The Neurology Lounge – A blog for everything neurological
Welcome to my blog. I am a UK Neurologist with an interest in everything neurological. I have also dipped my toes in the world of patient safety. This blog is an avenue to share my thoughts about neurology, but I hope it becomes a place for Neurologists to discuss and explore everything Neurology.
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I admit I have a keen interest in rivalries. I think they reveal something primal about the human psyche. Nothing beats professional conflicts in their sheer intensity, and the scientific world is particularly rife with fierce duels and petty jealousies. And the main driver for these squabbles, often prolonged and bruising, is the ambition to be recognised as the first and the best. And the fuel is often the tempting allure of a juicy patent, and perhaps a Nobel prize to boot. Some scientific feuds are legendary, such as the one between Isaac Newton and Robert Hooke, or the one between electricity giants Nicola Tesla and Thomas Edison.
How has the field of neuroscience fared in the duelling arena? Here are our 7 epic historical rivalries that shaped neuroscience.
1. Wilder Penfield versus Francis Walshe
This is not a huge controversy, but there is enough hurt ego to class it a rivalry. Wilder Penfield, the brilliant neurosurgeon, was instrumental to mapping the representation of the motor and sensory cortex, defining the homonculus. He did this through his experiments during awake surgery for people with intractable epilepsy at the prestigous Canadian Neurological Institute. Francis Walshe, neurologist at the National Hospital for Neurology and Neurosurgery was, to say the least, unimpressed by Penfield’s surgical approach. And he said so to Penfield’s hearing at an Anglo-American Symposium which held in London. The controversy also played out in a series of lettersbetween the two. But it is possible the rivalry goes further back in time; they probably never took to each other when they both trained under the great neurologist Gordon Holmes. And at the heart of the matter is the disdain with which neurologists regarded neurosurgeons at that time. How the tide has changed.
These are two of the leading figures in psychoanalysis. The older Sigmund Freud, and the younger Carl Jung, liked each other at the outset…until their scientific theories about the nature of the unconscious made them rivals. This resulted in the two distinct Jungian and Freudian concepts. Some go as far as to argue that sex and race were also driving their rivalry. Whatever the reasons, things got very heated with Freud claiming Jung wanted him dead. How much worse could a rivalry get?
The French Neurologist Jean-Martin Charcot is considered by many to be the father of modern neurology. Charles Bouchard on the other hand was a student of Charcot. Things fell apart between the two as soon as Bouchard became a professor. No Nobel prizes at stake here-their feud revolved around a brutal struggle for power and influence. Even though Bouchard got the upper hand, history hasn’t remembered him as well as it has Charcot. Just by the way, Charcot may have also had a simmering rivalry with Jules Joseph Dejerine! I am not quite sure what that says about the personalities at the crucible of neurology.
Vladimir Bekhterev is not a household name, but the Russian neurologist is instrumental to defining the role of the hippocampus in memory, and indeed has an eponymous non-neurological disease known as Ankylosing spondylitis. Bekhterev had a simmering conflict with his fellow countryman and physiologist Ivan Pavlov. And this had to do, unsurprisingly, with their rather similar theories of conditioned reflexes. It did not help that they both had “oversized and confrontational personalities“. This is one rivalry that blew out of all proportions, spilling into open enmity.
This rivalry is between two people who shared the Nobel Prize in Medicine in 1906. It was at the prize-giving ceremony that the Italian anatomist Camillo Golgimaliciously shredded his co-recipient, the Spanish Santiago Ramon y Cajal. The stakes in this rivalry were very high for neuroscience, as it concerned the fundamental structure of the nervous system. Golgi originally developed the staining method which made neurones visible, but Cajal refined and improved it. He then went on to demonstrate that neurones do not form seamless interconnected cells, firing in all directions, as Golgi argued. Rather, he found neurones to be individual cells firing in one direction. Cajal’s neuron doctrine was the eventual winner in this one.
This is a rivalry that played out in royalty. The French surgeon Ambroise Pare was already recognised for refining the treatment of battlefield wounds and amputations. And he later became the official surgeon to King Henry. The Spanish Andreas Vesalius, on the other hand, had established his fame with
Benjamin Disreali, the two-time British Prime Minister, is quoted to say “The wisdom of the wise, and the experience of ages, may be preserved by quotation”. Joseph Roux, the French poet, describes ‘a fine quotation’ as ‘a diamond in the hand of a man of wit, and a pebble in the hand of a fool”.
Many have put their wisdom and wit to the task of capturing the beauty and complexity of the brain. And they have used the most illuminating of words which have achieved the status of quotablequotes. Over the last few years I have etched some of these quotations in marble, and circulated them via social media. Here I bring together 18 most insightful and profound brain quotations, sculptured by those who should know a thing or two about the brain: neuroscientists, astronomers, and literary greats. Enjoy, and click to see them in their original tweet.
