Frontiers of Neurology and Neuroscience最新文献

Little is known about the neurological control of human sexual behavior. Investigating and measuring this behavior by using quantitative and objective methods is difficult. Insights from lesion studies contribute to analyze the effects of neurological disorders on human sexual behavior. In this chapter, we focus on frontal lobe lesions, brain injuries, epilepsia, dementia, and Parkinson disease to describe human sexual behavior disorders, in order to highlight cortical and subcortical brain regions and neural networks involved in human sexual behavior.

The personal and bibliographical histories of the two Russian writers, Leo Nikolaevich Tolstoy and Ivan Sergeevich Turgenev, are strictly connected to social and scientific developments in nineteenth century Russia. In particular, in the field of medicine and of neurology, these two authors had personal issues and interests, kindled by Russia's opening to Western European thought. Neurology at the beginning of the nineteenth century was not developed in Russia, and in the second half of the century the new generation of neurologists trained abroad, in particular in France, where Charcot was an eminent figure who also travelled to Russia to help establish the new "Russian neurology." The following generation of neuropsychiatrists, in turn, looked upon Russian writers, and in particular Tolstoy, as models of psychopathology both for their personal biography and for character depictions. Tolstoy experienced depression, which he overcame after a religious/philosophical conversion; his renewed views were expressed in his later works, and led to the coining of the term "Tolstoyism" in medical literature. Turgenev admired the works by Tolstoy, but his vision was more pragmatic and close to those of his European colleagues of the time. His best effort was in the description of physical illnesses, and this was recognized by physicians and psychiatrists reading and commenting on his works.

The issue of First World War shell shock has been documented mainly from a medical perspective. Many medical texts dealing with war psychoneuroses and their aggressive treatments, such as electrotherapy, were published during the war. Accounts from shell-shocked soldiers are rare. Nevertheless, shell shock was described from a non-medical point of view by a few writers who had undergone or witnessed this pathology. Their texts deal mainly with the psychiatric forms, the most striking ones, but also with the more common concepts of commotion, emotion and pathological fear. The French philosopher Émile Chartier (1868-1951), alias Alain, described the commotional syndrome from which he suffered. The German writer Ernst Jünger (1895-1998), a brave officer and an example for his men, reported his emotional shock. Some psychiatric forms of shell shock are present in the work of the pacifist writer Jean Giono (1895-1970), the naturalist Maurice Genevoix (1890-1980), who suffered himself from a section of the left median and ulnar nerves, or the British poet Siegfried Sassoon (1886-1967). War hysteria and pathological fear have been described, on several occasions, by Blaise Cendrars (1887-1961) or the German writer Erich Maria Remarque (1898-1970). Electrotherapy has been scarcely reported except by Louis-Ferdinand Céline (1894-1961).

Body representation disorders continue to be mysterious and involve the anatomical substrate that underlies the mental representation of the body. These disorders sit on the boundaries of neurological and psychiatric diseases. We present the main characteristics of 3 examples of body representation disorders: phantom sensations, supernumerary phantom limb, and apotemnophilia. The dysfunction of anatomical circuits that regulate body representation can sometimes have paradoxical features. In the case of phantom sensations, the patient feels the painful subjective sensation of the existence of the lost part of the body after amputation, surgery or trauma. In case of apotemnophilia, now named body integrity identity disorder, the subject wishes for the disappearance of the existing and normal limb, which can occasionally lead to self-amputation. More rarely, a brain-damaged patient with 4 existing limbs can report the existence of a supernumerary phantom limb.

The famous poet Arthur Rimbaud (1854-1891) stopped writing poetry at 21 years and subsequently had a rather adventurous life mainly in the Arabic peninsula and Ethiopia. He died at 37 years, only a few months after the amputation of his right lower limb due to a developing tumor in the knee, which probably was an osteosarcoma in the lower third of the femur. His letters to his sister Isabelle suggest that he suffered from severe stump pain rather than phantom limb, but since he lived only shortly after surgery (he developed extensive carcinomatosis), one does not know whether a full phantom would have developed and how this would have affected his subsequent life.

