シャルコーの三世紀—ALSから機能性神経障害まで

Success and Failure during Three Centuries of Charcot's Clinical Neuropathology: From Amyotrophic Lateral Sclerosis to Functional Neurological Disorders

19世紀，神経症状とその原因と思われる脳病変を対応させる臨床神経病理学をシャルコーは確立し，筋萎縮性側索硬化症の上位・下位運動ニューロン障害を側索および前角の変性として解剖学的に関連づけた。一方，シャルコーが捉えたパーキンソン病がレヴィー病変，シヌクレイン沈着として収斂するには20世紀全体を要した。対して，ヒステリーの症状は医師，患者，観衆が相互作用する劇場的背景の中で誘発，観察され，恒常的な病変に対応させる臨床神経病理学では原因を捉え切れなかった。逆にそれは20世紀にフロイトやジャネによる力動精神医学の出発点となり，21世紀の機能性神経障害までつながる道を拓いたのはシャルコーの功績であると筆者は考えている。

Abstract

Clinical neuropathology was advanced by Charcot at la Salpêtrière Hospital in the 19th century. The lower and upper motor signs of amyotrophic lateral sclerosis were corroborated at autopsy by degeneration of the anterior horns and lateral columns, respectively. The redefinition of paralysis agitans as Parkinson's disease was substantiated in the 20th century through a series of pathological, biochemical, and genetic studies that provided definitive, museum-like evidence of neurological diseases. In contrast to these scientific achievements, the phenomenology of hysteria was publicly evaluated and recognized in front of the audiences that included non-medical professionals. This theater-like format, which encouraged interaction between patients and spectators, might have influenced the clinical presentation of hysteria and complicated its interpretation. Contrary to Charcot's expectations, attempts to identify the causative lesions of hysteria were unsuccessful. Paradoxically, however, this failure paved the way for the development of dynamic psychiatry by Freud and Janet, and later, the conceptualization of functional neurological disorders in the 21st century.