Book Review: Brain on Fire by Suzannah Catalan

Brain on Fire by Suzannah Cahalan

This book provides an amazing window into the agonies of mental illness. While the book focuses on a certain type of mental illness, you’ll also learn about others. After reading this book you’ll have a greater appreciation for all who struggle with mental illness.

My Notes (I apologize for the randomness of these notes. These are just a few things that I found interesting.)

S’s problems began with two red bumps on her arm that she thought must have been bed-bug bites. From there the paranoia began to grow and grow until she began to have zombie like features.

Different Types of Seizures:  Zombie like moves, staring episodes, foggy consciousness, repetitive mouth or body movements. Long-term effects can be cognitive defects and death.

S. was drooling and smacking her lips. It seemed like she was sleeping with her eyes open.

Dr. Najar was the first doctor to really understand what was happening with S. He grew up in Damascus, Syria.

Dr. Najar gave her the clock test. He told her to draw a circle and then add the numbers for each hour. S. drew the circle, but when she wrote the numbers they were all on one side of the circle. Dr. Najar took this test to show that the problem was only in one side of her brain.

Anti-NMDA-REceptor Encephalitis

NMDA Receptors are vital for learning and behavior. They are mostly in the hippocampus and the frontal lobes. They either excite a neuron to fire or supress it. Antibodies were attaching to the surface of the neurons preventing them from sending chemical signals. Decrease NMDA Receptors by 40% and you get psychosis. By 70% you have catatonia. Catatonia is the height of the disease. If untreated, it can progress to breathing failure, coma and sometimes death. For 70% the disease begins like flu - headaches, nausea, etc. After two-weeks psychiatric issues begin - insomnia, anxiety, fear, grandiose delusions, hyper religiosity, and paranoia. 75% have seizures. Language and memory deficits arise. Autonomic issues develope such as too low or too high of a heart rate. 50% it is started by an ovarian tumor called a terratoma. In the other 50% the cause is never discovered. The terratoma was discovered by a German doctor in the 1800s. Terraton=monster in Greek. These tumors have hair, teeth, bone, even eyes, limbs and brain tissue. They are found in the reproductive organs and head.

Treatment: Steriods, Plasmapheresis (to remove the antibodies), IV IG.

Drugs: Prednezone (sp?) and Adivan (to treat catatonia), Geodone (psychosis), Trileptitol (seizures), Labetilol (high blood pressure), Nexium (acid reflux), Colase (constipation)

S went to college in St. Louis (I think Wash U.)

Deborah was a roomate diagnosed with colon cancer. She was very heavy. The nurses liked her. When she found out she had cancer, the nurses prayed with her. Over and over again Deborah said, “God is good. God is good.” When they all left, S said to Deborah, “God is good.” At one of the most intense times when it seemed possible that S would never be cured, her father went to a church to pray. These are the only two references in the book to seeking God’s help. However, at least they did cry out to God when all seemed to be lost.

The brain can create new neurons - process called neurogenesis. Our brains are like a computer that can create new hardware. This is also called neuroplasticity.

As S was improving she planned her day noting every little thing she did such as “walk to town” or “read the papers.” This was important because it showed that the frontal lobe was starting to repair itself.

The hippocampus tags a memory with context. The amygdala provides the emotion (fear, excitement, pain). When a thought is stamped by the amygdala with high emotional value, it’s more likely to be preserved. This is called encoding and consolidation. When any part of this is compromised, the memory may not be formed. (This is an important thing for teachers to consider. If we simply dole out information, it may not be remembered. We need to try to give the information in ways that might create stronger memories. I try to tag my teaching with life-stories that I hope make an emotional impact.)

Dr. Loftus studied memory problems. Scientists discovered that when memories are recalled they are sometimes remade and can be distorted. A memory can be distorted by one person, and that distortion can be shared and spread to others.

In the last part of the book she wondered about how people in the past were treated who had this disease. The disease has been diagnosed in children. She noted that the symptoms of the disease were similar to the the symptoms that were displayed by the character in the book The Exorcist.

S. thinks that Dr. Najar might be on the verge of breaking the barrier between immunology, neurology and psychiatry.

S. contacted one of her first doctors (a neurologist) who thought that her problems were due to alcohol abuse. When she told him about the disease, he indicated that he had never heard of it. Yet it had been widely circulated in every major medical journal and in the New York Times (This shows one of the great problems in the medical field - doctors who learn a lot in medical school but who stop learning later in their practice. This is also a big problem among clergy and probably only most any profession.) She notes that he saw 35 people a day. He had to do this to maintain the bottom line. She said it is a bad system. (However neurologists have very high salaries. They should be higher due to the higher skill level and training required. But could part of the problem also be their desire to make more and more money at the expense of lower quality medical care?)