It is time for James Okun to pick our brain and inform us on some important medical matters. You can show your support by buying his books or leaving a comment here if you like- Jeyran Main

James D. Okun, MD is a Phi Beta Kappa graduate of Duke University and of the Albert Einstein College of Medicine in New York. He is the co-author of The History of New Innovations in Modern Medicine and of Erasing Scars: Herpes and Healing.

Herpes Simplex Encephalitis is an infection of the brain caused by the HSV (Herpes Simplex Virus) usually Type 1 and is the most common cause of viral encephalitis in developed countries (www. Healthline.com) and of “fatal sporadic fulminant necrotizing viral encephalitis” (Radiopaedia.org).

Encephalitis is often confused with Meningitis which is an infection of the three- layered covering of the brain (meninges). Meningoencephalitis is an infection of both the meninges and of the brain. Encephalitis is derived from the Greek with “en” meaning “in” and “kephale” meaning “head” (www.dictionary.com.) The suffix “itis” means inflammation. Combined into one word the meaning is inflammation “in the head.”

It is thought that the Herpes 1 Virus ascends through the nose via the eighth cranial nerve and travels to the frontal (emotions, behavior, and judgment) and temporal (memory and speech) lobes of the brain (Erasing Scars: Herpes and Healing p.11). Herpes encephalitis can affect persons of any age, sex, or economic status. Especially at risk are older patients and those with compromised immune systems or those taking steroids.

About fifteen percent of patients who develop Herpes encephalitis have histories of recurrent herpes labialis (cold sores). There have been estimates that up to thirty-eight percent of patients who are in a coma from herpes encephalitis and who have seizures or paralysis will die, with any survivors having a severe neurological impairment. (Erasing Scars pgs. 11-12).

Patients with acute encephalitis become acutely ill with symptoms such as a severe headache, photophobia, nausea, and vomiting. One- third of the patients will develop concurrent fever blisters during their illness, Other patients will become paralyzed or comatose. (Erasing Scars p. 12.) Some exhibit severe behavioral changes including hallucinations and angry outbursts and poor judgment.

Oscar Wilde is a well-known English writer and playwright best known for The Importance of Being Ernest and The Picture of Dorian Gray. He was a controversial figure who sued the powerful aristocratic father of his male lover for slander for speaking against him (Wilde had openly flaunted his relationship with the Lord’s son); during this time homosexuality was outlawed in England.

He wound up losing his case, being arrested himself and then was “charged with gross indecency, convicted” (oscarwildesociety.co.uk) and eventually he spent two years in prison at hard labor. There has been a dispute among scholars as to what eventually killed Oscar Wilde (syphilis vs. meningoencephalitis etc.), and it begs the question whether his deteriorating judgment could have been due to encephalitis/meningitis. In addition to his ill-advised lawsuit

which backfired, Wilde moved into a flophouse despite his ability to access funds from his plays to live in a more decent area evidencing continued questionable judgment.

According to an article in The New York Times books section in 1988, there is indeed documentation from Wilde’s attending doctors that he had encephalitis probably along with meningitis: (http://www.nytimes.com/1988/03/20/books/l-what-killed-oscar-wilde “A surviving report dated Nov. 27, signed by (Dr.)Tucker and (Dr.) Cleiss describes the patient’s worsening condition without mentioning syphilis: ”The diagnosis of encephalitis meningitis must be made without a doubt. . . . Surgical intervention seems impossible.” He died November 30, 1900.

Encephalitis due to HSV can be treated with IV acyclovir (drug of choice) to try to “shorten the clinical course, prevent complications, prevent the development of latency and subsequent recurrences, decrease transmission, and eliminate established latency (emedicine.medscape.com Herpes Simplex Encephalitis Medication Jun 15, 2016).

New research now indicates that a chronic form of recurrent herpetic encephalitis exists which has been linked through multiple studies (100) to the development of Alzheimer’s Disease (See Chapter 10 The History of New Innovations in Modern Medicine.)

Could a condition of chronic, recurrent encephalitis also have played a part in Oscar Wilde’s condition and symptoms before the acute episode of encephalitis that killed him? The evidence seems convincing that Encephalitis played a large role in Wilde’s death and bad judgment. Wilde’s actions though helped open a political discourse in the United Kingdom on homosexuality, and so this is part of his legacy along with his writings.

James D. Okun, MD is a Phi Beta Kappa graduate of Duke University and of the Albert Einstein College of Medicine in New York. He is the co-author of The History of New Innovations in Modern Medicine and of Erasing Scars: Herpes and Healing.