66 Sentences With "encephalitis lethargica"

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The explanation for the Salem Witch trials range from fungus poisoning or undiagnosed encephalitis lethargica causing hysteria, fear of strong women, or competition between families.
" Dr. Greene, the physicist, said that he was "awe-struck" when he met Dr. Sacks, who he said had "a ferocious talent and a rare gift" for finding beauty and humanity in the stories of people given diagnoses of illnesses like autism, Tourette's or encephalitis lethargica — the disease that afflicted the patients in his book "Awakenings.
Encephalitis lethargica is identified by high fever, headache, delayed physical response, and lethargy. Individuals can exhibit upper body weakness, muscular pains, and tremors, though the cause of encephalitis lethargica is not currently known. From 1917 to 1928, an epidemic of encephalitis lethargica occurred worldwide.
Encephalitis Lethargica : During and after the Epidemic Oxford ;: Oxford University Press, 2011.
This encephalitis with acute inflammation of the grey matterEconomo, C. (1917). Encephalitis lethargica. Wiener Klinische Wochenschrift. 30, 581–585.
K. von Economo.Wiener klinische Wochenschrift, 10 May 1917, 30: 581–585. Die Encephalitis lethargica. Leipzig and Vienna, Franz Deuticke, 1918.
German neurologist Felix Stern, who examined hundreds of encephalitis lethargica patients during the 1920s, pointed out that the encephalitis lethargica typically evolved over time. The early symptom would be dominated by sleepiness or wakefulness. A second symptom would lead to an oculogyric crisis. The third symptom would be recovery, followed by a Parkinson-like symptom.
If patients of Stern followed this course of disease, he diagnosed them with encephalitis lethargica. Stern suspected encephalitis lethargica to be close to polio without evidence. Nevertheless, he experimented with the convalescent serum of survivors of the first acute symptom. He vaccinated patients with early stage symptoms and told them that it might be successful.
The hyperkinetic form manifested itself with restlessness, motor disturbances as twitching of muscle groups, involuntary movements, anxious mental state and insomnia or inversion of sleep patterns. The amyostatic-akinetic form often led to a chronic state similar to Parkinson's disease, called postencephalitic parkinsonism. The symptoms were weakness of muscles, rigidity of movements and insomnia or sleep inversion. Von Economo published his findings in an article of 1917, "Die Encephalitis lethargica," and in the monograph "Die Encephalitis lethargica, ihre Nachkrankheiten und ihre Behandlung" in 1929 (Encephalitis lethargica – Its sequelae and treatment).
He first noticed the presence of the disease in French soldiers at Verdun. Historically encephalitis lethargica was referred to as "Cruchet's disease".
Postencephalitic parkinsonism was clearly documented to have followed an outbreak of encephalitis lethargica following the 1918 influenza pandemic; evidence for viral causation of the Parkinson's symptoms is circumstantial (epidemiologic, and finding influenza antigens in encephalitis lethargica patients), while evidence arguing against this cause is of the negative sort (e.g., lack of viral RNA in postencephalitic parkinsonian brain material). In reviewing the relationship between influenza and encephalitis lethargica (EL), McCall and coworkers conclude, as of 2008, that while "the case against influenza [is] less decisive than currently perceived… there is little direct evidence supporting influenza in the etiology of EL," and that "[a]lmost 100 years after the EL epidemic, its etiology remains enigmatic." Hence, while opinions on the relationship of encephalitis lethargica to influenza remain divided, the preponderance of literature appears skeptical.
Encephalitis lethargica. Its sequelae and treatment – Constantin Von Economo, 1931: front page The causes of encephalitis lethargica are uncertain. Some studies have explored its origins in an autoimmune response, and, separately or in relation to an immune response, links to pathologies of infectious disease — viral and bacterial, e.g., in the case of influenza, where a link with encephalitis is clear.
During the time of the encephalitis lethargica period, the rise of bradyphrenia was seen in many of the cases. In one case in Russia it was believed that this condition could be treated with steroid therapy after the patient's condition had improved after three months using steroid. Paul Bernard Foley. Encephalitis Lethargica The Mind and Brain Virus New York, NY: Springer New York, 2018.
