Awakenings

The movie Awakenings, follows the story of Dr. Malcolm Sayer (Robin Williams), a researcher looking for a job. His job search ends when he gets a placement at a local hospital in the Bronx section of New York. Out of place, Dr. Sayer soon finds catatonic patients who survived the 1917-1928 epidemic, encephatlitis lethargica, who respond to certain stimuli. These certain stimuli reached beyond the patients' respective catatonic states; actions such as catching a ball thrown at them, hearing their name or specific genres of music, and experiencing human touch all have unique effects on the patients in different ways. This allows Dr. Sayer a glimpse into their worlds. One particular patient Leonard Lowe (Robert Di Niro) proves to be elusive in this regard, but Dr. Sayer discovers another way of reaching into his world through communicating using an Ouija board.
After attending a lecture on a new drug called L-Dopa used in Parkinson's disease, Dr.Sayer hypothesis, that the drug will cause a break through to his catatonic patients. A trial run with Leonard leads to amazing results as Leonard completely "wakes" up from his catatonic state. With donations and funds soon all the catatonic patients are "awake." Leonard and the other patients soon realize they are not in the same world they once knew. They begin to experience all of life’s new things.
Over the summer of 1969, the success of L-Dope with this group of patients is a dream come true but it soon is realized that this is only a temporary measure. As the summer proceeds, Leonard being the first one to be "awakened", starts having tics. Leonard's tics grow more and more prominent and he starts to loose his ability to walk. He soon begins to experience full body spasms and can hardly move. Soon after, Leonard returns back to his catatonic state. All the other patients go back to their catatonic states as well. Over the years many of the patients experienced "awakenings" but "none were as dramatic as the summer of 1969."
The science in the movie was based on Oliver's Sacks' 1973 memoir Awakenings, with the true story of Olive Sacks, fictionalized by the character of Dr.Sayer. The movie itself was great story of friendship and scientific inquisition. However, it often leaves you wondering; why did these survivors of encephatlitis lethargica become catatonic? In their Catatonic state, were the patients able to hear or see the world around them? Why did only certain stimuli work with the patients? And finally the biggest question of all, why did the L-Dope work?
In 1917, Von Economo was the first to describe the Encephalitis lethargica (EL), shortly after the epidemic. The symptoms of EL can differ from patient to patient but it usually starts out with a high fever, headache, and sore throat. Shortly after double vision, disturbance of eye movements, weakness of the upper body, tremors and strange movements, neck stiffness, intense muscle pains, a slowing of physical and mental response, drowsiness and lethargy.
In rare cases patients may developed brain and nerve symptoms changing the patient's behavior causing them to be psychotic, OCD, or have disturbed thinking. The original epidemic caused the death of many people but a few did survive the initial stages of the disease. The survivors developed a form of Parkinson's disease, which in the movie led to a catatonic state.
In the movie, the survivors responded to certain stimuli when they were in a catatonic state. Like those with Parkinson’s disease the patients can listen and understand what is spoken to them but they exhibit little to no facial movements.
In Oliver's Sacks 1973 memoir Awakenings, he recorded that most of the survivors in a catatonic state have a tendency to only remember events that occurred in their environment. In the beginning of the movie they give the example of Lucy, who upon “awakening” states that she does not know the year. Later in the movie, we find out that she actually does she just wishes that it wasn't. Furthermore when Leonard is finally "awaken" he can recognize his mother, even though the last time he saw her was 30 years back at the age of 11.
At the time of EL from 1917-1928 children were also susceptible to the influenza epidemic. Thus many scientists proposed that there was a link between the two epidemics. However Von Economo and Oliver Sacks did not believe this to be true. In more recent experiments, it has failed in achieving EL brain material to demonstrate influenza RNA, this somewhat proves that the two cannot be linked. In Oliver's memoirs, it also recorded that only 2 of the patients had influenza.
Although Oliver's hypothesis were mostly right one that was particularly wrong was that idea that the survivors in their catatonic state were "getting the will of" the stimuli. Like Parkinson’s patients, EL patients can still occasionally control their body movement if they focus really hard. In the movie, Dr.Sayer throws a ball at the catatonic patients, which they catch. This moving object is going to attract the body attention; this is the reason why the patients catch the ball. In recent pathological findings, scientists have discovered that EL is localized to the basal ganglia and midbrain structures. The parts of the frontal lobe can control some body movement; this area of the brain is less affected according to the research. This could also explain why the patients caught the ball.
Over the years, there were no further epidemics of EL, although there were some sporadic cases that have been reported and continue to be reported. Recent studies, have consistently failed to demonstrate the cause of EL. In recent studies, they found a CSF oligoclonal bands and successful treatment of some of EL cases with steroid have led them to propose that this phenotype may be immune-mediate. However, Dale and his colleges presented a paper which studied 20 patients consisting primarily of children and teenagers with sleep disorder, lethargy, Parkinsonism and neuropsychiatric disorders, including autism, anxiety, depression, obsessions and compulsions. After 3 years of examining their patients, they point that autoimmune complication commonly occurred many weeks or months after the precipitating organism and the growth of organism is rarely possible. They instead found a connection between their patients and Streptococcus. They propose that, "although the association with streptococcus is a useful line of further investigation alternative environmental triggers may be important in the disease evolution of this EL phenotype" (Dale et al., 2004).
Although today, there are some successful treatments using steroids with EL patients. The most common treatment is L-Dopa, the same drug they used in the movie. L-dopa increases the production of dopamine in the brain. This access of dopamine in brain causes the EL patients to have chemical imbalance and this imbalance is what "awakens" Dr. Sawyer's patients. This chemical imbalance works for the summer of 1969 until the patients develop a tolerance for it, and soon the patients return to their catatonic state.
Overall, the Awakenings was really great movie. You don’t want it to end and you hope that at the end of the movie it says that all the survivors were cured. Great performance by Robert De Niro as one of patients.
Bibliography
Work
Awakenings. Dir. Penny Marshall. Perf. Robin Williams and Robert Di Niro. Columbia Pictures Corporation, 1990. DVD.
Sacks, Oliver W. Awakenings. New York: Vintage, 1999.Print.

Figure
Awakenings. Dir. Penny Marshall. Perf. Robin Williams and Robert Di Niro. Columbia Pictures Corporation, 1990. DVD.