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The Babinski sign
Correspondence
The Babinski sign
Emmanuel Drouin
Joseph Babinski (1857–1932), a French neurologist of Polish descent, first described the Babinski sign, the best known neurological eponym and one of the most important signs in clinical neurology, in 1896.1 Babinski was the favourite pupil of Jean-Martin Charcot, who markedly influenced Babinski’s research. He appears in the famous painting of Charcot’s lesson at Salpêtrière hospital (“Une leçon clinique à la Salpêtrière” by Pierre Aristide André Brouillet [1857–1914]), helping to support a patient who was being treated for hysteria. Babinski would later spend much of his career searching for objective clinical signs that cannot be mimicked by the patient, consciously or unconsciously. Babinski’s historical report on the abnormal cutaneous plantar reflex, a concise note of only 28 lines, was published on Feb 22, 1896. Copies of Babinski’s original publication 1 are quite rare because the report was
Figure: Photograph of the original paper by Babinski
180
never reprinted. However, we were able to gain privileged access to the report, which is not available for public viewing, in an old bookstore in Paris, France (figure). In this report,1 Babinski describes the dorsiflexion of the great toe on stimulation of the sole of the foot in patients with hemiplegia or lower limb paralysis. 2 years later, he narrowed the definition of lesions associated with the toe sign from brain or spinal cord to the pyramidal tract.2 In 1903, Babinski also reported on the signe de l’éventail (the fan sign), describing how the other toes fan out on stimulation of the sole of the foot. Babinski’s contribution to the description of neurological symptoms was not restricted to the plantar skin reflex, but extended to other areas such as epilepsy or the effects of strychnine poisoning. Although the Babinski reflex did not immediately gain recognition, he continued to try to distinguish neurological syndromes from psychiatric syndromes.
A trend of abolishing eponymous names for neurological signs is emerging, but they serve to remind us of the important work of great neurologists of the past. We declare no competing interests.
Emmanuel Drouin, Guillaume Drouin, *Yann Péréon [email protected] Centre d’Etudes Supérieures de la Renaissance, Université François Rabelais, Tours, France (ED); Medical School, University of Nantes, Nantes, France (GD); and CHU de Nantes, Centre de Référence Maladies Neuromusculaires NantesAngers, Hôtel-Dieu, Filnemus, F 44093, Nantes, France (YP) 1
2
Babinski J. Sur le réflexe cutané plantaire dans certaines affections organiques du système nerveux central. C R Seances Soc Biol Fil 1896; 48: 207–08. Van Gijn J. The Babinski sign: the first hundred years. J Neurol 1996; 243: 675–83.
Dementia research priorities—1 We agree with Lon Schneider1 that advancements and innovation in dementia research are needed, and that the research agenda has at times been imbalanced in its formation and constrained by unquestioned frameworks. In recognition of the urgent need for progress, WHO has led an array of activities, including the identification of research priorities.2 We agree that any circularity would threaten the validity of the exercise. However, a Delphi exercise was not done, as implied by Schneider.1 We used the Child Health and Nutrition Research Initiative (CHNRI) method, validated by 70 large exercises in many health areas, involving more than 10 000 experts.3 The CHNRI method was designed to address the limitations of a Delphi process (its proneness to circularity and limited involvement of non-experts)4 and capture “the wisdom of the crowd” in a transparent, replicable, and democratic way, without necessitating consensus.5 The method does not allow any person to have any appreciable effect on the outcome, www.thelancet.com/neurology Vol 16 March 2017
The Babinski sign
Emmanuel Drouin
Joseph Babinski (1857–1932), a French neurologist of Polish descent, first described the Babinski sign, the best known neurological eponym and one of the most important signs in clinical neurology, in 1896.1 Babinski was the favourite pupil of Jean-Martin Charcot, who markedly influenced Babinski’s research. He appears in the famous painting of Charcot’s lesson at Salpêtrière hospital (“Une leçon clinique à la Salpêtrière” by Pierre Aristide André Brouillet [1857–1914]), helping to support a patient who was being treated for hysteria. Babinski would later spend much of his career searching for objective clinical signs that cannot be mimicked by the patient, consciously or unconsciously. Babinski’s historical report on the abnormal cutaneous plantar reflex, a concise note of only 28 lines, was published on Feb 22, 1896. Copies of Babinski’s original publication 1 are quite rare because the report was
Figure: Photograph of the original paper by Babinski
180
never reprinted. However, we were able to gain privileged access to the report, which is not available for public viewing, in an old bookstore in Paris, France (figure). In this report,1 Babinski describes the dorsiflexion of the great toe on stimulation of the sole of the foot in patients with hemiplegia or lower limb paralysis. 2 years later, he narrowed the definition of lesions associated with the toe sign from brain or spinal cord to the pyramidal tract.2 In 1903, Babinski also reported on the signe de l’éventail (the fan sign), describing how the other toes fan out on stimulation of the sole of the foot. Babinski’s contribution to the description of neurological symptoms was not restricted to the plantar skin reflex, but extended to other areas such as epilepsy or the effects of strychnine poisoning. Although the Babinski reflex did not immediately gain recognition, he continued to try to distinguish neurological syndromes from psychiatric syndromes.
A trend of abolishing eponymous names for neurological signs is emerging, but they serve to remind us of the important work of great neurologists of the past. We declare no competing interests.
Emmanuel Drouin, Guillaume Drouin, *Yann Péréon [email protected] Centre d’Etudes Supérieures de la Renaissance, Université François Rabelais, Tours, France (ED); Medical School, University of Nantes, Nantes, France (GD); and CHU de Nantes, Centre de Référence Maladies Neuromusculaires NantesAngers, Hôtel-Dieu, Filnemus, F 44093, Nantes, France (YP) 1
2
Babinski J. Sur le réflexe cutané plantaire dans certaines affections organiques du système nerveux central. C R Seances Soc Biol Fil 1896; 48: 207–08. Van Gijn J. The Babinski sign: the first hundred years. J Neurol 1996; 243: 675–83.
Dementia research priorities—1 We agree with Lon Schneider1 that advancements and innovation in dementia research are needed, and that the research agenda has at times been imbalanced in its formation and constrained by unquestioned frameworks. In recognition of the urgent need for progress, WHO has led an array of activities, including the identification of research priorities.2 We agree that any circularity would threaten the validity of the exercise. However, a Delphi exercise was not done, as implied by Schneider.1 We used the Child Health and Nutrition Research Initiative (CHNRI) method, validated by 70 large exercises in many health areas, involving more than 10 000 experts.3 The CHNRI method was designed to address the limitations of a Delphi process (its proneness to circularity and limited involvement of non-experts)4 and capture “the wisdom of the crowd” in a transparent, replicable, and democratic way, without necessitating consensus.5 The method does not allow any person to have any appreciable effect on the outcome, www.thelancet.com/neurology Vol 16 March 2017