German Neurologist Research Articles

"Witzelsucht". On the introduction and meaning of the term by Hermann Oppenheim in 1890 and its distinction from "moria"

Hermann Oppenheim (1858-1919) was a German neurologist without an academic career, who in his productive period around 1900 made aname for himself during his lifetime as amajor player in the history of German neurology with his many contributions to multiple sclerosis, syphilis and the controversial study of traumatic neurosis; however, it is almost unknown that in 1890 he introduced the term "witzelsucht", which is still used internationally today. Moritz Jastrowitz dealt with behavioral abnormalities due to frontal brain injuries 1year earlier and used the term "moria" for aform of mental disorder associated with akind of childish behavior and inappropriate jocularity. Oppenheim was critical of this and differentiated his "witzelsucht" from this. With this term he wanted to describe humoristic feeble-mindedness in a much narrower sense, which stands in striking contrast to the usual symptoms in cases of cerebral tumors. Oppenheim recognized the frontal brain, particularly the right brain, to be an important functional unit for humorous behavior. Modern research has confirmed that the processing of humor requires a complex interaction of multiple brain regions. Damage to the right frontal lobe or to connecting structures can lead to the disorder "witzelsucht". Whether asimultaneous damage to the left hemisphere must be present or if this is dependent on the individual dominant hemisphere, needs further research.

One third of physicians discuss exit strategies with patients with amyotrophic lateral sclerosis: Results from nationwide surveys among German and Polish neurologists.

This paper examines neurologists' approaches to exit strategies (ESs), such as euthanasia and physician-assisted suicide, in patients with amyotrophic lateral sclerosis (PALS) in two European countries. In a nationwide anonymous survey, we collected responses from 237 Polish and 228 German neurologists, focusing on their practices and beliefs about ESs, as well as their viewpoints on life-sustaining measures (LSMs) (percutaneous endoscopic gastrostomy, non-invasive, and invasive ventilation). To analyze the data, we employed statistical methods, including Mann-Whitney U, Kruskal-Wallis, chi-square tests, Spearman's rank correlation, and multiple regression analysis. One third of the neurologists initiated the discussion about ESs with PALS. Half were ready to have this conversation upon patient's request. Age, gender, religiousness, and nationality were closely associated with this approach. One in 9 neurologists received a request to terminate an LSM, whereas 1 in 10 to implement an ES. German neurologists and palliative care trainees acquired both demands more commonly. Neurologists quoted a low quality of life, decreased mood, and being a burden to the family/closest ones as primary reasons for a wish to hasten death among PALS. Although the majority expressed a willingness to terminate an LSM at a request of the patient, most opposed the legalization of euthanasia. Younger and less religious individuals were more likely to favor accepting euthanasia. Neurologists vary significantly in their approaches to terminal care. Complex relationships exist among personal indices, shared beliefs, and current practices.

Coming to Terms with “Self-Actualization”: The Reception of Kurt Goldstein in Humanistic Psychotherapy

The ideals and practices of self-improvement aimed at achieving a sense of self-realization of our lives have permeated popular culture since the mid-20th century, largely due to the work of American humanistic psychologists. This paper delves into the popularization of these notions, arguing that they partially stem from a particular American appropriation of the German neurologist and psychiatrist Kurt Goldstein’s concept of self-actualization. First, the paper examines Goldstein’s encounter with American psychology, tracing his early interest in psychotherapy, the stages of his forced migration to America, and the reception of his work within American psychology. Second, it offers an analysis of the interpretations and applications of Goldstein’s holistic approach and its concept of self-actualization by humanistic practitioners, notably Abraham Maslow’s theory of motivation and Carl Rogers’s client-centered approach to psychotherapy. Finally, the paper closes with a critical discussion of the distinction between Goldstein’s approach, which emphasizes the creative process of a “coming to terms” between organism and environment, and humanistic psychotherapy, which underscores individual responsibility.