Some neurological or psychiatric positive, productive symptoms are an abnormal persistence of a sensorial feeling or abnormal repetition of a motor, behavioral or cognitive process corresponding to a perseverative symptom. Palinopsia, palinacousis, and related sensorial symptoms have been described. Verbal and motor symptoms include echolalia, palilalia, echopraxia, and motor perseveration. Cognitive disorders induce perseverative behavior, perseverative thinking, including palipsychism, flashbulb memories, and reduplicative paramnesia (also known as "palimnesia") and many related perseverative symptoms. We propose a review of physiological phenomena and pathological symptoms involving these perseverative or repetitive characteristics and discuss the potential mechanisms and neural network involved in this productive semiology.

The catastrophic reaction (CR; a disruptive and uncontrolled behavior triggered by anger, irritability, and hostility) and emotionalism (a condition of uncontrolled crying or laughing) are disorders of the emotional regulation and expression, the prevalence of which is underestimated in neurology. Their occurrence is an additional factor of poor outcome for neurologic patients. Although they have been recognized and completely described in their clinical manifestations more than a century ago, many issues remain unsolved regarding their pathogenesis and the respective role of the brain damage and psychological factors. Thus, if pathological crying and laughing can be linked to one or more lesions within the corticospinal tracts, the emotional lability and CR have uncertain connections within specific functional brain systems and seem to be influenced by personality factors or depression and anxiety generated by coping with a serious neurological disease. These epistemological difficulties are also the consequence of some methodological limits of the questionnaires and scales, which diagnose these disorders and for which the cut-off values between the normal and pathological condition could be questioned. Thus, their assessment requires new psychophysical. The CR and emotionalism manifest in association with several different neurological disease (degenerative, vascular, inflammatory, epilepsy) and psychiatric conditions as psychosis, mania, and mood disorders. Across these different diseases, the findings of common patterns of lesion location, cognitive dysfunction, emotional changes, and behavioral responses to new paradigms might clarify the pathogenesis and orient the treatment.

In 1955, English psychiatrist John Todd defined the Alice-in-Wonderland syndrome (AIWS) as self-experienced paroxysmal body-image illusions involving distortions of the size, mass, or shape of the patient's own body or its position in space, often accompanied by depersonalization and/or derealization. AIWS had been described by American Neurologist Caro Lippman in 1952, but Todd's report was the most influential. Todd named the syndrome for the perceptual disorder of altered body image experienced by the protagonist in Alice's Adventures in Wonderland (1865) by Lewis Carroll (Charles Lutwidge Dodgson). In Carroll's original story, Alice experienced several dramatic changes in body size and shape (e.g., shrinking to 10 inches high, growing unnaturally tall but not any wider, and growing unnaturally large). Todd reported 6 cases of AIWS, all of whom had episodic body-image distortions like those experienced by Lewis Carroll's Alice character; some also had visual perceptual disturbances, but none had visual perceptual disorders without body-image distortions. Therefore, AIWS may be accompanied by visual perceptual disorders (e.g., micropsia, macropsia, telopsia, pelopsia), but basing the diagnosis of AIWS on isolated visual perceptual disorders, as has subsequently been done by a number of authors, is inaccurate and misleading. Cases of isolated visual illusions without self-perceived distortions of body size, shape, or form, do not meet Todd's original criteria, nor are they commensurate with the experiences of the protagonist in Alice's Adventures in Wonderland. Furthermore, such cases differ by age and etiology from those that involve somesthetic perceptual disorders. Therefore, the use of the term AIWS for isolated visual illusions is problematic and should be discouraged. Although Todd's and Lippman's cases were adolescents or adults, AIWS is most commonly reported in children. Reported causes include infection (especially with Epstein Barr virus), migraine, epilepsy, depression, and toxic and febrile delirium.