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Cause, Symptoms and Treatment of Lathyrism

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Cause, Symptoms and Treatment of Lathyrism well. Minchin also noted affection of the bladder. Ruge and his co-workers (1925) and Ranjan (1944) described incontinence of urine and faeces as well as sexual impairment. It has been postulated that the disease is never pro- gressive after a few days or weeks beyond the initial paralysis (Bicknell and Prescott, 1942). Ranjan (1944), however, notes rapid progress of the disease. The published accounts of the reflexes in lathyrism are equally puzzling. Minchin (1940) observed normal cremasteric and abdominal reflexes along with spastic legs and extensor plantar responses. Trabaud and Mouharram (1932) found completely normal reflexes, including the plantar responses, though there was spasticity and clonus of the legs. A common symptom associated with lathyrism is night-blindness according to McCombie Young (1928), and Ranjan (1944) reports marked dimness of vision. Even the diseases which can experimentally be produced in animals by feeding them on certain species of legumes of the genus Lathyrus have also been called lathyrism, although they do not show the characteristic symptoms of the human lathyrism. Geiger et al. (1933) fed rats with a diet consisting of Lathyrus odoratus, the flowering sweet pea (at levels of 80, 50 and 25 per cent of the diet). Characteristic symptoms were lame- ness, paralysis and contracture of the spine and sternum. In other experiments on white rats also fed with a Lathyrus odoratus diet, carried out by Lewis and Esterer (1943), these authors produced a disease which they call lathyrism showing the following symptoms : Incon- tinence, lameness, paralysis of limbs, spinal curvature of the thoracic region. Another nutritional disease by feeding sheep with a certain species of legumes, viz, cull beans, has experimentally been produced by Willman and his co-workers. They call the resulting disease ' The Stiff Lamb Diseasewhich shows the following symptoms : The animal concerned has diffi- culty in walking and rising. It gets tired very soon after walking and tries to lie down whenever permitted to do so. On standing and walking there is disturbance of keeping the balance; later on, inability to rise at all, not even with help. Since the author is working in an area where lathyrism patients are a common sight and since all of them show a uniform symptomatology, it appears advisable to establish first of all a record of the symptoms of this disease, which we regard in this area of Central India as indis- pensable for the diagnosis of lathyrism. Symptoms.?The following trail of symptoms is in our experience found in every lathyrism patient :? 1. Spastic and painful rigidity in the muscles of the lower loin muscles. SYMPTOMS AND TREATMENT extremity, including CAUSE, From this results a typical spastic-ataxic gait, OF LATHYRISM frequently associated with a so-called scissor- Y A SPECIFIC NUTRITIONAL NEUROPATH gait. 2. reflexes in the legs, H. m.d. Exaggerated deep By JACOBY, generally clonus. Chief Physician, Prince of Wales Hospital, Bhopal, 3. The absence of disease-symptoms Bhopal State complete in other parts of the body, especially in the difference Introduction.?There is considerable upper extremity and the head. in the description of symptoms in lathyrism by 1. The flexor and frequently also the different authors. adductor muscles of calf and thigh, particularly Shah (1939) and Minchin (1940) report, the M. gastrocnemius, feel hard and are tender besides of the also involve- spastic paralysis legs, on squeezing. All- these muscles are invariably ment of the arms and sensory impairment as 54 THE INDIAN MEDICAL GAZETTE [Feb., 1947 well developed and never or flabby atrophic. deviation in The patients complain of permanent pain in any direction (Barany's Pointing these muscles which is increased on standing Test). If the is made to and walking. In more advanced cases even the (c) patient walk forwards and sleep is disturbed due to the pains. The backwards with his eyes shut, he will not present the deviation of the so-called examination of passive movements shows per- ' peculiar manent muscle resistance to flexion and extension compass gait' (Krohn, 1938). 