Deficit, recovery and the vis nervosa

Abstract

Physicians have long sought to explain neurological deficit and recovery on the basis of alterations in the agent of nervous action. The ancient Greeks knew that the brain influences muscles and they showed experimentally that the effects were mediated by nerves. Galen believed that the agent of action was the animal spirits. Ideas began to change with a new approach to knowledge and the revival of experimentation that followed the arrival in Venice of ancient Greek manuscripts after the fall of Constantinople in 1453. In the mid-18th century the notion of animal spirits was replaced by that of the vis nervosa and speculation began that the agent might be electrical. This was established by the mid-19th century. The nature of conduction in nerve was clearly different from that in a wire but how it took place remained uncertain until Hodgkin and Huxley proved the ionic hypothesis in the mid-20th century. In the following decades the membrane mechanisms of conduction failure and restoration were elucidated, with practical consequences in the form of improved diagnostic methods and the potential for more rational approaches to treatment. The demonstration that adaptive cortical plasticity contributes to recovery raises the possibility of new strategies for neurological rehabilitation.