Encephalitis Lethargica

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Bizarre neural condition.

"Awakening" with Robin Williams depicts it.

The contention being, as Williams illustrated to the guest-speaker/chemist in that flick, that the postural/muscular rigidity was a far gone form of parkinsonian based syndrome where dystonia became so extreme that the movement disorders essentially unified and caused an overall "locked" paralysis.

Clearly a neural/neurological disorder, affecting excitatory cellular function (neural/muscular).

What's most interdasting however, is the films portrayal and illustration of not only neural/physiological symptoms, but cognitive functional symptoms and anomalies in perspective of their clear neural impairment.

So - neuro-cognition, the two separate expressions are almost characterized as essential synonyms of one another.

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I mention this specifically as there are other uncommon but devastating and poorly understood neural conditions,

Example:

https://www.youtube.com/watch?v=OwbD5Bn96TI

Which was in a sense a form of "locked in syndrome",

https://en.wikipedia.org/wiki/Locked-in_syndrome#:~:text=Neurology%2C%20Psychiatry,vertical%20eye%20movements%20and%20blinking.



What they all have in common is, they're so devastating the reality of living with them is, as "Awakenings" describes, "unimaginable".

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Encephalitis Lethargica = thought to be caused by an autoimmune response.

Of which thought most likely to be caused by an Enterovirus (intestinal contraction).

Deficit of adequate dopamine transmission as per parkinsonian symptoms of muscular dystonia (loss of movement control), extremely exacerbated to the point of paralysis.

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BUT, they remain cognitively responsive... to certain stimuli;

As per,

https://www.youtube.com/watch?v=Hj52vD7KGxs

This conflates with the OP vid linked, 6:40 timestamp illustrates a new caregiver intuitively sensed the afflicted "Martin" was actually cognizant underneath, despite his outward paralysis.

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Specific to E.L., treatment takes the form of addressing the immune response, symptom specific remediation and steroid treatment for muscular symptoms is noted as yielding benefit.

Obviously "Awakening's" illustrated conventional Parkinsons treatment of dopamine precursor compound administration "L-Dopa" as rendering a profound, though short lived improvement.

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Responsive to specific/certain cognitive stimuli.

Movement disorder most specifically related to the transmitter Dopamine - which is the "reward" transmitter.

Relative to dystonia, movement disorder, is this case catatonia, ADHD, addiction and impulse/reward based behavior.

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Cognitive stimuli - reward behavior.

The effective cognitive stimuli is rewarding in some capacity, stimulates their neuro-cognitive impulse (neural action potential) - facilitating dopamine release?

Transcending dopamine transmission impairment?

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In the case of brain hemorrhaging causing neural impairment leading to a case of locked in syndrome (i.e. cognitively aware but completely impaired).

There was actually a nice scene from the TV series "Better Call Saul" with the character Hector, after suffering a stroke, the Johns Hopskins Dr concisely explains restoration of neural pathways = restoration of cognitive function.

Thus his rehabilitation treatment is cognitive encouragement,

(starts at 0:23 - boards.ie still not coded to facilitate time stamping).

Cognitive stimulation = restoration of functional neural process.

"The more you speak to him, the more his brain will work and find ways to restore functional neural pathways".

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Scenes in "Awakenings" outlining disease onset (resulting from infection associated with brain inflammation, encephalitis related):

https://www.youtube.com/watch?v=Cm7Y6gFjVvg

So, we can clearly see the characters functionality is limited specifically by some kind of cognitive blockade.

When the Dr identifies an intervention to reinstate a sense of cognitive "flow", her functionality assumes the accordant restoration.

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From https://en.wikipedia.org/wiki/Dopamine#Cellular_effects

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Relative to dopamine - general over view:



Dopamine effects in central nervous system:



Reward/motivational behaviour and impetus associated with dopamine:



Noting here primary dopaminergic projections occur through the pre-frontal cortex, the brains cognitive control center.

Pleasure associated with dopamine, related pleasure seeking behavior and associated motivational impetus:



There's another thread active on this sub' currently questioning why anit-psychotics are so fatigue inducing.