2. The reflex are also at the knee- and hip-joints. The degree of this following reactions of lesion. resistance runs parallel to the advancement of significant pyramidal Without excep- tion a is the disease. In very far advanced cases the greatly exaggerated knee-jerk elicited, the resistance is such that it is not possible at all ankle-jerks often being diminished or absent. In some to achieve these movements force. cases, however, also the ankle-jerks are passive by is In this late all such movements are exaggerated. Almost always ankle-clonus stage possible ' present and also of the only by the patients themselves actively, very frequently dancing \ Far cases sudden slowly and with the help of their own hands. patella advanced show?on brisk dorsiflexi'on of the foot to elicit Most characteristic is the of the passive gait patients. ankle-clonus?an reflex The onlooker the as these involuntary complex gets impression though movement of flexion at the patients walk against the obstacle of their own consisting hip-joint and flexion at the knee-joint. Frequently this muscles. They walk with a ' generally slight, flexion reflex' occurs a flexion at the already by gentle apparently voluntary knee-joints, like or of the which is associated or caused a stimulus, deep pressure pinching by foot-drop, skin of the distal of the lower limb. Either in an to for part involuntary attempt compensate i.e. the flexion reflex as well as the the the so-called reflex, latter, resembling Strumpell increased is indicative of Or another of deep reflexes, hyper- phenomenon. way involuntary of So is the is achieved the in irritability pyramidal origin. compensation by swinging leg flexion reflex a feature of the a convex arch instead of the foot prominent lifting (circum- usual flexor contracture (the tendon reflexes duction). The patients seem to walk on their being frequently decreased) and exaggerated toes Another group of who do not only. patients reflexes are an characteristic show the above flexion at the knees will deep equally drag feature of extensor contracture. The latter form the feet on the as soles are ground, though their, is indicative of a less severe lesion than the pasted to it. These patients describe their gait ' flexor contracture (Babinski). Babinski's sign themselves as the \ All scratching ground by stroking the sole along the lateral border these which appear on walking are ' symptoms rather than the median border is as a rule associated as are known to movements, they extensor and signifies a less severe occur in but are not en- pyramidal pyramidal lesions, affection than does an extensor response elicited countered in motor lesions nor extra-pyramidal from the median border as well as from the lateral in the normal individual. These modes of walk- border of the sole 1938). There is elec- rather to the advanced of the (Krohn, ing belong stages no reaction of The senses disease. In the initial the trically degeneration. stages only slight of position and of movement are always and muscle resistance and the bent knees on slightly definitely unimpaired as well as the In cases of all temperature walking prevail. many stages, and touch senses. The Romberg if in of the adductor muscles of sign, positive, whom the spasm is of little significance on account of the above the thigh dominates, the so-called scissor-gait described inco-ordination of muscle movements. results. The walk with crossed patients legs, The reflexes vary : All or some of the the blades of superficial resembling somewhat opened abdominal reflexes as well- as the cremasteric scissors. The movements of the arms, normally reflexes are in less advanced stages normally the of are accompanying gait healthy persons, but are missing in far advanced cases. in and elicitable, always unimpaired lathyrism. Walking This pathological abdominal reflex is generally in more ' advanced stages standing of these associated with the flexion reflex' and the is a kind of patients complicated by peculiar extensor plantar response all belonging to the This ' swaying (ataxia). goes frequently along order of reflexes of spinal automatism' and are with of the muscles of the fibrillary twitchings of involvement. Anyhow, re- lower which in combination with the signs pyramidal extremity, appearance of the previously absent superficial contractures result in mco-ordinated movements. reflexes and of a normal plantar response and This disturbance of inco-ordination of different the disappearance of the 'flexion reflex' are muscle is the cause of this groups certainly among the denoting improvement under of ataxia of signs particular kind lathyrism patients. successful treatment. to cerebellar the It is not due lesions, because 3. There are definitely no abnormal nervous following tests exclude this type of ataxia :? whatsoever in any other part of the ' signs (a) There is 110 decomposition' in the body. Never was any disturbance of sensa- nor of the functions of the sequence of complicated single movements. tion encountered, of the of the sex and of the (fc>) The test of moving the leg and big toe bladder, bowels, away from and back to the examiner's finger as mentality. Examination of the cerebrospinal fluid as to a target, with eyes shut, does not show a pressure, cell count, albumin content and Kahn OF I.ATHYRISM : MCOBY 55 SYMPTOMS AND TREATMENT Feb., 1947] CAUSE, them state that before the occurrence of the no abnormalities. There are also 110first symptoms there was fever with shivering, na fk s^10Ty*s malaria. Dr#*cc? 1(?al filings in urine and blood. Bloodresembling Frequently, this statement normal? Radiologically, lungs andwas confirmed by malaria relapses taking place ?* /u our in the A shanpUr<ft4 the ^eart are always found normal.
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