Frontiers Of Neurology And Neuroscience[JOURNAL]
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200 papers
Composite Scores and Other Outcome Measures in Stroke Trials.
Pistoia F, Sacco S, Ornello R … +3 more , Degan D, Tiseo C, Carolei A
Front Neurol Neurosci · 2016 · PMID 27463096 · Publisher ↗
BACKGROUND: Randomized controlled trials represent the most useful tool to evaluate the effectiveness of a treatment in medical research. When designing a clinical trial, the choice of end points, assessment tools, and s...
BACKGROUND: Randomized controlled trials represent the most useful tool to evaluate the effectiveness of a treatment in medical research. When designing a clinical trial, the choice of end points, assessment tools, and scores is crucial as they represent the prerequisites for the evaluation of outcomes and for the critical appraisal of findings. SUMMARY: In stroke research, outcomes are mainly represented by composite end points focusing on the occurrence of cardiovascular and cerebrovascular events in trials on primary and secondary prevention and by measures of recovery and residual disability in acute stroke trials. Assessment tools which are more frequently used to evaluate recovery after acute stroke care include the National Institutes of Health Stroke Scale, the Modified Rankin Scale, the Barthel Index, the Glasgow Outcome Scale, and the Stroke Impact Scale. However, there is a wide heterogeneity of outcome measures across different trials, which makes it difficult to compare results and to draw definitive conclusions on the usefulness of the investigated strategies and treatments. Moreover, in some cases, details about outcomes are poorly reported with a tendency to focus on outcomes that are statistically significant while information about nonsignificant outcomes is frequently missed. KEY MESSAGES: There is an urgent need to improve the quality of designing, conducting, analyzing, and reporting data from randomized clinical trials in order to obtain complete, clear, and rigorous information on the effectiveness of management strategies in stroke care. Key properties of tools measuring outcome should include validity, reliability, and convenient statistical characteristics.
General Overview, Conclusions, and Future Directions.
Beghi E, Logroscino G
Front Neurol Neurosci · 2016 · PMID 27463091 · Publisher ↗
BACKGROUND: The traditional design of the randomized clinical trial (RCT) is challenged by the peculiarities of the genotype and phenotype of neurological disorders. SUMMARY: RCTs are intended to verify the net effect of...
BACKGROUND: The traditional design of the randomized clinical trial (RCT) is challenged by the peculiarities of the genotype and phenotype of neurological disorders. SUMMARY: RCTs are intended to verify the net effect of an investigational treatment on the outcome of a disease. This implies the inclusion of strictly homogeneous sample of patients that represent only in part the full disease spectrum. For this reason, pragmatic trials on representative samples of the general population are welcome. In neurodegenerative disorders, RCTs are generally performed in symptomatic individuals, when the pathologic process is already in course. Although genetic, biological and structural markers are the ideal instruments to detect the disease at a preclinical stage, the development of biomarkers is still in its infancy and even identified markers require in most of cases validation. Given the limited duration of an RCT, prospective studies with prolonged follow-up in well-defined inception cohorts are needed to assess the effectiveness of the treatment in all affected individuals seen in everyday practice. RCT are conducted mainly in Caucasians excluding other ethnicities. The difference of brain biology between men and women are still underestimated in RCTs. Patients, treating physicians, pharmaceutical companies, and regulatory authorities have differing needs, which may have important implications in planning and conducting RCTs. New therapeutic approaches are represented by personalized and precision medicine. Although largely investigational, these approaches may challenge the traditional RCT design. KEY MESSAGES: All those interested in the development of new treatments and treatment strategies for neurological disorders should be involved when planning an RCT and ad-hoc designs should be developed to address the peculiarities of neurological disorders. Differences in age, sex and ethnicity should have a primary role in the design of an RCT. The traditional structure of the RCT should be also revised taking into account the new perspectives of personalized and precision medicine.
Modeling and Prediction in Neurological Disorders: The Biostatistical Perspective.
Copetti M, Fontana A, Pellegrini F
Front Neurol Neurosci · 2016 · PMID 27462982 · Publisher ↗
BACKGROUND: Statistical methods are often considered as mere tools to address research questions. The lack of critical understanding can make their use sometimes highly questionable if not inappropriate. Biostatistics sh...
