Functional movement disorders.

Functional movement disorders (FMD) represent a complex and disabling entity characterized by a broad range of clinical symptoms not explained by a classical neurological disease. In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) added a clinical criterion based on incongruence and inconsistency, supported by recent literature highlighting the role of "positive clinical signs". These clinical signs allow a "rule-in" procedure in making a diagnosis of FMD so that the diagnosis is no longer a "rule-out" or "by default" diagnosis made after exclusion of other neurological conditions. This review summarizes current evidence on common clinical features and highlights bedside signs in FMD, such as tremor, dystonia, myoclonus and parkinsonism. Tics, chorea and hemiballism are also briefly discussed.

Lazarevic-Lasègue sign.

Charles Lasègue is reputed to have described the test/sign bearing his name, but he never wrote about it and misinterpreted its mechanism. The purpose of this note is to highlight the work of the Serbian, Laza Lazarevic, who was first to present the original report of this seminal sign in sciatica and provide its appropriate pathophysiological interpretation.

Lazarevic-Lasègue sign / Sinal de Lazarevic-Lasègue

ABSTRACT Charles Lasègue is reputed to have described the test/sign bearing his name, but he never wrote about it and misinterpreted its mechanism. The purpose of this note is to highlight the work of the Serbian, Laza Lazarević, who was first to present the original report of this seminal sign in sciatica and provide its appropriate pathophysiological interpretation.

RESUMO Charles Lasègue guarda a reputação de ter descrito o sinal que leva seu nome, mas nunca escreveu sobre isso e interpretava erradamente sua etiopatogenia. O propósito desta nota é chamar atenção para o trabalho do sérvio Laza Lazarević, que apresentou a descrição original do sinal mais importante na ciatalgia e forneceu a interpretação apropriada da sua fisiopatologia.

[Surgeons and Neurosurgeons as Nobel Prize Winners]. / Chirurgové a neurochirurgové jako laureáti Nobelovy ceny.

Since 1901 Nobel Prize is awarded for exceptional achievements in physics, chemistry, literature, peace, economy (since 1968) and medicine or physiology. The first aim of the paper is to provide an overview of surgeons - winners of Nobel Prize for medicine or physiology. Although the prominent neurosurgeons were frequently nominated as Nobel Prize candidates, surprisingly no neurosurgeon received this prestigious award so far despite that the results of their research transgressed the relatively narrow limits of neurosurgical speciality.The most prominent leaders in the field of neurosurgery, such as Victor Horsley, Otfrid Foerster, Walter Dandy and Harvey Cushing are discussed from the point of their nominations. The overview of the activity of the Portuguese neurologists and Nobel Prize Winter in 1949 Egas Moniz (occasionally erroneously reported as neurosurgeon) is also provided. Although his work on brain angiography has fundamentally changed the diagnostic possibilities in neurology and neurosurgery, he was eventually awarded Nobel Prize for the introduction of the currently outdated frontal lobotomy.The fact that none of the above mentioned prominent neurosurgeons has not been recognised by Nobel Prize, may be attributed to the fact that their extensive work cannot be captured in a short summary pinpointing its groundbreaking character.

[The origins of the French neurosurgery]. / Aux origines de la neurochirurgie française.

Modern French neurosurgery starts at the beginning of the XXth century under the motivation of Joseph Babinski. He submitted his patients to Thierry de Martel who had learned this new specialized area of medicine with H. Cushing in the États-Unis and V. Horsey in Great Britain. His first successfully treated case of an intracranial tumor was published in 1909. But the true founding father was Clovis Vincent, initially a neurologist and collaborator of de Martel, who became the first chairman in 1933 of the neurosurgical department at the Pitié hospital of Paris and the first professor of neurosurgery in 1938. After the Second World War, many departments were created outside of Paris. Neurosurgery was definitively recognized as a specialized area in medicine in 1948. Currently, more than 400 neurosurgeons work in France. Because I had the very great privilege to be present at the birth of this society in 1970 and to still be in contact with some of the second and third generation of French neurosurgeons who led it to its high international recognition, the Chairman of the French Neurosurgical Society asked me to write this short historical vignette.

Lazar K. Lazarevic, the author who first described the straight leg raising test.

OBJECTIVE: To highlight the contributions of Lazar K. Lazarevic (1851-1891), physician, scientist, writer, and translator in the field of neurology. During his brief period of professional activities, Lazar K. Lazarevic published 78 articles in various branches of medicine. His most important contribution to neurologic science was his description of the straight leg raising test. The article "Ischiac postica cotunnii: one contribution to its differential diagnosis" was published in Serbian in the Serbian Archives of Medicine in 1880, and republished in German in Vienna in 1884. In this article, based on 6 patients from his medical practice, Lazarevic correctly explained that stretching the sciatic nerve is the cause of pain during the straight leg raising test. He gave a full description of several maneuvers used to perform the test, and described the control test. Maneuvers described by Lazarevic are known by other names. CONCLUSIONS: Analysis of the historical events and documentation indicates that Lazarevic could have described the straight leg raising test in sciatica before Lasègue. He identified stretching of the sciatic nerve as the cause of pain and presented several maneuvers, which are now known by other names as labels for various diagnostic categories.

