Humanity in Medicine Book Review
Brain On Fire-My Month Of Madness
By: Juliana Jaramillo, MD, PGY1
Edited: Teresa Y. Smith, MD, MSEd
Imagine walking on the streets of Manhattan, and every light appeared exuberantly bright. Every sound rang like drums in your ears. Slowly, you start to lose your sense of self, and symptoms of psychosis appear. One could imagine this is the perception of a newly diagnosed schizophrenic, but what if your brain felt like it was on fire. Susannah Cahalan, a New York Post reporter, describes in breath-taking detail her experience with Anti-NMDA Receptor Encephalitis in her book titled, Brain On Fire: My Month Of Madness. Susannah provides a vivid account of what it was like to develop a mysterious illness that stumped numerous physicians at the time. Despite her normal evaluations and tests, Susannah knew something was wrong.
Anti-NMDA receptor encephalitis is a recently diagnosed autoimmune disorder formally named by Dr. Josep Dalmau and his team in 2008 and is still an active area of research. Following the initial discussion by Dalmau et al, many case reports similar to Susannah’s have surfaced. At this point the disorder is thought to progress in 3 main stages: 1) prodromal viral like illness, 2) memory problems, behavioral disturbances, and psychiatric symptoms (such as aggression, confusion, psychosis, sexual disinhibition), and 3) neurologic symptoms typically seizures, unresponsiveness, dyskinesia, catatonia, and autonomic instability. Routine physical investigations in these patients were largely normal, but common findings are minor slowing on EEG and leukocytosis in the cerebral spinal fluid. The cause of this disorder is still unclear but is noted to have an association with tumors, especially ovarian teratomas.
Susannah, unlike many other patients had a physician who believed her symptoms were “real.” After an extensive diagnostic work-up and psychiatric consultation, her neurologist referred her for brain biopsy and began a treatment that would eventually lead to a long course back to normalcy.
This is an engaging novel that allows you to experience her life during this illness first-hand. You feel not only sympathy for her deteriorating condition, but finish the book feeling empathy towards all patients suffering from psychosis, metabolic or otherwise. You will not be able to put this book down until you get to the end. Regardless of medical background, this book is a fantastic read and highly recommended.
Interview with Susana Callahan: https://youtu.be/Najj0aVLJwU
Brian
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