BACKGROUND: Statistical methods are often considered as mere tools to address research questions. The lack of critical understanding can make their use sometimes highly questionable if not inappropriate. Biostatistics should be seen more as a paradigm than a set of tools. Knowledge of methods means a flexible utilization of them, in which modeling and prediction correspond more to an art than to a routine use dictated by circumstances and habits. SUMMARY: Tree-based methods (or tree-growing techniques) are discussed here as a flexible statistical framework for modeling and prediction to address key questions such as prognostic stratification and treatment effects heterogeneity in both randomized clinical trials and observational studies. KEY MESSAGES: We provide some examples in neurology and possible future extensions in which tree-based methods are shown to be crucial for the assessment of the best available therapy for a patient. We show how trees can represent a clinically interpretable and easy-to-implement approach for stratified medicine and treatment tailoring based on responsiveness, as well as for selecting populations for new studies.
The Right Therapy for Neurological Disorders: From Randomized Trials to Clinical Practice - Patients versus Investigator Expectations and Needs.
Bruijn LI, Kolb S
Front Neurol Neurosci · 2016 · PMID 27462978 · Publisher ↗
BACKGROUND: People living with amyotrophic lateral sclerosis (ALS) are now more proactive in making decisions about their treatment options, in particular with increased awareness through social media and the Internet. T...
BACKGROUND: People living with amyotrophic lateral sclerosis (ALS) are now more proactive in making decisions about their treatment options, in particular with increased awareness through social media and the Internet. Together with increased awareness about the disease comes increased frustration that there is still only one Food and Drug Administration (FDA)-approved drug that modestly improves survival. SUMMARY: While efforts are underway to improve clinical trial design, patient involvement in trial design, clinical outcomes, and risk/benefit evaluations have become more recognized and will play a major role in the future success of clinical trials. This chapter addresses the perspective of people living with ALS and their perceptions of clinical trials. We describe various organizations and programs available that provide increased education and patient involvement. KEY MESSAGE: Stronger partnerships between those living with ALS, clinicians, government, nonprofit organizations, and regulatory agencies will significantly impact treatment development.
How to Distinguish between Statistically Significant Results and Clinically Relevant Results.
Bennett DA
Front Neurol Neurosci · 2016 · PMID 27462704 · Publisher ↗
BACKGROUND: A practicing clinician will often be confronted with the results of a new clinical trial in their relevant field and will be faced with the dilemma of determining whether these results are clinically relevant...
BACKGROUND: A practicing clinician will often be confronted with the results of a new clinical trial in their relevant field and will be faced with the dilemma of determining whether these results are clinically relevant to their own work. This chapter aims to describe the concepts of statistical significance in randomized clinical trials from a mainly classical statistical inference perspective. This chapter describes approaches to assess clinical significance and illustrates these approaches with examples from the contemporary neurological literature. RESULTS: There are several approaches that have been described in the research literature to assess the clinical significance including the minimal important clinical difference, the fragility index, Bayesian approaches, and a graphical approach. Unfortunately none of these methods have been widely used in the neurological research literature. Examples are provided to illustrate how these methods can be applied to the contemporary neurological literature in order to provide the clinician with some guidance on their use. CONCLUSIONS: How the trial is designed can affect the external validity of the results and subsequently the clinical relevance of a randomized clinical trial. Large-scale streamlined clinical trials with inclusion criteria that are not too restrictive can improve the generalizability of trial results. Even highly statistically significant treatment effects can be unreliable if they are based on a small number of events. The approaches described in this chapter should provide the practicing clinician with a starting point in order to determine whether the reported statistically significant results are indeed clinically relevant.
Randomized Trials in Developing Countries: Different Priorities and Study Design?
Marin B, Agbota GC, Preux PM … +1 more , Boumédiene F
Front Neurol Neurosci · 2016 · PMID 27462701 · Publisher ↗
BACKGROUND: Clinical trials are increasingly conducted in the field of neurology in developing countries. To our knowledge, no review has been performed to date about the temporal evolution, geographical distribution, pa...
