Awakenings

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Awakenings
In 1973, Dr. Oliver Sacks published his book AWAKENINGS. It is a remarkable account of a group of patients who had contracted encephalitis lethargica during a great epidemic just after World War I. Frozen in a decades-long sleep, these men and women were given up as hopeless until 1969, when Dr. Sacks gave them the new drug L-DOPA. It had an explosive, "awakening" effect.
The neurological disease depicted in The Awakenings is encephalitis lethargica, or sleeping sickness. Encephalitis is an acute inflammation of the brain caused by either a direct attack by any of several viruses or an allergic response to any of the many viruses that are generally harmless to the central nervous system. It is characterized by a high fever, double vision, delayed physical and mental response, and lethargy. Lethargy is a condition of functional exhaustion. In acute cases, patients can go into a coma. Patients may also experience irregular eye movements, upper body weakness, muscular pains, tremors, neck rigidity, and behavioral alterations.

There was an outbreak of encephalitis lethargica in the winter of 1916-1917. The patients were pretty much motionless in time, incapable of moving or speaking but still responsive. When doctors observed the brains of patients with the sickness, they found that those who demonstrated minimal symptoms had minimal tissue damage and those that showed almost all of the symptoms had larger amounts of tissue damage. Encephalitis lethargica also causes the inflammation of the adjacent meninges. Meninges are the three membranes covering the brain and spinal cord. Patients will have spasms and will suffer ticks. A diagnosis of encephalitis is based on signs of basal ganglia involvement, oculogyric crises, ophthalmoplegia, obsessive-compulsive behavior, akinetic mutism, central respiratory irregularities, and sleep inversions.
The patients in the story had very different ways of dealing with their di...