Why neurology eponyms are here to stay

By Michael Woodhead

21 Jan 2020

Eponyms have been condemned by some neurologists as inaccurate, unscientific and misattributing credit but their use and the creation of new eponyms is likely to continue, according to a new study.

A review of the frequency of eponyms in neurology literature over the last three decades has shown that terms such as Huntington’s disease, Lewy bodies, and Guillain-Barre syndrome have appeared consistently in about 20% of all papers, with no sign of any decline.

The analysis conducted by neurologists at Stanford University also found that new eponyms continue to be coined in neurology, with recent examples including Barakat Syndrome, Puusepp’s sign and the Lille Apathy Rating Scale.

pervasiveness, ease of use and eponyms being part of the culture and tradition of neurology.

Published in the journal Neurology, the analysis examined the trends in use of more than 2000 eponyms in neurology literature between 1988 and 2017. It found there was a modest increase in the use of eponyms, averaging about 2% a year, with almost 70% of mentions relating to the top 10 eponyms in neurology such as Alzheimers and Parkinson’s disease (see table).

Top 10 eponyms in neurology:

Alzheimer’s disease
Parkinson’s disease
Rankin scale
Huntington disease
Lewy bodies
Guillain-Barre syndrome
Schwann cell
Purkinje cell
Duchenne muscular dystrophy

The overall prevalence of eponym use in neurologist-affiliated publication titles and abstracts ranged from 15%to 25%, with a mean of 21%. Some obscure eponyms such as Collier’s sign, Kahler’s disease and Schilder-Foix disease fell out of common usage over the last 30 years, but the overall balance of discontinued and new eponyms remained equal.

A survey of 59 neurology trainees found that 44% were familiar with the meaning of a random sample of 50-150 eponyms. At the same time, 57% of trainees were not aware of alternative descriptors for eponyms they were familiar with, and of those who were, only 34% preferred the more scientific alternative.

The least popular eponyms for which trainees would prefer to use a more mechanistic descriptor were Landau-Kleffner syndrome, Isaacs’syndrome, Charles Bonnet syndrome, Argyll Robertson pupil, Jacksonian seizures, Virchow-Robin space, and Heschl’s gyrus.

While most trainees agreed with statements of concern regarding eponyms such as lack of specificity, 83% said they would continue to use them. Reasons included their being memorable and embedded in neurology practice

“We are creatures of habit. Also, neurologists take pride in knowing things, and knowing the eponym adds an additional order to your knowledge and lets you show off to others that you know stuff,” commented one trainee.

“Eponyms are too pervasive in the field in descriptions of common diseases that will always be at the core of neurology; I do not see them going away completely. I do think that descriptive names are better and wish that we could move toward better names for these diseases,” said another.

The study authors said the message was that eponyms are not going to be abandoned anytime soon.

“Focus should therefore be shifted away from debating the utility of eponyms and toward quality improvement efforts that ensure that current trainees learn the most effective, meaningful eponyms and avoid ethically controversial ones,” they suggested.

They noted that most of the medical eponyms derived from physicians who worked in the Nazi era, had been abandoned, although some such as Wegener’s granulomatosis, remain in common usage.

“Multiple calls have been made to reduce or eliminate eponyms from clinical practice and published literature moving forward. Our historical analysis and survey of current neurology trainee perspectives provide evidence that neurologic eponyms will continue to be integral to medical education and communication,” they concluded.

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