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Het Brown-Séquard Syndroom X Verantwoording XI Inleiding ХШ PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/113632 Please be advised that this information was generated on 2021-10-10 and may be subject to change. Het localisatieconcept in de neurologie van Brown-Séquard P.J. Koehler Vormgeving: Hein Berendsen De Wever-Ziekenhiais/Bureau Public Relations © 1989 Met befiuíp van Apple Macintosh, lettertype Bookman Het localisatieconcept in de neurologie van Brown-Séquard Frontispice: Portret van Brown-Séquard op 66 jarige leefiijd. (Bron: Archives de VAcadémie des Sciences, Parijs). Het localisatieconcept in de neurologie van Brown-Séquard Een wetenschappelijke proeve op het gebied van de Geneeskunde en Tandheelkunde Proefschrift ter verkrijging van de graad van doctor aan de Katholieke Universiteit te Nijmegen, volgens besluit van het college van decanen in het openbaar te verdedigen op vrijdag 12 mei 1989 des namiddags te 1.30 uur precies door Petrus Johannes Koehler geboren op 21 juni 1955 te 's-Gravenhage Uitgever Rodopi Amsterdam 1989 Promotores: Prof. Dr. D. de Moulin en Prof. Dr. B.P.M. Schulte Co-referent: Dr. L.J. Endtz De uitgave van dit proefschrift werd mede mogelijk gemaakt door financiële steun van: • de firma's: Geigy, ICI, MSD, Rhône-Poulenc, Sandoz en UCB. • Tevens werd een bijdrage toegekend uit het onderzoeksfonds van het De Wever-Ziekenhuis. Aan: mijn ouders Mettie Esther Edith Iris Ruben Inhoudsopgave Het Brown-Séquard Syndroom X Verantwoording XI Inleiding ХШ Hoofdstuk 1 ι Biografíe 1.1 Inleiding; reeds bestaande biografieën. 1 1.2 Jeugd op Mauritius ( 1817-1838). 4 1.3 Medische studie en promotie; Parijs (1838-1852). 6 1.4 Verenigde Staten; reizen en trekken (1852-1860). 15 1.4.1 Philadelphia. 15 1.4.2 Mauritius; cholera-epidemie. 15 1.4.3 Richmond (Virginia). 17 1.4.4 Parijs - Boston. 18 1.5 National Hospital for the Paralysed and 23 Epileptic, London (1860-1863). 1.6 De periode 1864-1878. 25 1.6.1 Reizen tussen Europa en Verenigde Staten. 25 1.6.2 Bernards rapport over de fysiologie als 28 academisch leervak in Frankrijk anno 1867. 1.6.3 Parijs 31 1.6.4 Brown-Séquards aanstelling aan de medische 32 faculteit van Parijs. 1.6.5 New York - Boston. 33 1.6.6 Parijs; Naturalisatie-kwestie, 37 1.7 Het Collège de France ( 1878-1894). 38 1.7.1 Professoraat en eerbewijzen. 38 1.7.2 Ziekte; testikelextracten. 40 1.7.3 Correspondentie. 42 1.7.4 Nabeschouwing. 48 Hoofdstuk 2 51 Overzicht van de diverse onderzoeksterreinen 2.1 Inleiding. 51 2.2 Rigor mortis. 52 2.3 Vasomotorische zenuwen. 53 VI 2.4 Bijnieren. 57 2.5 Artificiële, hereditaire epilepsie. 59 2.6 C02 in de uitademingslucht. 63 2.7 Testikelextract. 63 Hoofdstuk 3 66 Heersende ideeën in de neurologie omstreeks 1840. 3.1 Inleiding. 66 3.1.1 Opkomst van de natuurwetenschappelijke 66 geneeskunde. 3.1.2 Enkele fundamentele begrippen in de 68 neurofysiologie. 3.1.2.1 Functie. 68 3.1.2.2 Localisatie. 69 3.1.3 Vroege geschiedenis van het localisatiebeginsel. 70 3.1.3.1 Van Pythagoras tot Galenus. 70 3.1.3.2 De ventrikellocalisatie. 71 3.1.3.3 De frenologie. 73 3.2 Het localisatiebeginsel sinds het midden van 76 de negentiende eeuw. 3.2.1 De Wet van Bell en Magendie. 