A New Spin on The “Founder” of Neurology

Jean-Martin Charcot (1825-1893) is regarded by most scholars to be the founder of modern neurology.

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Known to be an excellent clinical teacjer, he was a professor at the University of Paris for 33 years and was  associated with Paris’s Salpêtrière Hospital that lasted throughout his life, ultimately becomiwas known as an excellent medical teacher, and he attracted students from all over Europe. His focus turned to neurology, and he is called by some the founder of modern neurology.

Charcot took an interest in hysteria, a mental disorder with physical manifestations, which he believed to be the result of an inherited weak neurological system, set off by a traumatic event like an accident

He learned the technique of hypnosis to evaluate these patients, and very quickly became a master of the relatively new “science.”

He believed that a hypnotized state was very similar to a bout of hysteria, and so he hypnotized his patients in order to induce and study their symptoms.

Charcot’s work also included other aspects of neurology – he was first to describe the degeneration of ligaments and joint surfaces due to lack of use or control, now called Charcot’s joint. He discovered the importance of small arteries in cerebral hemorrhage.  He described hereditary motor and sensory neuropathy.

He died in 1893 in Morvan, France.

The new movie focuses on his relationship with one hysterical patient named Agustine,

Click here to find out more about this.

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Stereotactic radiosurgery for obsessive compulsive disorder, Phineas Gage meets the Jetsons.

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Small studies have shown that gamma knife stereotactic radiosurgery can relieve symptoms in as many as 50% of patients with obsessive-compulsive disorder (OCD) who got no help from conventional behavioral or medical therapies.

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What is OCD?

OCD is an anxiety disorder in which people have unwanted and repeated fearful thoughts (obsessions) that drive them to perform repeated behaviors (compulsions) to temporarily relieve the associated anxiety.

Examples of OCD include excessive hand washing or cleaning, repeated checking and nervous obsessive rituals like such as opening and closing a door a certain number of times before entering or leaving a room.

Anxiety from OCD and the resultant obsessive ritualistic behaviors can be alienating and time-consuming, leading to emotional and financial distress.

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Symptoms of OCD can be ameliorated by medications, such as serotonin reuptake inhibitors, and behavioral therapy.  However, many severely affected patients remain unable to function normally despite these interventions, leading them to look for more effective or permanent solutions to this difficult problem.

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Surgery for psychiatric disorders.

Phineas Gage (1923-1960) survived an accident in which a pole impaled his head going through his left cheek, destroying his eye, through the frontal part of his brain, and back out the right top part of his skull.
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Before the accident, he was described by his friends as a friendly, calm, caring man.  After the accident, he became bad mannered, aggressive, foul-mouthed, and anti-social to the point where he could no longer hold a job and none of his friends wanted to associate with him anymore.

His skull was saved and later analyzed to plot the trajectory of this pole through his skull, finding that the rod mostly damaged the middle region of the frontal lobes.

This and other cases of medial frontal lobe lesions causing similar changes in behavior led to the conclusion that this part of the brain’s function is related to normal social  social behavior

Surgical frontal lobotomy was first performed in the 1935, and lobotomized patients showed a decrease in agitation, anxiety, and depression.  Walter Freeman and James Watts spread the technique of lobotomy across America in the 1930 and 40s, and it became considered as a quick fix for dealing with overcrowded insane asylums.

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Ultimately the procedure was conducted using an “ice pick” inserted into the frontal lobe through the orbit under a brief period of unresponsiveness induced by ECT.

However, with the advent of psychotherapeutic drugs and increasing evidence for the horrors and limited therapeutic effects of lobotomy, the surgery lost popularity, almost becoming completely extinct.

Nevertheless, the important influence of the frontal lobes on social behavior was not forgotten, and more recent PET studies have further reinforced the influence of this brain region area in OCD:

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PET study showing increased activity in the frontal lobes in a OCD patient compared to a normal control.

There has been a limited comeback of psychosurgery, initially the form of less invasive non destructive  surgical techniques like the anterior cingulotomy (designed just to sever the connections between the frontal lobes and the underlying subcortical structures) still used for patients with severe OCD and depression refractory to conventional therapies.

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Gamma knife for OCD.

Activated deep brain stimulation electrodes placed into the anterior limb of the internal capsule can also interrupt the circuits than connect the frontal lobes to the rest of the brain and ameliorate OCD behavior:

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Gamma knife radiosurgery can create permanent lesions in these same regions of the brain, leading to Permanent lesions resulting in long-lasting benefit to OCD patients without the need for implanted hardware.

A recent study published in Neurosurgery by Kondziolka et al (click here for link) demonstrated the long-term benefit of bilateral gamma knife lesioning to the internal capsule in three patients with OCD intractable to conventional medical therapies.

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Gamma knife radiosurgery for OCD. Left – MRI showing the lesions resulting from the procedure. Right – clinical improvement in na OCD rating score in all three patients after surgery (lower score = better).

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Where can you get help and more information?

The International OCD Foundation has a website with more information on medical therapies, psychosurgery, DBS and gammaknife radiosurgery for OCD.