German Neurological Society Research Articles

German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions.

Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson's disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on "Parkinson's disease" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders. The recommendations were based on literature reviews, other relevant guidelines, and expert opinions. Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive trainingand physical aerobic training are recommended. To treat Parkinson's disease (PD)-related dementia, cognitive stimulation (as anon-pharmacologicalintervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety. In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.

Inflammatory causes of stroke-Diagnostics and treatment

Inflammatory causes of stroke are frequent and often pose diagnostic and therapeutic challenges due to the scarcity of randomized trials and the absence of clear guideline recommendations for many scenarios. Following the publication of the recommendations of the European Stroke Organization on primary angiitis of the central nervous system (PACNS) last year, the German Neurological Society (DGN) has issued very clear guidelines this year on the diagnostics and treatment of PACNS and updated the recommendations for systemic vasculitides; however, stroke often occurs not only as aresult of primary vascular inflammation but also as acomplication of another organ infection. Approximately 5% of all patients with sepsis, ca. 20% of patients with bacterial meningitis and up to 40% of patients with bacterial endocarditis suffer from astroke as acomplication. This article summarizes the key characteristics of these inflammatory causes of stroke and particularly focuses on the current recommendations for diagnostic and therapeutic management.

Limbic encephalitis – A case report of atypical dementia syndrome with potentially therapeutic consequence

IntroductionLimbic encephalitis (LE) is a subacute or chronic, non-infectious inflammation of the brain, usually occurring in adulthood, with predominant involvement of mesiotemporal structures and a clinical manifestation consisting mainly of new memory impairment, affective disorder, temporal lobe epilepsy, psychoses, etc.ObjectivesTo point out the importance of knowledge of potentially treatable dementia syndromes such as atypical manifestation of probably LE.MethodsWe present a clinical case of a 47-years-old woman with an atypical dementia syndrome and typical radiological findings corresponding to a LE, among others, but without the previously known immunological antibodies.ResultsAccording to the literature, the diverse subsyndromes of LE can be subsumed under the two main categories of “paraneoplastic” and “non-paraneoplastic”. In addition to the acute and subacute courses, there is increasing evidence for chronic, slowly progressive courses, which expand the spectrum of potentially treatable dementia syndromes. Understanding and knowledge of the broad, clinical syndrome of LE have increased dramatically in recent years. Both nosological classification through differentiated diagnosis and specific therapeutic protocols have become increasingly developed and established. Nevertheless, there are rare clinical cases with a clinical phenotype and radiological findings that correspond to LE, but are both non-paraneoplastic in origin and seronegative with respect to the previously known immunological typing by autoantibodies. This gray area of nosological entity represents a diagnostic and therapeutic challenge.ConclusionsThe authors would like to point out the importance of an adequate diagnosis of the forms of LE that have been nosologically classified so far and are partly well treatable. Limbic encephalitis is an important differential diagnosis in dementia, especially in young patients with atypical courses. There is a need for further research regarding better diagnosis and therapy of the so far immunologically unidentifiable forms of clinical LE.Literature:Bazir Ahmad et al., Practical Neurology 2011Guidelines of the German Neurological Society (DGN), 2008Leypoldt et al., Akt Neurol 2012Prüss et al., Neurology 2012Disclosure of InterestNone Declared

Differential diagnosis of chorea (guidelines of the German Neurological Society)

IntroductionChoreiform movement disorders are characterized by involuntary, rapid, irregular, and unpredictable movements of the limbs, face, neck, and trunk. These movements often initially go unnoticed by the affected individuals and may blend together with seemingly intended, random motions. Choreiform movements can occur both at rest and during voluntary movements. They typically increase in intensity with stress and physical activity and essentially cease during deep sleep stages. In particularly in advanced stages of Huntington disease (HD), choreiform hyperkinesia occurs alongside with dystonic postures of the limbs or trunk before they typically decrease in intensity.Summary or definition of the topicThe differential diagnosis of HD can be complex. Here, the authors aim to provide guidance for the diagnostic process. This guidance was prepared for the German Neurological Society (DGN) for German-speaking countries.RecommendationsHereditary (inherited) and non-hereditary (non-inherited) forms of chorea can be distinguished. Therefore, the family history is crucial. However, even in conditions with autosomal-dominant transmission such as HD, unremarkable family histories do not necessarily rule out a hereditary form (e.g., in cases of early deceased or unknown parents, uncertainties in familial relationships, as well as in offspring of parents with CAG repeats in the expandable range (27–35 CAG repeats) which may display expansions into the pathogenic range).ConclusionsThe differential diagnosis of chorea can be challenging. This guidance prepared for the German Neurological Society (DGN) reflects the state of the art as of 2023.