76 Sir Charles Beíí. 76 Magendie. 77 Strijd om de prioriteit. 78 3.2.2 Enkele invloedrijke geneeskundigen en 80 neurofysiologen uit de negentiende eeuw in West- Europa, voorzover zij direct of indirect te maken hebben gehad met de ontwikkeling van het localisatieconcept van Brown- Séquard. 3.2.2.1 Inleiding. 80 3.2.2.2 Frankrijk. 81 Fïourens. 81 Langet. 83 Charcot. 84 Vulpian. 84 Broca. 85 3.2.2.3 Engeland. 86 Ηαίί. 86 Ferner. 87 Jackson. 88 3.2.2.4 Duitsland. 89 VII Müííer. 89 3.2.2.5 Nederland. 90 Van Deen. 90 3.2.3 De ontdekking van de remmende werking 96 van de nervus vagus op het hart. 3.2.3.1 Vroege experimenten met betrekking tot de 96 vaguswerking. 3.2.3.2 Experimenten met electrische prikkeling 98 van de nervus vagus. Hoofdstuk 4 100 Het localisatieconcept van Brown-Séquard. 4.1 Inleiding. 100 4.2 Het ruggemerg. 100 4.2.1 Het proefschrift. 101 4.2.2 Experimenten uit de periode 1846-1855. 104 4.2.3 Brown-Séquards ruggemergexperimenten 111 nader geadstrueerd door zijn tekeningen. 4.2.4 Klinische gevallen. 118 4.3 Werking op afstand: dynamogenesis en inhibitie. 121 4.4 Localisatie van hersenfuncties. 124 4.4.1 Tweekampen. 124 4.4.2 Bestrijden van het concept van de 125 "localisateurs". 4.4.3 Brown-Séquards hypothese over het 130 "Réseau de cellules anostomosées" (sic). 4.5 De stand van zaken omstreeks 1890. 134 4.5.1 Brown-Séquards artikel: "Cerebral localization" 134 4.5.2 Charcots artikel: 'The topography of the brain" 135 4.5.3 Samenvattend overzicht van Soury 136 4.6 Re-interpretatie van de ruggemergexperimenten. 139 4.6.1 Aanleiding tot de re-interpretatie. 139 4.6.2 Overgang van anaesthesie en hyperaesthesie. 141 4.6.3 Uiteindelijke re-interpretatie. 142 4.7 "Have we two brains or one?" 144 VIII Hoofdstuk 5 147 Het localisatieconcept ná Brown-Séquard. 5.1 Brown-Séquards invloed op de localisatie- 147 theorieën aan het einde van de negentiende eeuw. 5.1.1 Ruimere interpretatie van de cerebrale 147 localisatie 5.1.1.1 Hughlings Jackson. 149 5.1.1.2 Von Monakow. 150 5.1.1.3 Sherrington. 152 5.1.1.4 Foerster. 154 5.1.1.5 Controversen in Duitsland. 156 5.1.1.6 Het geneeskundige congres van 1881. 158 5.1.1.7 Overeenkomsten met Goltz. 160 5.2 Brown-Séquards theorieën in het licht van 163 moderne theorieën ten aanzien van de werking van de hersenen. Samenvatting en conclusies 164 Summary and conclusions 171 Résumé et conclusions 178 Noten: Hoofdstuk 1 186 Hoofdstuk 2 211 Hoofdstuk 3 216 Hoofdstuk 4 230 Hoofdstuk 5 244 Tijdtafel 251 Bibliografie 253 Persoonsregister 268 Dankwoord 273 Curriculum vitae 274 IX Het Brown-Séquard Syndroom Syndroom veroorzaakt door halfzijdige mggemergbeschadiging ("hemisectio") met de volgende symptomen (bijvoorbeeld bij een rechtszijdige beschadiging (zie figuur 1)). Aan de linker lichaamszijde Aan de rechter lichaamszijde onder het niveau van de laesie: onder het niveau van de laesie: • uerlies uan de vitale • spastische paralyse beneden sensibiliteit tot een of twee het niveau van de beschadi­ segmenten onder de laesie ging, met voetzoolrefiex vol­ (analgesie; Brown-Séquard gens BabinskU afwezige buik- noemde het destijds anaes- huidreflexen, verhoogde pees­ thesie). reflexen, afwezige gnostische sensibiliteit • soms segmentale anaesthe sie of hyperpathie op het niveau van de beschadiging. In de bovenstaande zuivere vorm is het syndroom van Brown- Séquard meestal het gevolg van steek- of kogelverwondingen. De vaker voorkomende onzuivere vorm wordt meestal veroor­ zaakt door een tumor, die druk op het ruggemerg uitoefent. ЬШ<Ь CsfeCHTS Figuur 1, (A) Rechtszijdige (gear­ ceerde) thoracale rug- gemergbeschadiging (op dwarsdoorsnede) met uitval van pijn- en temperatuurzin (vitale sensibiliteit) aan de (gecureerde) finfcer lichjéamshelfi (B) en вж gnostische sensi- nteit met párese aan • rechterzijde. Verantwoording In 1984 hebben de auteur van dit werk en zijn opleider, Dr. L.J. Endtz, naar aanleiding van een patiënt met een Brown- Séquard syndroom, opgeroepen door het zeldzame spinale sub- arachnoïdeale haematoom, het denkbeeld opgevat zich wat nader in dit syndroom te verdiepen 1. Enerzijds waren zij geïnteresseerd in de kliniek van het naar Brown-Séquard genoemde syndroom, anderzijds wilden zij wat meer te weten komen over de persoon die het syndroom voor het eerst heeft beschreven. Wat de kliniek van het Brown- Séquard syndroom betreft, hierover werd in 1986 op grond van uitgebreid literatuuronderzoek een overzichtsartikel gepubli­ ceerd 2. Over de persoon en het werk van Brown-Séquard bleek al het een en ander geschreven te zijn, met name in een drietal biografieën. In al deze biografieën ís echter, naar het ons bleek, onvoldoende aandacht besteed aan Brown-Séquards ideeën over de "dynamogénie" en "inhibition" en aan hun centrale plaats in zijn werk en vooral in zijn localisatietheorieën. Het plan werd opgevat vooral een studie van zijn werk te maken. Aangezien de begrippen "dynamogénie" en "inhibition" in de huidige neurofysiologische wetenschap nog steeds geldig zijn - wij noemen ze nu excitatie en inhibitie -, werd onderzocht of Brown-Séquards werk hierover een aantoonbare invloed heeft gehad in de ontwikkeling van de ideeën over de werking van het zenuwstelsel. Als verantwoording voor de daarbij gevolgde werkwijze dient een kort essay van Lester S. King, dat in 1984, het jaar waarin met dit werk is begonnen, verscheen 3. "The events are there". Maar soms moesten zij uit de mist der tijden tevoorschijn wor­ den gehaald. "We place the event into a context that does chan­ ge". Niet alleen aan de levensloop van de hoofdrolspeler maar ook aan die van zijn belangrijkste medespelers werd aandacht besteed, zij het dat aan de beschrijving van de levensloop van deze laatsten beperkingen moesten worden opgelegd. Het woord context is afgeleid van texere, weven: 'The historian by a process analogous to weaving places the event into relation with other events. Just as a weaver can choose the threads he wants to weave together, so the historian can choose the relationships he wants to emphasize". Die keuze wordt door XI vele factoren bepaald, King noemt onder andere "the spirit of the times or Zeitgeist, the dominant intellectual currents". Waar mogelijk werd getracht deze tijdgeest te doen spreken door de eigen woorden van de spelers aan te halen.
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