![]() In this the ‘functional’ proponents have arguably had more success recently. ![]() If we are to avoid the arid mind versus body, psychology versus cytokines debates that have bedevilled this and related fields for so long, proponents on each side need to generate truly falsifiable hypotheses amenable to experimental testing. They strongly favour a functional aetiology for these cases, driven by the introcontrovertable mental health toll on young people of the pandemic and lockdown. ![]() 2 Such debates have a lineage back to the well-attested mass outbreaks of ‘dancing mania’ of the 14th–17th centuries, where religious fervour was probably more important than postinfectious processes.Īgainst this background, Heyman et al 3 highlight their experience of a marked increase in referrals of young people with severe acute exacerbations of tics during the COVID-19 pandemic, an experience I and anecdotally others share. In the 21st century, we have the hotly debated, proposed phenomenon of paediatric autoimmune neuropsychiatric syndrome (PANS) whose advocates insist on an autoimmune aetiology for many phenomena (particularly obsessive–compulsive disorder and tics) more conventionally viewed as arising from a non-inflammatory, polygenic predisposition. A causal role for H1N1 influenza in the Awakenings tragedy is widely assumed, although in fact the evidence is somewhat circumstantial. Our understanding of the links between inflammation, the brain and behaviour has a long and controversial history, particularly in relation to movement disorders. Mindful of this story, systematic efforts to capture and report neuropsychiatric sequelae of COVID-19 were put in place at the outset of the pandemic and, in contrast to 1918, where a single syndrome predominated, a complex picture including intracerebral haemorrhage, infarction and inflammation is emerging. ![]() For neurologists, 1918 produced an additional unforgettable lesson in postinfectious neuropathology as an outbreak of encephalitis lethargica left cohorts of institutionalised adults living with severe Parkinsonism into the 1970s and immortalised in Oliver Sacks’ Awakenings. In grappling with COVID-19, the world has been relearning many lessons-from second waves to the importance of mask wearing-from that neglected tutor, the great 1918 (‘Spanish’) influenza pandemic. ![]()
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