Sleep 2023 Awakenings - Done
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University of Texas, Dallas *
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Course
425
Subject
Medicine
Date
Dec 6, 2023
Type
docx
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4
Uploaded by ConstableTitaniumGoose43
Awakenings –
Victor Ikiakhe
The movie represents the medical consequence
s of encephalitis lethargica and its connections to the control of sleep and wakefulness.
1.
What aspects of the movie stood out to you and why? Please provide at least two examples and carefully explain your rationale (4)
1.
The patients' frozen, statuesque postures vividly depicted the impact of encephalitis lethargica.
i.
These visuals made the patients' awakenings all the more astonishing and highlighted the severity of the condition.
2.
The emotional connection between Dr. Sayer and the patients.
i.
This connection added depth to the storyline and underscored the human side of medicine, making the film more engaging.
2.
Using your knowledge of the sleep and wake centers of the brain, explain the control of sleep and wakefulness in healthy humans and how we switch from wakefulness to NREM sleep (This is a chance to redo the exam question of a similar nature) (8)
o
In healthy individuals, the regulation of sleep and wakefulness involves various brain regions. The hypothalamus, especially the suprachiasmatic nucleus (SCN), controls our daily sleep-wake cycle. The SCN receives light signals from the eyes, which influence the production of melatonin. During the night, melatonin levels rise, signaling the body that it's time to sleep, while in the daytime, the SCN keeps melatonin levels low, promoting wakefulness. The transition from being awake to non-rapid eye movement (NREM) sleep
is influenced by the reticular formation in the brainstem. This region acts as a kind of "arousal switch." When it becomes less active, it reduces sensory input to the brain's thalamus and cortex, making it easier to fall into NREM sleep. This coordinated activity of different brain regions helps maintain a regular sleep-wake cycle and enables the smooth transition between being awake and experiencing restorative sleep.
3.
Using your knowledge, which neuroanatomical areas do you think were affected by the virus in these patients? Explain your answer (3)
1.
The basal ganglia, leading to cataleptic states and movement difficulties.
2.
The hypothalamus, potentially contributing to disrupted sleep-wake cycles and excessive
sleepiness.
3.
The frontal cortex might have been affected, impacting cognitive functions and emotional regulation, which can be observed in the patients.
4.
The movie explores the use of L-Dopa (Dopamine) as a treatment for the patients’ sleep-like states. How does this drug affect sleep/wake patterns, and why does it lose its efficacy over time? (2)
1.
L-Dopa initially increases dopamine levels, enhancing alertness and sleep-wake patterns
because dopamine plays a role in regulating wakefulness.
2.
Over time, L-Dopa becomes less effective due to the development of tolerance. The brain adapts to higher dopamine levels, necessitating increased doses to achieve the same effect.
5.
What ethical dilemmas did Dr Sayer face in the movie? (2)
1.
Dr. Sayer faced the ethical dilemma of administering an experimental drug with potential
side effects, balancing potential benefits against patient risks.
2.
Ethical concerns regarding informed consent arose, as Dr. Sayer had to navigate the complexities of treating patients who might not fully comprehend the risks and potential
long-term consequences of the experimental treatment.
6.
Knowing what you know now about the eventual outcome, were there any benefits to administering the drug, and what were they? What was the emotional cost? (4)
1.
The benefits of administering L-Dopa included awakening the patients from their catatonic state, allowing them to communicate, regain some independence, and experience moments of normalcy.
2.
However, the emotional cost was substantial. Some patients experienced severe side effects, including distressing motor fluctuations and hallucinations. Furthermore, many patients ultimately regressed back into their catatonic state, which was emotionally challenging for both the patients and Dr. Sayer. This rollercoaster of hope and disappointment took a toll on everyone involved.
3.
Administering L-Dopa offered a chance for the patients to regain some quality of life that had been taken away by encephalitis lethargica, allowing them to communicate and
experience moments of normalcy.
4.
However, this came at the emotional cost of witnessing the patients' inevitable decline, the return to catatonia for many, and the burden of managing the side effects, making it a morally and emotionally challenging endeavor for Dr. Sayer and the medical team.
7.
All things considered, would you as the physician have administered the drug? Please explain your rationale (4) 1.
As a physician, I would have administered the drug because it offered the patients a chance to regain some quality of life that had been taken away by encephalitis lethargica.
2.
Ethical considerations would involve careful monitoring and management of potential side effects, ongoing communication with the patients and their families to ensure informed consent, and a compassionate approach to their care.
3.
The decision to administer the drug is justifiable because it provided the patients with an
opportunity to communicate, experience moments of normalcy, and potentially regain some independence.
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4.
The ethical considerations of administering L-Dopa involve not only informed consent and monitoring for side effects but also the overarching goal of enhancing the patients' quality of life while considering the emotional toll on both the medical team and the patients' families. Compassion and empathy play a crucial role in guiding this complex decision.