Bassetti, C.

Valko, Ph

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J Neurol (2006) 253 : 537–538DOI 10.1007/s00415-006-0104-4 PIONEERS IN NEUROLOGYPhilipp ValkoClaudio L. BassettiAleksej Yakovlevich Kozhevnikov(1836–1902)JON 2104Aleksej Yakovlevich Kozhevnikov(1836–1902) is mainly known forhis description in 1894 of “epilepsiapartialis continua”, today referredto as Kozhevnikov’s epilepsy [1]. Hemade several other important con-tributions to neurology. Moreover,he can be considered the ‘father ofRussian neurology’ because of hisappointment in 1869 in Moscow tothe newly created chair in neurol-ogy and psychiatry (13 years beforeCharcot at the La Salpêtrière) andhis pivotal role for the developmentof this discipline in Russia.Kozhevnikov, the son of a mili-tary officer, was born in 1836 inRyazan, the same city in centralRussia where 13 years later thephysiologist Pavlov would be born.In 1853 he went to Moscow, wherehe obtained his degree in medicinein 1858. In 1860 he became assistantin internal medicine at the MoscowUniversity Hospital.At that time thedepartment was directed by Varvin-skij, who played a crucial role in di-recting Kozhevnikov’s attention to-wards diseases of the nervoussystem. In 1865 Kozhevnikov com-pleted a doctoral thesis in which hedemonstrated that the underlyingpathology of tabes dorsalis and ofDuchenne’s ‘ataxie locomotrice pro-gressive’are identical [2].From 1866to 1869 he visited academic institu-tions in Berlin, Würzburg, Vienna,Munich, Paris, London, Geneva andBerne. He attended lectures byCharcot and Griesinger, and workedin the laboratories of von Kölliker,du Bois-Reymond and Virchow.During this period he published tworemarkable studies on the course of pyramidal and cerebellar nervefibers including the transition fromthe Purkinje cell bodies into myeli-nated nerve fibers [3, 4]. In 1869 hewas nominated ‘Privatdozent’ andappointed to the newly created chairof neurology and psychiatry. Theconditions at the beginning of hiswork at the Novo-EkaterininskijHospital were difficult owing toshortages of space (initially only 19beds), personnel, equipment and fi-nances. Kozhevnikov had to givelectures in hospital corridors ordirectly at the bedside. In 1871 hewas appointed as extraordinaryprofessor and in 1881 as ordinarius(full professor) of neurology.Kozhevnikov was, as usual in histime, both a neurologist and a psy-chiatrist.He felt,however, that a sep-aration of the two disciplines wasnecessary for the development ofeach. In 1889, relatively early com-pared with other European coun-tries, Kozhevnikov gave the direc-tion of the psychiatric division ofhis department to his favouritepupil Korsakov, who became the‘father of Russian psychiatry’ andthe first to describe (1887–1891) theamnestic syndrome in alcoholics.Kozhevnikov died in 1902 at the ageof 66 from metastatic prostatic car-Received: 12 September 2005Accepted: 9 October 2005Ph. Valko · Prof. C. L. Bassetti ()Department of NeurologyUniversity HospitalZürich, SwitzerlandE-Mail: claudio.bassetti@usz.chAleksej Yakovlevich Kozhevnikov (1836–1902)537_538_Bassetti_JON_2104  13.04.2006  9:18 Uhr  Seite 537538cinoma, from which he had sufferedfor a considerable time.Most of Kozhevnikov’s scientificpublications were on clinical topicsand, whenever possible, he appliedthe anatomo-clinical correlationmethod. In several papers on amy-otrophic lateral sclerosis (ALS) hedemonstrated degeneration of cor-ticospinal fibers in the brainstemand hemispheres, contradictingCharcot’s view that degenerativechanges were restricted to the spinalcord [5]. Kozhevnikov’s descriptionof pyramidal cell loss in ALS [6] wasof particular clinical importancebecause it proved that the origin ofthe pyramidal tract was confined tothe precentral gyrus. In a mono-graph on aphasia in 1874Kozhevnikov gave a detailed de-scription of a case of sensory apha-sia, though without anatomical ver-ification [7]. A monograph onlathyrism was based on his experi-ences with 140 patients during theepidemic in the district of Saratov(winter 