BACKGROUND: Clinical trials are increasingly conducted in the field of neurology in developing countries. To our knowledge, no review has been performed to date about the temporal evolution, geographical distribution, pathological fields, and types of trials conducted. Besides, the validity of those clinical trials needs to be evaluated. SUMMARY: Our main aim was to describe, using a systematic literature review, the clinical trials performed in the field of neurology in developing countries. The specific objectives were (1) to describe the pathologic fields, (2) to evaluate the methodology, and (3) to assess the validity of neurological clinical trials performed in developing countries. A systematic review of the literature was conducted accessing PubMed, Pascal, ScienceDirect, African Journal Online, and the Virtual Library of African Neurology. The 145 studies included allowed us to identify (1) an exponential evolution of the number of clinical trials, (2) the strong contributions from Asia, followed by Africa and Latin America, (3) a fairly good coverage of pathologic fields including noncommunicable diseases, (4) an increasing diversity of intervention type, (5) the lack of early-phase trials (phases I and IIa), and (5) the need of improvement for some critical methodological issues. KEY MESSAGE: There is a need (1) to develop structures dedicated to the early investigation of interventions in humans, and (2) for sustaining the development of structures specialized in the methodology of clinical research and of dedicated courses for researchers in tropical areas about good practice in clinical trials. This would help in improving methodological quality, appropriateness of data management, and statistical analysis.
Nostalgia in the Army (17th-19th Centuries).
Battesti M
Front Neurol Neurosci · 2016 · PMID 27035922 · Publisher ↗
People died from nostalgia in the army in the 17th-19th centuries. The term 'nostalgia', created by the doctor Johannes Hofer (1669-1752), from Mulhouse, came from the Germanic Heimweh, or 'homesickness'. It affected the...
People died from nostalgia in the army in the 17th-19th centuries. The term 'nostalgia', created by the doctor Johannes Hofer (1669-1752), from Mulhouse, came from the Germanic Heimweh, or 'homesickness'. It affected the young people enrolled in the army, such as Swiss mercenaries. Longing for their native land, they were consumed by an ongoing desire to return home. If it was impossible to do so, they sank into 'a sadness accompanied with insomnia, anorexia and other unpleasant symptoms' that could lead to death. Nostalgia became classified as a disease during the last quarter of the 18th century and ravaged the French army during the Revolution and the Napoleonic wars. However, as soon as the wars ended, it ceased to exist in the army (except the colonial army). It was removed from the nosology in the first half of the 19th century. Rapidly explained as an example of a misdiagnosis or a confusion between 'connection and cause', nostalgia needs to be assessed in regard to the medical debate between 'alienists' and 'organicists'. Creating much concern, nostalgia needs to be considered in the historical context of a society destabilized by modernity, with some individuals uprooted by the sudden transition from civil society to military life. It raises questions about the role that the army played in the creation of the French national union. Nostalgia may have also covered psychic traumatisms later designated as combat fatigue, war neurosis, or post-traumatic stress disorder.
Elaboration of the Visual Pathways from the Study of War-Related Cranial Injuries: The Period from the Russo-Japanese War to World War I.
Lanska DJ
Front Neurol Neurosci · 2016 · PMID 27035915 · Publisher ↗
As a result of the wars in the early 20th century, elaboration of the visual pathways was greatly facilitated by the meticulous study of visual defects in soldiers who had suffered focal injuries to the visual cortex. Us...
As a result of the wars in the early 20th century, elaboration of the visual pathways was greatly facilitated by the meticulous study of visual defects in soldiers who had suffered focal injuries to the visual cortex. Using relatively crude techniques, often under difficult wartime circumstances, investigators successfully mapped key features of the visual pathways. Studies during the Russo- Japanese War (1904-1905) by Tatsuji Inouye (1881-1976) and during World War I by Gordon Holmes (1876-1965), William Lister (1868-1944), and others produced increasingly refined retinotopic maps of the primary visual cortex, which were later supported and refined by studies during and after World War II. Studies by George Riddoch (1888-1947) during World War I also demonstrated that some patients could still perceive motion despite blindness caused by damage to their visual cortex and helped to establish the concept of functional partitioning of visual processes in the occipital cortex.
German Emergency Care in Neurosurgery and Military Neurology during World War II, 1939-1945.
Stahnisch FW
Front Neurol Neurosci · 2016 · PMID 27035838 · Publisher ↗
A critical analysis of the historical involvement of neurology and neurosurgery in military emergency care services enables us to better contextualize and appreciate the development of modern neurology at large. Wartime...
