Adolf Hitler and his parkinsonism

Sir,

K. B. Bhattacharyya,[1] in his interesting paper “Adolf Hitler and his parkinsonism” discussed the controversies about the possible etiology and nature of Hitler's parkinsonism based on an extensive review of the relevant literature. He focused on Lieberman's[2] suggestion that Hitler had suffered from postencephalitic parkinsonism, a hypothesis previously put forward by Recktenwald.[3] However, other authors, analyzing German newsreels and other sources, have come to the conclusion that Hitler rather suffered from idiopathic Parkinson's disease,[4,5,6,7] indicated by rest tremor and hypokinesia with onset on the left side, followed by disorders of gait and posture, and a significantly progressive course from 1941 which was equivalent to Hoehn and Yahr stage II.[6,7] Unfortunately, neither Lieberman nor Bhattacharyya did refer to the excellent retrospective mobility analysis by Gibbels, which is based on 83 German newsreel editions between 1940 and 1945 and is supplemented by a large number of detailed written and personal communications by eye witnesses of Hitler's nearest entourage.[6,7] In addition to the tremor already present in 1923 and an epileptic seizure in 1932, this excellent analysis reports some additional interesting phenomena, for example, paradox kinesia,[8] occasional sialorrhea, speech disorders, micrography, fluctuations, and postural instability (in late disease stages) that are known to be characteristic of parkinsonism, whereas there are no definite historical data for von Economo's encephalitis in 1918 as suggested by Lieberman.[6,7] Since no postmortem examination of Hitler's brain is available to clarify the type of his unequivocal clinical parkinsonism, Bhattacharyya should have given reference to a number of important previous papers before trying to retrospectively classify Hitler's parkinsonian syndrome.[9]

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