Brain on Fire: My Month of Madness: Chapter 29 Summary & Analysis

Dr. Russo arrives to speak to Mom about what the possible diagnoses are. After she lists a few, Mom pulls her into the hallway and asks her personal opinion. Dr. Russo explains that she and Dr. Najjar have a bet: he thinks it's autoimmune encephalitis; she thinks it's paraneoplastic syndrome, which happens when someone has cancer and the immune system attacks healthy parts of the body along with the tumor. This terrifies Mom.

Meanwhile, samples of Susannah's blood and cerebrospinal fluid are on their way to the lab of Dr. Josep Dalmau. Four years earlier, Dr. Dalmau had begun studying four women who developed psychiatric symptoms and encephalitis. All experienced hallucinations, memory problems, and delusions, and they all had tumors called teratomas in their ovaries. He'd discovered that the women's antibodies had been attacking their brains. He performed tests on rat brains and on kidney cells and discovered that that the antibodies were binding to particular receptors, called NMDA receptors. He called the disease anti-NMDA receptor encephalitis.

Susannah explains that while it's unclear exactly how NMDA receptors in the brain alter behavior, compromising those receptors can be deadly. In tests with mice, decreasing or eliminating those receptors leads to psychosis, catatonia, or respiratory failure, depending on how many receptors they had. By 2007, Dr. Dalmau had diagnosed a hundred patients, not all women, and had developed two tests to diagnose the disease. Susannah would be the 217th person to be diagnosed since 2007. Susannah wonders how many other patients go without a diagnosis worldwide, since it took so long to reach her own diagnosis.