A History of Dystonia: Ancient to Modern

Abstract

Before 1911, when Hermann Oppenheim introduced the term dystonia, this movement disorder lacked a unifying descriptor. While words like epilepsy, apoplexy, and palsy have had their meanings since antiquity, references to dystonia are much harder to identify in historical documents. Torticollis is an exception, although there is difficulty distinguishing dystonic torticollis from congenital muscular torticollis. There are, nevertheless, possible representations of dystonia in literature and visual art from the pre‐modern world. Eighteenth century systematic nosologists such as Linnaeus, de Sauvages, and Cullen had attempted to classify some spasmodic conditions, including torticollis. But only after Charcot's contributions to clinical neuroscience were the various forms of generalized and focal dystonia clearly delineated. They were categorized as névroses: Charcot's term for conditions without an identifiable neuroanatomical cause. For a time thereafter, psychoanalytic models of dystonia based on Freud's ideas about unconscious conflicts transduced into physical symptoms were ascendant, although there was always a dissenting “organic” school. With the rise of subspecialization in movement disorders during the 1970s, the pendulum swung strongly back toward organic causation. David Marsden's clinical and electrophysiological research on the adult‐onset focal dystonias was particularly important in establishing a physical basis for these disorders. We are still in a period of “living history” of dystonia, with much yet to be understood about pathophysiology. Rigidly dualistic models have crumbled in the face of evidence of electrophysiological and psychopathological overlap between organic and functional dystonia. More flexible biopsychosocial frameworks may address the demand for new diagnostic and therapeutic rationales.

Delineating the electrophysiological signature of dystonia

“…The subtle boundary between the two favoured the development of conflicting theories about aetiology and pathogenesis of certain disorders. This is true for dystonia which, at the time of the schism, was retained amongst organically unaligned or functional conditions and then classified as a motor neurosis (Newby et al 2017). David Marsden, with his brilliant intuition, removed dystonia from this unclear classification and recognized it as a basal ganglia (BG) disorder.…”

“Nonsense Rides Piggyback on Sensible Things”: The Past, Present, and Future of Graphology

“…If so, this highlights a gap in the existing research: we need to know more about the nature of the connection between physical and mental states and handwriting. In fact, the boundary between "physical" and "mental" states, itself, is not clear, since there is currently active discussion among neurologists about what comprises a "psychiatric" disorder versus a "neurological" disorder-with some that have been previously labelled "disorders of the mind" being recently re-classified as having possible organic causation (Newby et al 2017). Thus, the final section of this chapter demonstrates how academics are finally moving to fill this gap, going "back to basics" with their inquiries into individual difference and handwriting features.…”

Cervical Dystonia in Modigliani's Paintings: The Clue Was the Sensory Trick

“…We read with interest the paper by Newby at al., published recently in MDCP, "A History of Dystonia: Ancient to Modern," about Modigliani's "Portrait of Jeanne Hebuterne in a Large Hat." 1 In fact, we had previously suggested that this painting showed an example of a sensory trick for cervical dystonia (Supporting Figure S1). 2 Now, here we share further evidence to confirm that this lady, common-law wife, and muse of the painter indeed had cervical dystonia.…”