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Standing on the shoulders of giants: 100 years of neurology and epidemic infections
  1. Harriett Van Den Tooren1,2,
  2. Mark A Ellul1,3,4,
  3. Nicholas WS Davies5,
  4. Ava Easton4,6,
  5. Angela Vincent7,8,
  6. Tom Solomon1,3,4,
  7. Benedict Daniel Michael1,3,4
  8. On behalf of the CoroNerve Studies Group
  1. 1 Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
  2. 2 Medicine, Hull University Teaching Hospital, Hull, UK
  3. 3 NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, UK
  4. 4 Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
  5. 5 Neurology, Chelsea and Westminster Hospital, London, UK
  6. 6 Encephalitis Society, Malton, North Yorkshire, UK
  7. 7 Neurosciences Group, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
  8. 8 Institute of Neuroscience, University College London, London, UK
  1. Correspondence to Dr Benedict Daniel Michael, NIHR HPRU for Emerging and Zoonotic Infection, Liverpool, UK; benmic{at}

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One hundred years ago, neurologists were faced with a surge of cases of uncertain cause manifesting a protean array of symptoms. Through careful semiological description, pattern recognition and histopathological analysis, von Economo and others unified these seemingly disparate cases, defining the epidemic of encephalitis lethargica. Several landmark papers in the Journal of Neurology and Psychopathology (now JNNP) helped to illuminate clinical and pathological aspects of this new disease. In the subsequent hundred years, there have been other infectious epidemics affecting the nervous system, with causative agents including flaviviruses, influenza, enteroviruses (eg, poliomyelitis) and coronaviruses (CoV). Neurologists seeing patients in the age of COVID-19 have much to gain from the historical lessons of the epidemics of the last 100 years in responding to these new challenges.

A case of encephalitis lethargica involving chiefly the cerebral cortex

Authors: Watson GA

Year Published: 1920

Epidemic encephalitis: Clinical papers by various authors

Authors: Horder T

Year Published: 1920

Encephalitis lethargica

The first systematic descriptions of encephalitis lethargica were those of von Economo in 1916–1917, who coined the term (figure 1),1 which is also known as ‘von Economo’s disease’.2 However, there were probable cases in 1915 predating the ‘influenza epidemic’, and von Economo and others suggested that earlier epidemics throughout modern history may also have been related.3

Figure 1

Constantin Freiherr Economo von San Serff (von Economo (1876–1931)) Austrian neurologist, psychiatrist, pilot and originator of the diagnosis encephalitis lethargica (

Encephalitis lethargica appears to have spread from Eastern Europe to Germany, France and Britain between 1916 and 1918 and and then to have affected much of the rest of the world in the following few years.1 4 It probably affected more than a million people during the first half of the twentieth century, before apparently disappearing, although some clinicians …

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