Post-encephalitic Parkinsonism is a disease believed to be caused by a viral illness that triggers degeneration of the nerve cells in the substantia nigra. Overall, this degeneration leads to clinical parkinsonism. Historically, starting in 1917 an epidemic of encephalitis lethargica, also called von Economo’s encephalitis or "sleepy-disease" occurred, possibly related to the 1918 Spanish flu pandemic; however, even with the use of modern molecular diagnostic tests on appropriate corpses no firm link between encephalitis lethargica with influenza has been made. Although parkinsonism was occasionally seen during the acute encephalitic phase of encephalitis lethargica, it was often encountered in the post-encephalitic phase.
Encephalitis lethargica is an atypical form of encephalitis. Also known as "sleeping sickness" or "sleepy sickness" (distinct from tsetse fly-transmitted sleeping sickness), it was first described in 1917 by the neurologist Constantin von Economo and the pathologist Jean-René Cruchet. The disease attacks the brain, leaving some victims in a statue-like condition, speechless and motionless. Between 1915 and 1926, an epidemic of encephalitis lethargica spread around the world.
One of the first instances in which an infectious disease was associated with klazomania was the notable pandemic of the encephalitis lethargica from 1916 to 1927. This pandemic also gave rise to observations of other tics that came to be associated with encephalitis lethargica such as complex vocalizations of blocking, echolalia, palilalia, and oculogyric crises. In 1961, Wohlfart et al. reported a case of klazomania accompanied by oculogyric crises, another symptom of postencephalitic Parkinsonian syndrome.
Examples of gram-negative diplococci are Neisseria spp. and Moraxella catarrhalis. Examples of gram-positive diplococci are Streptococcus pneumoniae and Enterococcus spp. Presumably, diplococcus has been implicated in encephalitis lethargica.
In the same year, at the request of his parents, he returned to Vienna to care as a military physician for patients with head injuries. Here, he saw his first cases of Encephalitis lethargica.
Welsh never married. In 1935, she returned to her family's home in Columbia, Pennsylvania after the death of Mary Sherwood, her long-time companion and life partner. Welsh died of encephalitis lethargica on February 23, 1938.
Gabrielle Charlotte Lévy (11 January 1886 – 6 October 1934) was a French neurologist, for whose work the Roussy–Lévy syndrome and the Lhermitte-Lévy syndrome are named. She also made significant contributions to the understanding of encephalitis lethargica.
The onset of post encephalitic parkinsonism can be delayed by several years from the resolution of encephalitis lethargica. The brain regions affected contain neurofibrillary tangles, similar to those seen in Alzheimer's disease. Nevertheless, the senile plaques common in Alzheimer's disease are not found.
Constantin von Economo Constantin Freiherr von Economo (21 August 1876 - 21 October 1931) was an Austrian psychiatrist and neurologist of Romanian origin and Greek descent. He is mostly known for his discovery of encephalitis lethargica and his atlas of cytoarchitectonics of the cerebral cortex.
In December 1866, Ridge returned to his home in Grass Valley, California, where he died of "brain fever" (Encephalitis lethargica) on October 5, 1867." American Indian Biography: John Rollin Ridge, Cherokee Writer." Posted by Ojibwa on Native American Netroots, January 4, 2011. Retrieved July 9, 2014.
Douglas was born in Tunbridge Wells, Kent, the son of Capt. Keith Sholto Douglas, MC (retired) and Marie Josephine Castellain. His mother became unwell and collapsed in 1924 of encephalitis lethargica, never to fully recover. By 1926, the chicken farm business set up by his father had failed.
With limited clinical experience, involving typically one or two patients, authors advanced different ideas, including brain lesions similar to those resulting from rheumatic chorea or encephalitis lethargica as a cause of tics, faulty mechanisms of normal habit formation, and treatment with Freudian psychoanalysis. The psychogenic view prevailed well into the 20th century.
In addition, a major influenza epidemic spread around the world. Overall, the Spanish flu killed at least 17 million to 50 million people, including an estimated 2.64 million Europeans and as many as 675,000 Americans. Moreover, between 1915 and 1926, an epidemic of encephalitis lethargica spread around the world affecting nearly five million people.
