The Introduction of Emotions and Behavior in the Assessment of Neurological Patients.

In neurology and neuropsychology, behavior refers to the way human beings act and make decisions in contact with their environment. Behavioral impairment is therefore defined as a pathology, following brain lesion, that impacts the interactions between the brain-lesioned individual and his/her surrounding social world. First descriptions of behavioral disorders, including neuroanatomical correlates, date back to the mid-19th century. However, attempts towards their systematic identification and analysis only began at the turn of the 19th to 20th century. In this chapter, we shall span 3 main themes by introducing the first case reports based on thorough clinical descriptions, dating back to the 19th century. We then examine the emergence of checklist questionnaires and their application to large cohorts of individuals starting after World War II. Finally, we outline how, over the last 3 decades, the pace has significantly accelerated in the pursuit of defining the fine-grained processes underlying behavioral functioning, as well as the development of new and more complex measures, along with the emergence of the social cognition and social brain concepts. As the assessment tools have expanded and become more specific, an increasing complexity of mechanisms underlying behavior has begun to emerge.

The physiological experiments of Constantin von Economo on the central pathways of mastication and deglutition.

The first study of Constantin von Economo on the mammalian brain was published in 1902. Experiments were carried out in rabbits at the Physiological Institute headed by Siegmund von Exner-Ewarten in Vienna to investigate the central pathways of chewing and swallowing. After placing cortical lesions, Economo applied cortical and subcortical electrical stimulation to obtain masticatory movements, and tracked degenerated fibers by means of the Marchi method. He traced fibers through the internal capsule, ventral nucleus of the thalamus, subthalamic nucleus, substantia nigra and its connections with the motor nucleus of the trigeminal nerve, and nucleus solitarius. He suggested that the substantia nigra is responsible for coordinating alimentation movements, with the involvement of cranial nerves V, VII, IX and X as well. We discuss these findings in a historical and a modern perspective, including the concept of a central pattern generator in the pontine reticular formation and its interaction with the nucleus solitarius. Today we understand that mastication is a voluntary action controlled by motor cortical areas, by motoneurons of the trigeminal, and by a neural pattern generator in the pons. On the other hand, deglutition comprises 'reflex swallowing' triggered by sensory fibers of cranial nerves V, IX and X, and 'voluntary swallowing' which may be controlled by both cortical fields and subcortical areas, such as the internal capsule, the hypothalamus and the mesencephalic reticular formation.

The Place of Post-Traumatic Amnesia in the Assessment of Blunt Head Trauma: The Epistemic, Professional and Material Factors Shaping British Neurology, circa 1920-40.

The increase in road traffic accidents in twentieth-century Britain brought with it a rise in the number of patients admitted to hospital with blunt, non-penetrating head injuries. Patients who had suffered mild to moderate trauma typically complained of a variety of problems, including headaches, dizziness and giddiness. For the neurologists tasked with diagnosing and treating these patients, such symptoms proved difficult to assess and liable to obscure the clinical picture. This article focuses on why neurologists turned to time as a diagnostic-tool in helping to resolve these issues, specifically the measurement of post-traumatic amnesia (PTA). This article argues that PTA became so central to neurological diagnosis owing to a set of epistemic, professional and material factors in the decades prior to the Second World War. It concludes with a call for deeper appreciation of the range of issues that contribute to the shaping of medical theories of head trauma.

Stanley Cobb, the Rockefeller Foundation and the evolution of American psychiatry.

Stanley Cobb founded the Harvard Departments of Neurology (1925) and Psychiatry (1934) with Rockefeller Foundation funding. Cobb was an important transitional figure in both neurology and psychiatry. He and his friend Alan Gregg were the most visible parts of the Rockefeller Foundation psychiatry project, which prepared American psychiatry for the rapid growth of psychiatric research after World War II. Edward Shorter called him the founder of American biological psychiatry, but this misunderstands Cobb and the Hegelian evolution of twentieth-century American psychiatry. I review the major role of the Rockefeller Foundation in the evolution of American academic psychiatry and the disappearance of Cobb's teaching and that of his mentor Adolf Meyer, a founding father of American academic psychiatry.

The exciting field of neuro-repair in multiple sclerosis: an interview with Sarah I Sheikh.