Symptomatic treatment options for Huntington’s disease (guidelines of the German Neurological Society)

IntroductionAmeliorating symptoms and signs of Huntington’s disease (HD) is essential to care but can be challenging and hard to achieve. The pharmacological treatment of motor signs (e.g. chorea) may favorably or unfavorably impact other facets of the disease phenotype (such as mood and cognition). Similarly, pharmacotherapy for behavioral issues may modify the motor phenotype. Sometimes synergistic effects can be achieved. In patients undergoing pragmatic polypharmacological therapy, emerging complaints may stem from the employed medications' side effects, a possibility that needs to be considered. It is recommended to clearly and precisely delineate the targeted signs and symptoms (e.g., chorea, myoclonus, bradykinesia, Parkinsonism, or dystonia). Evidence from randomized controlled trials (RCTs) is limited.Summary or definition of the topicTherefore, the guidelines prepared for the German Neurological Society (DGN) for German-speaking countries intentionally extend beyond evidence from RCTs and aim to synthesize evidence from RCTs and recommendations of experienced clinicians.RecommendationsFirst-line treatment for chorea is critically discussed, and a preference in prescription practice for using tiapride instead of tetrabenazine is noted. In severe chorea, combining two antidopaminergic drugs with a postsynaptic (e.g., tiapride) and presynaptic mode of action (e.g., tetrabenazine) is discussed as a potentially helpful strategy. Sedative side effects of both classes of compounds can be used to improve sleep if the highest dosage of the day is given at night. Risperidone, in some cases, may ameliorate irritability but also chorea and sleep disorders. Olanzapine can be helpful in the treatment of weight loss and chorea, and quetiapine as a mood stabilizer with an antidepressant effect.ConclusionsSince most HD patients simultaneously suffer from distinct motor signs and distinct psychiatric/behavioral symptoms, treatment should be individually adapted.

Guideline for the management of myasthenic syndromes.

Myasthenia gravis (MG), Lambert-Eaton myasthenic syndrome (LEMS), and congenital myasthenic syndromes (CMS) represent an etiologically heterogeneous group of (very) rare chronic diseases. MG and LEMS have an autoimmune-mediated etiology, while CMS are genetic disorders. A (strain dependent) muscle weakness due to neuromuscular transmission disorder is a common feature. Generalized MG requires increasingly differentiated therapeutic strategies that consider the enormous therapeutic developments of recent years. To include the newest therapy recommendations, a comprehensive update of the available German-language guideline 'Diagnostics and therapy of myasthenic syndromes' has been published by the German Neurological society with the aid of an interdisciplinary expert panel. This paper is an adapted translation of the updated and partly newly developed treatment guideline. It defines the rapid achievement of complete disease control in myasthenic patients as a central treatment goal. The use of standard therapies, as well as modern immunotherapeutics, is subject to a staged regimen that takes into account autoantibody status and disease activity. With the advent of modern, fast-acting immunomodulators, disease activity assessment has become pivotal and requires evaluation of the clinical course, including severity and required therapies. Applying MG-specific scores and classifications such as Myasthenia Gravis Activities of Daily Living, Quantitative Myasthenia Gravis, and Myasthenia Gravis Foundation of America allows differentiation between mild/moderate and (highly) active (including refractory) disease. Therapy decisions must consider age, thymic pathology, antibody status, and disease activity. Glucocorticosteroids and the classical immunosuppressants (primarily azathioprine) are the basic immunotherapeutics to treat mild/moderate to (highly) active generalized MG/young MG and ocular MG. Thymectomy is indicated as a treatment for thymoma-associated MG and generalized MG with acetylcholine receptor antibody (AChR-Ab)-positive status. In (highly) active generalized MG, complement inhibitors (currently eculizumab and ravulizumab) or neonatal Fc receptor modulators (currently efgartigimod) are recommended for AChR-Ab-positive status and rituximab for muscle-specific receptor tyrosine kinase (MuSK)-Ab-positive status. Specific treatment for myasthenic crises requires plasmapheresis, immunoadsorption, or IVIG. Specific aspects of ocular, juvenile, and congenital myasthenia are highlighted. The guideline will be further developed based on new study results for other immunomodulators and biomarkers that aid the accurate measurement of disease activity.

