1919–1930 encephalitis lethargica epidemic

none 200px Title page of Encephalitis Lethargica, Economo, 1931 1918–1930 Encephalitis lethargica epidemic Deaths 20% mortality The epidemic of encephalitis lethargica lasted from around 1918 to 1930.Dourmashkin R R September 1997 What caused the 1918–30 Epidemic of Encephalitis Lethargica? Journal of the Royal Society of Medicine en 90 9 515–520 10.1177/014107689709000916 0141-0768 1296535 9370993 The cause is still unknown.Encephalitis Lethargica https://www.ninds.nih.gov/health-information/disorders/encephalitis?search-term=Lethargica National Institute of Neurological Disorders and Stroke 7 July 2023 en 7 July 2023 https://web.archive.org/web/20230707175735/https://www.ninds.nih.gov/health-information/disorders/encephalitis-lethargica live Though the cause was once attributed to the coinciding Spanish flu epidemic, modern research has disputed this claim.McCall Sherman Henry James M. Reid Ann H. Taubenberger Jeffery K. Influenza RNA not Detected in Archival Brain Tissues from Acute Encephalitis Lethargica Cases or in postencephalitic parkinson Cases Journal of Neuropathology & Experimental Neurology July 2001 60 7 696–704 10.1093/jnen/60.7.696 https://academic.oup.com/jnen/article/60/7/696/2916255?searchresult=1&login=false 7 July 2023 free 11444798 7 July 2023 https://web.archive.org/web/20230707165014/https://academic.oup.com/jnen/article/60/7/696/2916255?searchresult=1&login=false live The mortality was as high as 20%.Shorter Edward The first psychiatric pandemic: Encephalitis lethargica, 1917-27 Medical Hypotheses January 2021 146 110420 10.1016/j.mehy.2020.110420 33268001 227261441 1532-2777 The epidemic is thought to have started in Romania during 1915, and the disease supposedly spread through the movement of the various troops during World War I. In 1917, it reached the epidemic status in Vienna, where it was first described. Disease outbreaks of encephalitis were first reported in England and France during 1918, followed by Canada, Central America, India, and the United States in 1919. Disease outbreaks were also reported in Germany and the Soviet Union during 1920. The epidemic peaked between 1920 and 1929, with an estimated one million people diagnosed with encephalitis lethargica during the epidemic period. The disease suddenly disappeared in the beginning of the 1930s. In the aftermath of the epidemic, many cases of post-encephalitic parkinsonism were reported. This condition was distinctive from idiopathic Parkinson's disease, as it occurs in younger patients than typical idiopathic Parkinson's disease, and lacks the "pill-rolling tremor" of idiopathic Parkinson's disease. Background Encephalitis lethargica is a neurological syndrome that causes lethargy, a "mask like" face, excessive blood in the meninges, and other general neurological symptoms.Hoffman Leslie A Vilensky Joel A Encephalitis lethargica: 100 years after the epidemic Brain 1 August 2017 140 8 2246–2251 10.1093/brain/awx177 https://academic.oup.com/brain/article/140/8/2246/3970828?login=false 7 July 2023 free 28899018 7 July 2023 https://web.archive.org/web/20230707165235/https://academic.oup.com/brain/article/140/8/2246/3970828?login=false live subscription Officially recognized as its own condition in 1917, it is believed to have existed far longer in human history. It is known to cause post-encephalitic parkinsonism. Timeline According to Urechia (1921), the pandemic possibly started in 1915, Romania. It is believed that the disease spread through the movement of the troops during World War I.Hoffman Leslie A. Vilensky Joel A. 2017 Encephalitis lethargica: 100 years after the epidemic https://academic.oup.com/brain/article/140/8/2246/3970828 15 March 2025 Brain 140 8 Oxford University Press 2246–2251 10.1093/brain/awx177 28899018 subscription In 1917, it reached the epidemic status in Vienna, where it was first described.Rogers Jonathan 30 October 2024 A Million Were Struck by This Mysterious Disease Before It Vanished https://www.sciencealert.com/a-million-were-struck-by-this-mysterious-disease-before-it-vanished ScienceAlert 18 March 2025 https://web.archive.org/web/20250318155143/https://www.sciencealert.com/a-million-were-struck-by-this-mysterious-disease-before-it-vanished 18 March 2025 It was followed by France and England in 1918. In 1919, the disease was present in Europe, the US, Canada, Central America, and India. In 1920, the disease was present in the Soviet Union and Germany.Williams David Bruce 2020 Encephalitis Lethargica: The Challenge of Structure and Function in Neuropsychiatry Archives of Medicine and Health Sciences 8 2 Yenepoya University 255–262 