Motion and Emotion The Neuropsychiatry of Movement Disorders and Epilepsy Andrea E. Cavanna 123 Motion and Emotion Andrea E. Cavanna Motion and Emotion The Neuropsychiatry of Movement Disorders and Epilepsy Andrea E. Cavanna Dept of Neuropsychiatry University of Birmingham Birmingham United Kingdom ISBN 978-3-319-89329-7 ISBN 978-3-319-89330-3 (eBook) https://doi.org/10.1007/978-3-319-89330-3 Library of Congress Control Number: 2018943132 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface Three passions, simple but overwhelmingly strong, have governed my life: the longing for love, the search for knowledge, and unbearable pity for the suffering of mankind Bertrand Russell, What I have lived for (1956) It is hard to imagine anything more fascinating than the study of what makes us who we are—human beings. The human brain, in health and pathology, is what offers us the best chances of fulfilling the millennial injunction of the Delphi oracle ‘know thyself’ (γνῶθι σαὐτόν). Importantly, the wisdom of the ancient Greek fathers of Western culture over two millennia ago still provides us with formidable insights into the most fruitful approaches to reach self-understanding and to allevi- ate the suffering caused by brain dysfunction. It is therefore hardly surprising that the clinical discipline of neuropsychiatry is currently going through a modern Renaissance, fostered partly by exciting advances in neuroscience research and partly by our relentless quest for a better understanding of our inner self. Both com- ponents are key aspects of the care of patients who have mental and behavioural problems caused by deranged brain activity—arguably all patients who suffer from neurological or psychiatric conditions in the traditional sense of the terms. The centrality of the understanding of the brain to the life of human beings is now regarded as intuitive. It is arguably best encapsulated in the words written by Polish-born author and Nobel Prize winner Isaac Bashevis Singer, referring to Ezriel Babad, fictional nineteenth-century neurologist, in his novel The Manor: ‘What, for example, was now going on in his brain? If only one could see all the physical and chemical changes! Nerves trembled, cells moved, substances blended […] Ezriel remarked that, in the broad sense, knowledge of the brain included all the sciences, all the arts, all thoughts and feelings. We study the psyche even when we are studying Latin or tailoring’. This book is not a comprehensive textbook of neuropsychiatry sensu stricto. It is limited in perspective, range, and scope. Rather, this book is a sui generis introduc- tion to neuropsychiatry, written in an accessible style with the aim of ‘setting fires’ of sheer enthusiasm with the subject, rather than ‘filling vases’ with in-depth knowl- edge on the subject. v vi Preface The presented material was selected in an attempt to highlight how the neuropsy- chiatry/behavioural neurology approach could open up privileged access to the understanding of the behavioural symptoms of patients with movement disorders and epilepsy. In fact, these conditions are two of the most lively areas in current neuropsychiatric practice and clinical research. Moreover, movement disorders and epilepsy exemplify the complexities of brain–behaviour correlations across two key neuroanatomical regions in neuropsychiatry: the basal ganglia and the limbic sys- tem, respectively. The chapters on the neuropsychiatry of movement disorders and epilepsy are preceded by an introductory section on the foundations of neuropsy- chiatry and are followed by a final section on the past, present, and future of neuro- psychiatry. In line with the introductory spirit of the book, particular care has been taken in the selection of the references: a list of primary sources which could serve as first ports of call for readers who are keen to explore in greater depth the material outlined in this book. The vast majority of the referenced work therefore consists in review articles and books published over the past decade (with a few notable exceptions). Most of the text is devoted to the illustration of the behavioural symptoms associ- ated with neuropsychiatric conditions, with only brief mention of cognitive dys- function—which is nevertheless widespread and would probably deserve more space or a separate book. Moreover, there is a constant focus on brain–behaviour correlations rather than treatment approaches, which are nevertheless broadly addressed since the book is written from a clinical perspective. Experienced neuro- psychiatrists and behavioural neurologists are probably among the best placed read- ers to appreciate that accuracy is often sacrificed on the altar of simplification. It is to them that the author’s most sincere apologies should go, in the hope that this is not a sacrifice made in vain. I would like to think that the general feeling evoked by reading this book is the importance of constantly keeping the human being at the centre of this technologi- cally informed era. Two millennia ago, in his Epistulae Morales ad Lucilium, Roman Stoic philosopher Lucius Annaeus Seneca wrote ‘What good is there for me in knowing how to parcel out a piece of land, if I know not how to share it with my brother?’