Towards an understanding of the aetiology, genomic landscape and management of Moebius syndrome

Moebius Syndrome (MBS) is a rare neurodevelopmental disorder characterised by facial paralysis and ocular motility defects. Its origins trace back to the 19th century, with its clinical delineation attributed to German neurologist Paul Möbius. The syndrome presents with a spectrum of variable systemic clinical features, necessitating a multidisciplinary approach to diagnosis and management. The prevalence of MBS has been estimated to range between 1 in 50,000 to 1 in 500,000 individuals, with a universal distribution across ethnicities and genders. The aetiology of MBS is poorly understood but is likely multifactorial, with developmental, genetic, and environmental factors playing roles. Recent research has identified potential genetic contributors, REV3L and PLXND1, but further work is needed to elucidate the genetic landscape of this rare neurodevelopmental disorder. Here we describe the current understanding of the clinical features, aetiology, genetic landscape, and management of MBS, emphasising the importance of early diagnosis and a holistic approach to patient care. We also propose a set of criteria aimed at standardising MBS reporting to enhance information sharing and bolster MBS research initiatives. Collaborative research efforts in the future hold the potential to offer transformative insights and improved outcomes for affected individuals and their families.

Henry Head (1861-1940) and his importance for neurology

Nowadays, Henry Head is best known for his Head zones. The concept was understood very differently by Head in comparison to what current medical books falsely describe them to be. In reality, there is no direct relationship between one particular skin zone and one single organ. It is certain that the drawings considered depictions of the Head zones in today's medical textbooks were actually not created by Head. From aneurological point of view, Head is important for two reasons: his self-experiment in 1909 to damage one of his own peripheral nerves followed by regeneration was heroic. It has helped generations of neurologists to have a better understanding of the pathophysiology of peripheral nerve damage and thus make a better assessment of the prognosis of such injuries. Head's second contribution pertains to the radicular organization at the level of the spinal cord. The pathophysiology of herpes zoster radiculitis enabled him to develop the concept of the dermatomes on the basis of preliminary work around 1900. Henry Head's contribution was the systematic compilation of the existing publications of the time and amendment of his own cases. As he was the most important neurologist at that time, at least in the English speaking world, and was well connected with people in the German neurology community, it was probably easy for him to make his dermatome maps well known. In retrospect, Head was less successful in neuropsychology with holistic concepts for higher cognitive functions which were in vogue during his lifetime. His late work on aphasia is now considered refuted. Head's criticism of the strict localization was well in syncronization with the zeitgeist of the early twentieth century. Establishing the fact that Broca's aphasia and Wernicke's aphasia are not easily diagnostically distinguishable from each other was more an achievement of subsequent generations of neurologists and neuropsychologists as well as technical advances.

Conventional and living guideline for schizophrenia: barriers and facilitating factors in guideline implementation

This study aims to investigate the barriers and facilitators to guideline adherence for the print format of the German schizophrenia guideline as well as for the concept of a digital living guideline for the first time. For this purpose, the schizophrenia guideline was transferred to a digital guideline format within the web-based tool MAGICapp. An online survey was performed under participation of mental healthcare professionals (medical doctors, psychologists/psychotherapists, psychosocial therapists, caregivers) in 17 hospitals for psychiatry in Southern Germany and a professional association for German neurologists and psychiatrists. 524 participants opened the survey, 439 completed the demographic questions and commenced the content-related survey and 309 provided complete data sets. Results indicate a higher occurrence of knowledge-related barriers for the living guideline. The print version is associated with more attitude-related and external barriers. Older professionals reported more attitude-related barriers to a living guideline compared to younger professionals. Differences between professions regarding barriers were found for both formats. Various barriers exist for both guideline formats and a need for facilitators was expressed across professions. Many of the mentioned obstacles and facilitators can be more easily addressed with living guidelines. However, also living guidelines face barriers. Thus, the introduction of these new formats alone cannot lead to sustainable behavior change regarding guideline adherence. Yet, living guidelines seem to be a cornerstone to improved and tailored guideline implementation as they facilitate to keep recommendations up to date and to address the need of individual professional groups.

