Brain ON FIRE (RP) - Reflection paper PDF

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Brain on Fire The movie entitled “Brain on Fire” is a true story drama film based on Susannah Cahalan’s memoir “Brain on Fire: My Month of Madness.” It was released on 2016 under the direction of Gerard Barrett. The movie features the life of Susannah Cahalan a young, healthy, energetic English journalist who works at the New York Post. She almost had a perfect life. She had her dream job, her aspiring musician boyfriend Stephen, and her improbable attractive divorced parents Tom and Rhoda. Furthermore, she had a strong relationship with her co-workers like Margo and her boss Richard. She had her whole life in front of her and had absolutely no idea what’s waiting for her. Her enthusiastic everyday life started to change on her 21st birthday. When she was about to blow the candles, she suddenly felt deaf for a short period. The next day, she mysteriously started zoning out at random moments, suffering from headaches, feeling numbness in her limbs, hearing mysterious voices, and seeing things that nobody can such as bed bug bites and faucet leaking out. Accordingly, doctors assured her that there’s nothing to worry about, for all her medical exams were normal. Then, her condition continued to worsen. She began to have seizures, violent outbursts, hallucinations, symptoms of psychosis and eventually catatonia. She was then admitted to the hospital and had a prolonged stay there. Consequently, doctors don’t have any idea about her state and they continue giving her wrong diagnoses. They lastly diagnosed her to be psychotic without strong basis. Luckily, in the last moment Doctor Souhel Najjar had finally identified her condition wherein she had AntiNMDA receptor encephalitis. Thereafter she received proper treatment and she had rebuilt her life. Realization about the movie The unknown illness that attacks Susannah was terrifying. Consequently, the movie brings awareness to an issue many patients’ struggles with which is to have a correct diagnosis. I realize that many were routinely misdiagnosed especially those who have autoimmune diseases like what Cahalan had. Base on my research, medicine plus declares that there are over 80 different autoimmune diseases. Similarly, these diseases are difficult to diagnose. It had many similar symptoms which makes it hard for doctor to identify. For instance, the symptoms that Susannah experienced can be associated to other disease such as schizophrenia and bipolar disorder. Hence, knowing if the patients have an autoimmune disease is hard. Furthermore, I realized that it’s hard to be non-functional. Like Susannah’s condition, she seems to have lost her mind and direction. Hence, I felt that those people who suffer from same

illness should be given extra care, love and patience. The family of the affected should stay strong and never lose hope like Susannah’s family. In addition we should be cautious and observant about our health. We should take care of ourselves properly. Opinion The movie was good and it had portrayed clearly the experienced of those people who suffer from such illness though I can say that there were some lapses in the movie. I had not quietly felt the character despite the movie being based on a real story. The character of Susannah was flat or thin. It didn’t give me any appeal or get my attention first. I think any audience would have felt the same. Hence, I don’t really feel that dramatic even though the lead character was having paranoid episodes, manic mood swings, hallucinations, and unbearable fatigue. Hence, I think it’s a good idea that the movie had let us first care about the character. Furthermore, Susannah’s family should have given more emotional reluctance when the doctors wanted her to be send to a psych hospital, as well as a flood of relief when the doctor had finally identify the problem. Therefore, I can say that the family’s connection was dramatically ineffectual and emotionally flat. If you were the family of the patient what would you do? If I am the family of the patient, I think I would be so worried and restless about the condition of Susannah. I might lose hope for the repeated misdiagnoses given to her but just like her family I won’t give up to save her. I won’t also be sending her to a psych hospital without strong findings. I would do my best to save Susannah. I might send her to other hospital with best doctor just to find out her state. Furthermore, during this time I would double my efforts for her. I will support her and prolong my patience. I would do anything just to save Susannah. Background of the disease Anti-NMDA receptor encephalitis is a disease occurring when antibodies produced by the body’s own immune system attack NMDA receptors in the brain. NMDA receptors are proteins that control electrical impulses in the brain. Their functions are critical for judgement, perception of reality, human interaction, the formation and retrieval of memory, and the control of unconscious activities (such as breathing, swallowing, etc), also known as autonomic functions. In anti-NMDA receptor encephalitis, antibodies are generated against NMDA receptors and go on to attack these receptors where they are found in their highest concentration: within the brain. The reasons why anti-NMDA receptor antibodies are formed is not yet fully understood. Similarly, the causes of anti-NMDA receptor encephalitis are still unknown. The symptoms of anti-NMDA receptor encephalitis are: flu-like symptoms, memory deficits, including loss of short-term memory; sleep disorders; speech dysfunction – the patient is no longer able to produce coherent language or may be completely unable to communicate; cognitive and behavioural disturbances – confused thinking, hallucinations, delusional thinking,

disinhibited behaviours; seizures; movement disorders – usually of the arms and legs and the mouth and tongue, but may include full body spasms. These types of movements are very common in Anti-NMDA Receptor Encephalitis and the patient is unable to control them. They are often quite severe, requiring the patient to be restrained and sedated for their own safety and those of their care-givers. Sometimes patients are unable to move, and may appear like a statue, holding the same position for hours or days (catatonia); loss of consciousness – the patient may be semi-conscious or may slip into a coma; autonomic dysfunction – erratic breathing, heartbeat and blood pressure; loss of bladder control and bowel movements; central hypoventilation – the patient may stop breathing, and may require a mechanical breathing machine; and vision and/or hearing may also be impaired. The majority of cases occur in young adults and children, although cases have been diagnosed in people in their 80’s! Females are approximately four times more likely to be affected than males. A diagnosis of anti-NMDA receptor encephalitis requires antibodies to be detected in the body fluids of someone with symptoms consistent with anti-NMDA receptor encephalitis. Antibodies may be found in either blood or spinal fluid. Tests on the spinal fluid are more accurate than those on the blood. Therefore, if blood tests are negative, the spinal fluid should be tested before concluding that the patient does not have anti-NMDA receptor encephalitis. Patients diagnosed with anti-NMDA receptor encephalitis need to be admitted to hospital where they can be monitored and attended to by a team of doctors, nurses and other health professionals. Although every patient’s disease, symptoms and experience is different, most are treated with medications that reduce the levels of antibodies in the blood and spinal fluid. These include corticosteroids (“steroids”), intravenous immunoglobulin (antibodies collected from healthy blood donors that bind host antibodies) and plasmapheresis (PLEX; that involves use of a machine to filter antibodies out of the host’s blood). Occasionally, the uses of more powerful drugs are required to eliminate antibodies. The drugs most commonly used to treat Anti-NMDA Receptor Encephalitis are rituximab (Rituxin®) and cyclophosphamide 9 (Cytoxin®). Many other medications may also be required, including those used to control blood pressure, stop seizures, ease anxiety, improve sleep, and to treat hallucinations or abnormal behaviours. Also, medications may need to be continued after the patient has begun to recover.

Ranao Council – Al Khawarizmi International College Foundation Inc.

Senior High School Basak Malutlut, Marawi City

Reaction paper

“Brain on Fire”

Submitted by: Macadaag, Alyanah Zahra STEM 12 - Shirazi

Submitted to: Ma’am Salwa U. Amanoden

October 2019...