Abe, Fujimura, Tatsumi, Toyooka, Yorzfuji, Yanagihara

develop frontal lobe dysfunction'2 13 and that
damage to the frontal lobe caused by various
diseases can affect eyelid movements.7-9
Therefore, eyelid apraxia may occur in
patients with motor neuron disease, if the dis-
ease process involves the frontal lobe.

1 Iwata M, Hirano A. Current problem in the pathology of
amyotrophic lateral sclerosis. In: Zimmermann H, ed.
Progress in neurology. New York: Raven Press, 1979.

2 Lessell S. Supranuclear paralysis of voluntary lid closure.
Arch Opthalmol 1972;88:241-4.

3 Harvey DG, Torack RM, Rosenbaum HE. Amyotrophic
lateral sclerosis with ophthalmoplegia. A clinicopatho-
logic study. Arch Neurol 1979;36:615-7.

4 Lapresle J, Salisachs P. Phenomenes de dissociation
volontaire et automatico-reflexe au niveau de certains
muscles innerves par les paires craniennes dans deux
observations de sclerose laterale amyotrophique. Revue

Neurologique 1976;132:157-61.
5 Goldstein JE, Cogan DG. Apraxia of lid-opening. Arch

Ophthalmol 1965;3: 155-9.
6 Nutt JG. Lid abnormalities secondary to cerebral hemi-

sphere lesions. Ann Neurol 1977;1:149-51.
7 Dehaene I. Apraxia of eyelid opening in progressive

supranuclear palsy. Ann Neurol 1984;15:115-6.
8 Lepore FE, Duvoisin RC. "Apraxia" of eyelid opening: an

involuntary levator inhibition. Neurology 1985;35:423-7.
9 Johnston JC, Rosenbaum DM, Picone CM, Grotta JC.

Apraxia of eyelid opening secondary to right hemisphere
infarction. Ann Neurol 1989 25:622-4.

10 Li TM, Swash M, Alberman E, Day SJ. Diagnosis of
motor neuron disease by neurologists: a study in three
countries. J Neurol Neurosurg Psychiatry 1991;54:980-4.

11 Heilman KM, Rothi LJG. Apraxia. In: Heilman KM,
Valenstein E, eds. Clinical neuropsychology. Oxford:
Oxford University Press, 1993:141-63.

12 Abe K, Fujimura H, Toyooka K, Hazama T, et al. Single-
photon computed tomographic investigation of patients
with motor neuron disease. Neurology 1993;43:1569-73.

13 Kiernan JA, Hudson AJ. Frontal lobe atrophy in motor
neuron diseases. Brain 1994;117:747-57.

Headache
Headaches seem to be an almost female prerogative in
the nineteenth century novel. None of Jane Austen's
men, not even the awful Mr Woodhouse, experience
them. The symptom is often used by the sufferer,
whether consciously or unconsciously, as a means of
avoiding a difficult social situation and afflicts, in Jane
Austen's works, perhaps only the more fragile of her
creations. The robust Emma Woodhouse can hardly
be imagined falling back on such an expedient.
Dickens, incidentally, hardly refers to any headache
sufferers in his novels despite his experience of attacks
of facial pain.'

Jane Austen, 1811, Sense and sensibility
My sister will be equally sorry to miss the pleasure of
seeing you; but she has been very much plagued lately
with nervous head-aches, which make her unfit for
company or conversation.

J7ane Austen, 1813, Pride and prejudice
The agitation and tears which the subject occasioned,
brought on a headache; and it grew so much worse
towards the evening that, added to her unwillingness
to see Mr Darcy, it determined her not to attend her
cousins to Rosings, where they were engaged to drink
tea.

Jane Austen, 1814, Mansfield Park
"Fanny," said Edmund after looking at her attentively;
"I am sure you have the headache?"

She could not deny it, but said it was not very bad
"There was no help for it certainly," rejoined Mrs

Norris, in a rather softened voice; "but I question

whether her headache might not be caught then, sis-
ter. There is nothing so likely to give it as standing
and stooping in a hot sun. But I dare say it will be well
tomorrow. Suppose you let her have your aromatic
vinegar; I always forget to have mine filled."

Jane Austen, 1816, Emma
"Miss Fairfax was not well enough to write;" and
when Mr Perry called at Hartfield, the same morning,
it appeared that she was so much indisposed as to
have been visited, though against her own consent, by
himself, and that she was suffering under severe
headaches, and a nervous fever to a degree, which
made him doubt the possibility of her going to Mrs
Smallridge's at the time proposed.

Charlotte Bronte, 1839, Caroline Vernon
"I've got a head-ache, Mary." This was a lie-told to
awaken sympathy and elude further cross-examina-
tion. "Have you, Adrian, where?" "I think I said a
head-ache, of course it would not be in my great toe."

Victor Hugo, 1862, Les Miserables
This done, and saying that she had a headache,
Cosette bade her father good night and went back to
her bedroom ...
Not that he was troubled by her headache, which

he regarded as nothing but a trifling crise de nerfs, a
girlish sulk that would wear off in a day or two.

G D PERKIN
Regional Neurosciences Centre,

Charing Cross Hospital,
Fulham Palace Road,
London W6 8RF, UK

1 House M, Storey G, eds. The letters of Charles Dickens. Vol
2. 1840-41. Oxford: The Clarenden Press, 1969.

NEUROLOGY IN LITERATURE

632
 o

n
 A

p
ril 5

, 2
0
2

1
 b

y g
u
e

st. P
ro

te
cte

d
 b

y co
p

yrig
h

t.
h

ttp
://jn

n
p

.b
m

j.co
m

/
J N

e
u

ro
l N

e
u

ro
su

rg
 P

sych
ia

try: first p
u

b
lish

e
d

 a
s 1

0
.1

1
3

6
/jn

n
p

.5
9

.6
.6

3
2
 o

n
 1

 D
e
ce

m
b
e
r 1

9
9
5
. D

o
w

n
lo

a
d
e
d
 fro

m
 

http://jnnp.bmj.com/