1891–1892) [8]. In 1892Kozhevnikov opened a neurologicalmuseum in his clinic, to which hedevoted much energy and means.This unique collection of neu-ropathological specimens, anatomi-cal diagrams, illustrations and pho-tographs had increased to 1500exhibits at the time of his death; un-fortunately it was destroyed duringthe Soviet period.On the 21st January 1894,Kozhevnikov described to theMoscow Society of Neurology andPsychiatry the condition that per-petuates his name. In four patientsseen between 1883 and 1893 he hadseen “. . . constant clonic convulsionsin strictly defined parts of thebody”,“epilepsia corticalis sive par-tialis continua”. These convulsionsfluctuated in intensity and coulddevelop into generalised epilepticseizures. Purely on clinical groundsKozhevnikov postulated a chronicand localized inflammatory processwithin the motor cortex and recom-mended surgical removal as theonly therapeutic option. In 1895 hepublished his findings in a Germanjournal [9]. In the following yearsseveral further observations ap-peared on this new syndrome (e. g.Spiller and Martin in 1909, Wilsonin 1928). Russian authors identifiedRussian spring-summer tick-borneencephalitis in Siberia as a cause ofepilepsia partialis continua.Kozhevnikov wrote the first text-book of neurology in Russia in 1883.In 1890 he was among the foundingmembers of the Moscow Society ofNeurology and Psychiatry, overwhich he presided until his death. In1901 he founded the first Russianjournal of neurology and psychiatry(Korsakov’s ‘zhurnal neurologii ipsichiatrii’) and became its first ed-itor-in-chief. This journal has re-mained the leading Russian neuro-logical journal until today.The exceptional position thatKozhevnikov holds in Russian neu-rology is reflected also by the emi-nence of his pupils. To the so-called‘Moscow Neurology School’ (in con-trast to the ‘St. Petersburg School’around Bekhterev) belonged Kor-sakow, Rot, who in 1895 describedentrapment of the lateral femoralcutaneous nerve and coined thename meralgia paraesthetica,Darkshevich, who described thesmall nucleus in the midbrain nowcalled after him, and Rossolimo.In his obituary Rot rememberedKozhevnikov as a highly intelligent,honest, unassuming and very con-scientious man, who devoted all hisenergy and time to work and sci-ence without concern for his ownhealth [10].■ Note: A. Y. Kozhevnikov should not beconfused with Dr. A. M. Kozhevnikov, whowas also a well-known neurologist inMoscow (specialist in neuroinfections, par-ticularly syphilis) and who was among the27 physicians called at Lenin’s sick-bed.References1. Kozhevnikov AY (1894) A particulartype of cortical epilepsy (epilepsia cor-ticalis sive partialis continua). MedObozr 42:97–118 (Russ.)2. Kozhevnikov AY (1865) The diseasecalled by Duchenne ‘Ataxie loco-motrice progressive’. Diss Moscow(Russ.)3. Kozhevnikov AY (1868) Axencylinder-fortsatz der Nervencellen im kleinenHirn des Kalbes. Arch f microscopAnatomie, 3324. Kozhevnikov AY (1869) Axencylinder-fortsatz der Nervencellen aus derGrosshirnrinde des Menschen. Arch fMicroscop Anatomie, 3745. Kozhevnikov AY (1883) Cas de scleroselatérale amyotrophique(Dégénérescens des fasciaux pyrami-daux de propageant a travers tout l’en-cephale). Arch Neurol 6:356–3766. Kozhevnikov AY (1885) Ein Fall vonlateraler amyotrophischer Sclerose. ZblNervenheilk 187. Kozhevnikov AY (1874) Aphasia andthe central organ of speech. Moscvrach vest, 18–21 (Russ.)8. Kozhevnikov AY (1894) Lathyrism.Disease due to the consumption of thechickling vetch lathyrus. Vest klinsudeb psichiatr nevropat 2:152–211(Russ.)9. Kozhevnikov AY (1895) Eine beson-dere form von corticaler epilepsie.Neurol Centralbl 14:4710. Rot VK (1902) Aleksej YakovlevichKozhevnikov (obituary). Zhurnalnevrol psichiatr im SS Korsakova3:339–369 (Russ.)537_538_Bassetti_JON_2104  13.04.2006  9:18 Uhr  Seite 538

Aleksej Yakovlevich Kozhevnikov (1836-1902)

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Aleksej Yakovlevich Kozhevnikov (1836-1902)

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