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The first psychiatric pandemic: Encephalitis lethargica, 1917-27
1Jason A Hannah Professor of the History of Medicine, Professor of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 263 McCaul Street, Room 408, Toronto, ON M5T 1W7, Canada.
Medical Hypotheses
|December 3, 2020
Summary
The 1917-1927 encephalitis lethargica (EL) pandemic caused severe psychiatric issues and long-term neurological problems, offering insights into current COVID-19 neurological sequelae. Understanding EL
Area of Science:
- Neurology
- Psychiatry
- Epidemiology
Background:
- The COVID-19 pandemic has renewed interest in the psychiatric consequences of pandemics.
- Encephalitis lethargica (EL), also known as Von Economo's Disease, represents a historical parallel.
Observation:
- The EL epidemic (1917-1927) was the first central nervous system pandemic.
- It affected children significantly, causing personality changes and lasting postencephalitic Parkinsonism (PEP).
- EL had a high mortality rate (around 20%) and prominent psychiatric morbidity, including depression, mania, catatonia, and psychosis.
Findings:
- Unlike coronavirus, EL heavily impacted children and had a high mortality rate.
- Psychiatric symptoms were a major feature of EL, with long-term sequelae such as PEP.
- EL concluded without specific therapeutic or public-health interventions.
Implications:
- Lessons from the EL psychiatric pandemic may inform the study of long COVID psychiatric symptoms.
- Historical pandemics provide valuable models for understanding current neurological and psychiatric sequelae.
- Continued sporadic cases of EL highlight the potential for neurotropic viral impacts.
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