Kapronczay Károly szerk.: Orvostörténeti Közlemények 190-193. (Budapest, 2005)

KÖZLEMÉNYEK - COMMUNICATIONS - Paskalev, Dobrin - Kircheva, Anna B.: Bulgarian contributions to the development of medicine - Bolgár hozzájárulások az orvostudomány fejlődéséhez

Encephalitis lethargica: An insidious disease The illness is also known as von Economo disease bearing the name of Constantin Economo (1876-1931), a neurologist in Vienna (Austria), who described the clinical triad (fever, somnolence and ophtalmoplegia) appearing in the acute phase of disorder. The insidious disease burst on the medical horizon after World War I and continued to occur for about 10 years. No definite instances of this form of encephalitis were recorded before the period 1914-1918. The epidemic wave of encephalitis lethargica swarmed Europe and the United States. The suspected viral agent was never identified but both the clinical and pathological pattern were typical of viral infection. Thus, von Economo disease was recognized as the first slow virus infection of the nervous system in humans. The main clinical symptoms were as mentioned above ophthalmoplegia and pronounced somnolence from which the disease originated its popular name: sleeping sickness, Schlafkrankheit. In addition, headache, dizziness, fatigability and frank confusional psychosis were common features. The onset of the disease was acute or subacute and symptoms persisted for several weeks. More than 20% of the affected patients died within a few weeks. After an interval of months or years (occasionally as long as 25 years!) a high proportion of survivors developed a syndrome of parkinsonism. The clinical feature of this pathological condition was described for the first time (1817) by James Parkinson (1755-1824) from whom the disorder took its name. Von Economo disease is the only form of encephalitis known to cause an immediate or delayed extrapyramidal syndrome of this type.(22) The pathological findings were typical of a viral infection with nerve cell destruction and neuronophagia, perivascular cuffing with lymphocytes and other mononuclear cells and meningeal infiltrations of similar cells. The alterations were localized principally in the midbrain, subthalamus and hypothalamus. In patients who died years later with a Parkinson's syndrome the main pathological finding was a loss of pigmented cells in the substantia nigra and locus caeruleus due to nerve cell destruction (22). At that time there was no effective treatment of Parkinson's syndrome due to encephalitis lethargica. Cura Bulgara: The Bulgarian treatment The active principle of the treatment proposed by Ivan Raev is the wine extraction from roots of Deadly Nightshade (Atropa belladonna) (23,24,25,27,30,33). Atropa belladonna is a poisonous perennial herbaceous plant from the Solanaceae family. It grows in humid and humus-abundant soils in the foothills and the mountain regions with altitude up to 1600 m. Atropa belladonna occurs in Southern, Central and Western Europe. In Bulgaria that plant occurs most often in the Stara Planina, Sredna Gora and Rodops mountains. The roots (Radix belladonnae) and the leaves (Folia belladonnae) are used for treatment purposes. They contain a series alkaloids, the most important of which are the atropine and scopolamine. Furthermore, in the roots there are also tannins, pectin, Cumarin, etc.

(31,32). The treatment with belladonna has been applied for a long time by the Bulgarian folk healers to some disorders of the nervous system. Tsani Ginchev (1835-1894), a famous