Играта в антропологическа перспектива: теорията на Фредерик Бойтендайк

Play theory has been consistently regarded as a cornerstone of 20th century theoretical discourse in areas as diverse as philosophy, psychology, ethology and cultural studies. On the other hand, the rise of digital technology and the spread of video games on a broad cultural level have raised the necessity to reevaluate historical approaches to the multifarious phenomenon of play. Along with Johan Huizinga, another scholar of Dutch origin – the biologist and animal psychologist Frederik J. J. Buytendijk – developed a novel theory of play in the 1930s. Buytendijk’s attempt at theorising human and animal play has been variously defined as biological, psychological and psycho-dynamic due to this scholar’s background in the study of animal behaviour and his reliance on biological models to explain the mechanisms of play. However, Buytendijk’s ideas were shaped in a theoretical setting shared by German philosophical anthropology and he also borrowed heavily from prominent philosophers and phenomenologists such as Hungarian-born Melchior Palágyi, German neurologist and psychiatrist Erwin Straus and Catholic theologian Romano Guardini. This paper tries to provide an overview of Buytendijk’s conception of vital play by examining its original yet synthetic nature. Further emphasis is placed on the aesthetical and anthropological implications of Buytendijk’s contribution.

뇌손상 연구에 기반한 골드슈타인의 환자론

Goldstein, a German neurologist and physician, devoted his professional life to treating numerous patients with brain injuries. Among these was Schneider, a World War I veteran, who was unable to utter an abstract sentence as simple as “The snow is black.” Goldstein observed another patient who could intricately draw a church window from memory, but failed to produce a simple square. Likewise, some patients could discern various colors but struggled to categorize similar shades and assign them correct names. For Goldstein, these patients’ predicaments were not merely physical or chemical deviations from a normal condition. Instead, they became patients due to a shrinkage in their world, making them heavily dependent on environmental stimuli and limiting their response spectrum. According to Goldstein, a normal, healthy state involves the ability to think abstractly and categorically, maintain some detachment from the milieu's stimuli, and not be solely bound by its concrete demands. Within this framework, Goldstein strived to help patients grappling with pathological conditions to lead the most fulfilling lives possible in their shrunken world. His philosophy of medicine paves the way for the study of “patientology,” an ontological exploration of the state of being a patient. This ontological approach to understanding the inherent potential of humans becoming patients offers deep insights into our contemporary medical environment, where individuals may live significant portions of their lives in hospital settings.

Guideline for schizophrenia: implementation status and attitude toward an upcoming living guideline

The implementation status of clinical guidelines is, despite their important role in connecting research with practice, frequently not satisfactory. This study aims to investigate the implementation status of the current German guideline for schizophrenia. Moreover, the attitude toward a living guideline has been explored for the first time by presenting screenshots of the German schizophrenia guideline transferred to a digital living guideline format called MAGICapp. A cross-sectional online survey was performed under the participation of 17 hospitals for psychiatry and psychosomatic medicine in Southern Germany and one professional association for German neurologists and psychiatrists. 439 participants supplied sufficient data for analysis. 309 provided complete data sets. Regarding the current guideline for schizophrenia and key recommendations, a large awareness-to-adherence gap was found. Group comparisons between different professions (caregivers, medical doctors, psychologists/psychotherapists, psychosocial therapists) detected differences in the implementation status showing higher awareness and agreement with the schizophrenia guideline and its key recommendations among medical doctors compared to psychosocial therapists and caregivers. Moreover, we detected differences in the implementation status of the guideline as a whole and its key recommendations between specialist and assistant doctors. The attitude toward an upcoming living guideline was mostly positive, especially among younger healthcare professionals. Our findings confirm an awareness-to-adherence gap, not only for the current schizophrenia guideline in general but also for its key recommendations with apparent differences between professions. Overall, our results show promising positive attitudes toward the living guideline for schizophrenia among healthcare providers, suggesting that a living guideline may be a supportive tool in everyday clinical practice.

Unusual case of Trigeminal Neuralgia Associated with Poland -Moebius Syndrome.

