Encephalitis Lethargica

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,



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



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.

"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.....).

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.



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.

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.

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.