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Symptomatic parkinsonian syndromes acquired 

Symptomatic parkinsonian syndromes acquired
Author(s):

Ivan Donaldson

, C. David Marsden

, Susanne A. Schneider

, and Kailash P. Bhatia

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date: 22 October 2020

In 1993, Geddes et al. wrote: ‘The world pandemic of encephalitis lethargica (Von Economo’s disease) from 1916 to 1927 resulted in an estimated half a million people dead or disabled. One-third of patients died in the acute phase, one-third survived with chronic disability and the remainder recovered, although a significant number later developed a parkinsonian syndrome after a prolonged latent period of variable length. In many patients with persisting disability, late deterioration mainly involving motor function and sparing the intellect has been observed, decades after the acute infection’. The overall presentation was of a prodromal influenza-like illness lasting less than a week with fever, followed either by increasing somnolence, stupor, and coma, or by excitement, restlessness, mania, or delirium, accompanied typically by ophthalmoplegia, a variety of dyskinesia (especially chorea and myoclonus), or parkinsonism. There have been some subsequent reports of presumed encephalitis lethargica or postencephalitic parkinsonism unrelated to the 1917–1927 pandemic (Blunt et al. 1997; Wenning et al. 1997; Caparros-Lefebvre et al. 1998; Kun et al. 1999; McAuley et al. 1999; Ghaemi et al. 2000; Kiley and Esiri 2001). However, many of these cases do not fit the diagnostic criteria. Encephalitis lethargica has virtually disappeared, apart from the occasional sporadic case, and the vast majority of those with PEP have now died, this chapter will not dwell on the treatment of this historical disease.

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