A critical analysis of the historical involvement of neurology and neurosurgery in military emergency care services enables us to better contextualize and appreciate the development of modern neurology at large. Wartime neurosurgery and civil brain science during the German Nazi period tightly coalesced in examining the specific injury types, which military neurosurgeons such as Wilhelm Toennis, Klaus Joachim Zuelch, and Georg Merrem encountered and treated based on their neurophysiological understanding gained from earlier peacetime research. Collaborative associations with Dr. Toennis in particular proved to be highly beneficial to other military neurologists and neurosurgeons during World War II and beyond. This article also discusses the prewar developments and considers the fate of German neurosurgeons and military neurologists after the war. The envisaged dynamic concepts of fast action, reaction, and recycling, which contemporary physicians had intensively studied in the preceding scientific experiments in their neurophysiological laboratories, had already been introduced into neurological surgery during the interwar period. In retrospect, World War II emergency rescue units greatly strengthened military operations through an active process of 'recycling' indispensable army personnel. Neurosurgical emergency chains thereby introduced another decisive step in the modernization of warfare, in that they increased the momentum of military mobility in the field. Notwithstanding the violence of warfare and the often inhumane ways in which such knowledge in the field of emergency neurology was gained, the protagonists among the group of experts in military neurology and neurosurgery strongly contributed to the postwar clinical neuroscience community in Germany. In differing political pretexts, this became visible in both East Germany and West Germany after the war, while the specific military and political conditions under which this knowledge of emergency medicine was obtained have largely been forgotten.
Post-Traumatic Stress Disorder among French Armed Forces Members in Afghanistan: A New Approach.
Paul F, Marimoutou C, Pommier de Santi V … +1 more , Clervoy P
Front Neurol Neurosci · 2016 · PMID 27035830 · Publisher ↗
During the 20th century, the management of war-related psychological trauma shifted from neurology to psychiatry. After September 11, 2001, the French forces participated in a multinational force deployed in Afghanistan...
During the 20th century, the management of war-related psychological trauma shifted from neurology to psychiatry. After September 11, 2001, the French forces participated in a multinational force deployed in Afghanistan to fight against terrorism. Post-traumatic stress disorder (PTSD) became a priority. We report the daily work of the psychiatrists involved in this mission and the organization developed to psychologically support wounded military personnel. The doctrine of early intervention psychiatrization and the technique of collective debriefing are the key points of this procedure. The psychiatrist is also responsible for the healthcare community, particularly vulnerable when confronted with severe ballistic injuries. One aim of this organization is also to screen PTSD in soldiers returning from Afghanistan. The military general practitioner is a pivotal point of this procedure built to detect PTSD, anxiety, depressive reaction and behavioral problems. The French health service has developed a genuine care strategy aimed at identifying patients, accompanying them in the formalities for recognition and compensation, and offering them treatment locally by arranging clinical psychology consultations near their home.
Impact of 20th Century Wars on the Development of Neurosurgery.
Dowdy J, Pait TG
Front Neurol Neurosci · 2016 · PMID 27035828 · Publisher ↗
The treatment of neurosurgical casualties suffered during the wars of the 20th century had a significant impact on the formation and early growth of neurosurgery as a specialty. This chapter explores how the evolution of...
The treatment of neurosurgical casualties suffered during the wars of the 20th century had a significant impact on the formation and early growth of neurosurgery as a specialty. This chapter explores how the evolution of military tactics and weaponry along with the circumstances surrounding the wars themselves profoundly influenced the field. From the crystallization of intracranial projectile wound management and the formal recognition of the specialty itself arising from World War I experiences to the radical progress made in the outcomes of spinal-cord-injured soldiers in World War II or the fact that the neurosurgical training courses commissioned for these wars proved to be the precursors to modern neurosurgical training programs, the impact of the 20th century wars on the development of the field of neurosurgery is considerable.
French Neurologists during World War I.
Walusinski O, Tatu L, Bogousslavsky J
Front Neurol Neurosci · 2016 · PMID 27035726 · Publisher ↗
The Great War accelerated the development of neurological knowledge. Many neurological signs and syndromes, as well as new nosological entities such as war psychoneuroses, were described during the conflict. The period b...