10.4103/amhs.amhs_308_20 free Neurologist Constantin von Economo published a paper in April 1917 on six cases he encountered in the winter months of 1916 and 1917 in the Psychiatric-Neurological Clinic of the University of Vienna. These patients, despite their various previous diagnoses, had a similar pattern of symptoms. This led him to suggest a novel disease, which he named Encephalitis lethargica. In France, physician René Cruchet was encountering similar patterns, and published his findings within a few days of Constantin von Economo. Following these two reports, many more cases were reported, first in Europe, but quickly spreading around the globe. Reviews from both works considers Economo as the first to describe the disease, while Cruchet reported a group of heterogeneous conditions. Initially, encephalitis lethargica main symptoms were described as somnolence and lethargy, but after 1919 cases of insomnia and hyperkinesia appeared. Economo also described hiccups as a symptom, which was later linked to the hyperkinetic–insomniac variety of encephalitis lethargica, but no case between 1920 and 1930 showed this symptom. Endocrine symptoms, such as diabetes, were only present in cases described between 1922 and 1923. Following von Economo description of the disease, many speculated that it had the same cause as the Spanish flu. Many poorly conducted experiments pointed to that hypothesis, but in 1923 Simon Flexner highlighted the problems with the investigations.Vilensky Joel A. Foley Paul Gilman Sid 2007 Children and Encephalitis Lethargica: A Historical Review https://www.sciencedirect.com/science/article/abs/pii/S0887899407001944 19 March 2025 Pediatric Neurology 37 2 Elsevier 79–84 10.1016/j.pediatrneurol.2007.04.012 17675021 subscription William Matheson founded the Matheson Commission in 1927, promising to find a cure to encephalitis lethargica within two years. They worked with two main hypothesis, that encephalitis lethargica was a form of herpes or it was a focal infection resulting from a neurotropic form of Streptococcus viridans. The commission ended in 1940 without finding the cure, but it produced data about the disease. The epidemic peaked between 1920 and 1929, with an estimated million people diagnosed with encephalitis lethargica during the epidemic period. In the beginning of 1930s, the disease suddenly disappeared, and the attention of the medical community changed to more pressing matters.Rosen Dennis 2010 Asleep: the Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries Journal of Clinical Sleep Medicine 6 3 American Academy of Sleep Medicine 299 10.5664/jcsm.27831 2883045 During the pandemic, approximately 9000 papers about encephalitis lethargica were published. Causes The causes of encephalitis lethargica are still unknown. Though the connection to the Spanish flu epidemic is often made, the encephalitis outbreak did begin slightly earlier. However, this cannot disprove the claim, simply point out that not all of the existing evidence lines up. Aftermath In the aftermath of the epidemic, many cases of post-encephalitic parkinsonism were reported. This condition was distinctive from idiopathic Parkinson's disease, as it occurs in younger patients than typical idiopathic Parkinson's disease, and lacks the "pill-rolling tremor" of idiopathic Parkinson's disease. Estimates of the number of people infected varies greatly, from a thousand to a million. The estimated mortality varies between 15% and 40%. It is estimated that 50–75% of cases went unreported. At the same time, the number of reported cases may have been inflated by overdiagnosis due to the description of generic symptoms and lack of established diagnostic criteria. Popular culture Books Crosby, Molly Caldwell: Asleep: the Forgotten Epidemic That Remains One of Medicine's Greatest Mysteries (2010) Other works Both Sandman comic books and series depict the epidemic. In the story, Dream is locked against his will, thus causing his realm to collapse and the epidemic to start.Orquiola John 5 August 2022 The True Story Of The Sandman's Sleeping Sickness Of 1916 https://screenrant.com/the-true-story-of-the-sandmans-sleeping-sickness-of-1916/ Screen Rant live 19 February 2025 https://web.archive.org/web/20250320023333/https://screenrant.com/the-true-story-of-the-sandmans-sleeping-sickness-of-1916/ 20 March 2025 The after effects of the pandemic are addressed in the film Awakenings. References Category:1919 disease outbreaks Category:1930 disease outbreaks Category:1910s epidemics Category:1920s epidemics Category:1930s epidemics Category:Encephalitis encephalitis lethargica Category:Disease outbreaks in Romania