Early Controversies Over Athetosis: II. Treatment

Abstract

Background: Since the description of athetosis in 1871 by American neurologist William Alexander Hammond (1828-1900) the disorder has been a source of controversy, as were many aspects of Hammond’s career.  Methods: Review of treatment controversies in the semi-centennial since the description of athetosis.  Results: The treatments used most commonly for athetosis employed available agents (e.g., bromides, arsenicals) and modalities (e.g., galvanism).  Initial anecdotal reports of success were seldom confirmed with subsequent experience.  Several novel invasive therapies were also developed and promoted, all of which damaged or destroyed either upper or lower motor neuron pathways.   In general these therapies substituted paresis for abnormal spontaneous movements.  These included peripheral nerve stretching (as promoted by William Morton and Graeme Monroe Hammond), excision of a portion of the precentral gyrus (by Victor Horsley), rhizotomy (by Charles Loomis Dana and Robert Abbe, and later William Spiller and Charles Frazier), nerve “transplantation” (i.e., nerve section and nerve-to-nerve anastomoses, by Spiller and Frazier), and “muscle group isolation” (i.e., alcohol neurolysis, by Sidney Schwab and Nathaniel Allison). Discussion:  Available modalities employed in the treatment of athetosis had little a priori evidence-based justification and no biologically plausible theoretical framework to guide empiric treatment selection.  With the later development of novel invasive therapies, several factors contributed to the disparity in outcomes between favorable initial reports and the often-disappointing results of later studies, including reliance on anecdotal reports or small uncontrolled case series, placebo effects, biased observation, misdiagnosis, and biased reporting.