This publication was the culmination of several years of cooperation between the two doctors. Flatau was the first in Poland to describe the cases of encephalitis lethargica and on occasion the name "Economo-Flatau disease" was used to identify this disease in Polish medical literature.Kanigowski Z., Przypadek choroby Economo-Flatau’a, Pam Wil Tow Lek 14, 2, s. 217 (1938).
Inflammatory extra-adventitial lesions are found not only in the brain but in the spinal cord as well. Lesions might be uniform in acute phase or disseminated in subacute phase. Unlike in cases of encephalitis lethargica the main damage is found in white brain matter. Meninges are infiltrated with T cells, plasmatic cells and phagocytic cells.
L-DOPA Modern treatment approaches to encephalitis lethargica include immunomodulating therapies, and treatments to remediate specific symptoms. There is little evidence so far of a consistent effective treatment for the initial stages, though some patients given steroids have seen improvement. The disease becomes progressive, with evidence of brain damage similar to Parkinson's disease. Treatment is then symptomatic.
Cruchet is remembered for his research of spasmodic torticollis. In 1907 he published Traité des torticolis spasmodiques, an influential monograph in which he documented 357 cases of torticollis. He also conducted investigations on tic disorders and studies of motion sickness experienced by aviators. In the winter of 1915-16 he was the first physician to give a report on encephalitis lethargica (Economo's disease).
"Levadopa: A Pharmacologic Miracle Four Decades Later", in Parkinson's Disease: Diagnosis and Clinical Management (Google eBook). Eds. Stewart A Factor and William J Weiner. Demos Medical Publishing, 2008 who used greatly increased oral doses. The neurologist Oliver Sacks describes this treatment in human patients with encephalitis lethargica in his book Awakenings, upon which the movie of the same name is based.
Dr Shepherd Dawson FRSE (1880–1935) was a British psychologist and author. He specialised in a deeper understanding of Encephalitis lethargica and in the effects of childhood epilepsy upon intelligence. He was a strong believer in the use of statistics to demonstrate clinical conclusions.Nature: International Weekly Journal of Science, 27 April 1935 He served as president of the Psychological section of the British Medical Association.
In 1922, Bontecou returned to Bryn Mawr as its Acting Dean. She received her Ph.D. from the Brookings Graduate School of Economics and Government (now the Brookings Institution) in 1928. Bonctecou then briefly worked as a professor in the School of Social Service Administration at the University of Chicago until contracting encephalitis lethargica. The long-term illness led her to spend most of the 1930s bedridden.
Encephalitis lethargica is characterized by high fever, sore throat, headache, lethargy, double vision, delayed physical and mental response, sleep inversion and catatonia. In severe cases, patients may enter a coma-like state (akinetic mutism). Patients may also experience abnormal eye movements ("oculogyric crises"), Parkinsonism, upper body weakness, muscular pains, tremors, neck rigidity, and behavioral changes including psychosis. Klazomania (a vocal tic) is sometimes present.
Native Americans, Penn Treaty Museum. Accessed July 16, 2015. Several wars, at least 14 separate epidemics (yellow fever, small pox, influenza, encephalitis lethargica, etc.) and disastrous over-harvesting of the animal populations reduced their population to around 4,000 by the year 1700. Since the Lenape people, like all Native Americans, had no immunity to European diseases, when the populations contacted the epidemics, they frequently proved fatal.
Awakenings is a 1973 non-fiction book by Oliver Sacks. It recounts the life histories of those who had been victims of the 1920s encephalitis lethargica epidemic. Sacks chronicles his efforts in the late 1960s to help these patients at the Beth Abraham Hospital (now Beth Abraham Center for Rehabilitation and Nursing) in the Bronx, New York. The treatment used the then-new drug L-DOPA.
Klazomania (from the Greek κλάζω ("klazo")—to scream) refers to compulsive shouting; it has features resembling the complex tics such as echolalia, palilalia and coprolalia seen in tic disorders, but has been seen in people with encephalitis lethargica, alcohol abuse and carbon monoxide poisoning. It was first reported by L. Benedek in 1925 in a patient with postencephalitic parkinsonism. Little is known about the condition, and few cases have been reported.
