From hysteria to gait dementia: History of the concept of astasia-abasia.

Paul Blocq (1860-1896) and his teacher Jean-Martin Charcot (1825-1893) introduced the expression "astasia-abasia" into medical terminology in 1888 to designate a pathology they believed to be caused by hysteria. This condition makes it impossible to remain erect and to walk, whereas the ability to move the legs while lying down remains normal. At the turn of the 20th century, and now almost exclusively, this motor disturbance is recognised as a syndrome with multiple possible organic causes, and now described as "higher-level gait disorder". After briefly mentioning earlier descriptions by other authors, I will review Charcot's Tuesday lessons in 1889 that covered astasia-abasia and elucidated the beginnings of the breakdown into organic aetiologies: medial-frontal and corpus callosum tumors, damage to the cerebellar vermis, lacunar state as described by Pierre Marie (1853-1940), Parkinson's disease, and Parkinson-plus syndrome. The long history of astasia-abasia reveals a cluster of neurologists, often emerging from oblivion herein and all of whom, through the precision of their clinical examinations and their pathophysiological findings, helped advance the understanding of the mechanisms by which human beings are the only erect, constantly bipedal mammals, whether immobile or walking.

Astasia-abasia, ¿Psicógena u orgánica? No es fácil / 50 / 5,000 Translation results Astasia-abasia, psychogenic or organic? Is not easy

La astasia-abasia fue descrita por Paul Blocq como un cuadro de origen psicógeno aunque posteriormente se han descrito numerosas lesiones orgánicas cerebrales que pueden justificarla. Presentamos el caso de una mujer de 19 años que tras un intento de ahorcamiento presenta un cuadro compatible con una astasia-abasia que inicialmente fue etiquetado como conversivo ante la ausencia de otra clínica neurológica distinta de la incapacidad para la marcha y la ausencia de hallazgos patológicos en RMN y estudios neurofisiológicos. La reevalución y reexploración profunda de la paciente puso en duda este diagnóstico y tras la realización de un PET TAC se descubrió la presencia de hipometabolismo hemisferio cerebral izquierdo, de ambos cuerpos estriados, tálamos y cerebelo. Se discute sobre el diagnóstico diferencial de la astasiaabasia y se aportan datos que hagan posible un diagnóstico clínico fiable.(AU)

Astasia-abasia was described by Paul Blocq as a psychogenic condition; later, several brain injuries have been described for its explanation too. We present a case of a 19-year-old woman who, after a hanging attempt, presents an astasia-abasia syndrome, initially labeled as functional, in the absence of other neurological clinic than the inability for walking and the absence of pathological findings in IMR and neurophysiological studies. The reassessment and re-exploration of the patient questioned this diagnosis and after performing a PET scan, the presence of hypometabolism in left cerebral hemisphere, both striatum bodies, thalamus and cerebellum was discovered. Differential diagnosis of astasia-abasia is discussed and data are provided for a reliable clinical diagnosis.(AU)

Functional gait disorders: Demographic and clinical correlations.

OBJECTIVE: We aimed to describe the prevalence and clinical-demographical features of patients with functional gait disorders (FGDs) and to compare them to patients with functional motor disorders (FMDs) without FGDs (No-FGDs). METHODS: In this multicenter observational study, we enrolled patients with a clinically definite diagnosis of FMDs in 25 tertiary movement disorders centers in Italy. Each subject with FMDs underwent a comprehensive clinical assessment, including screening for different subtypes of functional gait disorders. Multivariate regression models were implemented in order to estimate the adjusted odds ratio (OR; 95% confidence interval) of having FGDs in relation to sociodemographic and clinical characteristics. RESULTS: Out of 410 FMDs, 26.6% (n = 109) of patients exhibited FGDs. The most frequent FGDs were slow gait (n = 43, 39.4%), astasia-abasia (n = 26, 23.8%), and knee buckling (n = 24, 22%). They exhibited single FGDs in 51.4% (n = 56) or complex FGDs (more than one type of FGDs) in 48.6% (n = 53) of cases. On multivariate regression analysis, the presence of FGDs was more likely associated with older age (OR 1.03, 95% CI 1.01-1.04), functional visual symptoms (OR 2.19, 95% CI 1.08-4.45), and the diagnosis of somatic symptoms disorder (OR 2.97, 95% CI 1.08-8.17). FGDs were also more likely to undergo physiotherapy (OR 1.81, 95% CI 1.08-3.03). CONCLUSIONS: People with FMDs may present with different and overlapping types of FGDs, which may occur in older age. The association of FGDs with functional visual symptoms and somatic symptoms disorder opens up to new avenues to the understanding of the neural mechanisms of these disorders.

"Spreading the word of the master": the contribution of Italian physicians in the early dissemination of Jean-Martin Charcot's theories.

Jean-Martin Charcot (1825-1893) laid the foundations of modern neurology. The lectures he gave at La Salpêtrière Hospital in Paris attracted a large number of visitors from all over the world. Some of them transcribed these clinical lessons, translating and publishing them when returning home. This article discusses the contribution of some Italian physicians (Gaetano Rummo, 1853-1917; Domenico Miliotti; Giulio Melotti, 1857-19?; and Augusto Tebaldi, 1833-1895), who were pioneers in disseminating the ideas and discoveries of Charcot. The early Italian translations were based on personal handwritten notes and memories, not relying on official French versions personally revised or edited by Charcot himself. As such, their veracity cannot always be verified, particularly in the lack of other independent works reporting details on the same lectures. However, the Italian transcriptions providing information which cannot be found elsewhere in Charcot's corpus of works represent an invaluable and a unique source for fully understanding some theories by the French neurologist. Furthermore, they are the first documents providing original materials related to Charcot's teaching translated in a foreign language. The first Italian publications that included photographs of patients were deeply influenced by and clearly modeled on the famous volumes of the Iconographie photographique de la Salpêtrière and further contributed to the early dissemination of Charcot's theories.

Functional Neurologic Symptom Disorder in Children: Clinical Features, Diagnostic Investigations, and Outcomes at a Tertiary Care Children's Hospital.

OBJECTIVE: To describe the presenting symptoms and short-term outcomes of children diagnosed with functional neurologic symptom disorder and to compare the demographic and clinical characteristics of children who received neurodiagnostic testing to those who did not. STUDY DESIGN: Single center, retrospective review of 222 children who presented to the emergency department of a children's hospital, and diagnosed with functional neurologic symptom disorder, between 2010 and 2015. RESULTS: Out of 222 visits (females = 156, African Americans = 130, mean age = 13.9 years), neurodiagnostic tests were performed in 102/222 (46%) visits. The most commonly performed investigations were magnetic resonance imaging (MRI) of brain (n = 37) and electroencephalogram (EEG) (n = 56) and were noted to be unremarkable in all instances. Neurodiagnostic tests were more likely to be performed in patients who (1) were non-African American (54% vs 40%; P = .03), (2) presented with new-onset symptoms (55% vs 31%; P < .01), (3) underwent hospitalization (61% vs 17%; P < .01), and (4) were evaluated by a neurologist (59% vs 9%; P < .01) or a psychiatrist (58% vs 28%; P < .01). Common clinical presentations included seizurelike or strokelike symptoms. Short-term follow-up was possible in 20%, with an alternate diagnosis of syncope, noted in only 1 child. CONCLUSIONS: Most children who presented with a functional neurologic symptom disorder in our study were noted to have seizurelike or strokelike presentations and were adolescent females. Caucasians were more likely to undergo neurodiagnostic investigations. Radiologic and neurophysiological tests were more commonly performed when neurology and psychiatry consultations were sought. Such investigations had low diagnostic utility.