If you know some English, read “Brian on fire: my month of madness”, the book written by a young and beautiful New York journalist, Susannah Cahalan .
To this girl, in 2007, at the age of 24, in just over a month, many different diagnoses were made: bipolar disorder, epilepsy, schizophrenia, alcohol withdrawal syndrome, possible brain tumor . Neurologists and psychiatrists came to her bed without finding an explanation for her symptoms.
The clinical picture was really a diagnostic challenge because Susannah had presented a very particular course.
In the week preceding his admission he had noticed a slight exhaustion, some malaise, and a slight fever. Nothing that could not be confused with a trivial flu. In fact, the doctor prescribed some rest from work. She was very busy at the time: a new job at the New York Post, the city tabloid, the move to the new apartment with her musician boyfriend …
After a week, however, what was a simple flu, turns into hell. Susannah begin to have sudden changes in her mood. She went from unmotivated laughter to crying with great ease (“While I was sobbing hysterically crying, a minute later I found myself laughing out loud” she says in her book).
He went from unstoppable talkative to not saying a word anymore. She often for no reason she became aggressive, suddenly. Very soon sudden fainting, hallucinations appeared; her speeches became more and more confused and twisted, I begin to believe that something around her had changed, that “her father had kidnapped her”.
She had very strange body movements. She herself said:
“I had bizarre abnormal movements that I couldn’t control. They told me I drooled and, when I was tired, I left my tongue hanging out on the side of my mouth, like dogs do when they are hot ”.
She was admitted to a psychiatric clinic. So many diagnoses, so many therapeutic attempts made. But she Susannah instead of getting better, she got worse and worse. As a friend of hers said, she had become a zombie.
All this until a Syrian doctor asked her to draw the face of a clock, obtaining from the patient the drawing of only one half of the clock, “concrete proof that the right side of her brain was on fire”, says Dr. . Najjar.
Susannah begins anti-inflammatory treatment that modulates the immune system and returns to life within a month. Recovery was a little slower, but the worst was over.
Susannah’s disease is an autoimmune inflammation of the brain. She belongs to the group ofAutoimmune Encephalitis . The most common form of autoimmune encephalitis is from antibodies directed towards receptors called NMDA, receptors involved in the processes of memory, as in the case of Susannah. But many forms are described that affect other receptor structures.
These are diseases very similar to autoimmune thyroid disease, to make you understand. Except that the antibodies produced are directed towards brain structures that regulate emotional, cognitive, affective life, leading to clinical pictures very similar to some psychiatric syndromes.
In Italy, very little is known about these diseases. But reading the story of this girl from New York, one realizes how many stories of this type have arrived in the neurology and psychiatry departments all over Italy, indeed all over the world. And many patients who in the past had been labeled as schizophrenic and who had flocked to psychiatric clinics, asylums, neurology and psychiatry institutes, probably, in the light of these new discoveries, could have had a different fate.
Susannah herself says it:
“What happened to me was something beyond my control, something different from me, which took over my life, robbing me of a good part of my youth.
Some say they would like to live in different eras. I, on the other hand, am very grateful to live in this age. If I had had the disease at any time before 2007, or had been born at any other time, I probably wouldn’t be here talking to you.
Yet despite the treatments, there are still 7% of people who continue to die. Others, however, receive severe cognitive impairment. I suspect that many people have spent their lives in psychiatric institutions, without ever having had the correct diagnosis ”.
Well, that’s something I think too.
In medicine, you should never take anything for granted. An error of assessment, an attempt never made, a mistake, can change a person’s destiny, perhaps forever.
Good luck, Susannah.

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