Encephalitis Lethargica: The Sleepy Sickness of the 1920s

By | July 30, 2019

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Robin Williams and Robert De Niro in Awakenings. Source: (oscarchamps.com)

In the 1990 film Awakenings, Robin Williams starred as a 1960s doctor working with patients who had been left catatonic due to a 1920s epidemic of a mysterious illness. The movie, based on the book of the same name written by Dr. Oliver Sacks, was inspired by real events and the mysterious illness was Encephalitis lethargica, also known as von Economo disease or “sleepy sickness.”

While the sickness didn’t reach epidemic proportions until after the end of World War I, the earliest cases appeared among the soldiers around 1915 or 1916. These soldiers experienced symptoms including lethargy and confusion. They were examined by doctors in Paris who initially believed the symptoms to be a reaction to the mustard gas used during the war, but that idea was later disproved when the same symptoms began to appear among civilians.

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Constantin von Economo. Source: (investigacionyciencia.es)

The symptoms were observed by a neurologist from Vienna named Constantin von Economo. In 1917, he published a paper on his observations entitled “Die Encephalitis lethargica.” In his paper, he described the illness as “a kind of sleeping sickness.” According to his observations, the early symptoms included headaches and uneasiness, followed by drowsiness and delirium. In some cases, the delirium led to death while others resulted in a persistent catatonic state.

Von Economo went on to detail variations in the presentations of the illness. He identified the hyperkinetic form which involved rapid motor movements, twitching, anxiousness, insomnia, and restlessness. Another form, the amyostatic-akinetic form, presented similarly to Parkinson’s Disease. But the deadliest form, somnolent-ophthalmoplegic, was characterized by the subject falling asleep at random times before slipping into a comatose state. Those with the third form who didn’t die were left in a catatonic state like the patients in the aforementioned movie.