Moebius Syndrome is a rare congenital neurological condition characterized by paralysis of several cranial nerves, commonly the VI(Abducens) and VII(Facial) cranial nerves which causes lateral gaze strabismus and internal strabismus & classical mask like appearance respectively. Other cranial nerves such as V, VII, IX, X, XI, XII are rarely affected. Von Graefe and German neurologist Moebius (1888), after whom the syndrome was eventually named, provided the earliest descriptions of it. Although the etiopathogenesis is unknown, it appears to occur sporadically in the majority of cases, and some documented cases show hereditary predisposition. This paper presents a rare instance of trigeminal neuralgia associated with Moebius syndrome. According to the author's research, this is the first case of Poland Moebius syndrome with trigeminal neuralgia documented from India.

The 'Tabes Syphilis Controversy' : A Dispute About the Cause of Tabes Dorsalis and Progressive Paralysis at the End of the 19th Century

For some years now, the incidence of syphilis and neuroluetic clinical pictures has been increasing. As a result, tabes dorsalis and progressive paralysis are once again gaining relevance in neurology. In the last two decades of the 19th century, there was a heated debate in German neurology about the understanding of the aetiology of these conditions, the so-called 'tabes syphilis controversy'. In 1879, Wilhelm Erb had called on the German neurological community in a much-noticed lecture to finally tackle the problem to unequivocally identify the cause of tabes dorsalis. Mainly on the basis of disease statistics he himself postulated a previous syphilitic infection as of key importance. Answering this question was urgent, because the proportion of patients in psychiatric institutions suffering from progressive paralysis, to which tabes was seen in close parallel, was rapidly increasing. The Berlin neurologists Carl Westphal, Ernst Julius Remak, Martin Bernhardt and Ernst Victor von Leyden regarded Erb's thesis as a gauntlet. They saw the causes of tabes and progressive paralysis in social impoverishment such as damp and cold living conditions, in physically one-sided work overloads or in the hardships of soldiers in the army. They assumed that traumatic tabes was caused by concussions or bruises. The Leipzig neurologist Paul Julius Möbius was the first to state between 1890 and 1897 that the only cause of tabes and progressive paralysis was a previous syphilitic infection. He consistently ruled out all other aetiological theories. Above all, bacteriological and microbiological research in the following years proved Möbius right. Thus 40 years after Erb's lecture, in addition to diagnostic, specific therapeutic approaches could be developed and applied.

FAHR's Disease and MCA Aneurysm Bleeding Case Report

Fahr's disease is named after the German neurologist Karl Theodor Fahr, who first reported it in 1930. This is a rare neurological condition characterized by abnormal idiopathic calcification of the basal ganglia and is usually inherited in autosomal dominant manner.

Awareness Creation of Neurotoxins‐induced Wallerian‐type degeneration causing brain Acetylcholine‐imbalance and frank Alzheimer disease

AbstractBackgroundPresence Environmentally Mediated Intellectual Decline Neurotoxins ('presence‐EMIDN') threats from 'bounded', 'unbounded' and 'pervasive' sources puts everyone at risk of developing neurodegenerative diseases (eg. Alzheimer) once specific lipophilic‐neurotoxins breach the blood‐brain and nose‐brain barriers to reach the brain and build up to harmful thresholds. Such neurotoxins exist; how they provoke Wallerian‐type degeneration to cause FAD have been threaded together from experimental evidenced‐based reviews. My intent/interest is to create awareness and establish the aetiology for FAD, which has remained idiopathic since 1906, when the German Neurologist, Alois Alzheimer, discovered the disease.MethodThrough threaded literature reviews from multiple sourcesResultsMany neurotoxins produce Wallerian‐type degeneration: organophosphorus compounds (DFP, TOCP), acrylamide, n‐hexane and some of its metabolites. Wallerian‐type degeneration have been demonstrated in animals: hens, cats, rats, rabbits. Changes during Wallerian‐type degeneration can be grouped into two (Histopathological and Biochemical): it describes the cascade of events taking place in the distal part of an axon that has been cut or crushed. The histopathological changes occur in stages in the following order of succession: stage a: primary degeneration of axon followed by secondary degeneration of myelin in these order: axon swelling; axon disintegration; loss of normal myelin structures with swelling; tumefaction; and breakdown of myelin sheaths; followed by stage b: Cellular proliferation; and then stage c: Fibrosis. The biochemical changes result from liberations of normal biochemical constituents of axon and myelin. There is specifically a decrease in the CNS neurotransmitter's Acetylcholine content, in stage a (causing deficiency‐imbalance), increase in collagen in stage c, and other stage b changes.ConclusionThere are evidences showing that symptoms of FAD is due to 'Acetylcholine deficiency‐imbalance in the brain' where it exercises Excitatory and Inhibitory effects which progressively kick‐starts FAD with fatalities after 5 years. Establishing this aetiology brings vistas of new hope/challenges for possible therapeutic interventions developments.

