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See Inside Scientific American Mind Volume 23, Issue 6

MIND Reviews: Brain on Fire



Brain on Fire: My Month of Madness
Susannah Cahalan
Free Press, 2012 ($25)

In early 2009 Cahalan woke up in a hospital with electrodes glued to her head. She was restrained to the bed and unable to breathe a word, with a security guard keeping a watchful eye on her. Just days earlier she had been living a dream life—a 24-year-old rising star reporter at the New York Post, with a serious boyfriend and a loving family.

In Brain on Fire, Cahalan recounts her gripping story of suddenly and inexplicably going mad. Without warning, Cahalan, a healthy, hard-hitting and even-tempered journalist, had degenerated into a violent, irrational psychotic, at one point ripping off her electrodes and running through the hospital hallways.

For a month Cahalan's friends and family watched helplessly as a baffled medical team struggled to uncover what was happening to her, keeping notes in journals to document their experiences and to inform one another of updates. A team of doctors racked up $1 million in medical bills conducting blood tests, spinal taps, an MRI, an ECG, a seizure-monitoring test, as well as an experimental treatment that cost $20,000 for a single infusion. None of these tests explained her symptoms.

As hope of her recovery waned, her doctor, Souhel Najjar, had an idea. He asked Cahalan to draw a clock. As she struggled through the task, Najjar realized what was wrong: “Your brain is on fire,” he said. Cahalan had drawn a one-sided clock, which showed Najjar that only one side of her brain was working properly.

After a brain biopsy and an additional spinal tap, Najjar discovered that Cahalan had contracted a rare and potentially fatal autoimmune disease called NMDA receptor autoimmune encephalitis, an attack on the brain by the body's immune system. The team rushed to save her from the mysterious condition, which was first characterized in 2007. With unknown origins and mechanisms, this disorder can elude even the best doctors. What we do know is that the disease is associated with psychiatric symptoms, memory lapses, seizures and tumors, among other problems. Luckily, Cahalan's treatment came quickly enough for her to pull through mostly unscathed, and she eventually resumed her job at the Post.

Although Cahalan could not remember anything from her month of madness, she pieced together her story through her family's journals, hospital videos and reports, as well as friends' accounts. In her hospital videos, she recalls watching herself as an angry, terrified stranger. As she reflects on her illness, Cahalan wonders how many people go misdiagnosed or undiagnosed in a psychiatric ward as a result of lesser-known neurological diseases.

A page-turner, Brain on Fire is a true story that reads like fiction. Although the level of medical detail Cahalan provides is limited, she manages to bring this neurological disorder to life. The book walks the line between heart-warming personal story and medical thriller and will appeal to science and biography fans alike.

This article was originally published with the title "Crazy Tale."

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