Pharmacology and molecular mimicry in childhood movement disorders: or, How advances in pharmacology can sometimes interfere with identification of underlying pathology

Howard I. Kushner
Simon Fraser University, Harbour Centre, Vancouver, Canada

Recent research, points to a role of molecular mimicry for a certain subset of patients diagnosed as afflicted with Gilles de la Tourette's syndrome and other childhood movement disorders. Ironically, the "discovery" in the 1960s of the action of the dopamine antagonist, haloperidol, in controlling motor and vocal tics, made it difficult for researchers to explore the possibility that these symptoms were a sequel to an infectious substrate. In 1956, Angelo Taranta and Gene H. Stollerman established the connection between the onset of Sydenham's chorea and prior infection by Group A beta hemolytic streptococcus (GABHS)--rheumatic streptococcus. By 1976 Gunnar Husby and his colleagues implicated the basic mechanisms of antigen antibody response. Why weren't these robust findings about the etiology of Sydenham's chorea, applied to disorders with similar symptoms, such as Gilles de la Tourette's syndrome and obsessive compulsive behaviors? The answer to this question, in part, is that ironically a pharmacological advance inadvertently served to retard research that only today has revealed a possible role of cross-reactive molecular mechanisms in these neurological disorders. The resistance to search for parallel mechanisms was as much a historical as a scientific issue. This paper argues that competition over the classification of movement disorders held back the possible connection between the work on Sydenham's chorea with those symptoms associated with Gilles de la Tourette's syndrome and obsessive compulsive disorders. Thus, haloperidol not only served to control the symptoms of a number of movement disorders, but also it was used as a weapon against those who made other claims about the etiology of childhood compulsive and movement disorders.

Session V
Saturday, 21 June 1997, 9.10 - 9.25

Second Annual Meeting of the International Society for the History of the Neurosciences (ISHN) and 6th Meeting of the European Club on the History of Neurology (ECHN)

Leiden, The Netherlands