Persecution, expulsion, annihilation. Neurologists in the NS era-For active remembrance

The German Neurological Society (DGN) has commissioned historical research related to the expulsion and murder of German-speaking neurologists during the National Socialism era (NS). Intended as an introduction to the following background essays and biographies in this special issue of Der Nervenarzt, this article summarizes the results and perspectives of medical historical research addressing the persecution of German physicians. Additionally, it shows how the current project of the DGN fits into the context of an interdisciplinary culture of commemoration by a confrontation with National Socialism. Of particular importance for the DGN is that it was founded as the successor to the Society of German Neurologists (GDN), which was dissolved in 1935. In the early stages of the NS era, the GDN was the professional home of numerous Jewish specialists and those labeled "Jewish" by NS law, who were expelled from Germany and (after the "Anschluss" of 1938) from Austria, deported to concentration camps or driven to suicide. With this in mind, "persecution", "expulsion", and "extermination" raise not only questions of collegiality, decency, and morality. Investigating and remembering this era also affects today's public image of the neurological specialist society and constitutes an important part of its culture of remembrance and its history politics.

Persecution, expulsion and extermination of German-speaking neurologists during the NS era: attempt at an assessment

Some 90years after the beginning of the Nazi regime, the German Neurological Society (DGN) commissioned an investigation into the extent to which persecution, expulsion and extermination during the "Third Reich" also affected neurologists. In total, the biographies of 61mostly Jewish physicians and scientists, of whom more than 70% were members of the neurological association of the time, could be analyzed. Most of them emigrated, afew remained in Germany or Austria despite persecution, and nine died in the Holocaust or by suicide. The racistically motivated expulsion affected all age groups, especially those who were 30-60years old in "middle" positions. In close connection with Nazi legislation, three waves of emigration can be distinguished (1933-1934, 1935-1937, 1938-1939) and the clearly preferred destination country was the USA (64.7%). Younger age, knowledge of a universal language, reliable family and academic connections as well as internationally recognized publications, could make it easier to start acareer in the country of exile. It was not uncommon for those who were involved in neurological fields before emigration to turn to basic science or psychiatry afterwards. The general "brain-drain"/"brain gain" hypothesis must be expanded by analyses on the biographical microlevel in order to illustrate the difficulties emigrants encountered when trying to start anew career and to publicize a sometimes unsuccessful acculturation. Not asingle neurologist returned to Germany and, as far as can be assessed, any compensation, if at all was low. The critical assessment of the racistically motivated persecution between 1933 and 1945 can today be an occasion for the DGN and its members to reflect on collegiality as avalue as well as to become more aware of structurally related discrimination and injustice and to counteract it in a timely manner.

Disparate lives: Ludwig Guttmann and Robert Wartenberg

The neurologists Sir Ludwig Guttmann and Robert Wartenberg had a number of things in common, e.g., both enjoyed high international recognition for the clinical care they provided to paraplegics and for their contributions to the development of neurological diagnostics. Both were born before 1900. Both were classified as "Jewish" by the National Socialist regime because of their origins. Both had to flee from Germany in the 1930s but nevertheless did not appear to harbor any grudges after 1945; however, both also show differences even more than similarities. Guttmann (1899-1980) stood up for those persecuted, for instance during the November pogroms in 1938. After his late emigration, he soon found anew home in England. His skills in neurosurgery enabled him to convert amilitary hospital into the world's leading treatment center for spinal cord injuries. He was the founder of the Paralympic Games and received aknighthood from Queen ElizabethII. In 1971 the German Neurological Society (DGN) awarded him with a late honorary membership during the presidency of the former SS captain Helmut Bauer. In contrast, Robert Wartenberg (1886-1956) found anew neurological home at the University of California in San Francisco and published numerous books, some of which also attracted attention in the German translation. On various occasions, he opposed the remembrance of National Socialist injustice and even justified the "concurrent research" in conjunction with "euthanasia".

