A contribution to the pathology of paramyoclonus multiplex (Friedreich's type) / by J. Ramsay Hunt.

  • Hunt, James Ramsay, 1872-1937.
Date:
1903
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Licence: In copyright

Credit: A contribution to the pathology of paramyoclonus multiplex (Friedreich's type) / by J. Ramsay Hunt. 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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    In some cases peripheral stimuli have failed to increase the symp- toms. The knee-jerks, although usually exaggerated, have been found occasionally of normal intensity or even diminished. In two cases they were absent. The electrical reactions have been essentially normal. In a few cases only was a slight qualitative increase noted. Rarely contractions have persisted during sleep. Pains and paresthesias have been observed accompanying and fol- lowing the paroxysms. Fright as an etiological factor was by no means constant, and a variety of predisposing and exciting causes are on record. Classification. But a small proportion of the cases now repos- ing in the literature under the title paramyoclonus multiplex or its abbreviated form, myoclonus multiplex, are typical examples of this affection. Many cases are hardly recognizable if Fried- reich’s conception is adhered to, some observations having more in common with convulsive tic, maladie de tic, chorea and hysteria. In some observations the peculiar features which led Friedreich to separate this from the other motor neuroses, i.e., the isolated contraction of a muscle not singly under voluntary control and the absence of locomotor effect, have been completely ignored. Cases are recorded as paramyoclonus multiplex in which the affection was characterized by convulsive movements of a paroxysmal char- acter very far indeed from the individual shock-like muscle con- traction which usually first becomes apparent when the surface of the body is exposed, and which interferes but little with voluntary movement. This statement will receive more weight when the tabulations of Unverricht are considered, who collected and clas- sified the cases recorded up to the-year 1891. Of the forty-eight cases collected, Unverricht accorded to only six the dignity of paramyoclonus multiplex, and to eleven cases a resemblance only to the paramyoclonus; eleven cases he considered uncertain, and the remainder were grouped with hysteria, chorea, or the tic forms. A survey of the more recent literature shows the same confu- sion to prevail. Nearly all forms of myoclonia in the broadest sense of the term are included under this head, while the pure cases of paramyoclonus form but a small minority. It must be observed, however, that muscular contractions idem