General paresis of the insane

As neurosyphilis (synonym: neurosyphilis ) a number of characteristic psychiatric or neurological symptoms is referred to, which can occur in untreated or not healed syphilis disease in humans with a latency period of years to decades. In the late stage of neurosyphilis suffer 2-5% of syphilis sufferers progressive paralysis ( progressive paralysis ), where men are affected more often than women. The progressive paralysis is usually associated with a locomotor ataxia (failure of functions of the spinal cord ). Important for the diagnosis of neurosyphilis is the study of cerebrospinal fluid ( CSF analysis ).

Overview

The neurosyphilis is not a disease, but a potential manifestation of the so-called tertiary stage (stage III, also referred to as " late stage " ) syphilis (syphilis ). In the recent literature it is also referred to as a separate stage IV.

In neurosyphilis, there is progressive loss of nerve tissue ( degeneration, atrophy) in the brain or spinal cord. Possible consequences of Gewebsuntergangs in the brain are personality changes through to dementia, delusions (classic: " megalomania ", that is, ideas of grandeur ), sometimes Raptus -like seizures and often hallucinations. A syphilitic spinal cord injury often causes gait abnormalities (ataxia) and lancinating (so-called lanzierende ) pain.

The neurosyphilis has become rare in the Western industrialized nations since the advent of effective antibiotics, as most syphilis disease be cured in earlier stages. In developing and emerging countries with inadequate health care, this stage is more common.

The Syphilis disease itself can be healed as the cause of neurosyphilis symptoms even at this late stage. However, limiting factors for the success of such therapy are the blood -brain barrier, which is penetrated sufficiently by only a few antibiotics, and the fact that already gone nervous tissue by the human body can not be replaced.

Epidemiology

The neurosyphilis was a very common complication of syphilis before the introduction of antibiotic therapy. About 25 to 30 percent of people suffering from syphilis patients developed neurosyphilis. Of these patients, about a third asymptomatic neurosyphilis or tabes dorsalis and approximately 10 percent had a paresis or cerebrospinal syphilis. The rest was distributed to rare forms of neurosyphilis.

Diagnosis

In neurosyphilis can be found in the cerebrospinal fluid lymphocytic pleocytosis in addition to IgG antibodies.

Progressive paralysis

The progressive paralysis ( progressive paralysis, popularly known as " softening of the brain " ) is now due to the good treatment options syphilis become rare.

It is characterized by a progressive dementia. Are typical psychotic symptoms such as delusions, especially delusions of grandeur and personality disorders. As an important physical symptom the Argyll Robertson sign is called, which presents itself as a reflex pupillary rigidity, often with an excessive convergence reaction.

In the final stage of progressive paralysis, the patient will become a long-term care.

The progressive paralysis in the history of psychiatry

Syphilis was a well-known since the Middle Ages disease. Multiple descriptions can be seen in retrospect that the progressive paralysis increasingly appeared as a disease of the brain towards the end of the 18th century. At the beginning of the 19th century, up to 10% towards the end of the 19th century even about 20% or more of the inmates have suffered from it.

The symptoms of progressive paralysis were described in 1822 by the French physician Antoine Laurent Bayle and associated with specific changes in the brain in a relationship. The syphilitic cause progressive paralysis was recognized in 1857 by Friedrich von Esmarch and Peter Willers Jessen. The causative agent, the Treponema pallidum, but was not identified until 1905 by the zoologist Fritz Schaudinn. August Paul von Wassermann invented in 1906 serodiagnosis. The Japanese Hideyo Noguchi succeeded in 1913, the detection of treponemes in the brains Paralysekranker. More detailed morphological studies led by, among others, Franz Nissl and Alois Alzheimer. A first treatment developed Julius Wagner von Jauregg in Vienna with the treatment of malaria, for which he received the Nobel Prize in 1927. This was based on clinical observation to reason that the disease with other infectious disease improved the symptoms of syphilitic. Therefore, Wagner sought by Jauregg after a controllable infectious disease and found it in the malaria vaccine. From the 1940s to the syphilis was treated with antibiotics. This resulted in a prevention of progressive paralysis can be achieved.

In the history of psychiatry, the discoveries to progressive paralysis were fundamental. Because that was the first time a mental illness attributed to somatic causes. This aroused the hope that mental illness could be generally explained by the somatic brain research. Although this hope was not fulfilled, but the progressive paralysis remained " the model of physically justifiable psychoses in terms of the exogenous reaction types according to Bonhoeffer. "

Tabes dorsalis

In the further course of the disease may lead to demyelination in the spinal cord posterior columns, this is called tabes dorsalis ( " spinal tuberculosis ", lat tabes, shrunk in the vernacular ').

Therapy

There are still penicillins in particular Benzylpenicilline ( eg penicillin G) drug of first choice, with the successful therapy must be clarified serologically by VDRL test quarterly.

Others

When French writer Alphonse Daudet (1840-1897) occurred in 1884 the first signs of spinal cord disease on. He suffered increasingly tabes dorsalis, the late effects of syphilis infection. His last years were strongly influenced by the progressive to total paralysis disease. During this time, probably be most moving work, which until 1930 under the title La Provence Doulou published In the land of pain arose. In this collection of notes Daudet viewed with unsparing view his disease and the associated changes his person and his environment. " In my [ ... ] skeleton echoes the pain like the voice in an apartment with no furniture and curtains. "