Late forced emigration without perspectives: Alfred Hauptmann and Adolf Wallenberg

Archival documents and further biographical testimonies reveal that dismissal and expulsion on racist grounds also affected neurologists in leading clinical positions and at an advanced age. Alfred Hauptmann (1881-1948), full professor for neurology and psychiatry in Halle/Saale, member of the Leopoldina and discoverer of phenobarbitone treatment for epilepsy, emigrated first to Switzerland and then to the USA after the anti-Jewish pogroms in November 1938 and asubsequent "protective custody" imposed on him at the age of 58years. Adolf Wallenberg (1862-1949), aself-made neurologist, described the syndrome later named after him in 1895. As a clinician he carried out research in the field of neuroanatomy until the National Socialists ousted him from his workplace in Danzig. At the age of77 years, he emigrated to the USA via Great Britain, but did not manage to settle down again in his profession. For both physicians, neurology was their purpose in life, they felt patriotically attached to their home country and saw no future for themselves after their late forced emigration. Hauptmann is today commemorated by an award for experimental and clinical research on epilepsy, Wallenberg by the German Neurological Society award for outstanding achievements in the fields of cerebrovascular diseases, brain circulation and brain metabolism.

Neurological manifestations of post-COVID-19 syndrome S1-guideline of the German society of neurology

Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to COVID-19 (COrona VIrus Disease-2019). SARS-CoV-2 acute infection may be associated with an increased incidence of neurological manifestations such as encephalopathy and encephalomyelitis, ischemic stroke and intracerebral hemorrhage, anosmia and neuromuscular diseases. Neurological manifestations are commonly reported during the post-acute phase and are also present in Long-COVID (LCS) and post-COVID-19 syndrome (PCS). In October 2020, the German Society of Neurology (DGN, Deutsche Gesellschaft für Neurologie) published the first guideline on the neurological manifestations of COVID-19. In December 2021 this S1 guideline was revised and guidance for the care of patients with post-COVID-19 syndrome regarding neurological manifestations was added. This is an abbreviated version of the post-COVID-19 syndrome chapter of the guideline issued by the German Neurological society and published in the Guideline repository of the AWMF (Working Group of Scientific Medical Societies; Arbeitsgemeinschaft wissenschaftlicher Medizinischer Fachgesellschaften).

Unsettling Realities of Nazism and the Legacy of the German Neurological Society.

On behalf of the German Neurological Society (DGN), a study was conducted into how far former chairmen, honorary chairmen, and honorary members could be regarded as incriminated from the National Socialist period. While an online supplement of this journal presents seven individual biographies (in six papers) by way of example, this paper offers an overview summarizing the project results and introducing the biographies. The first part and the methodological section discuss the difficulties of retrospectively identifying neurologists involved in the Nazi movement. Formal characteristics (eg, membership of the Nazi Party (NSDAP) or other Nazi organizations or participation in Nazi crimes) and content-related clues (eg, statements reflecting Nazi ideology, personal contacts with Nazi officials or active support of the system) can be helpful. The second part summarizes the principal results of a study of 28 German and Austrian neuroscientists with regard to their involvement and their post-war careers. Six of the seven "founding fathers" of the DGN were former NSDAP members; 10 of the 13 presidents in office until 1976 had belonged to Nazi organizations-the NSDAP, the SA ("Brownshirts") or the SS ("Blackshirts"). Moreover, seven out of 10 honorary presidents had formal or substantive links to National Socialism. Of the German and Austrian honorary members appointed up to 1985, two-thirds had leanings to Nazi ideology or the National Socialist system. This paper concludes by outlining how the DGN and its members are currently addressing this historical legacy in order to establish a responsible culture of remembrance. ANN NEUROL 2021;90:546-557.