The Great War accelerated the development of neurological knowledge. Many neurological signs and syndromes, as well as new nosological entities such as war psychoneuroses, were described during the conflict. The period between 1914 and 1918 was the first time in which many neurologists were concentrated in wartime neurology centres and confronted with a number of neurological patients never seen before. This concentration led to the publication of papers concerning all fields of neurological sciences, and these reports pervaded scientific journals during the conflict and the post-war years. The careers of French neurologists during the war were highly varied. Some were mobilised, whilst others enlisted voluntarily. They worked as regiment physicians at the front or in wartime neurology centres at the front or at the rear. Others were academics who were already authoritative names in the field of neurology. Whilst they were too old to be officially mobilised, they nevertheless worked in their militarised neurology departments of civil hospitals. We present here the careers of a few French neurologists during the Great War, including Charles Foix (1882-1927), René Cruchet (1875-1959), Georges Guillain (1876-1961), Jean Lhermitte (1877-1959), Clovis Vincent (1879-1947), Gustave Roussy (1874-1948), and Paul Sollier (1861-1933).
What's in a Name? Neurological Eponyms of the Nazi Era.
Kondziella D, Zeidman LA
Front Neurol Neurosci · 2016 · PMID 27035717 · Publisher ↗
The 1920s were a booming decade for neuroscience, and perhaps nowhere was this truer than in Germany. Following the rise of Hitler's regime and the persecution of Jews and others, however, Germany and Austria lost numero...
The 1920s were a booming decade for neuroscience, and perhaps nowhere was this truer than in Germany. Following the rise of Hitler's regime and the persecution of Jews and others, however, Germany and Austria lost numerous world-class neuroscientists. Vacant posts were quickly filled with 'Aryan' and academic staff loyal to the Nazis. Indeed, many physicians and scientists went even further and became engaged in National Socialist (NS)-euthanasia programs. In recent years, the medical community has become more aware of the ethical burden associated with eponyms derived from scientists of the Third Reich. This book chapter reviews 53 neurological eponyms derived from physicians who worked in the Nazi era. Among them are victims who were forced out of the country or murdered in concentration camps, protestors who risked their academic careers and often their lives, beneficiaries who published on brains from 'euthanized' children, and collaborators who were directly involved in the planning and execution of NS-euthanasia programs.
Neurosurgical Work during the Napoleonic Wars: George James Guthrie's Experience.
Roux FE
Front Neurol Neurosci · 2016 · PMID 27035714 · Publisher ↗
Involved in what is still considered, along with the two world wars of the 20th century, as one of the major conflicts in Europe, George James Guthrie (1785-1856) was the most famous English army surgeon of the Napoleoni...
Involved in what is still considered, along with the two world wars of the 20th century, as one of the major conflicts in Europe, George James Guthrie (1785-1856) was the most famous English army surgeon of the Napoleonic wars. After treating the injured throughout the Peninsular Campaign (1808-1814), in 1815 and then in 1842 he published two major books dealing with cranial and brain injuries, among other topics. In these books, we can find, for example, an early description of the plantar reflex further described by Joseph Babinsky, accurate descriptions of the clinical signs of intracranial hypertension, and details of the physiopathology of subdural and epidural haematomas. Skull fractures are also discussed intensively, along with the indications for trepanation, a much-debated issue at the turn of the 19th century. The dura was often the limit of the surgical field for Guthrie. Nevertheless, he tried to rationalize the use of trepanation and favoured its use in two main cases: in cases of depressed skull bones, jammed bone fragments or debris irritating the dura or the brain and in cases of life-threatening cerebral compression caused by supposed blood clots. In their works, Guthrie and his contemporaries did not address neurosurgery in the modern sense of the word, but rather 'cranial surgery' in most cases. Guthrie, who saw so many patients with brain injuries and amputations, failed to understand that cerebral functions could be localized to the cortex and neglected to describe the phantom limb phenomenon, as did most of his contemporaries.
Silas Weir Mitchell: Neurologists and Neurology during the American Civil War.
Boller F, Birnbaum D
Front Neurol Neurosci · 2016 · PMID 27035676 · Publisher ↗
With few exceptions, neurology was nonexistent in the United States until the Civil War years. From 1861 to 1865, the United States saw a bitter armed conflict between the North (the Union) and the South (the Confederate...
With few exceptions, neurology was nonexistent in the United States until the Civil War years. From 1861 to 1865, the United States saw a bitter armed conflict between the North (the Union) and the South (the Confederate States or Confederacy), and during those years, neurology was born in the United States. In 1861, Silas Weir Mitchell, together with George Morehouse and William Keen, opened and operated the first neurological hospital in Philadelphia, with the backing of the Surgeon General William Hammond. They treated and studied many peripheral nerve diseases, which led to their making the medical world aware of several conditions, including causalgia (now known as complex regional pain syndrome) and the phantom limb phenomenon. Progress in neurology, both at that time and in subsequent years, owed a great deal to cross-fertilization from Europe. Charles Edouard Brown-Séquard exemplified this. He held multiple medical positions on both sides of the Atlantic, including a position at Harvard in 1864. His teachings, to some extent, contributed to the development of neurology in the United States. In the Confederate states, medical care was less well organized, and neurology only developed later. After the war, in 1874, Mitchell, Hammond, and a few others founded the American Neurological Association. While war influenced the development of medicine, and neurology in particular, medicine also helped to shape the outcome of the war.
