In May 2020, Rachael Muggleton was completing her third year of pre-med studies at Penn State University when she unexpectedly and rapidly fell ill, the victim of a rare and dangerous inflammation in the brain. She chronicles her remarkable journey in a piece on the Neurocritical Care Society’s website, describing her decline in health, months of stay at Strong Memorial Hospital, and remarkable recovery.
Initially admitted to Arnot-Ogden Medical Center in her hometown of Elmira, NY, Rachael was quickly transferred to the Neuromedicine Intensive Care Unit (NMICU) in Strong, where doctors placed her in a medically induced coma for 42 days to control her seizures. to get. a multidisciplinary team of specialists aimed to calm her brain and immune system.
Rachael suffered from a rare and complex condition called autoimmune encephalitis (AE), an inflammation in the brain caused by the body’s own immune system attacking healthy brain cells, which can lead to seizures, impaired memory and cognition, and problems with balance, speech, and vision. Tests showed she had a specific type of AE characterized by the production of antibodies that attack NMDA receptors, which are located on the connections between neurons, disrupt normal signaling between nerve cells and cause inflammation. This form of AE is more common in women and may be associated with certain cancers, but sometimes the source of the damaging immune response cannot be identified, as was the case with Rachael.
“You can’t just treat cases like Rachael’s anywhere,” says Debra Roberts, MD, Ph.D., medical director of the NMICU. “You need experts in neurological disorders caused by inflammation or autoimmunity and seizures, along with the high level of intensive care required for these critically ill patients.”
A team consisting of neurocritical care specialists Roberts, Ben George, MD, Imad Khan, MD, and Andrea Esposito, CRN, epileptologist Olga Selioutski, DO, neuroimmunologist Lawrence Samkoff, MD, and physical therapist Melanie Rozek, DPT, and others took care of Rachael during her six-month ICU and hospital stay. During the medically induced coma, she was given one set of drugs to suppress her seizures, another set to suppress her immune system, and a treatment called plasmapheresiswho removes and replaces blood plasma in an effort to eliminate the antibodies that attack her brain cells.
In mid-August, the team began the process of waking Rachael, weaning off her meds, and helping her learn to swallow, speak and walk again. This continued after she was released from the hospital in October and over the weeks and months Rachael continued to slowly but surely regain cognitive function and motor skills.
Rachael returned to Penn State in the fall of 2021 to resume her studies. In December, she spent a week in the UR Medicine Neuro-ICU, this time to reunite with the doctors, nurses and staff who cared for her during her long stay at Strong Memorial Hospital and to shadow them. She is currently preparing to earn her MCATs, considering neurology as a specialty, and her experience could bring her back to the University of Rochester as a medical student.
“When someone is with you as long as Rachael is, you get attached and they become part of your family, especially if that person is young and has their whole life ahead of them,” Roberts said. “Every member of our team was determined to get her through this devastating illness, and to see how far the remarkable young woman has come and what lies ahead has been an amazing experience.”