Localization (neurology)

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Under localization (of lat. Locus 'place, space, location, area') is in the field of neurology, the attribution of services or functions certain way topographically understood circumscribed nerve cells and brain regions determined location. As a prototype of this idea, u. a. the Brodmann areas apply, which are intended as "brain maps" to provide as precise a topical classification as possible of various services of the cerebral cortex . The neuroscientific theories of localization relate to the observation of specific functional restrictions in the event of local brain damage as well as reactions to irritation of certain brain regions.

history

The (cerebral) localization theory in neurology is the equivalent of the localization theory in medicine. The diagnostic methods apart from the history of almost all based on the principle of localization. This means that a physical reference scheme is used to recognize illness , i.e. H. to a precise determination of the position of the disease process. In neurology and psychiatry, however, this is particularly problematic, cf. also → body-soul problem .

Theoretical viewpoints

Fig. 1 Title page of the original work by René Descartes: Les passions de l'âme. Paris 1649

The beginnings of today's theory of localization in the CNS , inspired by scientific research results - apart from Hippocrates and René Descartes - can be seen in the 18th century. Here - as indicated above in terms of the mind-body problem - a sometimes violent ideological debate was initiated, the consequences of which continued into the ordinance of the genetic health laws of the 20th century. Even if one assumes that neurology, in contrast to psychiatry, describes localizable diseases of the central and peripheral nervous system, the advocates of an extreme theory of localization must be confronted from a physiological point of view. The extreme doctrine of localization and its limitation to organs and organ components had to give rise to a counter-doctrine. In the field of general medicine, this was psychosomatic medicine . In the field of neurology, this was specifically the teaching of neuroplasticity . It says that the whole brain always has to work together for each individual performance and that individual functions cannot be located at all. In principle, brain cells are able to take on all possible functions in every area of ​​specific performance (→ equipotential theory ).

More recently, Henri Ey (1900–1977) has pointed out the interaction of higher and lower areas of the CNS with his organodynamic theory . Paul Joseph Barthez (1734–1806) already attributed the unity of the organism to a generally valid principle of life that holds the individual parts of the body together through " sympathy ". Marie Jean Pierre Flourens (1794–1867) made a distinction in 1824 between localized and comprehensive functions of the brain (action propre - action commune). Today, this would correspond to the distinction between strictly localizable centers ( primary cortex ) and association fields . The strict doctrine of localization is therefore contrasted with a holistic view of brain processes, just as it was almost 200 years ago. Flourens also dealt with the phrenology of Franz Joseph Gall (1758–1828). René Descartes (1596–1650) localized the interaction between body and soul in the pineal gland (see also his distinction between res cogitans and res extensa ) and Albertus Magnus (1200–1280) already suspected that feelings and memory were located in the cavities of the Brain. The church father Augustine (354-430) combined mental processes separated according to imagination, reason and memory with the anterior, middle and posterior cranial fossa. Hippocrates of Kos (460–370 BC), who was certainly also shaped by ideas of natural philosophy, can be regarded as the first natural scientist in medicine. He described as early as 400 BC The soul as dependent on a body. According to him, Erasistratos of Chios (around 305–250 BC) examined the brain anatomically in the medical school of Alexandria and viewed the interconnected cavities of the four cerebral ventricles as the "empty" seat of the soul. Today, however, the idea of ​​localization has increasingly also taken on thinking , learning and even many psychological processes.

The idea of ​​localization is still decisive today for the conceptual distinction between soul and psyche, which has been widely observed . While the term soul is often an immaterial and therefore not localizable substance , the term psyche is preferred by natural science in the sense of the “res extensa” of Descartes, ie the “(spatially) extended thing”. So is z. For example, Uwe Henrik Peters' dictionary of psychiatry and medical psychology does not even contain the term “soul”. Just by speaking of the soul, one distinguishes it from the body. Up until Friedrich Albert Lange (1828–1875) thesis of a "psychology without a soul", the question of the soul was and is the task of a more philosophically determined rational psychology .

