Epidemic Encephalitis Simulating Myasthenia Gravis

Grossman, Morris

doi:10.1097/00005053-192201000-00003

Cited by 7 publications

(3 citation statements)

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“…38 Grossman failed to demonstrate myasthenic fatigability and found it ''difficult to distinguish physically-based hypotonia from the effects of 'mental torpor.''' 39 Claude considered the asthenia of EL to be a reduction in psychic rather than muscle tone; it was ''a form of fatigability, which renders all activities difficult or impossible'' 40 ; he and others used the term ''psychic asthenia.'' 40- 42 Stern described a continuum of states.…”

Section: Asthenia and Fatiguementioning

confidence: 99%

On doing nothing: Descriptions of sleep, fatigue, and motivation in encephalitis lethargica

Ward

2011

Movement Disorders

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Epidemics of encephalitis lethargica (EL), from 1917 to the 1930s, are an important milestone in the history of movement disorders. Today, the two best-known features of EL are somnolence and parkinsonism but the full clinical picture was variable and complex. States of wakeful inactivity--as opposed to drowsiness--were often described both in the acute and postacute stages and were referred to in the EL literature as "lethargy" or "torpor." The study described here is based on a survey of clinical descriptions published in English, French, and German from 1917 to 1942. Its focus is on the history of clinical ideas, rather than applying modern pathophysiological concepts retrospectively. Descriptions of lethargy are explored as a way of elucidating concepts of sleep, fatigue, and motivation during the study period. The literature described many patients who had (1) lethargy without interruption in consciousness; (2) slowness of movement and catalepsy without other prominent parkinsonian features; and (3) apathy and lack of initiative without severe disorders of mood or thought content. Hence observers distinguished a state of wakeful inactivity from primary disorders of sleep, movement and behavior. Contemporaneous accounts suggest that writers had difficulty in reconciling their observations with preexisting concepts; there still may be limitations in our ability to describe and classify the clinical states connected during the epidemic era with the term "lethargy."

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Section: Asthenia and Fatiguementioning

confidence: 99%

On doing nothing: Descriptions of sleep, fatigue, and motivation in encephalitis lethargica

Ward

2011

Movement Disorders

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“…p. 11). Abrahamson wrote that “… The outstretched arms may fall and be raised at will only to fall again.”38 Grossman failed to demonstrate myasthenic fatigability and found it “difficult to distinguish physically‐based hypotonia from the effects of ‘mental torpor.’”39 Claude considered the asthenia of EL to be a reduction in psychic rather than muscle tone; it was “a form of fatigability, which renders all activities difficult or impossible”40; he and others used the term “psychic asthenia.”40–42 Stern described a continuum of states. First there were terms primarily suggesting fatigue or sleepiness including “Müdigkeitsgefühl” (fatigue feelings associated with drowsiness), “dösiger Schläfrigheit” (stupor/sleepiness) and “Schlafdämmern” (sleep‐twilight state).…”

Section: Lethargy As a Sleep Disordermentioning

confidence: 99%

Phase II trial of irinotecan plus cisplatin in patients with recurrent or metastatic squamous carcinoma of the head and neck

Gilbert

Cmelak

Shyr

et al. 2008

Cancer

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BACKGROUND.Patients with recurrent or metastatic HNC have a poor response and survival with currently available chemotherapy agents. Thus, new agents are needed. The authors report the results of a phase II trial of irinotecan and cisplatin in patients with metastatic or recurrent HNC.METHODS.Patients were treated with irinotecan 65 mg/m2 IV over 90 minutes and cisplatin 30 mg/m2 were administered intravenously weekly for four weeks, followed by a two week rest. However, after 17 patients were treated with weekly irinotecan at a dose of 65 mg/m2, toxicity analysis demonstrated the poor tolerance of that dose in this patient population. Thus, the protocol was amended, and irinotecan was dose reduced to a starting dose of 50 mg/m2. Twenty‐three additional patients were treated with this dose.RESULTS.Forty patients were enrolled on study between February 2002 and April 2006, 17 patients at the first dose level and 23 patients at the amended dose level. Overall, 12 of 17 patients (71%) treated with irinotecan 65 mg/m2 experienced clinically significant grade 3 or 4 toxicity. Twelve patients required dose reductions. Toxicity was reduced but 17% of patients still experienced grade 3 or 4 toxicity on the lower irinotecan dose. The response rate was 35% for patients treated at irinotecan 65 mg/m2 and 22% for patients treated at 50 mg/m2. No complete responses were noted.CONCLUSIONS.The combination of irinotecan and cisplatin is efficacious in a poor prognosis group of patients but toxicity is substantial. Cancer 2008. © 2008 American Cancer Society.

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“…Some diagnostic features of myasthenia gravis are presented : the shadow in the region of the thymus noted in roentgenograms ; the diminished creatinine output in a twenty-four hour specimen of urine ; the decreased sugar tolerance ; the Jolly reaction, and the presence of lymphorrhages in skeletal muscle obtained through biopsy. 3. The frequent association of thymomas with the myasthénie syn¬ drome is again emphasized.…”

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confidence: 96%