Perhaps related to induction of anhedonia or absence of ability to experience pleasure.
In doing so, reduces natural reward based behavior and basically takes the joy out of life experiences?

The condition being discussed here is "encephalitis lethergica", treated with dopamine elevation and primary symptom obviously "lethargy".

Therefore, in it's treatment with L-Dopa we can see an improvement in motivational related behaviour, cognition and overall functionality.
Therefore could infer with dopamine blockers, an exacerbation or emergence of those symptoms, reduced motivation and goal oriented behavior - thus associated letheragy?

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Ees posible.

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"Borrows the will of the ball....".

There's a subsequent scene at a later time in the film where a nurse demonstrates an immobile patient who cannot walk, CAN walk, when assisted by her.

"It's like he borrows my will", as she describes.

So, "will", relativity to dopamine - and I believe the other point mentioned, anhedonia or loss of ability to feel or experience pleasure (associated with dopamine blockers like anti-psychotics - notorious for induction of lethargy).

Dopamines most powerful affect is pleasure and reinforcement, thus the thinking in relation to its relativity to reinforcing and addiction behaviors and disorders; gambling addiction, spending addiction, sexual behavior etc., driven by will to experience that dopamine rush.

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What I'm highlighting is there's clearly a cognitive underpinning to this process.

And I contend that cognitive compromise leads to neural dysfunction and decline, like we see in late life disorders like multiple sclerosis, parkinsons, alzheimers, old age depression etc.

Cause why?

Cause cognition dictates the integrity of the nervous system (however geneticists may argue that, the integrity of the nervous system dictates cognition.....).

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"Borrows the will of the ball....".

Think of a personal trainer or "spotter" at a gym, it's like the client borrows their will, to push themselves a little harder, i.e. function a little better.

Why do people meet up in athletics clubs?

Cause being part of a team, they push themselves to train a little harder - maybe at all.
i.e. without adequate motivation, it can suck to acquire the "will" to go do 10 hard miles by oneself.

Reward.

Cognition.

Dopamine.

Function.

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In terms of behavioral affects naturally the two other transmitters are Serotonin (sociability related - and impulse control), noradrenaline (executive function, also cognition, related to dopamine in the PFC).

Reward......



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Seemed appropriate.

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Encephatlis lethergica thought to be caused by neural inflammation condition of some kind not dissimilar to meningitis, following a flu virus.

There was some kind of neural and therefore cognitive (therefore functional) impairment.

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Following trauma or injury to ones pudendal nerve complex (nerve that innervates the genital region), the sensitive area can actually rewire itself such that stimulation of an area NOT the genital region can cause them to experience climax.

The point is, neural regrowth, nerve regrowth = a certainty it can happen.
Documented cases of it happening.

Similar to Hector from BCS rewiring his brain after blood deprivation (stroke/ischemia) and loss of neural function thus in a state of dysfunctional catatonia.

However, cognitive testing and intervention - as that clip outlines, rewiring and subsequent return of cognitive function and control, CAN occur.
It's the basis of neurological rehabilitation.

https://www.youtube.com/watch?v=gqt96H02Mpk

Clip outlines nature of some cognitive/neural testing, and attempts to find effective cognitive interventions to stimulate improved nerve activity.

Notably it outlines human touch, contact, intimacy on some level - can act as a nervous system and therefore cognitive "stimulant" in its own right.

I say interestingly as, that applies to just about 100% of people, chronic physiological impairment or no.

Dopamine..... reward......

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As with the "Martin" (12 years in a coma, thought to be dead inside, but completely conscious and aware all the time), that video doesn't outline the nature of his rehabilitation process,

https://en.wikipedia.org/wiki/Martin_Pistorius

but demonstrates that neural restoration via cognitive intervention is a certainty.

Not much info on that case but via his wiki page it does mention,

His parents then gave him a speech computer, and he began slowly regaining some upper body functions

i.e. cognitive function seemed to be related to use of language.