Sarah Isabel Sheikh speaks to Laura Dormer, Commissioning Editor: Sarah I Sheikh, MD, MSc, MRCP, is a Senior Medical Director in Late Stage Clinical Development at Biogen. Her current focus is on developing therapies for multiple sclerosis/neuroinflammation, remyelination and neuro-repair. Prior to Biogen, Dr Sheikh was an attending in Neurology at Brigham and Women's Hospital. She completed her internship at Massachusetts General Hospital and residency in Neurology and Neuromuscular fellowship at Massachusetts General Hospital and Brigham and Women's Hospital. She received her medical degree from Oxford University Medical School, and a Masters in cell physiology from Oxford University, Corpus Christi College. She is a member of the Royal College of Physicians, London.

Advancing the understanding of progression in multiple sclerosis: an interview with Shibeshih Belachew.

Shibeshih Belachew speaks to Laura Dormer, Commissioning Editor: Dr Shibeshih Belachew, MD, PhD, is a Senior Medical Director for Multiple Sclerosis (MS) Disease Area in Global Product Development Medical Affairs at Roche (Basel, Switzerland). Prior to joining Roche in January 2016, he was Director of MS Franchise and Head of Medical Director's office for Biogen Region Europe and Canada. Previously at Biogen he also served as a Director in Global Neurology for the natalizumab program in Cambridge (MA, USA). Prior to joining industry, he was a Clinical Professor of Neurology at the University of Liège in Belgium. Shibeshih completed neurology postgraduate training at the University of Liège and has a PhD in Biomedical Science in the field of Developmental Neurobiology. Shibeshih has been a post-doctoral fellow in the Laboratory of Cellular and Synaptic Neurophysiology at the National Institutes of Health (Bethesda, MD, USA) and later at the Center for Neuroscience Research of Children's National Medical Center in Washington DC. He is a member of the Belgian Neurological Society.

Louis Delasiauve (1804-1893), an alienist at the dawn of epileptology and pediatric psychiatry.

This paper aims to honor the memory of the alienist Louis Delasiauve (1804-1893). His classification of the different types of epilepsy based on clinical symptoms is still relevant today and made him a precursor of contemporary epileptology. In 1851, Delasiauve clinically and etiologically isolated 'acute mental confusion' (acute confusional state) from all other forms of dementia. Never deviating from his republican and progressive ideals, he devoted himself throughout the 19th century to treating those insane asylum patients who received the poorest care: epileptics and children with intellectual disabilities. Studying functional cognitive disability as well as mental disability secondary to congenital malformations, Delasiauve developed a novel specific form of pedagogy to deal with delays in cognitive development. This made him one of the initiators of institutional pediatric psychiatry. His ideas would be carried forward by his favorite student, Désiré-Magloire Bourneville (1840-1909). Committed to social welfare, Delasiauve worked relentlessly to improve access to healthcare for the least fortunate throughout France. As a passionate supporter of universal, free and secular education, he participated in a major movement away from religious establishments that involved opening a public school in every French canton.

Neurocritical Care in China: Past, Present, and Future.

Despite the lack of resources and materials, there has been an increasing demand for acute neurologic care owing to the heavy burden of neurocritical illness in most developing countries, including China, where the morbidity and mortality of severe neurologic and neurosurgical disorders remains high. Neurointensive care units did not start appearing in China until the late 1980s. Although great progress has been made over the past 2 decades in the establishment of equipped neurocritical care centers, advancements in medical infrastructure, streamlining of resident training programs, and implementation of multidisciplinary care teams, there remain areas that warrant improvement to care for our growing patient population. Here we review and discuss the history, present state, and future of neurocritical care in the People's Republic of China.

[The Homburg clinic for nervous diseases in the National Socialist Era. Special features in the Saarland border region]. / Die Homburger Nervenklinik im Nationalsozialismus. Besonderheiten in der saarländischen Grenzregion.

BACKGROUND AND OBJECTIVES: When the National Socialists (NS) came to power in 1933, the German health care system was reorganized according to the principles of eugenics. Neuropsychiatric patients were victims of compulsory sterilisation and "euthanasia". As the Saar territory did not become part of the German Reich until the 1 March 1935, it is of special interest how quickly and completely NS health care policies were implemented. METHODS: The analysis is based on medical records of the Homburg State Hospital's (HSH) clinic for nervous diseases from 1929 to 1945 (n =7,816) found in the Saarland University Medical Centre. RESULTS: 1,452 patients were sterilised by force between 1935 and 1939 in the HSH. The most frequent diagnoses were congenital debility, schizophrenia, and epilepsy. Some of the 441 Homburg patients who were transferred to other mental hospitals from 1939 to 1940 were killed in the context of "Aktion T4" and presumably in a nonsystematic manner. CONCLUSIONS: NS health care policies were implemented immediately after incorporation of the Saar territory in 1935. Physicians of the HSH were involved directly in compulsory sterilisation of neuropsychiatric patients. An initial intention to kill by the time of patient transfers from Homburg cannot be proven. Further research concerning the killing centres is necessary.

