EPIDEMIC ENCEPHALITIS

An inflammation of brain tissue caused by a filterable virus, and sometimes associated with systemic infections such as measles, mumps, and hepatitis.The disease reached epidemic proportions following World War I, when it was known as encephalitis lethargica, or sleeping sickness. Today it is seldom seen and comprises only .1 per cent of first admissions to mental hospitals. There are two acute forms. In the “hypersomnic” form, the patient is drowsy, intellectually slow, sleeps excessively, and is subject to visual disturbances. The “hyperkinetic” form, which may follow a stuporous state, is characterized by insomnia, restlessness, agitation, irritability, and choreiform (jerky, uncontrolled) movements. These symptoms are sometimes followed by delirium, disorientation, and convulsions.In adults the aftereffects of encephalitis include parkinsonism, muscle twitching, tremors, oculogyric crisis (eyes suddenly turning upward), loss of the blink reflex, and a masklike facial expression. In most cases there is no serious impairment of intelligence or psychological adjustment. A few patients react with agitated depression or withdrawal, and others may become impulsive and aggressive. The aggressive patients are often aware of their dangerous urges but are powerless to control them.In children the aftereffects of encephalitis present a special problem. They tend to be restless, hyperactive, irritable and impulsive—and in many cases they lose all self-control and become cruel, destructive and generally unmanageable. Hospitalization is frequently necessary because of violent, aggressive and sexually deviant behavior. Other common symptoms are a peculiar bent posture, an expressionless face, and poor co-ordination. If the disease strikes before they are five years of age, they may become severely retarded.Today most investigators ascribe the poorly controlled hyperactive behavior of postencephalitic children to residual brain damage. Recent research has pointed to special perceptual defects which make it hard or impossible for them to organize and interpret what they see and hear, hence they cannot effectively use observation in controlling behavior. As a result, they become anxious, and try desperately to bring their world into some sort of order. This helps to explain their characteristic hyperactivity. It is probably due in large part to constant “reality testing”—that is, in attempting to adjust to the environment, control their bodies and get a perceptual hold on reality, they try one response after another in what seems to other people haphazard and disorganized activity. Their irritability and violence are, in part at least, the result of painful feelings of frustration and inadequacy experienced when they fail in these attempts—and these feelings are aggravated in many cases by the ridicule of other children.Today epidemic encephalitis can generally be arrested by antibiotics; in some cases, however, treatment is delayed and chronic symptoms set in. Atropine and other drugs may relieve Parkinson symptoms, and benzedrine sulfate has recently been used successfully in reducing hyperactivity and aggressiveness in child patients. Special educational procedures developed for brain damaged children can sometimes be applied effectively, and many of these children gradually learn to do academic work.Ilustrative Case: “Harold is a boy of fifteen years whose behavior is so unpredictably and dangerously impulsive that his family cannot keep him at home. He must always live in an institution.He presents a strange, almost uncannily freakish appearance. He is short and squat in stature and has a short squarish head that is oversized for his body. He walks with an awkward shambling gait, a little like a monkey. As you watch him, he sidles toward another child in a gingerly apparently affectionate manner. Suddenly he grasps the child’s finger and bends it backward mercilessly; then he slinks impishly away, laughing and chuckling. In a moment he raises his bitten nails to his mouth and stares at the cloudless sky as though abruptly transported, and mutters some incoherent remark about a ‘terrible storm coming that will break all the limbs of the trees.’ A few minutes later with tears streaming from his eyes he presents an appearance of genuine remorse. He puts his arms around the same child’s neck and suddenly chokes the child painfully with a tremendous hug. When a teacher pries him away he tries to bite her hand. He murmurs to the teacher: ‘I hurt you, didn’t I? Can you whip? Whip me.’ Perhaps a while later he may be seen to shuffle stealthily toward the same teacher and whisper to her in a childlike manner: ‘I like you.’ Then quick as a flash he may poke his finger into her eye and cry again. ‘Can you whip? Whip me.’“He did not thrive well in his childhood, for he was beset with many illnesses. His physical and mental development was markedly retarded. He failed to adjust himself to school and at home became uncontrollably provocative and destructive. Very much distraught, the parents resorted to beatings to discipline him, but they were of no avail.“His mental age is about eight years (I.Q. 60). Emotionally he is very unstable; often he unaccountably bursts into tears. The most striking aspects of his behavior are his uncontrolled impulsive cruelties and his perverted craving to suffer pain himself. Like the rest of us, he wants love and affection, but he seeks it in a strange way. He torments and hurts others so they may do the same to him. He appears to derive an erotic pleasure from the pain which he provokes from others in lieu of love. To such injuries he adds those which he inflicts upon himself.“This is a strange boy indeed. His disordered behavior is the consequence of an inflammatory illness of the brain, encephalitis, which complicated a contagious disease in infancy.”