Well-being on supportive techniques in amyotrophic lateral sclerosis: from neurologists' perspective.

To investigate intercultural neurologists' perception of well-being in patients with amyotrophic lateral sclerosis (ALS) using gastrostomy (PEG), non-invasive, and/or invasive ventilation (NIV/IV) and to analyse the determinants and impact on the management of the above medical interventions (MIs). The study was based on anonymous questionnaires addressing the clinical approach and personal attitude towards the use of PEG, NIV and IV in ALS patients completed by 465 neurologists: 228 from Germany and 237 from Poland. The German and Polish neurologists estimated the quality of life in ALS patients using PEG and NIV as neutral, whilst low in individuals using IV. A regression model revealed an independent influence of palliative care training (PCT) and age on that attitude in the German group. Higher values of estimated patients' depressiveness on PEG, NIV and IV were found amongst the Polish neurologists. Marital status, experience in ALS and being a parent independently influenced the perception of patients' depressiveness in the German, whilst marital status, age and PCT were factors in the Polish group. Amongst German neurologists, a higher perception of patients' depressiveness in individuals using PEG, NIV and IV was linked to the later timing of the MIs discussion. In the Polish group, it was a lower estimation of QoL in patients using PEG. Neurologists' perception of ALS patients' well-being on MIs reflects their demographic status, professional experience and potentially their cultural background. This perception plays an important role in the timing of MIs discussion, possibly influencing the decision-making process.

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.

The exclusion of "non-Aryan" scientists: universities, clinics and professional organizations

With the implementation of the Law for the Restoration of the Professional Civil Service (1933), including the Third Implementation Decree (1934), the Regulation for Obtaining aTeaching License (1934) and the Law for the Dismissal and Transfer of University Teachers (1935), the National Socialist (NS) government created legislative instruments to ban university staff (from lecturers to full professors) labelled as Jewish or considered politically unwanted from teaching and research. Whereas around 20% of the staff at the universities were affected by these measures after 1933, at various medical faculties the figures reached 30-40% and at neurological departments and institutes sometimes up to 90%. Student Nazi activists played asignificant role in expelling faculty members from office. As beneficiaries of the expulsions, young doctors often improved their career prospects and established professors remained silent out of political conviction, opportunism or fear. A(self) coordination (Gleichschaltung) with immediate or gradual exclusion of "non-Aryan" members and boards is documented for numerous medical organizations and associations (e.g. Deutscher Ärztevereinsbund, Hartmannbund, German Medical Women's Association, Association of Statutory Health Insurance Physicians) as well as for scientific academies (e.g. Leopoldina) and research societies (Kaiser Wilhelm Institutes, German Research Foundation). The NS-loyal Society of German Neurologists and Psychiatrists, which had been founded in 1935, tolerated "Jewish" members until 1938. As awhole, the picture that emerged from everyday medical (and neurological) practice is one of drastic changes that massively affected not only the lives of many doctors but also the moral standards in terms of patient care, teaching, research and collegiality.

