Paramyoclonus multiplex : a clinical lecture / by F.W. Langdon.

  • Langdon, Frank Warren, 1852-1933
Date:
[1896]
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Licence: Public Domain Mark

Credit: Paramyoclonus multiplex : a clinical lecture / by F.W. Langdon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    motor spasm caused by mental or phy- sical strain, and producing a hyper- excitability of the brain or cord. Others, among them Starr, are inclined to re- gard the primary lesion as a peripheral hyper-activity,producing secondary cen- tral over-action. While it may be objected that these views are merely hypothetical, yet it must be conceded that even hypotheses may assist our conception of the rela- tions of facts. Looking at the present case in this aspect, and accepting the modern doc- trine of the neuron of Waldeyer as the anatomical unit in neuro-dynamogene- sis, it would appear that abnormal action in any one of six groups of neurons might produce the clinical picture pre- sented. Thus: 1. The primary sensitive neurons, with their bodies in the posterior root- ganglia and their end-tufts at the peri- phery and in the cord and bulb respect- ively, may transmit exaggerated afferent impulses to the anterior horn motor neurons, producing the hyper-kinesis observed. 2. The secondary sensitive neurons of the bulb or cortex may be similarly affected, and the result a hyper-k'nesis of cortical origin. We see no evidence, however, that such hyper-excitability exists on the sensitive side. The ab- sence of anaesthesia, hyperaesthesia or parsesthesia to tact, pain and tempera- ture, and of the myo-neuric pains of tabes; of ataxia or other incoordination, is at least presumptive evidence of the integrity of the neurons of the cutaneous and musculo sensory tracts. Hyper-activity of the motor neurons, (3) cortical and (4) spinal, may be ex- cluded by (a) its rarity without loss of consciousness or organic cause; (6) by the absence of motor weakness, tremor and incoordination between the par- oxysms; (c) by the bilateral character and symmetry of the contractions; (d) by the escape of certain of the most highly developed groups, as those of the face, hands and feet. The main sensory and motor paths being thus excluded as the primary seat of pathological action, we must seek elsewhere for the expla- nation of the symptoms. The existence of special accelerator and inhibitory neurons in the cortex cerebri must be conceded as probable; such mechanisms are comparable to those that influence the frequency of the heart’s action. By the development and activity of these mechanisms we may account for the differences in individuals as regards volitional efforts on the one hand and self control on the other. In other words, one plies the whip, the other puts on the brake. In our case the brake appears to be out of repair, and acts irregularly. 5. An over action of accelerator me- chanisms would account for symptoms here presented; but such over-action is not likely in a man recovering from in- fluenza and mentally depressed from other causes. 6. Defect in function of inhibitory mechanisms dominating the psycho- motor neurons is a condition which physiologically exists in children, hence the frequency of convulsive affections in early life. It is quite conceivable, there- fore, that these inhibitory neurons, the latest structures of the cortex in time of development and function, are also, in obedience to ordinary physiological and pathological law, the first to suffer in states of depression. Note, for instance, the petulance of age, and the motor and mental irritability of the neurasthenic. Here, then, lies the most probable seat of the lesion in our patient. The peculiar distribution of the mus- cular spasm, well shown in the accom- panying chart,1 sufficiently excludes a spinal or peripheral origin. The fact that “ associated move- ments,” not anatomical muscle-groups, are involved, points strongly to a corti- cal seat of the disease. It is also of great significance that the movements involved in this case are those habitually and most vigorously exercised by the patient at his work of digging and bending alternately for- 1 This very useful chart for recording muscular paralysis, spasm, degeneration, etc., has been recently devised by Dr. W. H. B. Stoddart, of London. To secure uniformity of records I would suggest that plus marks be used for over-action, minus marks for weak- ness or degeneration, and ciphers for absolute paralysis.
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