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

vertigo, or trouble sleeping but then make a full recovery. Others became comatose and

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

state that they never recovered from. They 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 dopamine—sometimes 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 cool. He

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 community – and

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' eyes. Instead 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 was “How 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 were “awakened” from 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 symptoms. Nobody 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 patient. In 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.