. This message, which is central to the activity of any practitioner (espe- cially those dealing with conditions affecting the human brain), is famously echoed by the words of Sir Robert Hutchison: ‘From inability to let well alone; from too much zeal for the new and contempt for what is old; from putting knowledge before wisdom, science before art, and cleverness before common sense; from treating patients as cases; and from making the cure of the disease more grievous than the endurance of the same, good Lord, deliver us’. This book is humbly dedicated to my teachers, who are far too many to be indi- vidually mentioned, and to my students, who taught me far more than what I taught them. Neuropsychiatry is a noble collective enterprise, as each new generation of neuropsychiatrists stands on the shoulder of the giants who preceded them. Much of what can be found in this book reflects the pleasant and valuable experience of mul- tiple interactions with the most eminent fathers (and mothers!) of British neuropsy- chiatry. One of them, Professor Michael Trimble, was aptly described as a Preface vii ‘quintessential clinician scientist’ and generously acted as a role model and inspir- ing figure in the field of neuropsychiatry, since he established the Raymond Way Neuropsychiatry Unit in 1988. In a 2007 publication titled The Raymond Way Unit: a history, he concluded his account of the Unit’s successful enterprise with the fol- lowing words: ‘A new Raymond Way Research Fellow was appointed in September 2005. Thus, the Raymond Way endowment continues to provide the necessary sup- port to enable the future of the Unit to be secured’. It is that former Research Fellow’s highest hope that the readers of this book will be inspired at least in part by it to do the same. Birmingham, UK Andrea E. Cavanna Suggested Reading Books Trimble MR. The Raymond Way Unit: a history. Burleigh; 2007. Articles Krishnamoorthy ES. Michael Trimble: the quintessential clinician scientist. Epilepsy Behav. 2005;6:469–72. Salzberg M. A pioneer of neuropsychiatry: Professor Alwyn Lishman. Austr N Z J Psychiatry. 2004;38:2–9. Shankar PR. Sir Robert Hutchison’s petition and the medical humanities. Int J Med Educ. 2010;1:2–4. Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Part I F oundations of Neuropsychiatry 1 Men Ought to Know… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2 Between (or Beyond) Neurology and Psychiatry . . . . . . . . . . . . . . . . . 9 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3 The Scientific Approach to Neuropsychiatry . . . . . . . . . . . . . . . . . . . . 15 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 4 The Mind-Body Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 5 Neuroanatomy of Neuropsychiatry (with Treatment Implications) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 5.1 From the Neurone to the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 5.2 Frontal Lobe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 5.3 Basal Ganglia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 5.4 Limbic System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 5.5 Investigations in Neuropsychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . 63 5.6 Treatment Approaches in Neuropsychiatry . . . . . . . . . . . . . . . . . . . 65 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Part II N europsychiatry of Movement Disorders 6 Classification of Movement Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 77 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 7 Parkinson Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 8 Huntington Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 9 Tourette Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 ix x Contents Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 10 Dystonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 11 Psychogenic Movement Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Part III Neuropsychiatry of Epilepsy 12 Seizures and Epilepsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 13 Interictal Psychiatric Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 14 Ictal (and Postictal) Psychiatric Disorders . . . . . . . . . . . . . . . . . . . . . . 141 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 15 Psychogenic Nonepileptic Attacks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Part IV The Past, Present and Future of Neuropsychiatry 16 Neuropsychiatry: The Story So Far . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 17 Neuropsychiatry for the Twenty-First Century . . . . . . . . . . . . . . . . . . 169 MTNRG Publications (2009–2018) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Part I Foundations of Neuropsychiatry