{"id":15133,"date":"2020-09-27T10:29:00","date_gmt":"2020-09-27T14:29:00","guid":{"rendered":"https:\/\/www.shortform.com\/blog\/?p=15133"},"modified":"2020-10-01T13:41:28","modified_gmt":"2020-10-01T17:41:28","slug":"anti-nmda-encephalitis","status":"publish","type":"post","link":"https:\/\/www.shortform.com\/blog\/anti-nmda-encephalitis\/","title":{"rendered":"Anti NMDA Encephalitis Attacked Susannah&#8217;s Brain"},"content":{"rendered":"\n<p>What is anti NMDA encephalitis? How did it affect Susannah in <em>Brain on Fire<\/em>.<\/p>\n\n\n\n<p>Anti-NMDA-receptor encephalitis, or anti NMDA encephalitis, is the diagnosis that finally explained why Susannah had been so sick. Her immune system was attacking her brain.<\/p>\n\n\n\n<p>Read more about anti NMDA encephalitis and how Susannah finally received her diagnosis.<\/p>\n\n\n\n<!--more-->\n\n\n\n<h2 class=\"wp-block-heading\">Suspecting Anti NMDA Encephalitis<\/h2>\n\n\n\n<p>The biopsy confirms that Susannah\u2019s brain is inflamed, seemingly under attack by her own immune system. She\u2019s put on the highest possible dose of intravenous steroids, but her condition doesn\u2019t improve right away. Her panic attacks increase, accompanied by grimacing, shaking, and zombie-like arm motions.&nbsp;<\/p>\n\n\n\n<p><a href=\"https:\/\/www.shortform.com\/blog\/souhel-najjar\/\">Dr. Najjar<\/a> believes Susannah has NMDA autoimmune encephalitis. Dr. Russo thinks she has paraneoplastic syndrome, a condition associated with cancer: As the immune system attacks the cancer, it may also attack healthy tissue in the spine or brain, causing psychosis or catatonia.&nbsp;<\/p>\n\n\n\n<p>They\u2019re also investigating a third possibility, which is anti NMDA encephalitis. Drs. Russo and Najjar send Susannah\u2019s cerebrospinal fluid to <a href=\"https:\/\/www.shortform.com\/blog\/dr-dalmau-brain-on-fire\/\">Dr. Dalmau<\/a>, the neuro-oncologist who had conducted the study on four young women that Dr. Najjar remembered when he saw Susannah\u2019s clock test. Like Susannah, the four women in Dalmau\u2019s study had a high white blood cell count and suffered from hallucinations, confusion, and memory deficits. They also had two other things in common: an ovarian tumor and antibodies that disable a critical apparatus in the brain called the NMDA receptor. By the time Susannah is struck by anti NMDA encephalitis, Dr. Dalmau has developed two tests that allow for a swift and accurate diagnosis.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">NMDA Receptors<\/h3>\n\n\n\n<p>Everything we do, from lifting a glass to reading a book, results from a chemical signal triggering specific brain cells to fire or not. If a cell can\u2019t receive a signal, it can\u2019t initiate or inhibit behavior.<\/p>\n\n\n\n<p>Cells receive signals through <em>receptors<\/em>. NMDA receptors excite cells that participate in learning, memory, higher functions, and personality. In 2007, Dr. Dalmau identified a new disease that would come to be called anti NMDA encephalitis. This condition is caused when antibodies disable NMDA receptors. Experiments indicate that a 40 percent loss of NMDA receptors results in psychosis. A 70 percent loss results in catatonia. An absence of any working NMDA receptors results in death.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Confirming NMDA Autoimmune Encephalitis<\/h2>\n\n\n\n<p>That afternoon Dr. Russo gives Susannah\u2019s dad the news they\u2019ve been waiting for: Dr. Dalmau has confirmed a diagnosis of anti-NMDA-receptor encephalitis.&nbsp;<\/p>\n\n\n\n<p>Dr. Russo explains that NMDA autoimmune encephalitis is frequently instigated by a tumor. If Russo finds any links to Susannah\u2019s earlier bout with melanoma, the team will move on to chemotherapy. At the word \u201cchemotherapy,\u201d Susannah starts to sob.<\/p>\n\n\n\n<p>Being diagnosed with a rare disease changes Susannah\u2019s status in the ward. Doctors, interns, and residents invade her room to discuss her condition. One young intern speaks as if Susannah isn\u2019t present, telling the group that Susannah\u2019s ovaries may have to be removed.<\/p>\n\n\n\n<p>Susannah begins to cry. Her dad bolts to his feet. \u201cGet the fuck out of this room,\u201d he rages at the intern. He reassures Susannah the intern has no idea what he\u2019s talking about.&nbsp;<\/p>\n\n\n\n<p>Susannah is checked for tumors; she has none. Najjar decides to put her on an aggressive treatment plan\u2014her condition is too precarious to allow it to worsen. If his decision is wrong, Susannah might never recover, but she\u2019s too close to the edge to do otherwise.&nbsp;<\/p>\n\n\n\n<p>With anti NMDA encephalitis, antibodies can persist months after the disease has run its course. Recovery is often halting, with a 4 percent chance of mortality.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Going Home<\/strong><\/h3>\n\n\n\n<p>After twenty-eight days in the hospital, Susannah is discharged. She\u2019ll need an at-home nurse; biweekly visits to the hospital to flush out the antibodies with a plasma exchange; a full-body 3-D scan; and full-time rehab. It might not be enough to retrieve Susannah\u2019s former self, but they have a plan, and Susannah\u2019s going home.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>What is anti NMDA encephalitis? How did it affect Susannah in Brain on Fire. Anti-NMDA-receptor encephalitis, or anti NMDA encephalitis, is the diagnosis that finally explained why Susannah had been so sick. Her immune system was attacking her brain. Read more about anti NMDA encephalitis and how Susannah finally received her diagnosis.<\/p>\n","protected":false},"author":6,"featured_media":15321,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[40,16,7],"tags":[130],"class_list":["post-15133","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-books","category-health","category-lifestyle","tag-brain-on-fire","","tg-column-two"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.3 (Yoast SEO v24.3) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Anti NMDA Encephalitis Attacked Susannah&#039;s Brain - Shortform Books<\/title>\n<meta name=\"description\" content=\"Susannah experienced several scary symptoms, from hallucinations to seizures. 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