\u201cNeurological manifestations of COVID-19\u201d - guideline\xa0of the German society of neurology

Infection with the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to a previously unknown clinical picture, which is known as COVID-19 (COrona VIrus Disease-2019) and was first described in the Hubei region of China. The SARS-CoV-2 pandemic has implications for all areas of medicine. It directly and indirectly affects the care of neurological diseases. SARS-CoV-2 infection may be associated with an increased incidence of neurological manifestations such as encephalopathy and encephalomyelitis, ischemic stroke and intracerebral hemorrhage, anosmia and neuromuscular diseases.In October 2020, the German Society of Neurology (DGN, Deutsche Gesellschaft für Neurologie) published the first guideline on the neurological manifestations of the new infection. This S1 guideline provides guidance for the care of patients with SARS-CoV-2 infection regarding neurological manifestations, patients with neurological disease with and without SARS-CoV-2 infection, and for the protection of healthcare workers.This is an abbreviated version of the guideline issued by the German Neurological society and published in the Guideline repository of the AWMF (Working Group of Scientific Medical Societies; Arbeitsgemeinschaft wissenschaftlicher Medizinischer Fachgesellschaften).

Sensitivity and specificity of cerebrospinal fluid CXCL13 for diagnosing Lyme neuroborreliosis - a study on 1410 patients and review of the literature

IntroductionThe B-cell chemoattractant CXCL13 has been suggested as a cerebrospinal fluid (CSF) biomarker for Lyme neuroborreliosis (LNB). Our aim was to substantiate the value of CXCL13 in a large unselected cohort and determine a practical cut-off value to diagnose LNB. MethodsWe retrospectively studied clinical and CSF data of consecutive patients who underwent CSF CXCL13 testing over a period of three years (February 2015 to January 2018) at our academic teaching hospital. Patients were classified into 12 groups according to their final diagnosis. To diagnose LNB (definite or probable/possible), definitions of the respective guideline of the German Neurological Society were applied. ResultsOf 1410 patients, 29 were diagnosed with definite LNB and 9 with probable/possible LNB. Median CXCL13 levels were highly elevated in both LNB groups (554 pg/mL and 649 pg/mL, respectively) and the group with bacterial/fungal CNS infections (410 pg/mL; n = 6), while all other groups had markedly lower median CXCL13 levels (p < .001). For definite LNB, the best CXCL13 test cut-off was 55.5 pg/mL with a sensitivity of 96.6% (95% confidence interval, CI, 80.4%–99.8%) and a specificity of 94.9% (95% CI 93.5%–95.9%). All patients with LNB showed clinical improvement after antibiotic treatment. ConclusionIn this large monocentric cohort, CSF CXCL13 was found to be a highly sensitive and useful marker for LNB. In conditions with low index of suspicion for LNB, CXCL13 testing may be unwarranted. A review of the literature on the sensitivity and specificity of CSF CXCL13 in the differential of LNB is provided.

Austrian neurologists under the swastika: Julius Wagner-Jauregg-Walther Birkmayer-Franz Seitelberger

There were three Austrian neurologists with connections to neurology in National Socialism who have been honored by the German Neurological Society (DGN) or its predecessor organizations with honorary membership. From 1928 to 1934 Julius Wagner-Jauregg (1857-1940) was head of the Austrian Alliance for National Regeneration and the Study of Heredity; in at least two publications he advocated eugenic measures and racial hygienic positions as defined by Nazi ideology. As aformer member of the Greater German People's Party (Großdeutsche Volkspartei), he applied for membership of the National Socialist German Workers' Party (NSDAP) afew months before his death. Walther Birkmayer (1910-1996) was an early member of the NSDAP, SA, SS and other Nazi organizations. As astaunch supporter of the "movement" he worked from 1938 in the Office of Racial Policy of the Gauleitung of Vienna. In lectures and publications he demanded or recommended forced sterilization for anumber of neurological diseases. Due to the classification of his grandmother as "non-Aryan", he had to give up his party and university posts and served as aWehrmacht physician. After some hard years immediately after the war, he was allowed to continue his career. As aco-discoverer of the effect of L‑DOPA on parkinsonism, he was awarded numerous honorary doctorates and honorary memberships. Franz Seitelberger (1916-2007), amember of an SS unit during the Nazi era, benefited in his research work from the 1950s onwards from specimens obtained in the course of neuropathological "concomitant research" to Nazi "euthanasia". It is to be welcomed that the Austrian Society of Neurology (ÖGN) will soon start ahistorical project investigating open questions related to the Nazi era.

