states of the tissue. Vision Res. 1997; 37(24): 3509–3529.
- Clark D, Eggenberger E. Neuro-ophthalmology of movement disorders. Curr Opin Ophthalmol. 2012; 23(6): 491–496.
- Yoon WT. Comparison of dystonia between Parkinson's disease and atypical parkinsonism: The clinical usefulness of dystonia distribution and characteristics in the differential diagnosis of parkinsonism. Neurol Neurochir Pol. 2018; 52(1): 48–53.
- Alster P, Krzyżanowska E, Koziorowski D, et al. Difficulties in the diagnosis of four repeats (4R) tauopathic parkinsonian syndromes. Neurol Neurochir Pol. 2018; 52(4): 459–464.
- Weil RS, Schrag AE, Warren JD, et al. Visual dysfunction in Parkinson's disease. Brain. 2016; 139(11): 2827–2843.
- Visser F, Vlaar AMM, Borm CD, et al. Diplopia in Parkinson's disease: visual illusion or oculomotor impairment? J Neurol. 2019; 266(10): 2457–2464.
- Schindlbeck KA, Schönfeld S, Naumann W, et al. Characterization of diplopia in non-demented patients with Parkinson's disease. Parkinsonism Relat Disord. 2017; 45: 1–6.
- Nebe A, Ebersbach G. Selective diplopia in Parkinson's disease: a special subtype of visual hallucination? Mov Disord. 2007; 22(8): 1175–1178.
- Racette BA, Gokden MS, Tychsen LS, et al. Convergence insufficiency in idiopathic Parkinson's disease responsive to levodopa. Strabismus. 1999; 7(3): 169–174.
- Urwyler P, Nef T, Killen A, et al. Visual complaints and visual hallucinations in Parkinson's disease. Parkinsonism Relat Disord. 2014; 20(3): 318–322.
- Savitt J, Aouchiche R. Management of Visual Dysfunction in Patients with Parkinson's Disease. J Parkinsons Dis. 2020; 10(s1): S49–S56.
- Borm CD, Smilowska K, de Vries NM, et al. How I do it: The Neuro-Ophthalmological Assessment in Parkinson's Disease. J Parkinsons Dis. 2019; 9(2): 427–435.
- Almer Z, Klein KS, Marsh L, et al. Ocular motor and sensory function in Parkinson's disease. Ophthalmology. 2012; 119(1): 178–182.
- Lepore F. Parkinson's Disease and Diplopia. Neuro-Ophthalmology. 2009; 30(2-3): 37–40.
- Siuda J, Boczarska-Jedynak M, Budrewicz S, et al. Validation of the Polish version of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Neurol Neurochir Pol. 2020 [Epub ahead of print].
- Bejjani BP, Arnulf I, Houeto JL, et al. Concurrent excitatory and inhibitory effects of high frequency stimulation: an oculomotor study. J Neurol Neurosurg Psychiatry. 2002; 72(4): 517–522.
- Sciacca G, Nicoletti A, Mostile G, et al. Is it just a coincidence? Three new cases of Myasthenia Gravis associated with Parkinson's disease. Parkinsonism Relat Disord. 2016; 28: 166–168.
- Iwasaki Y, Wakata N, Kinoshita M. Parkinsonism induced by pyridostigmine. Acta Neurologica Scandinavica. 1988; 78(3): 236–236.
- Levin N, Karussis D, Abramsky O. Parkinson's disease associated with myasthenia gravis. A report of 4 cases. J Neurol. 2003; 250(6): 766–767.
- Zis P, Argiriadou V, Temperikidis PP, et al. Parkinson's disease associated with myasthenia gravis and rheumatoid arthritis. Neurol Sci. 2014; 35(5): 797–799.
- Chaudhuri KR, Martinez-Martin P, Schapira AHV, et al. International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study. Mov Disord. 2006; 21(7): 916–923.
- Ueno S, Takahashi M, Kajiyama K, et al. Parkinson's disease and myasthenia gravis: adverse effect of trihexyphenidyl on neuromuscular transmission. Neurology. 1987; 37(5): 832–833.
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