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As a comparison, we know in neurodevelopmental disorders like non-verbal autism (where they're deprived of access to language as a means to rationalize the emotional states), sufferers are prone to emotional dysregulation and thus temper outbursts etc. (to the point where sedatives like anti-psychotics can be administered to manage this).

The deduction being, language and emotional regulation seem to be intrinsically linked.

As we saw in the above "Awakenings" clip, one form of intervention which elicited a cognitive response was, music that appealed to them on an an emotional level,
i.e. "it can't be just any music, it has to be music that's right for them".
"They're only moved by music that moves them".

So two staple point emerging from effective cognitive interventions in neural impairment conditions are:

Language, and emotion.

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So, where were we at.

Cognition = language in perspective of emotion - something like that.

Famed linguist, cognitive scientist, scholar, most cited academic author of all time, Noam Chomsky weighs in on language V cognition in his interview with computer scientist Lex Fridman,

https://www.youtube.com/watch?v=ksZyMpg3HHc

0:42 = "language is the core of human cognitive nature"

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A video game I used to play as a teenager, it was called, "Metal Gear Solid".

It had several themes but as the game progressed, we could see it's primary underlying theme was actually - genetics.

A scene with the (having become) much loved supervillain "PsychoMantis", he describes how having been able to "dive into peoples minds and read their thoughts", he could see past our societal masquerades, pretenses and hypocrisies, and see the genuine underlying motives of human nature and humanity:

Basically what he's saying is, the primary driver of human nature, is to get laid, nut, get ones jollies,

i.e. optimal depth of human contact, intimacy, getting hot and sticky etc.

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How does this tie into cognition?

Dopamine?

Reward?

Well, that is the reward.
Attaining our optimal goal, nutting, climaxing etc.
As it's well documented the role dopamine plays in sexual pleasure and gratification/climax.

That is to say, according to Chomsky, language is the basis of cognition.
And our nervous system is emotionally driven.
Therefore an optimal neural state = optimal emotional cognizance (i.e. optimal neurocognitive state), such to render the optimal possible sexual outcome = optimal cognitive intervention.

Optimal driving force, optimal reward pathway, instates optimal purpose behind our actions = optimal performance.

You know - theoretically.

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I say theoretically as, dopamine is demonstrated via treatment for Encephalitis Lethargica as essentially "Awakening" them; it stimulates their reward pathway, and that brings them to life.

https://news.ohsu.edu/2004/05/06/ritalin-may-improve-parkinson-s-symptoms-ohsu-study-says

There's further studies which demonstrate improvement of dopamine transmission further alleviates parkinsonian symptoms (using dopamine reuptake blockers).

It's conceivable that during infection, their dopamine signalling pathways were damaged, resulting in this condition.

But just as with brain trauma in stroke victims, adequate rehabilitation, the brain clearly has the capacity to establish and strengthen new neural pathways (again re Better Call Saul clip above).

But - WITH - adequate cognitive intervention.

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However, the premise of cognition itself is not based in "downstream" chemical signalling, but rather the neural determinant, the "upstream" action potential (electrical impulse) itself.



i.e the neural pulse, nerve electricity

(nerve electrical bolt/impulse -> causes transmitter signalling)


Therefore, cognition improvement would (may) preclude the necessity for pharmacological intervention, or certainly reduce reliance on it.

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i.e. improving neural electrical integrity via adequate cognitive intervention (as demonstrated ad nauseum via above links), seems, in theory, the likely remedy I would argue to most, CNS disorders (Prof Manolis Kellis, computational biologist MIT - "when it comes to CNS disorders, the rising tide will raise all boats. The ultimate remedy will not be specific to one single disorder, but rather increasing nervous system integrity will address symptoms behind every CNS disorder").

But this specific condition via demonstrated response inducing interventions, does such a perfect job of illustrating WHY and HOW it is likely that will be the situation.

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Recapping:

Encephalitis Lethargica - a locked in, neurally impaired condition, which demonstrates responsiveness to cognitive intervention and emotional stimulation (i.e. stimulating neural electrical impulse response).