He is remembered for his extensive research of Parkinsonism, and in a 1921 treatise titled Rapport sur les syndromes parkinsoniens, he documented the importance of encephalitis lethargica as a cause of Parkinsonism. With his mentor Jean- Martin Charcot (1825-1893), he described the eponymous "Souques-Charcot geroderma", a condition that is a variant of Hutchinson–Gilford disease. Souques is also credited with introducing the term "camptocormia" to describe an abnormal forward-flexed posture.
As men's basketball head coach for the 1916–17 season, he directed the Longhorns to a 13–3 overall record (7–1 in conference play) and their third consecutive Southwest Conference championship. In 1921, Van Gent coached the Stanford Cardinal football team, compiling a 4–2–2 record. Van Gent also coached Stanford's basketball team in 1921–22. He fell ill with encephalitis lethargica in December 1922 and was hospitalized in San Francisco.
During the run Muriel Hewitt began to show early symptoms of encephalitis lethargica, a progressive and ultimately fatal illness.O'Connor, pp. 56, 58–59 Peggy Ashcroft in 1936, near the beginning of her long professional association with Richardson Richardson left the run of Yellow Sands in March 1928 and rejoined Ayliff, playing Pygmalion in Back to Methuselah at the Royal Court Theatre; also in the cast was a former colleague from the Birmingham Repertory, Laurence Olivier.
In 1901 he was living at 8 Douglas Road, Nottingham 1901 British Census and he subsequently lived on Richmond Drive and then Woodland Drive in Mapperley Park in Nottingham. His daughter Jessie Kathleen was born on 18 April 1901. In 1911, he was living at Hillcrest, Warwick Road, Nottingham, (1911 UK Census) and then moved to 205 Derby Road, Nottingham shortly before his death. He died at home on 5 November 1929 of Encephalitis Lethargica, diagnosed 5 years earlier.
At the time of his move south, Meehan was rated one of the best half-backs in England, and made his debut for the national side in October 1923. He was a regular in the Chelsea team over the next three years, playing in 133 games for the club, before being struck down with encephalitis lethargica, an inflammation of the brain which had reached an epidemic scale in the years after the First World War. He died in 1924.
In the ten years that the pandemic raged, nearly five million people's lives were taken or ravaged. Encephalitis lethargica assumed its most virulent form between October 1918 and January 1919. The pandemic disappeared in 1927 as abruptly and mysteriously as it first appeared. The great encephalitis pandemic coincided with the 1918 influenza pandemic, and it is likely that the influenza virus potentiated the effects of the encephalitis virus or lowered resistance to it in a catastrophic way.
It may also be seen in many medical disorders including infections (such as encephalitis), autoimmune disorders, meningitis, focal neurological lesions (including strokes), alcohol withdrawal, abrupt or overly rapid benzodiazepine withdrawal, cerebrovascular disease, neoplasms, head injury, and some metabolic conditions: homocystinuria, diabetic ketoacidosis, hepatic encephalopathy and hypercalcaemia. It can be an adverse reaction to prescribed medication. It bears similarity to conditions such as encephalitis lethargica and neuroleptic malignant syndrome. There are a variety of treatments available; benzodiazepines are a first-line treatment strategy.
Lévy's first article was a collaboration with Pierre Marie describing 10 cases of movement disorders associated with encephalitis lethargica. She subsequently published another 13 articles on the subject of postencephalitic syndromes, culminating in her 314-page thesis, published in 1922 and titled "Contributions à l'étude des manifestations tardives de l'encéphalite épidémique". Her thesis was based on the personal study of 129 cases from the Salpêtrière hospital, and contained over 700 references. It was reviewed by Eduard Feindel, who described it as rich in facts and original ideas.
Although the individual may sound like they are in pain, there does not appear to be any actual physical discomfort. The shouting can be accompanied by other symptoms, such as oculogyric crises or other involuntary movements. The presentation of klazomania has been compared to temporal lobe epilepsy, although the two can be distinguished by the duration of the attack and the fact that the patient experiencing klazomania appears to retain consciousness. A 1961 report by Wohlfart described a postman known as K.R. who contracted encephalitis lethargica at the age of 12.