[The Barrés test and Mingazzini test -Importance of the original paper by Giovanni Mingazzini].

In order to find a subtle hemiparesis of the arms and legs, so called "Barré's test" has been routinely used in clinical practice. This eponym has been questioned by several neurologists. To clarify this, I searched and found the original paper by Giovanni Mingazzini, reported in Revue Neurologique in 1913. He showed arm drift test with his original photo, as asking the patient to stretch his arms in front, hands in the same horizontal plane with the manner of swearing and the fingers spread. The eyes are closed. The examiner observes downward drift of the hand after one half to a minute. He described a similar test for the legs in this article. The patient in supine position raises the legs in a 45 degree angle from the bed. If the leg drops downward too early, an organic hemiparesis could be present. Barré described a new leg drift test in 1919 with a patient lying on the abdomen. He also presented the Mingazzini's arm and leg tests with photos as carried by his patient-models in his article of 1937. He did not quote the original article of Mingazzini as a reference. These brought us incorrect information to consider the presence of Barré's arm test.

The meaning of ‘general paralysis of the insane’ in Victoria, Australia; 1886 to 1906 / El significado de "parálisis general del demente" en Victoria, Australia; 1886-1906

This paper presents a conclusion to the meaning of the historical diagnosis "general paralysis of the insane" in nineteenth century Victorian Registrar General's reports. Most studies suggest that in the past the diagnosis refers to neuro-syphilis, and while after 1906 this is not disputed, this paper will show that the diagnosis had a much broader meaning incorporating many forms of degenerative brain disease during the study period (Victoria 1886 to 1906). It is acknowledged, however, that the use of this diagnosis may have varied dramatically in the past based on a doctor's education and/or background. This conclusion has been arrived at by analysing both government and general hospital records on the Australian, Victorian population. This paper also presents methods for determining the meaning of obsolete medical diagnoses where the definition is poorly understood (AU)

En este trabajo presenta una conclusión sobre el significado de la "parálisis general de los locos" como diagnóstico en los informes del Victorian Registrar General durante el siglo XIX. La mayoría de los estudios sugieren que en el pasado el diagnóstico se refiere a la neuro-sífilis, y aunque después de 1906 no se discute, este trabajo mostrará que el diagnóstico tiene un significado mucho más amplio e incorpora muchas formas de enfermedad degenerativa del cerebro durante el período de estudio (Victoria 1886 a 1906). Se reconoce, sin embargo, que el uso de este diagnóstico puede haber variado drásticamente en el pasado dependiendo de la formación y del ambiente médico. Se ha llegado a esta conclusión mediante el análisis de los registros hospitalarios de la población de Victoria, Australia. Este documento también presenta métodos para determinar el significado de los diagnósticos médicos obsoletos cuya definición es confusa (AU)

[Neuromuscular diseases were always difficult to diagnose]. / Neuromuskuläre Krankheiten waren schon immer schwer zu diagnostizieren.

The Deutsche Zeitschrift fuer Nervenheilkunde (German Journal for Neurology) was founded as a specifically neurological journal at the end of the nineteenth century and soon became a European platform for scientific discussion of neurological topics. Papers also came from the USA, Scandinavia and Russia. The difficulties of the diagnosis and definition of clinical entities are illustrated in cases of botulism, myotonic dystrophy and myasthenia gravis.

Validation and perspectives of neuromodulation in Japan.

Neuromodulation in functional neurosurgery is closely related to the development and availability of devices such as implantable electric stimulators and pumps. All such devices used in Japan are developed and made in foreign countries, and no made-in-Japan device exists. Introduction and approval by the government took many years for most devices, during which time many patients had to continue to live in our medically conservative country. The history of neuromodulation is summarized in Japan and the problems surrounding neuromodulation pointed out. Everyone has to aware of such circumstances and make every effort to improve the internationally unusual situation of neuromodulation in Japan. Otherwise, Japan will become a medically isolated country in the near future.

J.-M. Charcot and simulated neurologic disease: attitudes and diagnostic strategies.

BACKGROUND: Neurologists have long wrestled with the diagnosis of elaborated or feigned disease. Studies have not focused on early techniques utilized to diagnose malingering. OBJECTIVE: To analyze cases of purposeful neurologic malingering among patients treated by the 19th century neurologist J.-M. Charcot, describe his attitudes, and study his methods to separate malingering from primary neurologic diseases. METHODS: A study was conducted of Charcot's printed and original documents from the Bibliothèque Charcot, Paris, and added documents on American neurology. RESULTS: Charcot recognized that purposeful simulation occurred in isolation as well as in established neurologic disorders. Charcot was strict with subjects motivated by greed or spite, but showed forbearance and wonder in those who created illness as "art for art's sake." Charcot developed diagnostic equipment that measured inspiratory depth and muscle activity as a strategy to identify malingerers. His approach strikingly contrasted with contemporary military medical treatises on malingering and S.W. Mitchell's civilian neurologic approaches that unmasked patients through more aggressive strategies. CONCLUSION: Charcot provided an academically professional approach to the assessment of neurologic malingering, with a stern, often patronizing attitude, but without categorical condemnation. His diagnostic techniques are echoed by contemporary approaches and emphasized an attention to enhanced and inconsistent patterns of behaviors by malingerers.