Scientific research results

In a purely scientific form, the name of Paul Broca should first be mentioned, who published a theory of motor aphasia in 1861 . In 1864 John Hughlings Jackson suspected irritation of the precentral curl as the cause of certain focal seizures . In 1870, Bernhard von Gudden established a connection between damage to the occipital lobe and removal of both eyes in a young animal. In 1874, Carl Wernicke first observed damage to the first temple curl in patients with a disorder of word comprehension, from which the current name of Wernicke aphasia is derived .

Numerous animal experiments with electrical stimulation of different brain regions followed. Robert Bartholow carried out direct cerebral stimulus experiments in humans for the first time in 1874.

Karl Kleist (1879–1960), a student of Wernicke (1848–1905), designed the first, much discussed map of the cerebral cortex . He linked individual brain functions with the cytoarchitectural fields of Korbinian Brodmann (1868–1918). With a few changes made by the couple Oskar Vogt (1870–1959) and Cécile Vogt (1875–1962) as well as the work of Constantin von Economo (1876–1931), this map corresponds to the map of the cortex in use today . Through numerous work on the exposed brain, principles of somatotopia could be demonstrated neurosurgery. The EEG and a number of other technical procedures were found to be helpful for the detection of electrophysiological localization.

Development history

Fig. 2. Myelination stages of the brain according to Paul Flechsig . The dark areas become early, the light gray later and the white z. Sometimes myelinated only during puberty.

Paul Flechsig (1847–1929) pointed out the ontogenetic sequence of myelination of the brain in humans. Initially, the primary sensory and motor areas are myelinated. These are areas of the cerebral cortex, which are responsible for the primary processing of sight, hearing and touch, and which are bulged for the execution of movements. The areas not yet myelinated in early years of life are large parts of the frontal lobe, the parietal and temporal brain. These are areas that later belong to the association cortex . The myelination of a nerve only begins when it starts to function. The motor tracts are usually mature earlier than the sensitive ones. Among the sensory fibers, those of the vestibular nerve are the first to become medullary. Systems that are older in tribal history (see also → Paleocortex and Archicortex ) are mature earlier than those that are younger in tribal history, e.g. B. the pyramid track .

Another localization aspect of the history of the development of the CNS is the sensorimotor structure. In this respect, the mature human brain reveals its similarity to the segmental blueprint . This segmental blueprint emerges from the as yet undivided neural groove, which represents a common stage of origin for the brain and spinal cord. This means that topographical-anatomical features are encountered in the mature brain, as they can also be determined in the spinal cord. Sensitive afferents are the posterior roots in the spinal cord, motor efferents are the anterior root nerves . The brain is structured in a similar way. The sensory qualities are located in the back parts of the brain, the motor qualities in the front parts of the brain. These “motor qualities” include a. also the will formation localized in the frontal lobe . The borderline between sensory and motor areas is the Sylvian furrow . It represents, so to speak, the axis of symmetry between sensory and motor centers, such as B. also between sensory and motor language center.

According to the organodynamic theory developed by Henri Ey , the most recently developed areas of the brain should represent the most highly developed functions. However, the theory has been attacked by localization advocates such as Paul Broca .

Topical diagnostics

Topical diagnostics are of particular importance within neurology , since within the nervous system very complex structural relationships must be observed in a very small space, which are usually linked to physiological peculiarities. Topical diagnostics tries to take these functional and structural aspects into account in a special way.

For example, from a purely anatomical point of view, a peripheral nerve ends when it enters the spinal cord. From a functional neuronal point of view, however, a peripheral motor nerve runs from the anterior horn of the spinal cord to the motor endplate in the muscle. This neural functional unit and the design unit from an anatomical-macroscopic point of view do not always coincide.

Functional aspects are preferred by topical diagnostics, since structural features can only be understood through the associated performance and susceptibility to failure. In 1913, Robert Bing wrote the first textbook on neurology, which gave priority to the theoretical and empirical scientific foundations of the anatomy , topography and physiology of the nervous system over the otherwise customary, purely empirical clinical principles of classification according to disease units (→ nosology ), such as those used internally Medicine is common. His compendium of topical brain and spinal cord diagnostics was published as early as 1909. Bing reworked its textbook in many new editions in the decades that followed. Newer authors of textbooks on topical diagnostics in neurology are Peter Duus and Fritz Broser.