Born in Ashfield, New South Wales, to Maria Louisa Miles (née Binnington), and the third of five surviving children, she grew up in the Sydney suburb of St Ives. Her father, William John Miles, was a wealthy public accountant and hotheaded businessman who had a tempestuous relationship with his daughter. She studied at Abbotsleigh School and enrolled in an arts course, but opted out, citing a lack of Australian subject matter. Miles also enrolled in medicine, which was unusual for women at that time, but in the first year she contracted encephalitis lethargica.
Awakenings is a 1990 American drama film based on Oliver Sacks's 1973 memoir of the same title. It tells the story of a fictional character, Dr. Malcolm Sayer, which is based on a real life experience of the author, who, in 1969, discovers beneficial effects of the drug L-Dopa. He administers it to catatonic patients who survived the 1917–28 epidemic of encephalitis lethargica. Leonard Lowe and the rest of the patients are awakened after decades and have to deal with a new life in a new time.
The cause of the symptoms of those who claimed affliction continues to be a subject of interest. Various medical and psychological explanations for the observed symptoms have been explored by researchers, including psychological hysteria in response to Indian attacks, convulsive ergotism caused by eating rye bread made from grain infected by the fungus Claviceps purpurea (a natural substance from which LSD is derived),Secrets of the Dead: The Witches Curse, pbs.org; accessed December 24, 2014. an epidemic of bird-borne encephalitis lethargica, and sleep paralysis to explain the nocturnal attacks alleged by some of the accusers.
Although the cause of klazomania is unknown, it is considered to be associated with encephalitis lethargica; a 2006 journal review by Jankovic and Mejia attributes klazomania to tourettism (tics not due to Tourette syndrome), widely seen after the encephalitic lethargica pandemic of 1916 to 1927. Wohlfart (1961) hypothesized that klazomania is caused by an irritating lesion in the mesencephalon and a malfunction in the control of the motor circuit from the substantia nigra in the mesencephalon to the globus pallidus in the striatum (mesostraital pathway). This circuit becomes overstimulated during a mesencephalic "fit". In a 1996 report of one case, Bates et al.
The first sightings of bradyphrenia were documented by French neurologist Naville in the early 20th century, during the time of the epidemic of encephalitis lethargica, as it appears, he was investigating this disorder. The epidemic was a condition of the enlargement of the brain (encephalitis) where patients would experience mental delays and remain motionless for extended periods of time due to an unknown cause. Naville was dealing with patients experiencing several symptoms which he could only describe as a gradual brain impairment. Several symptoms listed included decreased attention span, memory and lack of motivation to perform any tasks.
In the 1980s, a large cohort of children with OCD were being evaluated prospectively. Following a streptococcal infection, a subgroup of children expressed OCD symptom exacerbations that were characterized as “coming on overnight.” The primary hypothesis derived from this study is that in some cases, OCD may develop as a consequence of an autoimmune reaction in which antibodies to streptococcal infections attack and damage the basal ganglia. Obsessions and compulsions are also very common in several other medical conditions, including: Tourette syndrome, Parkinson disease, epilepsy, schizophrenia, Huntington disease, encephalitis lethargica, Sydenham chorea, and damage to specific brain regions.
Many surviving patients of the 1915–1926 encephalitis lethargica pandemic seemed to make a complete recovery and return to their normal lives. However, the majority of survivors subsequently developed neurological or psychiatric disorders, often after years or decades of seemingly perfect health. Post-encephalitic syndromes varied widely: sometimes they proceeded rapidly, leading to profound disability or death; sometimes very slowly; sometimes they progressed to a certain point and then stayed at this point for years or decades; and sometimes, following their initial onslaught, they remitted and disappeared. Postencephaltic Parkinsonism is perhaps the most widely recognized of such syndromes.
Borthwick left Ireland in 1919 to live with her sister Grace Hay Borthwick, due to her own declining health. They first lived in Newcastle upon Tyne, then Scalfay in the Shetland Islands, and finally at Kilbride House, Kilbride, Skye in the late 1920s. By this point Borthwick was paralysed and unable to speak, having contracted encephalitis lethargica or sleeping sickness in the wake of World War I. When she died at Kilbride on 13 June 1934, she had suffered from sleeping sickness for 16 years, Parkinsonism for six years, and bulbar paralysis for two years. She is buried on the island.
