The concepts of heredity and degeneration in the work of Jean-Martin Charcot

Transcripts of the Tuesday Lessons at La Salpêtrière Hospital show that Jean-Martin Charcot often asked his patients about their family history. The information gathered on patients' heredity played also a significant role in the diagnostic reasoning he instructed his students in. Again and again, he included in his teachings the concept of degeneration to suggest an etiology for observed pathologies. This article analyzes the origin of Charcot's knowledge, imparted in the Tuesday Lessons, by examining the theories of heredity and degeneration successively developed by Prosper Lucas (1808-1885) in 1847, Bénédict-Auguste Morel (1809-1873) in 1857, and Jacques-Joseph Moreau de Tours (1804-1884) in 1859. I will review examples taken from the Tuesday Lessons to illustrate how Charcot assimilated the ideas of these alienists. Two of his students, Charles Féré (1852-1907) and Georges Gilles de la Tourette (1857-1904), known for championing their master's work, went on to publish their own books that developed theories of heredity and degeneration. I will conclude my review, which aims to examine a little known facet of Charcot's work, with a few examples from these authors' writings.

Disentangling Restrictive and Repetitive Behaviors and Social Impairments in Children and Adolescents with Gilles de la Tourette Syndrome and Autism Spectrum Disorder

Gilles de la Tourette syndrome (GTS) and autism spectrum disorder (ASD) are two neurodevelopmental disorders with male predominance, frequently comorbid, that share clinical and behavioral features. The incidence of ASD in patients affected by GTS was reported to be between 2.9% and 22.8%. We hypothesized that higher ASD rates among children affected by GTS previously reported may be due to difficulty in discriminating GTS sub-phenotypes from ASD, and the higher scores in the restrictive and repetitive behaviors in particular may represent at least a “false comorbidity”. We studied a large population of 720 children and adolescents affected by GTS (n = 400) and ASD (n = 320), recruited from a single center. Patients were all assessed with The Yale Global Tic Severity Rating Scale (YGTSS), The Autism Diagnostic Observation Schedule (ADOS), The Autism Diagnostic Interview Revised (ADI-R), The Children’s Yale–Brown Obsessive–Compulsive Scale (CY-BOCS), and The Children’s Yale–Brown Obsessive–Compulsive Scale for autism spectrum disorder (CY-BOCS ASD). Our results showed statistically significant differences in ADOS scores for social aspects between GTS with comorbid attention deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD) sub-phenotypes and ASD. No differences were present when we compared GTS with comorbid ASD sub-phenotype to ASD, while repetitive and restrictive behavior scores in ASD did not present statistical differences in the comparison with GTS and comorbid OCD and ASD sub-phenotypes. We also showed that CY-BOCS ASD could be a useful instrument to correctly identify OCD from ASD symptoms.

The Marquise de Dampierre identified at last, the first described clinical case of Gilles de la Tourette syndrome

Among the observations of patients suffering from abnormal movements, Jean-Gaspard Itard (1775-1838) published the case of Madame D. in 1825. It was republished in 1885 as the first clinical case characteristic of the disease described by Georges Gilles de la Tourette in the seminal article leading to his eponym, still in use today. However, the actual identity of Madame D., known throughout the 19th century as the Marquise de Dampierre, has remained a mystery, until now. The 17 July 1884 edition of the literary periodical Gil Blas provided an important lead by detailing the behavioural disturbances in society of the "Countess Picot de Dampierre". Information from diarists at that time make it possible to confirm that this patient, known for her involuntary verbal outbursts, typical of coprolalia, in salons frequented by the 19th-century Parisian aristocracy was in fact Ernestine Émilie Prondre de Guermantes, her maiden name. She was born on 22 August 1800, and her married name was Countess Picot de Dampierre. She died on 08 July 1884. This article examines the life of this woman, her disease, her identification and the connection with the Duchesse de Guermantes, heroine of LaRecherchedutempsperdu written by Marcel Proust.

The English Version of the Gilles de la Tourette Syndrome-Quality of Life Scale for Children and Adolescents (C&A-GTS-QOL)

Gilles de la Tourette syndrome is a chronic neuropsychiatric disorder that can have a detrimental impact on the health-related quality of life of children with the condition. To date no patient-reported health-related quality of life measures have been developed for children and adolescents in the English language. This study validated the first disease-specific scale for the quantitative assessment of health-related quality of life in 118 children and adolescents with Gilles de la Tourette syndrome (C&A-GTS-QOL) following language adaptation from Italian to English in the United Kingdom. Standard statistical methods were used to test the psychometric properties of the rating scale. Principal component factor analyses led to the identification of six health-related quality of life domains (cognitive, copro-phenomena, psychological, physical, obsessive-compulsive, and activities of daily living), explaining 66.7% of the overall variance. The C&A-GTS-QOL demonstrated satisfactory scaling assumptions and acceptability; validity was supported by interscale correlations (range 0.2-0.7), confirmatory factor analysis, and correlation patterns with other rating scales and clinical variables.

A case of Gilles de la Tourette's syndrome

Gilles de la Tourette's syndrome is an uncommon illness associated with repetitive un-voluntary abnormal movements and utterance. It is often associated with other psychiatric morbidities. Management requires awareness of this uncommon illness, keen observation, relevant evaluation, and combination of pharmacology and psychotherapy for an optimal outcome. This case is brought out here for florid presentation and nuances of management.

Gilles de la Tourette syndrome: clinical features of 75 cases from Argentina

A series of 75 cases of Gilles de la Tourette syndrome (GTS) from Argentina, whose ages ranged from 6 to 55 with a mean of 20.02, were evaluated to compare findings with those reported for other countries. Mean age at onset was 7.44 years and mean overall duration of symptoms was 12.58 years; 6.7% of cases were mild, 49% moderate and 44.3% severe. Most frequent presenting motor tics were excessive blinking in 41 followed by head jerking in 16 and eye winking in six, while phonic tics included coprolalia in 28.0%, echolalia in 17.5% and palilalia in 10.8%. Abnormal perinatal events were reported in 40.5%, while positive family history for tics was present in 26.66%. Obsessive-compulsive behaviour was evident in 66% and attention deficit disorder in 16% of cases. Self-injurious behaviour comprised onychophagia in 28 patients, lip-biting in seven and self-slapping in eight cases. Almost half of our patients were initially interpreted as having a psychogenic disorder indicating that GTS in Argentina is most likely underdiagnosed. It may be concluded that the overall pattern of GTS is not dissimilar to that described for European, Asian and American populations, thus highlighting the previously recognized cross-cultural uniformity.