See also

Individual evidence

  1. ↑ Hans-Dieter Mennel: Thinking from the gut - to the development of the cerebral localization theory. In: Gerhardt Nissen , Bernd Holdorff (Hrsg.): Series of publications of the German Society for the History of Neurology. Volume 9. Würzburg 2003, pp. 119-149.
  2. ^ Hermann Rein , Max Schneider : Human Physiology. 15th edition. Springer, Berlin 1964, p. 626.
  3. ↑ René Descartes : Les passions de l'âme. Paris 1649
  4. ↑ Peter R. Hofstätter (Ed.): Psychology. The Fischer Lexicon. Fischer, Frankfurt am Main 1972, ISBN 3-436-01159-2 , district brain, p. 132 f., Body-soul problem, p. 206
  5. ↑ Thure von Uexküll u. a. (Ed.): Psychosomatic Medicine. 3. Edition. Urban & Schwarzenberg, Munich 1986, ISBN 3-541-08843-5 , p. 141
  6. ^ Hermann Samuel glass pane : The labyrinth of medicine. The wrong ways and triumphs of medicine. Rowohlt, Reinbek near Hamburg 1961, p. 307 f.
  7. ↑ Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology. 3. Edition. Urban & Schwarzenberg, Munich 1984
  8. ^ Wilhelm Karl Arnold et al. (Ed.): Lexicon of Psychology. Bechtermünz, Augsburg 1996, ISBN 3-86047-508-8 , column 2017
  9. ^ Paul Broca : Remarques sur le siège de la faculté du langage articulé. In: Bull. Soc. anat. 36, Paris 1861, pp. 330-357
  10. ↑ John Hughlings Jackson : Loss of speech. In: Lond. Hosp. Rep. 1864, pp. 388-471
  11. ↑ Bernhard von Gudden : Experimental investigations on the peripheral and central nervous system. In: Arch. Psychiatr. Nerve crisis 1870, pp. 693-723
  12. ↑ Carl Wernicke : The aphasic symptom complex. A psychological study on an anatomical basis. Cohn & Weigert, Breslau 1874
  13. ↑ Carl Wernicke: Textbook of the brain diseases. Fischer, Berlin 1881, p. 229
  14. ^ Robert Bartholow : Experimental investigations into the functions of the human brain. In: Amer. J. med. Sci. 67, 1874, pp. 305-313
  15. ↑ Karl Kleist : Brain Pathology. In: Handbook of medical experience in World War I 1914-18. Volume IV. Barth, Leipzig 1922–1934
  16. ↑ a b Peter Duus : Neurological-topical diagnostics. Anatomy, physiology, clinic. 5th edition. Thieme, Stuttgart 1990, ISBN 3-13-535805-4 , p. 361 (a), o. P. (B)
  17. ↑ Paul Flechsig : Anatomy of the human brain and spinal cord on myelogenetic basis. Thieme, Leipzig 1920
  18. ↑ Helmut Ferner : Human development history. 7th edition. Reinhardt, Munich 1965, p. 126
  19. ^ A b Fritz Broser : Topical and clinical diagnostics of neurological diseases. 2nd Edition. U&S, Munich 1981, ISBN 3-541-06572-9 , p. 131, Fig. 2-2 (a), o. P. (B)
  20. ↑ Alfred Benninghoff , Kurt Goerttler : Textbook of Human Anatomy. Shown with preference given to functional relationships. Volume 3: Nervous System, Skin and Sensory Organs. 7th edition. Urban and Schwarzenberg, Munich 1964, p. 245 f.
  21. ↑ Peter Düweke : Brief history of brain research. From Descartes to Eccles. Becksche Reihe, 2001, ISBN 3-406-45945-5 ; P. 73 f.
  22. ↑ Martin Sack : From neuropathology to phenomenology . Königshausen and Neumann, Würzburg 2005, ISBN 3-8260-2379-X ; P. 44
  23. ^ Robert Bing : Textbook of nervous diseases for students and general practitioners. Urban & Schwarzenberg, Berlin 1913
  24. ↑ Robert Paul Bing: Compendium of topical brain and spinal cord diagnostics. Urban and Schwarzenberg, Berlin, Vienna 1909