Few diseases I find as eerie and daunting as autoimmune encephalitides. Subtle and insidious in their onset, and pervasive to any and all.

This piece was inspired by a young patient, a 20 year old aspiring physical therapy student - who I diagnosed and treated for a rare condition, Anti-NMDA encephalitis.

Encephalitis or “inflammation of the brain” occurs when the body’s intrinsic immune system starts to attack its own cells and in this case the cells of the central nervous system.

Symptoms including psychosocial disturbances, personality changes, seizures, oro-facial dyskinesias and overtime a complete loss of sense of self and awareness.

Antibodies detected in blood and CSF can help establish the diagnosis and treatment is focused on aggressive immunotherapies including IVIG, plasmapheresis and monoclonal antibody immunotherapy drugs.

Depicted in this painting is the psychotic facial appearance often seen in patients, the fading away of a sense of self, the inferno around the head to embody the inflammatory condition. Ant like bodies widely disseminated, and IVIG molecules that are often represented by (Y) providing freedom from the disease like the freedom of birds in a beautiful sunset. Characteristic EEG findings that helped me suspect the disorder in my patient was an EEG pattern of Delta brushes, sinusoidal slow delta waveforms with subtle brushes, characteristic for Anti-NMDA encephalitis.

She will go on to PT school, and hopefully equip herself with the skills to help others recover from their diseases.

Contributor: Anton Ostashko