In 1600, the Lenape population may have numbered as many as 20,000. Several wars, at least 14 separate epidemics of new infectious diseases (yellow fever, smallpox, influenza, encephalitis lethargica, etc.), and disastrous over-harvesting of the animal populations reduced the Lenape population to around 4,000 total by 1700. The Lenape people, like all Native Americans, had no immunity to Eurasian diseases, which had been endemic in European cities for centuries after arriving from Asia; and they suffered high fatality rates from the diseases.Penn Treaty Museum"Lenape" , Ulster County As the Lenape population declined and the European population increased, the history of the area was increasingly defined by the new European inhabitants.
The treatment of children with similar behavioral problems who had survived the epidemic of encephalitis lethargica from 1917 to 1918 and the pandemic of influenza from 1919 to 1920 led to terminology which referred to "brain damage." This would also be called "post-encephalitic behavior disorder." The association of symptoms similar to ADHD in the surviving children eventually led later authors to speculate that whenever the behavior pattern may be present, it may reflect an underlying disturbance of or damage to the brain. The syndrome came to be known as brain-injured child syndrome, to be amended later to minimal brain damage, and subsequently to minimal brain dysfunction.
He noted both nature and nurture could be influencing this disorder. Alfred Tredgold proposed an association between brain damage and behavioral or learning problems which was able to be validated by the encephalitis lethargica epidemic from 1917 through 1928. The terminology used to describe the condition has changed over time and has included: in the DSM-I (1952) "minimal brain dysfunction," in the DSM-II (1968) "hyperkinetic reaction of childhood," and in the DSM-III (1980) "attention-deficit disorder (ADD) with or without hyperactivity." In 1987 this was changed to ADHD in the DSM-III-R and the DSM-IV in 1994 split the diagnosis into three subtypes, ADHD inattentive type, ADHD hyperactive-impulsive type and ADHD combined type.
In 1898, he followed Forlanini to the University of Pavia where he continued to contribute to the development of Forlanini's method by showing that the technique did not have a major adverse effect on lung function. From 1900 until 1928 was chief clinician and director of the civic hospital in Varese, and helped to modernize the hospital by opening sanatorium wings and introducing vaccination, radiology and other methods to fight tuberculosis. From 1909 to 1916, he occupied the first chair of pediatrics at Pavia University. Illustration of Riva-Rocci's spygmomanometer in use In 1928 he retired from his medical positions due to a neurological condition, probably encephalitis lethargica, which he may have contracted from a patient or an autopsy during an epidemic in 1921.
The stream-of-consciousness novel tells the story of a psychiatrist Zack Busner and his treatment of a patient at Friern Hospital in 1971 who has encephalitis lethargica and has been in a vegetative state since 1918, when she was a munitions worker. The patient, Audrey Death, has two brothers whose activities before and during the First World War are interwoven into her own story. Busner brings her back to consciousness using a new drug (L-Dopa, which was used for the same purpose by Oliver Sacks in the 1970s). In the final element of the story, in 2010 the asylum is no longer in existence and the recently retired Busner travels across north London trying to find the truth about his experience with his patient.
An exploration of the modern world, going back to World War I. The novel takes place at three different times during the long 20th century: the time around World War I, the early 1970s, and the present day. Retired psychiatrist Zack Busner looks back at his days as a doctor at a mental hospital in the early 1970s, when he successfully woke up a number of patients suffering from encephalitis lethargica by applying the drug L-DOPA. As a backdrop to the story, we learn of patient Audrey Death's experiences during World War I, and the very diverse careers of her two brothers. As Busner's experiment shows unexpected consequences, it appears the encephalitic patients' condition – with their endless repetition of mechanical movements – is little more than a manifestation of the condition of 20th century man.
Stern is author of the 1920s definitive book Die Epidemische Encephalitis (1920 and 2nd ed. 1928). Stern was driven to suicide during World War II by the German state, his research forgotten. In 2010, in a substantial Oxford University Press compendium reviewing the historic and contemporary views on EL, its editor, Joel Vilensky of the Indiana University School of Medicine, quotes Pool, writing in 1930, who states, "we must confess that etiology is still obscure, the causative agent still unknown, the pathological riddle still unsolved…", and goes on to offer the following conclusion, as of that publication date:Subsequent to publication of this compendium, an enterovirus was discovered in encephalitis lethargica cases from the epidemic. In 2012, Oliver Sacks acknowledged this virus as the probable cause of the disease.
