Handbook of Clinical Neurology, Vol.
115 (3rd series)
Peripheral Nerve Disorders
G. Said and C. Krarup, Editors
© 2013 Elsevier B.V. All rights reserved
Chapter 1
Prelude to the peripheral neuropathies
ARTHUR K. ASBURY1 AND MICHAEL J. AMINOFF2
1
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
2
Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA
Recognition of, and interest in, peripheral neuropathies
began to evolve almost two centuries ago, mainly in
the UK and the rest of Europe, and then in the USA.
The newly developing techniques of histopathology dur-
ing the 19th century made it possible to study peripheral
nerves and nerve roots at autopsy and in experimental
studies in animals. Clinicopathological studies, notably
by Jean-Martin Charcot and his students in Paris but also
by others, allowed correlation with the clinical findings
recorded during life. Even persons who had recovered
from a nerve root or nerve trunk neuropathy with min-
imal or no persisting symptoms or findings, and who
then lived for many years, were often found at autopsy
to have residual pathological findings in the previously
affected neural structures. The clinicopathological
approach of correlating the clinical features with the
postmortem neuropathological findings has now been
in place for over 150 years. It has formed the base of
much of the knowledge of peripheral neuropathy, but
it has not indicated how to diagnose, manage, and ulti-
mately reverse all such disorders.
The remarkably insightful clinical studies by Silas
Weir Mitchell and his colleagues on casualties of the
American Civil War in the latter half of the 19th century
also led to further interest in the peripheral nervous sys-
tem, at least for a time. Mitchell’s work with George
Morehouse and William Keen was summarized in their
Copyright © 2013. Elsevier. All rights reserved.
pioneering book Gunshot Wounds, and Other Injuries of
Nerves (1864), which contained the first descriptions of
causalgia. Mitchell subsequently extended this into his
definitive Injuries of Nerves and Their Consequences
(1872), the first substantive work detailing the symp-
toms, signs, treatment, and outcome of nerve injuries.
Despite these advances on both sides of the Atlantic,
there was little interest in the peripheral nervous system
for many years. Indeed, until the 1950s, peripheral neu-
ropathies were of relatively minor interest to most neu-
rologists, who were occupied principally with the many
Peripheral Nerve Disorders, edited by Gérard Said, and Christian Krarup, Elsevier, 2013. ProQuest Ebook Central,
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disorders affecting the central nervous system. As such,
peripheral nerve disorders were not given the attention
they deserved, and patients with these disorders were
often managed by other physicians, particularly inter-
nists and general physicians.
This situation in 1950 was particularly evident in the
USA. There, physicians who wished to specialize in the
disorders of the nervous system generally received 2 years
of training, 1 year of neurology and 1 year of psychiatry,
and often became skilled in neither. Those specialists of
yesteryear were little interested in, and poorly knowledge-
able of, disorders of the peripheral nervous system. Since
that time, however with the advent of precise, objective
methods of studying peripheral nerve function these
disorders have assumed greater importance.
In the 19th and 20th centuries, basic and clinical neuro-
physiologists began to develop techniques that allowed
for a greater understanding of peripheral nerve function
and led to quantitative methods for evaluating neuromus-
cular function in health and disease. Guillaume Duchenne
de Boulogne in Paris, Emil Heinrich du Bois-Reymond in
Berlin, and Wilhelm Erb of Heidelberg were early (19th
century) pioneers in the field of electrodiagnosis or elec-
trophysiology, followed later by Charles Sherrington and
Edgar Adrian in Britain and by Joseph Erlanger, Herbert
Gasser, and George Bishop in the USA, who worked on
the selective functions of single nerve fibers and related
issues. The mechanism of nerve conduction and the
events at the neuromuscular junction only became clearer
in the latter half of the 20th century, however, with the
fundamental studies of J. Z. Young, Alan Hodgkin,
Andrew Huxley, Bernard Katz, Ricardo Miledi, and
many other physiologists and scientists. Adrian and Bronk
recorded the electrical activity of motor units with a con-
centric needle electrode in 1929, allowing the recruitment
pattern of motor units and regulation of muscle force to
be studied. Within 10 years, Derek Denny-Brown had
described the electrophysiological hallmark of fibrillation
 4 A.K. ASBURY AND M.J. AMINOFF
and fasciculation potentials in muscle, and shortly there- particular has grown exceptionally rapidly over the past
after Fritz Buchthal in Copenhagen began describing five or six decades, as can be seen from the breadth of
the electrophysiological features of a number of neuro- this book, and this already large body of knowledge will
muscular diseases, often in a quantitative manner. Erik surely continue to grow. More than 50 chapters follow-
Kugelberg in Stockholm, Roger Gilliatt and P.K. Thomas ing this one set forth in great detail the most modern
in London, and Edward Lambert in Rochester, Minne- ways of evaluating, characterizing, distinguishing, and
sota, were other pioneers in clinical neurophysiology, managing the numerous specific neuropathic syndromes
and their work led to the widespread clinical application that have been described. Some disorders are related to
of objective techniques for measuring peripheral nerve systemic disorders such as porphyria, uremia, sarcoido-
function and permitted the characterization and localiza- sis, systemic amyloidosis, diabetes mellitus, or vasculi-
tion of disordered function, even when the disorder had tis. Others are due to exogenous toxins such as alcohol
not yet become manifest clinically. or other drugs such as long-term anti-epileptic medica-
Detailed pathological, ultrastructural, microbiological, tion. The list of possible causes underlying a given poly-
immunological, and genetic studies soon followed. These neuropathy is large. It is easy for physicians to overlook
were important, but as many of the leaders in these fields the responsible culprit in individual cases. Many neurop-
are still living and indeed have contributed to these athies are amenable to treatment or avoidance of the
volumes they will not be named individually here. responsible cause. Virtually all of the irreversible neu-
The reader will be able to recognize their contributions ropathies can be managed by specialists to lessen the
in the chapters that follow. Through the application of symptoms and minimize the difficulties of everyday life.
these various techniques, many new disorders have come The editors of this two-volume work have taken on an
to be recognized, as is discussed in later chapters. These enormous task in organizing and summarizing present-
developments aroused the interests of young trainees in day knowledge of the peripheral nervous system and the
neurology, and the subspecialty of neuromuscular dis- myriad disorders that affect it. Their work will benefit
eases is now one of the most popular areas in neurology, not only the medical and scientific community, for
with neuromuscular specialists making up something whom these volumes will serve as a useful reference,
more than 15% of all fully-trained neurologists. but also members of the general public who will benefit
The body of knowledge concerning neuromuscular by the application of this knowledge in an individual set-
medicine in general and peripheral neuropathies in ting. They are to be congratulated on their achievement.
Copyright © 2013. Elsevier. All rights reserved.

Peripheral Nerve Disorders, edited by Gérard Said, and Christian Krarup, Elsevier, 2013. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/dadiangas-ebooks/detail.action?docID=1361896.
Created from dadiangas-ebooks on 2024-02-02 10:54:50.