La Malattia di Parkinson dopo James Parkinson (terza parte)
Parkinson's disease was first formally described in modern times in "An Essay on the Shaking Palsy," published in 1817 by a London physician named James Parkinson (1755-1824). James Parkinson described the medical history of six individuals who had symptoms of the disease that eventually bore his name. Unusually for such a description, he did not actually examine all these patients himself but observed them on daily walks. The purpose of his essay was to document the symptoms of the disorder, which he described as "Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from a walking to a running pace : the senses and intellect being uninjured."
It was not until 1861 and 1862 that Jean-Martin Charcot (1825-1893) with Alfred Vulpian (1826-1887) added more symptoms to James Parkinson's clinical description (Charcot and Vulpian, 1861, 1862) and then subsequently confirmed James Parkinson's place in medical history by attaching the name Parkinson's Disease to the syndrome. Charcot added to the list of symptoms the mask face, various forms of contractions of hands and feet, akathesia as well as rigidity. It was quite difficult to understand from his description what was meant by referring to rigidity. It was only after Charcot gave a clinical lesson in 1868 that the difference became clear (Charcot, 1868). In 1867 Charcot introduced a treatment with the alkaloid drug hyoscine (or scopolamine) derived from the Datura plant, which was used until the advent of L-Dopa a century later. In 1876 Charcot described a patient suffering from Parkinson's disease in the absence of tremor, while rigidity was present. In this case there was no paralysis, so Charcot rejected the term paralysis agitans. Instead he suggested that the disease be referred to in future as Parkinson's disease.
In 1868, Jean-Martin Charcot wrote that the French doctor Guillame Benjamin-Amand Duchenne (1806-1875), had reported a case in which he had cured paralysis agitans by application of galvanism. Duchenne had popularized the use of electrical means with his 1855 publication "On localized electrification, and on its application to pathology and therapy". The Irish physician U.S.L.Butler also claimed in 1869 that it cured a patient of paralysis agitans. William Sanders had mentioned in his paper in 1865 that the application of "galvanism" was without benefit for his patient. Hughlings Jackson, and William Gowers in 1893, who also tried it in paralysis agitans, were unstinting in their deprecation of the practice as "useless". Despite this, electrical stimulation in Parkinson’s disease continued to be used for decades more. In the 1924 edition of his handbook on electrotherapy, Toby Cohn commented that "remarkable results could not be expected", and that what benefits he had seen were largely psychological. In his 1941 review of the "modern treatment of parkinsonism", Critchley specifically warned against electricity and other spurious claims of curing the disease.
The first specific attempt to treat Parkinsonism surgically was reported by Leriche in 1912, via section of the posterior roots. The method relieved tremor or rigidity. Delmas-Marsalet claimed success in the treatment of rigidity with lesions of the cerebellum. Improvements in tremor were subsequently achieved by cortectomy, but often at the price of other functional losses. Cordotomy was directed against unilateral tremor and rigidity, and associated with fewer side effects. Meyers reported in 1951 that sectioning of pallidofugal fibres achieved the best results for relieving tremor and rigidity, but most surgeons chose to undertake a more direct attack on the pallidum, with equal success and a lower fatality rate. The publication of the first stereotactic atlas of the human brain by Spiegel and Wycis in 1952 increased the popularity of stereotactic surgery. The thalamus gradually became the preferred target, as the impact on tremor was greater and the operation was safer. By 1969, only 15% of patients were suitable for stereotactic operations, but up to 90% of those could expect relief from tremor and rigidity. After a sharp decline in stereotactic surgery, thalamotomy was revived in the 1970's for patients whose tremor was not helped by L-dopa. Laitinen and colleagues resumed operations on the medial pallidum in 1985.