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Sleep As a Problem of Localization

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Sleep As a Problem of Localization SLEEP AS A PROBLEM OF LOCALIZATION Prof. C. von Economo Vienna, Austria The Journal of Nervous and Mental Disease march 1930, vol 71, n°3 An American Journal of Neuropsychiatry, Founded in 1874 Paper read before the College of Physicians and Surgeons Columbia University, New York, Dec. 3, 1929 The search for a so-called sleep center may at the ceasing of the activity of this organ, i.e., the ceasing first sight appear a paradoxical idea. In the same man- of consciousness bringing about sleep. Others conceived ner as the waking state, so also does sleep appear as the mechanism of interruption not in this delicate histological such a complex biological condition that the problem manner but somewhat more massively. Purkinje belie- makes us at first sit up and take notice. Indeed, our enti- ved that by the congestion of the grey mass of the sub- re life takes place in the alternating change of two bio- cortical ganglia the thalamus corpus striatum, etc., pres- logical conditions, the waking and sleeping state and in sure is excited upon the nervous fibers of the corona this way the problem might appear primarily of the same radiata which run through this ganglia and that due to category as the problem of the center of life itself. The this strangulation an interruption of conduction from problem of a center of life in the nervous system has and to the brain is effected thus bringing about sleep. often been discussed in past centuries. But it has been put away as life is a much too complex condition as to The Viennese ophthalmologist Mauthner assu- be localized. So is sleep, too. But the change of sleep and med on the basis of Wernicke's description of encepha- waking state might, anyhow, have something to do with litis hemorrhagica superior in drinkers associated with some special centers of the nervous system and that sleep and paralysis of ocular muscles that this interrup- question has always been discussed over again. If we tion of conduction takes place in the region of the aque- do not give to the word "center" a too narrow definition duct in the cap of the peduncular region in the inter- but if we agree that the expression "nervous center" brain. He thought, then, that a physiological recurring swelling signifies only such an accumulation of nervous grey "fatigue edema" of these parti of the brainstem blocked matter the action of which is of direct primary impor- the conduction of the nerve fibers. In a somewhat more tance for the production of a definite function, we might complicated manner the interruption was explained by nowadays again discuss the possibility of locating sleep, Veronese and Troemner who assumed that the thalamus regulation in some definite part of the nervous system opticus was the point where the blockade of activity since we know that even so complicated a biological took place. function as the temperature of our body has got a very definite and localized regulating center in the dience- All these theories of sleep which assume an inter- phalon. ruption or a blockade of conduction of stimuli to the cerebral cortex as the essential character of sleep, can be The extinction of consciousness, this most stri- grouped under the name of "Theory of Lack of Stimuli." king symptom of sleep of man and of higher animals, An observation of Strümpell on a patient whose body's appeared until recently as the essential characteristic of tactile sensations had disappeared and who fell asleep imme- sleep and as the only one which demanded explanation. diately his eyes were closed and his ears were shut see- We shall see, later on, that this view is not quite right. med to corroborate such a theory. This test case has been But for those who embraced this theory of interruption incorporated in all textbooks. But it was the case of a hys- of consciousness the question of a center of sleep was terical patient and these sleep phenomena might be merely reduced to the question where this interruption explained nowadays by suggestive influence. All told, the occurred. Quite a number of theories have been put out theories of lack of stimuli, however important the clou- on that subject. Many investigators (Exner, Rabl- ding of consciousness might be, have neither in the past Rükhard) supposed that during sleep the ganglionic cells nor in the present, offered a satisfactory explanation for of the brain retract their dendrites like pseudopodia, the following reasons: (1) In cases of pathological sopor, whereby the interruption of conduction in the brain is brought a disturbance of sensation and of tonus cannot be about. The direct effect of this phenomenon was supposedly demonstrated, so that in these patients the interruption 1 of conduction to and from the brain cannot be, in itself, That proved that fatigue produces substances in the blood the cause of the change of their conscious state. (2) If which may provoke sleep. These fatigue substances are the blockade of conduction were brought about by the found also outside of the blood, for instance, in the cere- periodic change of a congestion or an anemia of the cen- brospinal fluid and in the substance of the brain itself. tral ganglia or by a recurrent sleep edema or by the They are nerve toxins which the author called retraction of dendrites of the cells, the very cause of this "Hypnotoxins." Since Piéron's experiments it can be periodical daily return of these phenomena would still accepted as a certainty that through activity during the bave to be explained. (3) Furthermore, the change o f conscious- waking state not only carbon dioxide and lactic acid but ness and unconsciousness is not the essential character also special fatigue substances are produced which exert of sleep but only one of its important symptoms. In fact, a narcotic action upon the brain and may inhibit its func- we know states of sleep for instance in plants which are tion. The accumulation of these residues (We i c h h a r d t devoid of a central nervous system and devoid of calls them Kenotoxins) could very well explain the per- consciousness. (4) Animals without cerebrum and anen- iodicity of sleep. During sleep these residues are again cephalic monsters lacking not only the cerebrum but, to excreted by the organism. As compared with the pre- a large part also the thalamus, and lacking consciousness, viously mentioned vasomotor theory and theory of inter- show also the periodic change of sleeping and waking. ruption this chemical theory has at least the great advan- (5) More recent knowledge teaches us that the sleep tage of being partially proved. But they, however, cannot changes most of the organic functions in some way or be the exclusive cause of sleep. o t h e r, not only by affording them rest, but also in a qua- litative manner, a fact suggested by the change of the sugar This fact we can deduce from many conside- and calcium content of the blood, the narrowing of the rations of which I shall mention only the two most appa- pupils, the Babinski phenomenon and other symptoms. rent: (1) sleep is initiated in many cases without fatigue These five reasons mentioned, are sufficient proof for the as we may assume from the naps after meals. (2) fallacy or, to use a better term, the one-sidedness of the Furthermore, the most striking characteristic of sleep, theory of lack of stimuli. the possibility of being aroused (we call this the rever- sibility of sleep), shows that sleep does not represent a Many other attempts of finding an explana- mere narcotic action. The reversibility of sleep means that tion of sleep in one or the other of its important symp- we can at any time by stimuli which are not extreme toms are afflicted with the same onesidedness, for ins- and do not injure the organism, interrupt the sleep in tance the vasomotor theory of Mosso, the anemia theory such a manner that complete clearness of consciousness, and the others. They again do not first of all explain the recurs. During the action of narcotics, for instance during essential character of sleep and its periodic change but narcosis, this complete reversibility does not exist as only one symptom although we agree that vasomotor long as the poison circulates in the central nervous sys- symptoms surely play a very important part in the pro- tem. Also the other pathological conditions of uncons- duction of sleep. ciousness which may be very similar to sleep, for ins- tance, syncope, coma, cerebral concussion, agony, etc., But even the very promoters of these theories do not show this reversibility so characteristic only of themselves realized that they were not sufficient to normal sleep. Even extreme stimuli, that is, such that explain the sleep mechanism which seemed much more cause a bodily injury, can in such cases, bring about at complicated. Purkinje, for instance, who was the first most a very incomplete psychic reaction with a very to conceive the idea that the congestion of stem ganglia limited return of consciousness and without disappearance squeezing the mass of fibers of the corona radiata inter- of sopor. So these states are irreversible in contrast to nor- rupts conduction, claims in order to explain the perio- mal sleep which is completely reversible. That shows that dic return of that congestion that the blood has a chemical the chemical fatigue theory explains much but it still is action during sleep that provokes that swelling and that insufficient to explain fully normal sleep and its perio- it again changes and stimulates the nervous system dicity.
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