Placeholder Image

Subtitles section Play video

  • In the decade after WWI, over a million people contracted a mysterious neurological

  • disease called encephalitis lethargica. Sometimes, patients would experience headaches, fever,

  • vertigo, or trouble sleeping but then make a full recoveryOthers became comatose and

  • died. And still others afflicted with the disease slipped into a sleepy, almost comatose

  • state that they never recovered fromThey presented with paralysis of the eye muscles,

  • double vision, and sometimes lost control of their facial muscles, rendering them expressionless.

  • But no two cases were the same, and doctors never figured out what caused the disease

  • or any good treatment options. The epidemic hit its peak in the 1920s and left up to half

  • a million people dead. But a number of patients survived in the sleepy state for decades.

  • Then thirty years later in the 1950s, researchers made a breakthrough into the body's production

  • of the chemical dopaminesometimes known as the happiness chemical. Dopamine treatment

  • was thought to be a miracle cure for Parkinson's disease, and an unconventional and empathetic

  • neurologist named Oliver Sacks wondered if it could also help the forgotten encephalitis

  • lethargica patients, bringing them back into the world after decades in their sleepy state.

  • You may have heard of Oliver Sacks before, but let me tell you, this dude was coolHe

  • rode motorcycles with the Hells Angels and was a competitive weightlifter who at one

  • point squatted 600 pounds! But more than anything, he was a misfit in the medical communityand

  • it was his approach as a clinician that set him apart. See, by the 1950s science had matured

  • to a place that was very modern, analytic -- and distant. In contrast, Oliver was extremely

  • empathetic and tried to see the world through his patients' eyesInstead of treating

  • the disease -- the approach popular in medicine at this time, Oliver treated the person. In

  • the words of one observer, his primary diagnostic question wasHow are you?”. In 1966,

  • he moved to New York and started working at Beth Abraham, a chronic disease hospital.

  • That's where he met a group of 80 patients who had been institutionalized with encephalitis

  • lethargica and they showed little awareness of their surroundings. Their ability to move

  • was severely compromised. They were unable to walk or even speak. Some had been admitted

  • in the 1920s at the peak of the epidemic and had been in their sleepy states for up to

  • 40 years. Now, around that time, researchers were using dopamine in experimental treatments

  • for Parkinson's Disease which presented with many of the same symptoms. So Sacks

  • wondered if their strategies might help with his patients, even though his patients were

  • more severely affected. While we associate dopamine these days as a “happiness chemical”,

  • it has a ton of jobs inside our bodies. In the 1950s, a scientist figured out that dopamine

  • is what's called a neurotransmitter, a chemical that lets nerve cells communicate with each

  • other. That same scientist then experimented with a chemical called DOPA, a chemical precursor

  • to dopamine, and found it alleviated Parkinson's symptoms in animals. A different researcher

  • took a look at the brains of deceased Parkinson's patients and found that they were deficient

  • in dopamine. Making the connection, this researcher proposed giving living Parkinson's patients

  • DOPA as a way to relieve symptoms. From there, scientists found that giving intravenous DOPA

  • improved symptoms of Parkinsons. And a form of the drug called L-DOPA proved especially

  • effective. It was later found that L-DOPA (in the presence of certain enzymes) could

  • cross the blood brain barrier while DOPA could not, making L-DOPA the best medication to

  • treat Parkinsons at the time. By the late 1960s, there was a lot of excitement around

  • L-DOPA in the neurological community. Some of Dr. Sacks's patients actually requested

  • the drug after hearing about it. But Sacks hesitated to use the drug on his patients

  • for 2 full years. Part of that was its prohibitively high cost. The other was the unknown: he was

  • concerned about how his patients would react to the new treatment. Yes, L-DOPA had a good

  • track record in Parkinson's patients, but encephalitis lethargica was a different disease

  • that still wasn't well understood. But following the death of some of his patients in the summer

  • of 1968, Oliver felt compelled to experiment with L-DOPA. So in March of 1969, he began

  • an experiment on a small group of patients. He studied 6 patients total, 3 were put on

  • L-DOPA, 3 were given a placebo for a 90 day long observational study. At first, the treatment

  • was a success. The L-DOPA patients wereawakenedfrom their decades-long sleep. Very quickly

  • after receiving the medication, some were able to speak and even walk for the first

  • time in decades. After seeing success in the trial, Sacks started treating his other encephalitis

  • lethargica patients with L-DOPA. They improved dramatically at first, but quickly developed

  • tolerance to the medication and needed increased dosage to keep their symptoms at bay. To this

  • day, we still don't know why. One idea is that some of the patients who had the disease

  • had symptoms that were exacerbated by some of the metabolic byproducts of dopamine. So

  • as patients took L-DOPA, their bodies metabolized it which created this byproduct that caused

  • other symptomsNobody has researched this hypothesis specifically on encephalitis lethargica

  • patients, but research from other brain disorders points in that direction. Regardless, Oliver

  • had a drug that he knew would help people, so he was compelled to share his results,

  • but his study was more observational than traditionally quantitative, so his work was

  • rejected by professional journals. Unable to publish in the medical literature, he described

  • his findings in a book, Awakenings, which was released in 1973. And not only did he

  • document how dopamine was involved in encephalitis lethargica, he gave detailed case histories

  • for each patientIn Awakenings, each patient is described by name, not relegated to a number.

  • And therein lies his legacy. Sacks wasn't the only person experimenting with L-DOPA

  • at the time, but his observations were meticulous and described his patients' Parkinson's-like

  • symptoms better than anyone else. He aimed a spotlight on the value of minute observation

  • and description. His lasting impact on medicine is his empathetic and personal approach to

  • treatment and his insistence on the individuality of every patient. His work finally caught

  • a more popular audience when Awakenings was adapted into a Hollywood movie starring Robert

  • de Niro and Robin Williams in 1990. Having read Awakenings, I was struck at how Oliver

  • wrote his patients' case histories in such a vivid and empathetic way. As a reader, I

  • couldn't help but to put myself in the patients' shoes. Oliver Sacks turned observations into

  • humanized stories, giving a face and voice to patients with chronic mental and neurological

  • conditions. This approach of treating the person, not the disease would ultimately make

  • him a key figure in modern neurology , and his work has now inspired generations of younger

  • doctors. If you're interested in the story of Dr. Oliver Sacks and the rest of his work,

  • check out Oliver Sacks: His Own Life, now streaming on PBS and available on major platforms!

  • And as always, we appreciate when you like the video, and subscribe. Thanks for watching.

In the decade after WWI, over a million people contracted a mysterious neurological

Subtitles and vocabulary

Operation of videos Adjust the video here to display the subtitles

B1 dopamine oliver parkinson disease neurological chemical

This Neurological Disease Kept People Sleeping for 40 Years

  • 3 1
    Summer posted on 2021/04/30
Video vocabulary