History of neurologyA history of oculogyric crises during the encephalitis lethargica pandemic
Section snippets
What is an oculogyric crisis?
Without a prodrome, or only a trembling of the eyelids or blepharospasm, “the eyes suddenly deviate, most often upward, hidden under the upper eyelid which is itself retracted. The patient tries repeatedly to lower their eyes and sometimes adopts a compensatory position of the head” [13], according to Georges Guillain (1876–1961) and Pierre Mollaret (1898–1987). This oculogyric crisis is sometimes also called a “tonic eye fit” (Fig. 1, Fig. 2). Physical exertion, emotions, and peripheral
Inclusion of oculogyric crises in the nosography of encephalitis lethargica
During the session on 13 February 1920 of the Medical Society of the Hospitals in Paris, Victor Morax (1866–1935) and Jacques Bollack (1883–1951) highlighted the frequency of associated ocular movement disturbances compared to the rarity of real opthalmoplegia [27] during the acute phase of encephalitis. They did not mention oculogyric crises. Demonstrating that these crises were little known (noticed), Louis Dor (1866–1954), an ophthalmologist from Lyon, did not mention them in his general
Pathogenic theories
Von Economo's encephalitis lethargica initiated the study of behavioural consequences of subcortical disturbances induced by a supposed viral infection. The acute manifestations, highly variable, included extrapyramidal disturbances, myoclonia, ocular movement disorders, paralysis, psychosis, mood swings, sleep inversion, and catatonia. These main pathological changes implicated the substantia nigra, globus pallidus, and hypothalamus (blocked striatum dopamine receptors). For those that
Conclusion
A century after the emergence of this pandemic, its aetiology remains unknown. After eliminating a toxic origin (botulism), authors writing at the time most often subscribed to the idea of viral infection, but lacked the means to prove it. The fact that this pandemic and the so-called Spanish flu were simultaneous supported this theory even though no virus was recognised as causing the parkinsonian syndrome. The current hypothesis centres on a post-infectious, auto-immune encephalitis primarily
Statement of ethics
This work required no approval from an institutional review board and was prepared in accordance with ethical guidelines of the journal.
Disclosure of interest
The author declare that he has no competing interest.
Funding sources
No funding was obtained for this work.
Acknowledgements
Many thanks to Heinz Krestel, Jacques Poirier, Hubert Déchy, Edward Shorter and to Anna Fitzgerald for her translation.
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