In the winter of 1916–1917, a "new" illness suddenly appeared in Vienna and other cities, and rapidly spread world-wide over the next three years. Earlier reports appeared throughout Europe as early as the winter of 1915–1916, but communication about the disease was slow and chaotic, given the varied manifestation of symptoms and difficulties disseminating information in wartime. Until Constantin von Economo identified a unique pattern of damage among the brains of deceased patients and introduced the unifying name encephalitis lethargica, reports of the protean disease came in under a range of names: botulism, toxic ophthalmoplegia, epidemic stupor, epidemic lethargic encephalitis, acute polioencephalitis, Heine-Medin disease, bulbar paralysis, hystero-epilepsy, acute dementia, and sometimes just "an obscure disease with cerebral symptoms." Just ten days before von Economo's breakthrough in Vienna, Jean- René Cruchet described forty cases of "subacute encephalomyelitis" in France.
After Sacks received his medical degree from The Queen's College, Oxford in 1960, he interned at Middlesex Hospital (now part of University College, London) before moving to the US. He then interned at Mount Zion Hospital in San Francisco and completed his residency in neurology and neuropathology at the University of California, Los Angeles (UCLA). He relocated to New York in 1965, where he first worked under a paid fellowship in neurochemistry and neuropathology at the Albert Einstein College of Medicine. Upon realising that the neuro-research career he envisioned for himself would be a poor fit, in 1966 he began serving as neurologist at Beth Abraham Hospital's chronic-care facility in the Bronx. While there, he worked with a group of survivors of the 1920s sleeping sickness encephalitis lethargica, who had been unable to move on their own for decades.
A middle-aged woman named Deborah, who has been in a comatose state for thirty years as a result of contracting "sleepy sickness," encephalitis lethargica, awakes with a mind still that of a sixteen-year-old. She must confront a body which seems to have aged without her prior knowledge or consent. Her sister Pauline and Pauline's husband, Hornby, who has been Deborah's devoted doctor over these three decades and who may have fallen in love with her, attempt gently to ease her back to her current reality, while withholding some of the more jarring information. Deborah reawakens to a changed world, attempting to take what appear to her to be rather shocking revelations in graceful stride, but ends the play with the ironic observation about her sister and brother-in-law that can only go so far towards accepting the realities that they have allowed her to know.
In addition to his academic career Lees has written a book about the city of Liverpool and the authorized biography of footballer Ray Kennedy. Lees also served as medical advisor to Patient 39 the film adaptation of a William Boyd short story and has written about how both Conan Doyle and William Burroughs have influenced his career as a neurologist. Lees was a longstanding friend of Oliver Sacks, who also trained at National Hospital for Neurology and Neurosurgery, Queen Square, London and was acknowledged in the preface of Sacks books Awakenings, a story about L-dopa treatment of encephalitis lethargica which was made into a film starring Robert De Niro and Robin Williams and The Island of the Colour Blind, which deals with parkinsonism caused by Lytico-bodig disease. In his memoir "Mentored by a Madman" Lees explains his career was influenced by Arthur Conan Doyle's character Sherlock Holmes and by the self-experimentation of William S. Burroughs, author of Naked Lunch.
In 1969, Dr. Malcolm Sayer (Robin Williams) is a dedicated, genuine, and caring physician at a local hospital in the Bronx borough of New York City. After working extensively with the catatonic patients who survived the 1917–1928 epidemic of encephalitis lethargica, Sayer discovers certain stimuli will reach beyond the patients' respective catatonic states; actions such as catching a ball, hearing familiar music, being called by their own name, and experiencing human touch all have unique effects on particular patients and offer a glimpse into their worlds. Leonard Lowe (Robert De Niro) proves elusive in this regard, but Sayer soon discovers that Leonard is able to communicate with him by using an Ouija board. After attending a lecture at a conference on the subject of the L-Dopa drug and its success with patients suffering from Parkinson's disease, Sayer believes the drug may offer a breakthrough for his own group of patients.

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