Looking at the future with Rita.

This paper on Rita Levi-Montalcini (1909-2012), who received in 1986 the Nobel Prize in Physiology or Medicine for the discovery of nerve growth factor, focuses on aspects of her advocacy and her commitment to education in which she has been especially active in the last part of her long life. With passionate confidence on the capabilities of the aging brain (together with severe admonition against the pursuit of immortality), she encouraged contributions of senior citizens to the society. Always projected into the future, with enduring faith in the potential of young individuals, in education as a key to development, in the capabilities of women, in the importance of gender equality, Rita established in 2001 the Rita Levi-Montalcini Foundation for the education of African women. Her legacy on engagement for a better 'global village' should not be forgotten by the neuroscience community.

Examining language functions: a reassessment of Bastian's contribution to aphasia assessment.

Henry Charlton Bastian (1837-1915) developed his network model of language processing, modality deficits and correlated lesion localizations in the 1860s and was a leading clinical authority for over four decades. Although his ideas are little referenced today, having been overshadowed by his more eminent Queen Square colleague John Hughlings Jackson, his work on aphasia and paralysis was highly regarded by contemporaries. This paper traces Bastian's lasting but largely unattributed contribution to the development of standardized clinical assessment of language disorders. From 1867 onwards, Bastian trained generations of medical students in neurology. In his 1875 book On Paralysis there is evidence in his case descriptions that Bastian had already implemented a detailed set of procedures for examining aphasic patients. In 1886, Bastian published a 'Schema for the Examination of Aphasic and Amnesic Persons'. Bastian insisted on the utility of this battery for diagnosis, classification and lesion localization; he argued that its consistent use would allow the development of a patient corpus and the comparison of cases from other hospitals. In 1898 his Treatise on Aphasia included a list of 34 questions that were to be used to examine all patients to provide detailed and systematic evidence of spared and impaired abilities in all receptive and expressive modalities. Bastian's contribution to the development of standardized clinical aphasia assessment is reassessed through detailed analysis of his publications and those of his contemporaries as well as new material from archives and casebooks. This evidence demonstrates that his approach to diagnosis of language and other cognitive impairments has propagated through the decades. His legacy can be seen in the approach to standardized aphasia testing developed in the latter 20th century through to today.

Dr. Haakon Sæthre: a Norwegian neuroscientist and his resistance against Nazi Germany.

Dr. Haakon Sæthre was a leader of Norwegian neurology and psychiatry. He was resourceful, compassionate and had immense pride in his independent homeland. He described Sæthre-Chotzen syndrome (acrocephalosyndactyly type III). When Nazi Germany occupied Norway during World War II, Sæthre fearlessly and actively resisted, from revoking his medical association membership, to hiding persecuted Jews as patients in his psychiatric ward and aiding in their escape to Sweden, to managing the largest "illegal" food warehouse in Oslo with Danish humanitarian aid. As a prominent and noticeable citizen, he was arrested and executed by the Nazis in reprisal for the resistance's assassination of a hated Norwegian Nazi. His legacy lives on in Norway, where he was honored by a scholarship fund, a portrait and multiple plaques at Ullevål Hospital, and a street and memorial statue in his hometown. He was a hero and should be remembered by all who practice neurology.

Neuropathology in Canada: the first one hundred years.

We describe the evolution of neuropathology in Canada, beginning with William Osler who began working in Montréal in 1874 and finishing with the major period of expansion in the 1970s. Organized services began in the 1930s, in Montréal with the neurosurgeons Wilder Penfield and William Cone, and in Toronto with Eric Linell and Mary Tom, who both began their careers as neuroanatomists. Jerzy Olszewski and Gordon Mathieson, who trained in Montréal and Toronto, drove the creation of the Canadian Association of Neuropathologists in 1960. Training guided by the Royal College of Physicians and Surgeons of Canada was formalized in 1965, with the first certifying examination in 1968 and the subsequent creation of formal structured training programs. The number of neuropathologists in Canada increased rapidly through the 1960s and 1970s, with individuals coming from both clinical neuroscience and anatomic pathology backgrounds, a pattern that persists to the present day.