Ep 30 Encephalitis Lethargica: Sleep Perchance to Dream (& Dream & Dream)
Jun 25, 2019
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Discover the mysterious epidemic of encephalitis lethargica, a 'sleepy sickness' that afflicted millions in the early 1900s. Learn about the impact and clinical varieties of this illness, including post-encephalitic Parkinsonism and its treatments with L-DOPA. Delve into the uncertainty about its cause and the potential resurgence of this forgotten medical mystery.
Encephalitis lethargica had three main forms: somnolent, hyperkinetic, and amisotic kinetic, each with distinct symptoms and outcomes.
Brain changes in the illness included vessel congestion, hemorrhages, and neurofibrillary tangles, affecting movement control areas and presenting unique challenges for treatment.
Long-term care for post-encephalitic patients emphasized supportive measures and a nurturing environment, with L-DOPA showing promise in reviving patients and restoring lost abilities.
Deep dives
Types of Encephalitis Lethargica
Encephalitis lethargica presents in three main forms: the somnolent form, characterized by intense sleepiness leading to a deep slumber sometimes resulting in death; the hyperkinetic form presents as restlessness, muscle twitching, and insomnia progressing to sleepiness; and the amisotic kinetic form showcases muscle weakness, rigidity similar to Parkinson's, without the characteristic tremors.
Brain Changes in Encephalitis Lethargica
Brain changes in acute encephalitis lethargica include vessel congestion, small hemorrhages, and brainstem involvement, with the disease affecting areas linked to movement control. Neurofibrillary tangles resembling Alzheimer's, rather than typical Parkinson's proteins, accumulate in the brain, explaining some symptoms.
Long-Term Care and Treatment
Long-term care for post-encephalitic patients primarily focused on supportive measures and a nurturing environment to enhance quality of life. Mount Carmel, an institution for post-encephalitic patients, witnessed significant growth over the years, housing patients who appeared much younger due to lack of facial muscle use. Oliver Sacks encountered forgotten post-encephalitic patients, highlighting the impact of the disease and the importance of ongoing care.
Awakening Postencephalitic Patients with L-DOPA
L-DOPA, a synthetic form of dopamine discovered in 1967 for Parkinson's treatment, was utilized by Dr. Sacks in a 90-day trial to revive patients deemed past hope. Remarkable transformations were observed, including sudden abilities to move, talk, and engage emotionally, rekindling lost connections with loved ones. Despite initial success, patients grew sensitive to Aldopa, facing unpredictable responses, showing both miraculous awakenings and temporary setbacks.
Exploring the Enigma of Encephalitis Lethargica
Encephalitis Lethargica, a mysterious disease historically linked to influenza outbreaks, presents a complex puzzle with uncertain origins and varied symptomatology. Proposed theories, from viral infections to autoimmune reactions, struggle to definitively explain its sporadic resurgence and shifting demographics. Diagnostic criteria updates and limited research funding further cloud the understanding of this enigmatic condition, leaving its true nature and potential future outbreaks shrouded in uncertainty.
Imagine this: a sickness where millions fell into a deep slumber from which they never woke. Of those that did, many remained trapped in a cage of their own bodies, unable to move or speak but fully aware of the world around them. Imagine that this sickness appeared suddenly, without warning, and spread across the globe, affecting millions in just a few decades. Then, just as quickly as it emerged it disappeared. Survivors were left to suffer, eventually forgotten, while hundreds of questions remained unanswered. This is the story of encephalitis lethargica, the subject of our first ever medical mystery episode. Encephalitis lethargica was a ‘sleepy sickness’ epidemic which afflicted millions in the early 1910s and 20s but has caused only sporadic cases since the 1940s. This mysterious illness revolutionized the fields of neurology and psychiatry and forced physicians to examine where the brain ends and the mind begins. What could cause such an illness and why haven’t we seen it since? Tune in to hear us tell you the story of this fascinating medical mystery.