Objective: We reviewed the diagnosis of the historical patient with “Parkinson’s disease” Bachère, presented by Charcot in his Tuesday lectures of June 12, 1888.

Background: Prevalence of Parkinson’s disease is on the rise as populations age. This is particularly true of industrialized countries including Japan. While clinical diagnosis of Parkinson’s disease is not straightforward, it is improving. Furthermore, it is interesting to look back at the history of the disease and its clinical diagnosis and presentation. On June 12th, 1888, Charcot presented a patient by the name of Bachère at one of his Tuesday lectures. This is perhaps the most famous case of Parkinson’s disease ever presented, and its importance increased when further described in textbooks by Gowers (1900) and Dejerine (1914).

Method: We reviewed Charcot’s presentation of Bachère’s case from three points of view:1) Its content,2) Its further description by Gowers and Dejerine,3) How it compares with contemporary diagnostic criteria, as defined by the International Parkinson and Movement Disorder Society (MDS) Clinical Diagnostic Criteria for Parkinson’s disease.

Results: Charcot described Bachère as follows:* As a 31-year-old male (therefore early onset).* Initial signs of immobile head and masked face.* No past personal or family histories aside from the patient’s rheumatoid attacks, three times, between 12 and 20 years of age.* Characteristic, deep wrinkling of the forehead, with occipito-frontalis (also known as the muscle of surprise) rigidity. Stiffening of other mimic muscles with resulting, overall lack of facial expression.* No tremor.* A posture with extended limbs (thus atypical of Parkinson’s disease). Dejerine’s textbook listed Bachère’s case as “type d’extension,” or an extension type case of Parkinson’s disease. Of the MDS criteria, none applies to Bachère’s case, while he did present symmetrical signs – a “red flag”, exclusion criterion. Thus Charcot’s case fails to meet contemporary diagnostic criteria of Parkinson’s disease.

Conclusion: an historically established case of Parkinson’s disease, as described by Charcot, was probably not accurate. It is more likely that it was a case of progressive supranuclear palsy (PSP) – a Parkinson-like condition.

References: 1. Goetz CG. Charcot, the Clinician: The Tuesday Lessons, Raven Press;123-40,1987. 2. Blin MM, Charcot JM, Colin H. Vingtième Leçon. Un cas de maladie de Parkinson sans tremblement homme de 32 ans.Policlinique du Mardi 12 Juin 1888. Cours de M.Charcot. Leçons du Mardi à la Salpêtrière, Professeur Charcot. Policlinique 1887-1888. Progrès Médical;331-9,1892. 3. Dejerine J. Sémiologie des Affections du Système Nerveux, Masson, Paris;684-9,1914 4. Gowers WR. A Manual of Disease of the Nervous System II, 2nd edition, Blakiston, Philadelphia;650,1900. 5. Postuma RB, Berg D, Stern M et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 30;1591-601, 2015.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-hot-cold-case-of-parkinsons-disease-charcot-and-bachere-was-this-case-misdiagnosed/