Under the influence of emotion the movements were increased, but
they could not be inhibited by an effort of attention. Their rate
was too slow for chorea. Ordinary voluntary movements were
performed without apparent trouble; the patient was able to dress
himself, and to drink without spilling the liquid. Diminution of
the knee-jerks was noticed, with what seemed to be an extensor
response. Slight scoliosis of the vertebral column and a misshapen
right foot recalled Friedreich's ataxia. There was nothing to
justify a diagnosis of hysteria.
This curious condition dated from the year 1874, when the patient
had a febrile attack, in the course of which pain and tingling
appeared in the toes of the right foot, followed by involuntary
movements of the same member. Analogous symptoms were not long in
appearing in the left arm. Two months later the condition had
become general, but from that time no special modification took
place.
In the subsequent discussion it was remarked by Souques that the case
resembled one recorded by Chauffard[176] as Friedreich's disease with
athetotic attitudes, where the patient was a child with club foot,
diminution of the knee-jerks, and generalised athetotic movements.
Notwithstanding our inability to assign a definite nosographical
position to examples of this kind, we think it desirable to make some
reference to them, in the hope that further observations will aid in
their diagnosis. They at least remind us that convulsions occurring in
the course of organic disease may be simulated by the manifestations of
certain motor neuroses.
TICS AND CHOREAS
A. Sydenham's Chorea
It would be difficult to find a better description of chorea minor than
that given originally by Sydenham himself:
The dance of Saint Guy, chorea Sancti Viti in Latin, is a sort of
convulsion whose incidence is greatest, in both sexes, between the
age of ten and puberty. Its onset is characterised by weakness of
one limb, which the patient drags behind him, and soon the arm of
the same side is affected in the same way. He finds it impossible
to maintain the same position of the arm for two consecutive
moments, however great be his efforts to attain this object. Before
he can bring a full glass to his lips he makes innumerable gestures
and antics, as the convulsive moments of the limb deviate it from
one side to the other, until at length he has piloted the glass
opposite his mouth, when he empties it at a gulp.
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