Additionally by implicating more downstream effectors responsible in chemical signalling and transmission (pharmaco intervention, L-Dopa, psycho stimulants), temporary functionality restoration can also be attained.

We assume that somehow over the course of infection, the neural signalling pathways became indefinitely impaired resulting in the "locked" nervous system outcome (compromised nerves insufficiently innervating the body).

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Then progressing to the understanding that adequate cognitive intervention/restoration most likely in this condition restores that cognitive/functional "flow", therefore reinstates adequate electrical pulsation (i.e. restoring neurocognition) = patients become responsive.

Putting this in perspective of additional emotional responsiveness.

Our subsequent cumulative deduction is that, cognitive intervention with specific focus on emotional encouragement - is likely to render the optimal response measure (i.e. kick start neural electrical impulse most acutely).

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As the Chomsky clip above outlines, the base of the human cognitive process itself - is language.

So, how do we see this in day to day terms?

The nature of this intervention has historically been used as I understand, almost exclusively in psychiatric conditions,

Cognitive behavioral therapy:

https://www.youtube.com/watch?v=9c_Bv_FBE-c

It rests on the premise of "thoughts", translating to "feelings", translating to "behavior".

Our "feelings", what we feel either mechanically, or in "emotional" terms - everything we feel - is based within the electrical flow of our nerves (neurons).

There's an interesting segment in the JRE podcast with Elon Musk where he outlines this in perspective of his latest invention endeavor, "Neuralink", describing the premise of the device being creating essentially synthetic nerve fibers and intersecting them with brain nerves to interfere in sending and receiving electrical impulses, restoring functionality to perhaps neurally impaired body parts such as with quadriplegia etc.

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We can see as that video outlines, "Cognitive behavioral therapy" - CBT - the focus of the intervention is, language.

Again as outlined in the Chomsky video, language can be used to externalize our thoughts and intentions (dialogue with another person), but by far and away its primary use, is internal self rationalization, to affect our own personal response and behavior.

As what we think in real time, is a function of our cumulative neural electrical response (brains electrical activity), therefore what we think can determine and dictate our nervous systems electrical state.

As I understand it, memory encoding etc., is more a function of downstream synaptic signalling, i.e. chemical signalling, but real time thought = a function of the upstream real time electrical impulse activity.

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Electrical activity is what we "feel" (our emotions), therefore, via the CBT concept, via cognitively applying certain "thoughts", we can actually control and dictate our neural electrical response.

In doing so, again via the CBT concept, we control/determine what we feel, the cumulative outcome being, we control how we behave, "act" etc., our functionality (ideally with those thoughts/cognitive-process having adequate emotional specificity).

i.e. thoughts -> neural electrical response (how we "feel" - emotions = excitatory motion - electricity moving through nerve fibers) -> actions/behavior.

As we see again in this clip, the strobe light based cognitive intervention did not elicite any meaningful neural electrical response (outline on the EEG reading), but the act of saying the patients name, induced an emotional response.

i.e. it induced an excitatory-motion response = excitation in motion = electricity propagating through a nerve fiber = a neural electrical response = nerve impulse response - which was transcribed as a distinct reading.

The cognitive intervention of language, with emotional relevance, stimulated the nerve respons = increased electrical impulse.

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So, the overall contention here being,

Increase in nerve electrical impulse = increase in downstream chemical signalling.

Via pharmacological intervention, which was PROVEN to reinstate a high level of functionality, it is demonstrated this form of intervention provides functional restoration and symptom alleviation;

But by the nature of its administration, patients seemed to effectively develop a tolerance to it, thus it was not sustained.

Following the logic, we could deduce that, "upstream" electrical intervention = a sustainable means to boost "downstream" chemical signalling = a sustained functional improvement.

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As per Prof Manolis Kellis quote, "increasing electrical integrity of the nervous system = amelioration to symptomatology of likely ALL central nervous system disorders", we could perhaps then infer than, such a cognitive intervention, i.e. something akin to modern day CBT (cognitive application with adequate emotional specificity to impact nerve response most acutely), could be used not only in psychiatric disorders, but nervous system disorders of all kinds.

