Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, March 3, 1991 TAG: 9103030068
SECTION: VIRGINIA PAGE: C-8 EDITION: STATE
SOURCE: Associated Press
DATELINE: LENGTH: Medium
Unlike Rip Van Winkle or Sleeping Beauty, however, this was no fairy tale. This was real life.
Leonard was the victim of an epidemic of sleeping sickness that swept through the United States and Europe in the 1920s. The effects of the disease, encephalitis lethargica, were devastating, often not appearing for months or even years after the initial infection.
In the most severe cases, post-encephalitic patients become immobile. Muscles become rigid, facial expressions are frozen. The patients, unable to feed or dress themselves, can be paralyzed in this trance-like state for decades.
In 1969, Dr. Oliver Sacks took a group of about 80 of these patients at Mount Carmel Hospital in New York and brought them back to life. The neurologist gave their brains a jump start with a wonder drug of the time, L-DOPA. The transformation was remarkable, but short-lived. Since then, little progress has been made in treating the condition.
The story of the Mount Carmel patients was told by Sacks in his book "Awakenings" and in the recent Hollywood movie of the same name.
In the film, Robin Williams plays the part of Sacks. Robert De Niro portrays the first of the patients to be put on the wonder drug, the person identified only as Leonard L. in Sacks' book.
After only a few weeks on L-DOPA, the De Niro character was able to leave his wheelchair and walk with little assistance. He began to speak for the first time in 21 years. Everything filled him with delight.
But a month later, trouble developed. He was overactive. He had uncontrollable muscle movement and severe facial twitching. He became consumed by paranoia and despair. In the end, he had to be taken off L-DOPA. Within weeks, he returned to his original motionless state.
In real life, Leonard continued slumbering until his death in 1981.
Pockets of sleeping-sickness victims still inhabit the wards of hospitals scattered across the country. Nobody knows their exact number, said Dr. Ronald Cranford, a Minneapolis neurologist and chairman of the Ethics Committee of the American Academy of Neurology.
New cases are rare, he said.
Although sleeping sickness patients are incapacitated, their minds are still sharp. They become imprisoned in their own bodies.
"It's a horrible, horrible thing," Cranford said. "These patients are normally aware of themselves. It's what we call a locked-in syndrome."
"I have no exit," the real-life Leonard related to Sacks in 1969. "I am trapped within myself. This stupid body is a prison with windows but no doors."
Sacks described it this way in his book: "Their minds remained perfectly clear and unclouded. But their whole beings, so to speak, were encysted or cocooned."
Sacks has since left Mount Carmel for a faculty position at the Albert Einstein College of Medicine. Although he was out of the country and not available for interviews, he continues to research the disorder. So are countless others across the nation.
In Richmond, Dr. Gregory J. O'Shanick has spent seven years at the Medical College of Virginia tracking the behavioral changes and neurological effects caused by damage to the brain.
"The problem is that the brain is so complicated and complex," the psychiatrist said. "I know that sounds pretty hokey, but it is."
The brain has tens of millions of nerve cells, each subject to different chemicals and influences, he said. Neurochemicals shuttle messages back and forth between the cells.
"In `Awakenings,' the specific neurochemical that's disrupted is one called dopamine," O'Shanick said. "Dopamine is an important chemical relative to things like arousal, attention, awareness, certain aspects of memory."
L-DOPA was converted to dopamine in the brains of the post-encephalitic patients. O'Shanick said it's now known why the drug failed to work over a long period of time. The brain developed a kind of tolerance to it, he said.
"There's only so much that's going to be able to be utilized," he said. "The brain has its own mechanism of kind of shutting itself down for awhile. The brain says, `Well, this is as much as we're going to be able to use at this point in time.' "
Doctors have since tried to mimic the effects of L-DOPA with other synthetic drugs.
"There's a drug called bromocripgine which basically is a chemical mimic of dopamine in use now," he said. "It's been used in some studies to see if we can't wake people up. Unfortunately, it hasn't worked in any great, exciting amounts."
O'Shanick said the research is often slow, but not without its rewards.
"All of science is basically trial and error," he said. "It takes only one success to keep you going for a long time."
by CNB