Paramyoclonus multiplex : a clinical lecture / by F.W. Langdon.

  • Langdon, Frank Warren, 1852-1933.
Date:
[1896]
Catalogue details

Licence: Public Domain Mark

Credit: Paramyoclonus multiplex : a clinical lecture / by F.W. Langdon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    eight months’ work in the two years since they began. The periods during which he was able to do some kinds of work varied from one day to three months. On his admission to the hospital, three days ago, he presented the condi- tions already noted. There has been no change of consequence up to the present time. Efforts at concentration of thought on his part seem usually to excite a par- oxysm; so also does sudden exposure of the body to the air, sometimes, not al- ways. Voluntary physical effort also tends to the same effect. But voluntary effort to turn and assume the prone position usually arrests a paroxysm if present, as does a deep inspiration at command. An individual paroxysm observed by Dr. Brown and myself yesterday presented the lollowing features: Decubitus dorsal. The attack began while the patient was being interro- gated respecting some points in the above history. Patient describes an “ aura” consisting of a “cold feeling” and sensation like “ electricity ” in legs, abdomen, chest and arms. This he says often precedes an attack. Onset sudden, with violent, shock-like, clonic contrac- tions of muscles of anterior abdominal wall, the individual segments of the recti standing out prominently during the contraction. The contractions are bilateral, symmetrical and synchronous with similar clonic contractions in the pectorals, cremasters, and the flexors, adductors and extensors of the thighs. The rate of these contractions is seventy for a full minute, but is not rhythmical, the rate varying at different portions of a minute from 50 to 250. The muscles of the face, neck, upper arms, forearms and hands are not in- volved; nor are the lower leg and foot muscles, as a rule, though Dr. Brown thinks he has seen the toes flexed and extended on one occasion. During this paroxysm respiration and phonation are irregular and “jerky.” The diaphragm is tonically contracted, and respiration is costal. The tongue was protruded at will and kept out indefinitely without spasm during the paroxysm. This par- oxysm ceased in four minutes, synchro- nously with a deep (involuntary) in- spiration. After an interval of five minutes another occurred; then a similar inter- val and a second recurrence, each of about five minutes’ duration. The paroxysms exhibited now (at intervals of five or ten minutes), as the patient lies before you, correspond with those just described. In another paroxysm, observed when the patient was in the prone posi- tion, the flat abdominal muscles were seen to contract forcibly at their attach- ment to the lumbar fascia. The quad- ratus lumborum could be felt to contract at its iliac attachment. These contrac- tions were similar to those noted of other muscles. At no time have the contractions been observed in the erector spinse, latissimus dorsi, glutei or trapezius muscles. Occasionally the sterno-mas- toids participate in the attack. When a paroxysm occurs while the patient is standing, there is a coarse tremor-like movement of the hands and feet, which, however, is apparently transmitted from the trunk movements, with which it is synchronous. Rarely, at the beginning of a paroxysm, one rectus abdominis contracts alone, but its fellow soon follows. In some slighter paroxysms the cremasters and thigh muscles seem to escape entirely. The patient has attempted to keep a record of the number of attacks in twenty-four hours, and has noted eleven, but says there were probably four times as many minor attacks not noted. The paroxysms have not been observed during sleep, and he thinks none occur at that time. He has had occasional vomiting spells with the paroxysms, which seem due to the over-action of the abdominal wall muscles. The pathology of the disease is un- known. The two autopsies1 on record revealed no assignable lesion. The disease is classed, therefore, with the functional neuroses. Friedreich believed it due to vaso- 1 Schultze, Neurol. Centralblatt, 1886, 363; and Slnk'er, “Text-book of Nervous Diseases by American Authors,” 1895, 269.