Jeanmartin Charcot And The Salpetriere School

The Parkinson's-Reversing Breakthrough

Parkinson Disease Treatment

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Jean Martin Charcot Parkinson

FIGURE 12 Jean-Martin Charcot. Working in Paris, in the second half of the 19th century, Charcot knew of Parkinson's description and studied the disorder in the large Salpetriere hospital that housed elderly and destitute women. He identified the cardinal features of Parkinson's disease and specifically separated bradykinesia from rigidity (5,16):

FIGURE 12 Jean-Martin Charcot. Working in Paris, in the second half of the 19th century, Charcot knew of Parkinson's description and studied the disorder in the large Salpetriere hospital that housed elderly and destitute women. He identified the cardinal features of Parkinson's disease and specifically separated bradykinesia from rigidity (5,16):

Long before rigidity actually develops, patients have significant difficulty performing ordinary activities: this problem relates to another cause. In some of the various patients I showed you, you can easily recognize how difficult it is for them to do things even though rigidity or tremor is not the limiting features. Instead, even a cursory exam demonstrates that their problem relates more to slowness in execution of movement rather than to real weakness. In spite of tremor, a patient is still able to do most things, but he performs them with remarkable slowness. Between the thought and the action there is a considerable time lapse. One would think neural activity can only be affected after remarkable effort.

Parkinson Paul Richer
FIGURE 13 Statue of a parkinsonian woman by Paul Richer. Richer worked with Charcot, and, as an artist and sculptor, produced several works that depicted the habitus, joint deformities and postural abnormalities of patients with Parkinson's disease (14,17).
FIGURE 14 Evolution of parkinsonian disability. These figures, drawn by Charcot's student, Paul Richer, capture the deforming posture and progression of untreated Parkinson's disease over a decade (15,18).
Deformity Posture Parkinson

Parkinson's disease, he showed two subjects, one with the typical or archetypal form of the disorder with hunched posture and flexion (/eft), and another case with atypical parkinsonism, showing an extended posture (right).The latter habitus is more characteristic of the entity progressive supranuclear palsy, although this disorder was not specifically recognized or labeled by Charcot outside of the term "parkinsonism without tremor" (5).

Parkinson's disease, he showed two subjects, one with the typical or archetypal form of the disorder with hunched posture and flexion (/eft), and another case with atypical parkinsonism, showing an extended posture (right).The latter habitus is more characteristic of the entity progressive supranuclear palsy, although this disorder was not specifically recognized or labeled by Charcot outside of the term "parkinsonism without tremor" (5).

Charcot Tremor

FIGURE 16 Charcot's early tremor recordings. Charcot adapted the sphygmograph, an instrument originally used for recording arterial pulsation, to record tremors and movements of the wrist. His resultant tremor recordings (lower right), conducted at rest (A-B) and during activity (B-C), differentiated multiple sclerosis (top recording) from the pure rest tremor (lower recording) or mixed tremor (middle recording) of Parkinson's disease (19).

FIGURE 16 Charcot's early tremor recordings. Charcot adapted the sphygmograph, an instrument originally used for recording arterial pulsation, to record tremors and movements of the wrist. His resultant tremor recordings (lower right), conducted at rest (A-B) and during activity (B-C), differentiated multiple sclerosis (top recording) from the pure rest tremor (lower recording) or mixed tremor (middle recording) of Parkinson's disease (19).

Maladie Charcot
FIGURE 17 Charcot's sketch of parkinsonian subject. Pencil sketch of a man with Parkinson's disease drawn by Charcot during a trip to Morocco in 1889 (20). Referring to the highly stereotyped clinical presentation of Parkinson's disease patients, Charcot told his students:

I have seen such patients everywhere, in Rome, Amsterdam, Spain, always the same picture. They can be identified from afar.You do not need a medical history (4,5).

Charcot's medical drawings form a large collection, which is housed at the Bibliothèque Charcot at the Hôpital de la Salpêtrière, Paris.

Belladonna Parkinson

FIGURE 18 Treatment of Parkinson's disease. Prescription dated 1877 (21). In treating Parkinson's disease, Charcot used belladonna alkaloids (agents with potent anticholinergic properties) as well as rye-based products that had ergot activity, a feature of some currently available dopamine agonists (21). Charcot's advice was empiric and preceded the recognition of the well-known dopaminergic/cholinergic balance that is implicit to normal striatal neurochemical activity.

FIGURE 18 Treatment of Parkinson's disease. Prescription dated 1877 (21). In treating Parkinson's disease, Charcot used belladonna alkaloids (agents with potent anticholinergic properties) as well as rye-based products that had ergot activity, a feature of some currently available dopamine agonists (21). Charcot's advice was empiric and preceded the recognition of the well-known dopaminergic/cholinergic balance that is implicit to normal striatal neurochemical activity.

Charcot Salpetriere

FIGURE 19 Vibratory therapy. Charcot observed that patients with Parkinson's disease experienced a reduction in their rest tremor, after taking a carriage ride or after horseback riding. He developed a therapeutic vibratory chair that simulated the rhythmic shaking of a carriage (18). A vibratory helmet to shake the head and brain was later developed. Such therapies were not utilized widely and have not been studied in modern times.

FIGURE 19 Vibratory therapy. Charcot observed that patients with Parkinson's disease experienced a reduction in their rest tremor, after taking a carriage ride or after horseback riding. He developed a therapeutic vibratory chair that simulated the rhythmic shaking of a carriage (18). A vibratory helmet to shake the head and brain was later developed. Such therapies were not utilized widely and have not been studied in modern times.

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