When the Immune System Turns Against the Brain
Christy Morrill described his experience as "my year of unraveling" - a nightmare period where his own immune system launched an attack on his brain. This condition, known as autoimmune encephalitis, strikes the very organ that makes us who we are, often appearing without warning.
Morrill had been enjoying a bicycle ride with friends along the California coast, stopping for lunch with nobody noticing anything amiss. The trouble only became apparent when his wife asked about his day and he realised he had no memory of the outing. His condition would deteriorate significantly before improvement began.
Autoimmune encephalitis represents one of medicine's most baffling conditions, where seemingly healthy individuals abruptly spiral into confusion, memory loss, seizures, and even psychosis as their immune systems damage rather than protect the body.
The Stealth Attack on Memory and Identity
Doctors are becoming increasingly skilled at identifying this mysterious condition, thanks to discoveries of rogue antibodies responsible for the attack. Dr. Sam Horng, a neurologist at Mount Sinai Health System in New York, explains that new culprit antibodies are being uncovered every year.
While current treatments involve general approaches to combat inflammation, two major clinical trials are underway aiming for more targeted therapies. The challenge remains that symptoms are often mistaken for psychiatric or other neurological disorders, delaying proper diagnosis and treatment.
"When someone's having new changes in their mental status that are worsening with a bizarre quality, that tips our suspicion," Dr. Horng noted. "It's important not to miss a treatable condition."
With early intervention, some patients achieve full recovery. Others, like Morrill, regain normal daily functioning but contend with lasting damage. In his case, the 72-year-old literature major lost decades of autobiographical memories while retaining factual knowledge.
"I remember 'Ulysses' is published in Paris in 1922 at Sylvia Beach's bookstore. Why do I remember that, which is of no use to me anymore, and yet I can't remember my son's wedding?" Morrill wonders.
Recovery and Hope Amidst the Challenges
The condition manifests when the brain becomes inflamed, with symptoms ranging from mild to life-threatening. While infections commonly cause encephalitis, when these are ruled out, autoimmune causes must be considered - particularly when symptoms emerge suddenly.
Different antibodies create distinct problems depending on whether they target memory and mood regions or sensory and movement areas of the brain. Dr. Horng describes how "facets of personhood seem to be impaired" in these cases.
Treatment approaches include filtering harmful antibodies from patients' blood, infusing healthy antibodies, and using high-dose steroids to reduce inflammation.
For Morrill, five years after his diagnosis of LGI1-antibody encephalitis, he still grieves lost memories of family gatherings, studying in Scotland, and travels with his wife. Yet he's creating new memories with grandchildren, has returned to outdoor activities, and leads a support group for the Autoimmune Encephalitis Alliance.
"I'm reentering some real time of fun, joy," Morrill reflects. "I wasn't shooting for that. I just wanted to be alive."