Neurology and War: From Antiquity to Modern Times.
Paciaroni M, Arnao V
Front Neurol Neurosci · 2016 · PMID 27035675 · Publisher ↗
Here, we chronicle the evolution of warfare from antiquity to modern times (18th century) and its impact on the later-to-be-defined field of neurology, especially with regard to brain, spinal cord and peripheral nerve in...
Here, we chronicle the evolution of warfare from antiquity to modern times (18th century) and its impact on the later-to-be-defined field of neurology, especially with regard to brain, spinal cord and peripheral nerve injuries and neurological disorders caused by biological weapons and psychological trauma. We describe how individuals courageously and intelligently dealt with the horrors of war, from the Egyptians to the Greeks and onward to the Romans, up until the physicians of modern times. In doing so, they responded to the call of duty by inventing solutions that benefitted not only soldiers but also civilian medicine.
The Central Role of Neuroscientists under National Socialism.
Zeidman LA
Front Neurol Neurosci · 2016 · PMID 27035666 · Publisher ↗
Neuroscientists played central roles in the victimization of colleagues and their patients during the era of National Socialism from 1933 to 1945. After helping dismiss Jewish and nonideologically aligned colleagues, Ger...
Neuroscientists played central roles in the victimization of colleagues and their patients during the era of National Socialism from 1933 to 1945. After helping dismiss Jewish and nonideologically aligned colleagues, German neuroscientists were among the physicians and researchers who joined the Nazi Party and affiliated groups in record numbers. Forced sterilization and then so-called 'euthanasia' of neurological and psychiatric patients were planned and executed by prominent German and Austrian neuroscientists. Other neuroscientists collaborated indirectly by using patients for unethical experimentation to discover the cause of multiple sclerosis or to try to induce epileptic convulsions in a hypoxic state. Some merely used neuropathological material from murdered patients for publications in scientific journals. In the totalitarian state, research funding and academic advancement were awarded to physicians engaged in eugenics research. Opportunism and ideologically tainted science without regard to medical ethics were the motivating factors for collaborating neuroscientists. Some German and Austrian neuroscientists tried to resist Nazi policies, although much more passively than their colleagues in German-occupied countries. French, Dutch, Norwegian, and Danish neuroscientists actively resisted the Nazification of their profession from the beginning and helped to save some patients and colleagues, at great personal risk. Many German, Austrian, Czech, and Polish neurologists were murdered in the Holocaust, and hundreds of thousands of neurological and psychiatric patients were sterilized or murdered in just 12 years. The Nazis used the 'successful' techniques developed in the 'euthanasia' programs to carry out the mass murder of millions in the Holocaust. Today's neuroscientists are obligated to learn of the ethical violations of their predecessors 70-80 years ago. No law will prevent abandonment of the basic principles of ethical patient care and professionalism that can occur in any totalitarian state, but neuroscientists can possibly prevent it.
Neurology and Neurologists during the Franco-Prussian War (1870-1871).
Walusinski O
Front Neurol Neurosci · 2016 · PMID 27035594 · Publisher ↗
The Franco-Prussian War (1870-1871) ended with the firm establishment of the French Republic and with German unity under Prussian leadership. After describing the events leading to the war, we explain how this conflict w...
The Franco-Prussian War (1870-1871) ended with the firm establishment of the French Republic and with German unity under Prussian leadership. After describing the events leading to the war, we explain how this conflict was the first involving the use of machine guns; soldiers were struck down by the thousands. Confronted with smallpox and typhus epidemics, military surgeons were quickly overwhelmed and gave priority to limb injuries, considering other wounds as inevitably fatal. Here, we present detailed descriptions of spinal and cranial injuries by Léon Legouest and of asepsis prior to trepanning by Ernst von Bergmann. Both the war and the Commune had disastrous effects on Paris. Jean-Martin Charcot continued to work intensely through the conflict, caring for numerous patients at La Salpêtrière Hospital according to his son Jean-Baptiste's account, which we've also excerpted below. As for young Dejerine, he treated the wounded from France who had taken refuge in Switzerland. Désiré-Magloire Bourneville also took heroic initiatives, as did Charles Lasègue, Alfred Vulpian, Alix Joffroy and Victor Cornil.