Max Nonne (1861-1959) and his attitude towards "euthanasia"

Max Nonne, an internationally renowned German neurologist, acted from 1918 to 1924 as president of the (first) Society of German Neurologists (GDN). Appointed honorary president in 1925, he held this position in the (second) German Neurological Society (DGN) until his death. Since 1961, this association has honored 16neurologists with acommemorative medal named after Nonne. His outstanding findings in various fields of neurology are uncontested and some of them live on as eponyms (Nonne-Apelt syndrome, Nonne-Froin syndrome, Nonne-Milroy-Meige syndrome); however, recent archival studies and an analysis of individual publications deeply darkened the image of the "grey eminence" of German neurology. Records kept at the Hamburg State Archive prove that in amemorandum from 1941/1942 following the example of Binding and Hoche, Nonne firmly approved the killing of "life absolutely unworthy of living". In areport addressed to the District Court of Hamburg he attested in 1946 that many physicians charged with manslaughter acted in accordance with the regulations governing "child euthanasia", resulting in the withdrawal of the accusation. In afurther statement from 1949 he confirmed that the killing of children and the "euthanasia program" during the NS era were consistent with the state of medical science. An earlier book chapter authored by Nonne immediately after World WarI suggested that his social-Darwinistically colored concept of mankind was developed clearly before the Nazi era. Notwithstanding the arrangement to which he came with the new powers after 1933 and his acceptance of tributes to him by them, he repeatedly stood up for his Jewish colleagues. He was never aNazi, nevertheless, he engaged in activities that fostered NS "euthanasia" going far beyond a"mentality of approval".

Neurologists and neuroscientists: who was aNazi? Changing perspectives on NS incrimination in the history of German medicine

The German Neurological Society (DGN) instigated an investigation into potential incrimination of some of the previous leading members regarding their Nazi involvement. The persons in question include former (honorary) presidents and honorary members of the DGN (or the predecessor organizations) and the name givers of prizes awarded by the DGN. This introduction to the following biographies explains the difficulties and the broad discretionary leeway needed to establish an involvement in Nazi activities going beyond justiciable crimes against humanity on the basis of formal criteria (e.g. membership in the NSDAP and/or other NS organizations, involvement in Nazi crimes) and/or substantive indications (e.g. statements advocating the NS ideology, personal contacts to Nazi functionaries, active support of the system). Alongitudinal analysis from 1945 until the present day reveals time-related variations in assessing who and why someone was considered to be aNazi. Acurrent overview of historical projects initiated by medical societies in Germany demonstrates that the endeavor of the DGN to deal with its Nazi involvement will be an integral part of the interdisciplinary "culture to cope with the past" of medical associations. Finally, it should be borne in mind that the fabric of history consists of adifferent material than clinical medicine or its natural scientific foundations. Checklists or scores for measuring NS involvement thus cannot and will not exist. Instead, balanced historical interpretations are needed as attempted by the biographical reconstructions presented in this volume.

In the “twilight zone”: honorary members of the German Neurological Society 1954–1982

From the mid-1950s to the early 1980s the German Neurological Society (DGN) appointed in addition to international physicians, numerous German physicians as honorary members. From apresent day perspective, some of them are to be classified as "incriminated" with their commitment to the National Socialist "movement" and its health policy goals, which at times went far beyond aformal membership of the party and its organizations. Thus, there is no doubt about the völkisch views of the Würzburg psychiatrist Martin Reichardt (1874-1966), which he articulated in lectures and publications. The Erb student Siegfried Schönborn (1874-1966), also a member of the National Socialist German Workers' Party (NSDAP), was in contact with Karl Fahrenkamp, who advised Reichsführer-SS Heinrich Himmler on medical issues. Hamburg-based Hans-Robert Müller (1901-1981), one of the "founding fathers" of the DGN, joined the Hitler party in 1937. In contrast, neurosurgeon Hans Kuhlendahl (1910-1992) was in addition amember of the Storm Troopers (SA). Hans Jacob (1907-1997), SA-Rottenführer, party comrade and head of the Neuropathology Department at Hamburg University, profited by the "euthanasia" action: as part of the so-called concomitant research he examined ca.40 brains of children who had been killed at the "special departments" in Langenhorn and Lüneburg. Unlike his peers, the renowned neurogeneticist Peter Emil Becker (1908-2000) is today judged as an opportunistic bystander. He was one of the few who faced up to his NS past later in life, but the response he met was ambivalent because he withheld mention of his party membership. With respect to the honorary members, it remains an open question why 40years after the end of the "Third Reich" the DGN still honored neurologists who in some cases had been heavily involved in the biopolitics of that era.

