The Incidence and Characteristics of Lewy Bodies in Idiopathic Paralysis Agitans

In 1913, the Breslau neurologist Lewy described globular inclusions of cytoplasmic condensations in the cells of the nucleus substantiae innominatae and the dorsal vagal nucleus in paralysis agitans. These cell inclusions have since been described by many other investigators. In 1923, Lewy also found them in the pigmented ganglion cells of the substantia nigra in Parkinson's disease. Tretiakoff (1919) found these "Lewy bodies" in six out of nine typical cases of paralysis agitans, and in one atypical case. Foix and Nicolesco (1925) described them as found in an unspecified number of cases of Parkinson's disease. Redlich (1930) found Lewy bodies in the substantia nigra in two cases of postencephalitic Parkinsonism and in one case of Parkinson's disease. Klaue (1940), on the basis of both clinical and anatomical pathological findings in a large amount of material, advocated the unitarian theory regarding the aetiology of idiopathic and postencephalitic Parkinsonian conditions. He found identical neuropathological changes in both instances. Van Valkenburg (1941) described one case of idiopathic paralysis agitans with Lewy bodies in the pigmented cells of the brain-stem. Beheim-Schwarzbach (1952) found Lewy bodies in 16 cases of Parkinson's disease and in 10 cases of senescence with no Parkinsonian signs. She found no Lewy bodies in 13 cases of postencephalitic Parkinsonism. She elaborated the material previously described by Hassler (1938). Greenfield and Bosanquet (1953) examined 19 cases of idiopathic paralysis agitans. In nine cases it was possible to examine the substantia nigra and the locus coeruleus; Lewy bodies were found in both. In nine cases, only the substantia nigra was available but Lewy bodies were invariably found in it. In the remaining case, only the locus coeruleus could be examined and Lewy bodies were found. In all these cases of idiopathic paralysis agitans, therefore, Lewy bodies were demonstrable. No Lewy bodies were found in 10 cases of postencephalitic Parkinsonism. They were demonstrated in two out of five cases of atypical Parkinsonism. A single atypical inclusion (not a genuine Lewy body) was found in the cytoplasm of a locus coeruleus cell in only one out of 22 patients aged 50-88, with no clinical signs of Parkinsonism. Roveti (1956) found no Lewy bodies in eight postencephalitic cases, but did find them in two out of 15 psychiatric patients with no clinical signs of Parkinsonism. In so far as the authors have presented numerical data, the findings from the literature have been tabulated in Table I.