Medication-overuse headache detoxification reduces headache disability-the Akershus study of chronic headache Kristoffersen ES, Grande RB, Aaseth K, Russell MB, Lundqvist C Eur J Neurol 2018; 25:1140-1147. Abstract BACKGROUND: Medication-overuse headache (MOH) is a chronic headache (≥15 days/month) associated with overuse of acute headache medication. The objective was to investigate headache-related disability before and after self-detoxification […]
Neurologists are often at the receiving end of the jokes of other medical specialists. They facetiously remark that neurologists know a lot, but do very little to cure their patients. Admittedly we do our fair share of dispensing weak platitudes, and we do break bad news with embarrassing regularity. There is no doubt that, for […]
White matter abnormalities in the corpus callosum with cognitive impairment in Parkinson disease. Bledsoe IO, Stebbins GT, Merkitch D, Goldman JG. Neurology 2018 (Epub ahead of print) Abstract OBJECTIVE: To evaluate microstructural characteristics of the corpus callosum using diffusion tensor imaging (DTI) and their relationships to cognitive impairment in Parkinson disease (PD). METHODS: Seventy-five participants […]
Ever wondered what Neurochecklists subscribers most frequently search? Below are the 10 most popular topics on Neurochecklists: Drug-induced encephalopathy: causes Seizure history Seizures: classification Antiepileptic drugs (AEDs): choice with medical conditions Sleep disorders: classification Exploding head syndrome (EHS) Anti DPPX autoimmune encephalitis Lumbar puncture (LP): indications and precautions Transient ischaemic attacks (TIA): clinical features Cervical […]
Alzheimer’s disease (AD) is one of the most fearsome and recalcitrant scourges of neurology. We think we know a lot about it; after all it has been a quite a while since Alois Alzheimer described amyloid plaques and neurofibrillary tangles in his index patient, Frau Deter. But the more neuroscientists study the disease, the murkier the field looks. For example, we are still not quite sure what the plaques and tangles really signify; for all we know, they may just be innocent bystanders, powerless by-products of a neurodegenerative process that defies understanding. We have accumulated an endlessly long list of AD risk factors, but we have singularly been unable to point a finger at the cause of AD.
This elusive void may however be a void no longer, if what superficially appears to be an outlandish theory turns out to be correct. And the theory is that AD is caused by infection! Just take a deep breathe, and allow yourself the space to make a giant leap of imagination. My attention was first drawn to the infective hypothesis of AD by a headline in Scientific American screaming Controversial New Push to Tie Microbes to Alzheimer’s Disease. The obvious key word here of course is controversial: is it possible that AD, this quintessential neurodegenerative disease, is…just another chronic infection?
To find the original source of the story, the trail of bread crumbs led to an editorial published in the Journal of Alzheimer’s Disease in 2016, plainly titled Microbes and Alzheimer’s Disease. But this is not a run-of-the-mill editorial at all because it was written by 33 senior scientists and clinicians from a dozen countries. And their reason for an alternative theory of AD is simple: amyloid, the long-suspected culprit for decades, has failed to live up to its billing. They point out that amyloid exists harmlessly in the brains of many older people who never go on to develop dementia. They also cite studies which demonstrate that treating amyloid, by immunological means, does not improve the state of people suffering from AD. Amyloid, in other words, is not such a bad guy after all. But all the while we have been setting traps to ensnare it, the microbial villains have been running amok, having a field day.
But why should microbes succeed where amyloid, the ubiquitous protein, has woefully failed? The editorial gave 8 good reasons to argue that the infection theory is better than the amyloid hypothesis. One reason is that the brains of people with AD are often riddled with inflammation, a characteristic feature of infections. Another reason is the observation that AD can be transferred to primates when they are inoculated with the brain tissue of someone with AD.
And the culprit with the most number of index fingers pointing at it is herpes simplex virus type 1 (HSV1). The editorial tells us that there have been about 100 publications, by different groups, demonstrating that HSV1 is a ‘major factor‘ in the causation of AD. Some of these studies have shown that people with AD have immunological signs of significant HSV infection in their blood. The editorial goes further to review the possible mechanisms by which HSV1 may cause AD; one of these is the possibility that the virus lowers the risk of AD in people who possess the APOE ɛ4 allele genetic liability.
Just when you are getting your head round the idea, the infection theory takes a very sinister turn. And this relates to the perverse modus operandi of the microbes. The authors tell us that the microbes first gain access to the brains of their victims when they (the victims) were much younger. Like sleeper cells in their ghoulish crypts, the microbes hibernate, biding their time until their victims get older, and their immunity declines. The microbes then awaken, and like malevolent zombies, set out to wreak gory mayhem and cataclysmic destruction. And they do this either by causing direct damage to the brain, or indirectly by inducing inflammation.