"…without avisible sign of protest or at least solidarity from colleagues": the expulsion of neuroscientists from Hamburg

In Hamburg, the National Socialists' racially motivated exclusion principally hit neurologists from two institutions: the Eppendorf Neurological Clinic (director until 1934 Max Nonne) and the Psychiatric and Neurological Clinic of Friedrichsberg State Hospital (director Wilhelm Weygandt). The chief physician of the neurological department of Barmbek Hospital, Heinrich Embden (1871-1941), who had been trained by Nonne, emigrated to Brazil, whereas Friedrich Wohlwill (1881-1958), another Nonne pupil who had been a pathologist at St Georg since 1924, lived for many years in Lisbon, before he found anew scientific home at the Harvard Medical School. The cerebrospinal fluid researcher Victor Kafka (1881-1955), aFreemason and intermittent member of the Communist Party, was briefly in so-called protective custody (Schutzhaft) in Fuhlsbüttel then fled via Norway to Sweden. Hermann Josephy (1887-1960) and WalterR. Kirschbaum (1894-1982), both imprisoned in the Sachsenhausen concentration camp after the November pogroms in 1938, could successfully continue their professional careers in Chicago. Richard Loewenberg (1898-1954) first opted to continue his career in China, then changed his mind and also went to the USA after the Japanese invasion. With the exception of the latter all were full members of the Society of German Neurologists. The broad scope of their research work clearly illustrates that in addition to clinical core competence, former neurologists could intensively follow scientific interests in the neighboring disciplines of pathology, serology, and psychiatry.

The Archive of Gerd Huber (1921-2012) at Bezirkskrankenhaus Günzburg

Gerd Huber (1921-2012) was an influential West German psychiatrist and neurologist of the postwar period. Especially his studies with imaging techniques on the question of brain atrophy, the long-term course and the basic symptoms of schizophrenic disorders made a significant contribution to the research of schizophrenia and were discussed internationally. The Huber Archive, which was handed over to Bezirkskrankenhaus Günzburg, is currently being catalogued for research purposes. The archive contains Huber's private and professional papers, his writings, and a small partial archive of Kurt Schneider. These archival records not only reflect the development of Gerd Huber's academic career, but also are significant for research on the history of psychiatry in postwar West Germany, the development of concepts in the fields of schizophrenia research and biological psychiatry, the history of universities and everyday life, and other topics.

Analysis of Parkinson's Disease Outpatient Counselling for Advance Directive Creation: A Cross-Sectional Questionnaire-Based Survey of German General Practitioners and Neurologists.

A major proportion of people with Parkinson’s disease (PwP) in Germany has written an advance directive (AD). Unfortunately, these ADs are unclear for PD-specific endpoints. We previously established consensus-based recommendations for disease-specific content of an AD in PwP. However, the implementation of those recommendations and the consulting of AD creation and modification in PwP remains to be evaluated. This study aimed to investigate the practical use of PD-specific recommendations for ADs in outpatient settings. A total of 87 physicians (45 general practitioners (GPs) and 42 neurologists, 10% response rate) answered a self-constructed semiquantitative questionnaire. The participants were asked to evaluate the suggested PD-specific recommendations for ADs and the supply of palliative care in the outpatient setting. Overall, the vast majority of treating physicians agreed on the usefulness of the newly constructed PD-specific recommendations. Consultations to discuss information about PD-specific ADs were scarce with short durations. Only 24% of participating physicians implemented the PD-specific recommendations in their daily practice. GPs and neurologists agreed on the benefit of disease-specific recommendations for ADs. In future, a more general integration of these recommendations in routine care might improve specific AD creation of PwP and advanced care planning.

The Tacit Dimension of Touch: Tactile Recognition, Tangibility and Self-touch in Kurt Goldstein’s Studies on Agnosia

In his experimental studies on tactile recognition, the German neurologist Kurt Goldstein observes a peculiar ‘twitching movement’ of the body in neurologically impaired patients suffering from mind-blindness. Drawing on Goldstein’s interpretation of these bodily movements as kinaesthetic reactions, the present article advances a symmetrical conception of tactility that relocates the bipolarity of the sense of touch within the human body. In line with this symmetrical approach, the kinaesthetic reactions will be construed as tactile self-activation or self-touch of the body and conceptualized, following Michael Polanyi’s epistemological notion, as the ‘tacit dimension of touch’. Combining neuropathological aspects with a media theoretical and epistemological trajectory, this article aims at re-evaluating the centrality of the registers of the sense of touch as the fundamental ground for grasping the world in its concrete encounters as well as in its symbolic abstractions.