Autoimmune Encephalitis”A Disease of Madness”

Kristi Wrolstad, Tristan Buie-CollardDepartment of Psychology, University of North Carolina-Asheville

Mistaken IdentityMany have mistakenly brought their loved ones to get exorcised believing that the sudden erratic and sometimes violent behavior was due to demonic possession

Case Study #1Patient 1 suffered from the following ailments and symptoms:•Severe headaches•Numbness in the mouth/on the face•Numbness in the legs•Mononucleosis •High fever for 9 months•Scoliosis

Answer: Five years ago, Patient 1 was misdiagnosed with MS. As of today, doctors still have not been able to deduce what is wrong with her. Patient response:“ Honestly, I haven't gotten a complete answer [as to what disease I suffer from]. The meds ruined years of my life. They decided didn't have MS when I convinced them that I never had a real exacerbation and I really didn't have any other symptoms of the disease. I suggested that it may have been brain damage due to the fever I had when I had mono since the lesions they found on the MRI are in my frontal lobe. The neurologist agreed and basically sent me on my way. I didn't really care at the time because I just wanted out of the situation. I think the cramping and numbness I was experiencing may have been an issue related to my back, maybe a pinched nerve? Either way, nothing has happened and it's been nearly 2 years since the diagnosis was reversed (fingers crossed). I work full-time in a hospital and I am in Nursing school.”

Case Study #2Patient 1 suffered from the following ailments and symptoms:•Blurred Vision Pink Eye Assumption Blind in one eye•Daily headaches•Fatigue•Slight verbal communication impairment •Poor long-term memory

Tonya was diagnosed with optic neuritis, a common symptom of multiple sclerosis. After two months of patience, and a confirmed diagnosis of MS, she was told that she would be “walking with a cane in 10yrs and in a wheelchair in 20 if [she] did not start treatment.” However, despite the recommendation from her neurologist, Tonya decided that the Rebif shots (Interferon Beta 1a) were not the treatment for her, considering the dangerous side effects. She opted to take her diagnosis into her own hands with chiropractor visits, exercise, a healthy diet, and a low stress life style. As advised by her doctor, using medication to “suppress” MS is not the choice for everyone.

Treatment 1•Natalizumab: Natalizumab is a monoclonal antibody that is used in patients with a relapsing high disease activity of Multiple Sclerosis. The purpose of the drug is to prevent the attaching and passing through of inflammatory immune cells to the blood brain barrier and the layers of cells lining the intestines. Patients who have had 2 or more documented relapses of MS are administered this antibody. The usage of this antibody assists in the reduction of MS symptoms, the prevention of relapses, the prevention of vision loss, and the prevention of cognitive decline. The results from the study Efficacy of Natalizumab in Multiple Sclerosis Patients with High Disease Activity: a Danish Nationwide Study showed that of the 234 patients treated in this experiment, 134 relapses occurred (a relapse rate of 0.68).

Treatment 2Injection devices of interferon-beta-1a: Subcutaneous administration of interferon-beta-1a (a drug produced by mammalian cells) was tested on patients to measure treatment satisfaction based upon injection devices being utilized. According to the study Patient Satisfaction with an Injection Device for Multiple Sclerosis Treatment, “Patients’ subjective experience of how effective, tolerable, and easy a medication is to use may affect their persistence with that medication. “ Patients who use subcutaneous treatments will fail to continue injecting their medication consistently, thus, it is essential to conduct research to determine whether or not injection of MS treatment drugs such as interferon-beta-1a are effective treatment plans. The research conducted tests pain and instrument sensitivity—major factors in determining whether patients will continue their treatment plans. Results from this research showed significant improvements with the new injection device (Rebeject II) in all MS Treatment Concerns Questionnaire subscales.

Treatment 3Cell Therapy: Stem cells from adipose tissue offers a sufficient treatment for patients with Multiple Sclerosis. The implications of implementing adipose derived cells in MS patients sheds potential on the treatment of inflammatory conditions. In a research study conducted, Non-expanded Adipose Stromal Vascular Fraction Cell Therapy for Multiple Sclerosis, Minev and his colleagues provided adipose-derived stem cells to 3 patients. Patient one, a 50-year-old man, reported a loss of coordination, imbalance, and severe pain prior to being treated. However, after being treatment, patient one reported significant improvements in coordination, energy, and balance. Patient two, a sufferer of persistent seizures, reported significant improvements in spasticity of his legs and arm. The last patient, a sufferer of MS for more than 15 years, reported improved coordination and energy after stem cell infusion.

ConclusionMedical treatment for multiple sclerosis is currently limited to treating symptoms. The primary treatments, such as Interferon Beta 1a and Natalizumab, suppress inflammation of the brain. We do not yet know the cause of demyelination in MS patients. Treatment can increase quality of life for MS patients and slow the progression of degeneration, however, there is no cure. Future research objectives aim toward preventing MS, reducing cognitive damage from MS, and repairing existing demyelination.

Mission Hospital Medication Treatment

•Interferon Beta 1aUse: Suspected MS (30 mcg IM 1/week or 22 or 44 mcg subcutaneously 3/week)

Relapsing-remitting MS (30 mcg IM 1/week or 8.8 mcg subcutaneously 3/week for 2 weeks with a gradual increase)•Interferon Beta 1b Use: MRI consistent with MS w/ first clinical episode, relapsing-remitting MS, progressive-relapsing, & secondary-progressive (Initial dose of 0.0625 mg subcutaneously with gradual increase to .25 mg every other day)

~Interferons are proteins that are released in the body in response to pathogens. They enable communication between cells to trigger the immune system, and are useful as an anti-inflammatory of immune cells and the blood-brain barrier. However, the body will eventually form a tolerance, often there are no seen effects, and is only used to reduce relapse rates and slow the progression of MS.

•MethylprednisoloneUse: Acute exacerbation (500 to 1000 mg IV for 3 to 5 days)

Optic neuritis (250 mg IV every 6 hrs for 3 days with tapering schedule)

~Methylprednisolone is a synthetic corticosteroid, a chemical that modifies the immune system and works as an anti-inflammatory in the central nervous system and the optic nerve.

•Natalizumab Use: Relapsing-remitting MS that has failed to respond to other therapies (300 mg IV 1 hour / 4 weeks)

~Natalizumab is an anti-body used to suppress inflammation, commonly used in conjunction with an interferon,.

There are also treatment plans for dealing with these symptoms:Acute pain, Musculoskeletal pain, Neuropathic pain, Fatigue, Increased muscle tone and spasticity, Nocturnal spasms, Urge incontinence / Detrusor Hyperreflexia, Flaccid bladder, Vertigo, Tremor, Ataxia & more

Mission Hospital Treatment Options

1. Chemotherapy- shuts down the immune system to change the course of MS2. Immunotherapy- prevents the immune system from attacking the body3. Steroids- may shorten the time an episode of symptoms last4. Medications- control and decrease MS symptoms5. Rehabilitation programs- mental and physical exercises