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The Controversy over the Classification of Gilles de la Tourette's Syndrome, 1800-1995
Perspectives in Biology and Medicine, Vol 39/3, Spring 1996
Howard I Kushner and Louise S Kiessling

Summary

This paper examines the historical context for the classification of Gilles de la Tourette's syndrome as distinct from Sydenham's chorea. This separation, made most emphatically in the 1880's by the influential 19th-century neurologist Jean-Martin Charcot of the Salpetriere hospital in Paris, was based upon observed differences in presenting symptoms. An alternative view, offered by a variety of physicians throughout the 19th century, focused on predisposing causes, rather than symptom manifestations. Those who emphasized an etiological perspective refused to accept Charcot's classificatory distinctions. Rather, these physicians insisted that Sydenham's chorea and Tourette's syndrome displayed a number of similarities that pointed to the conclusion that both were most likely variations of a common neurobiological mechanism.

This latter view is remarkably similar to our recent clinical findings. A number of obstacles, however, have made it difficult for many current researchers to rethink the possible etiological similarities between Tourette's syndrome and Sydenham's chorea. We believe that the reasons are as much historical as clinical, and that a historical perspective calls into question the diagnostic and clinical benefits of always viewing these disorders as distinct entities.

In what follows, we focus on the history of the separation of Tourette's syndrome from chorea. We explore the extent to which this separation has been informed by the emphasis on the classification of childhood movement disorders by their symptoms, that is as syndromes, rather than by possible common underlying pathologies. Although we are personally involved in this research, our purpose in this paper is not to make specific clinical claims. Rather, we point out the extent to which adherence to the classificatory boundaries established in the late 19th century has framed current clinical thinking, inhibiting consideration of alternative causal explanations (in the sense of predisposing co-factors) for childhood movement disorders and obsessive compulsive behaviors.