Neuroscientists at the Kaiser Wilhelm Institute for Brain Research in the "Third Reich": OskarVogt-HugoSpatz-WilhelmTönnis

The Kaiser Wilhelm Institute (KWI) for Brain Research in Berlin-Buch was one of the key institutions enmeshed in the euthanasia program between 1939 and 1945, generating scientific knowledge by dissecting the brains of murdered patients. As aconsequence, this institution and its early years have attracted the attention of historians for years. The neuroanatomist Oskar Vogt (1870-1959), director of the KWI until 1937 and his wife Cécile (1875-1962) who were both appointed honorary members of the German Neurological Society (DGN) in 1952, concentrated on the microstructure and brain architecture of healthy and "elite" brains. Vogt's successor, Hugo Spatz (1888-1969), shifted research activities towards pathology of the central nervous system (CNS) and incorporated psychiatric and military institutions into the institute's network. Spatz had been amember of the National Socialist German Workers' Party (NSDAP) since 1938. As acting director of the KWI he was responsible for the dissections performed by Hallervorden on murdered patients. After the war Spatz tried to justify his actions. Years after the unveiling of these relationships the DGN decided in 1998 to rename the Hugo Spatz award. Wilhelm Tönnis (1898-1978), the German pioneer of neurosurgery had been amember of the National Socialist Air Corps since 1933 and amember of the NSDAP since 1937, finally joining the NS Medical Association in 1938. After the war he played down his affiliation to NS divisions. When his denazification trial had ended he pursued his career in the young Federal Republic of Germany. In 1976 he was elected honorary member of the DGN, 2 years before his death.

Georg Schaltenbrand (1897-1979) and his research without moral boundaries on multiple sclerosis

In 1953 the prominent German neurologist Georg(es) Schaltenbrand became president of the German Neurological Society (DGN) and in 1967 honorary president. Less well known is the fact that from 1933 to 1936 he was member of the "Stahlhelm" and the Storm Troopers (SA). In 1937 he joined the National Socialist German Workers' Party (NSDAP) and other Nazi organizations. For the last three decades Schaltenbrand's name has primarily been associated with human experiments performed in 1940. His objective was to prove the viral etiology of multiple sclerosis (MS). To that end he injected cerebrospinal fluid (CSF) drawn from allegedly infected monkeys and MS patients into severely handicapped patients from the psychiatric asylum Werneck near Schweinfurt as well as into severely ill patients from the University Hospital of Würzburg without their consent. Weeks later he withdrew CSF samples from the recipients, sometimes repeatedly to control parameters of inflammation. Although not all details of his test series can be clarified, there is no doubt that he violated prevailing laws and ethical standards. According to the present state of knowledge, he was the only German professor of neurology during the Nazi era who performed such experiments on humans in terms of "research without moral boundaries". He later justified his actions by arguing that he had intended to exert apositive effect on the mentally ill. Judicial investigations ended in 1948 without an indictment. Long after his death, in 1994 the "Schaltenbrand experiments" became known to awider public and three years later the Medical Faculty of Würzburg condemned the unethical research and distanced itself from its former member. Today, Schaltenbrand's study is assessed as an unacceptable form of research on particularly vulnerable patients for the benefit of third parties. As aresult, ethical norms formulated in the 1930s were reinforced by international guidelines, e.g. the Declaration of Helsinki drafted by the World Medical Association.