Neurotoxic Weapons and Syndromes.
Carota A, Calabrese P, Bogousslavsky J
Front Neurol Neurosci · 2016 · PMID 27035576 · Publisher ↗
The modern era of chemical and biological warfare began in World War I with the large-scale production and use of blistering and choking agents (chlorine, phosgene and mustard gases) in the battlefield. International tre...
The modern era of chemical and biological warfare began in World War I with the large-scale production and use of blistering and choking agents (chlorine, phosgene and mustard gases) in the battlefield. International treaties (the 1925 Geneva Protocol, the 1975 Biological and Toxin Weapons Convention and the 1993 Chemical Weapons Convention) banned biological and chemical weapons. However, several countries are probably still engaged in their development. Hence, there is risk of these weapons being used in the future. This chapter will focus on neurotoxic weapons (e.g. nerve agents, chemical and biological neurotoxins, psychostimulants), which act specifically or preeminently on the central nervous system and/or the neuromuscular junction. Deeply affecting the function of the nervous system, these agents either have incapacitating effects or cause clusters of casualties who manifest primary symptoms of encephalopathy, seizures, muscle paralysis and respiratory failure. The neurologist should be prepared both to notice patterns of symptoms and signs that are sufficiently consistent to raise the alarm of neurotoxic attacks and to define specific therapeutic interventions. Additionally, extensive knowledge on neurotoxic syndromes should stimulate scientific research to produce more effective antidotes and antibodies (which are still lacking for most neurotoxic weapons) for rapid administration in aerosolized forms in the case of terrorist or warfare scenarios.
Traumatic Brain Injury Studies in Britain during World War II.
Lanska DJ
Front Neurol Neurosci · 2016 · PMID 27035489 · Publisher ↗
As a result of the wartime urgency to understand, prevent, and treat patients with traumatic brain injury (TBI) during World War II (WWII), clinicians and basic scientists in Great Britain collaborated on research projec...
As a result of the wartime urgency to understand, prevent, and treat patients with traumatic brain injury (TBI) during World War II (WWII), clinicians and basic scientists in Great Britain collaborated on research projects that included accident investigations, epidemiologic studies, and development of animal and physical models. Very quickly, investigators from different disciplines shared information and ideas that not only led to new insights into the mechanisms of TBI but also provided very practical approaches for preventing or ameliorating at least some forms of TBI. Neurosurgeon Hugh Cairns (1896-1952) conducted a series of influential studies on the prevention and treatment of head injuries that led to recognition of a high rate of fatal TBI among motorcycle riders and subsequently to demonstrations of the utility of helmets in lowering head injury incidence and case fatality. Neurologists Derek Denny-Brown (1901-1981) and (William) Ritchie Russell (1903-1980) developed an animal model of TBI that demonstrated the fundamental importance of sudden acceleration (i.e., jerking) of the head in causing concussion and forced a distinction between head injury associated with sudden acceleration/deceleration and that associated with crush or compression. Physicist A.H.S. Holbourn (1907-1962) used theoretical arguments and simple physical models to illustrate the importance of shear stress in TBI. The work of these British neurological clinicians and scientists during WWII had a strong influence on subsequent clinical and experimental studies of TBI and also eventually resulted in effective (albeit controversial) public health campaigns and legislation in several countries to prevent head injuries among motorcycle riders and others through the use of protective helmets. Collectively, these studies accelerated our understanding of TBI and had subsequent important implications for both military and civilian populations. As a result of the wartime urgency to understand, prevent, and treat patients with TBI during WWII, clinicians and basic scientists collaborated on research projects that none of them would likely have pursued without these unique circumstances. Very quickly, there was a sharing of information and ideas that not only led to new insights into the mechanisms of TBI but also provided very practical approaches for preventing or ameliorating at least some forms of TBI. Investigators in Great Britain, in particular, pioneered accident investigations, performed epidemiologic studies, and developed animal and physical models that accelerated our understanding of TBI and had subsequent important implications for both military and civilian populations.
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