CBT is proven effective in psychiatric conditions, as well as addiction disorders (which again, are based primarily in the dopamine/reward/reinforcement pathway).

Multiple sclerosis.
Parkinsons.
Dementia/Alzheimers.

In the latter, again, cognitive intervention of puzzle solving, crosswords etc., to keep the brain alert, i.e. keep neural electrical impulses at a good level - is the primary clinical application in preventing further degeneration

(however, given lack of emotional specificity of these cognitive endeavors, the associated nerve response will be affective to a superficial level such to slow neural degeneration, but not impactful enough to actually ameliorate the condition or cause new neural growth).

Another staple quote from Prof Manolis Kelis:

"Use it or lose it".

Refers to the principle that, something either gets used, or falls into disrepair.
i.e. as nerve electrical impulses slow with age, the nerves themselves degenerate.

The means to intervene and address this being, cognitive.

Cognitive measures to increase neural electrical activity = "using it", alleviating degeneration.

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To me the logic and evidence thus far makes perfect sense - just in current clinical therapeutics, all the various pieces haven't been sufficiently well pieced together - but none the less, all the pieces are there and glaringly obvious.

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lol - brief post script.

Just after I'd finished that post this song was queued on my playlist.

"Every time we have a thought, we make a chemical" (i.e. the "thought" itself is the real time cognitive state = the neural electrical impulse. When this impulse propagates, a transmitter like dopamine, serotonin etc., is discharged from the nerve terminal)

i.e. these impulses, electrical signals, are our cognition, our thoughts in real time, not dissimilar to how transistors code actions in a computer,

i.e.


= thoughts.

When the thought is sufficiently stimulating or powerful, it causes this,



i.e. transmitter or "chemical" to discharge from the cell, communicating with the next cell.

"If we have have good thoughts or happy thoughts, we make chemicals that make us feel more happy"

i.e. if the "thoughts", the electrical impulses are sufficiently stimulating/powerful, then there is sufficient transmitter discharge to induce a sense of "happiness", well being etc.

Where "sufficiently stimulating/powerful" we have established above = related to an activity associated with dopamine activity - i.e. reward/reinforcement activity.

Which again having established above, relates most acutely to sexual activity, relationships, intimacy - all underwritten by emotional process.
Thus, cognitive intervention taking an emotional form = renders most profound and sustained outcome.

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In this film "Awakenings" depicting Encephalitis Lethargica, the drug intervention is "LevoDopa" or "L-Dopa", which is a precursor to dopamine and noradenaline synthesis in the metabolic pathway.

Therefore it increases underactive or insufficient dopamine signalling.

This is an external intervention - so we're basically introducing "exogenously" the "chemicals that makes us feel more happy".

This is also the concept underwriting recreational drug use, cocaine etc = pleasure associated with them.

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What the cognitive intervention itself does, is affects the "thoughts", intervenes more "upstream" of the chemical itself - i.e. at the level of the electrical impulse, and THAT causes increased chemical signalling downstream = symptom alleviation.

That's the contention of cognitive intervention, vs drug therapeutic intervention.

This thread is genius.

Why is this subforum so dead?

https://youtu.be/gqt96H02Mpk

Emotion itself is the determinant of neurological function.

https://neurosciencenews.com/domapine-emotion-recognition-20507/

This film focuses on encephalitis lethargica with Dopamine being the key effector mediating its symptoms.

One video above shows the afflicted responding to music which "moves them", music which emotionally resonates with them, thus by default stimulating a functional response.

The above paper/article explores the relationship with dopamine and social/emotional-recognition.

It would seem social/emotional-process and integrity of neurological function are intrinsically entangled.

"Reward" related impulses mediated in emotion.

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Then of course it's entirely possible dopamine activity simply "masked" the dysfunction given the E.L. is thought to be degenerative in nature.

DA boosters simply overcompensated for DA neural degeneration?

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Never the less, reward-related behavior, dopamine activity all mediated in "emotion" (neural excitation), makes for some consolidated neurological definition.