In May 2020, Rachael Muggleton was wrapping up her third year of pre-med studies at Penn State University when she unexpectedly and rapidly fell ill, victim to a rare and dangerous inflammation in the brain. She details her remarkable journey in a piece on the Neurocritical Care Society website, in which she describes her decline in health, months-long 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) at Strong, where physicians put her in a 42 day medically-induced coma to control her seizures, as a multidisciplinary team of specialists strove to calm her brain and immune system.
Rachael suffered from a rare and complex condition called autoimmune encephalitis (AE), an inflammation in the brain triggered by the body’s own immune system attacking healthy brain cells, which can result in seizures, impaired memory and cognition, and problems with balance, speech, and vision. Tests determined she had a specific type of AE characterized by the creation of antibodies that attack NMDA receptors, which reside at the connections between neurons, disrupting normal signaling between nerve cells and triggering inflammation. This form of AE is more common in women and can be associated with certain cancers, however, the source of the damaging immune response sometimes cannot be identified, as was the case with Rachael.
“You can’t treat cases like Rachael’s just anywhere,” said Debra Roberts, M.D., 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 necessary for these critically ill patients.”
A team consisting of neuro-critical care specialists Roberts, Ben George, M.D., Imad Khan, M.D., and Andrea Esposito, C.R.N., epileptologist Olga Selioutski, D.O., neuro-immunologist Lawrence Samkoff, M.D., and physical therapist Melanie Rozek, D.P.T., members of the Brain Injury program in Acute Rehab rehabilitation, and others cared for Rachael during her six month stay in the ICU and hospital. During the medically-induced coma, she was put on a set of drugs to suppress her seizures, another set to tamp down her immune system, and a treatment called plasmapheresis, which removes and replaces blood plasma in an effort to eliminate the antibodies attacking her brain cells.
By mid-August, the team started the process of waking Rachael up and weaning her off her medications and helping her to relearn how to swallow, speak, and walk. This continued after she was discharged from the hospital in October and over the weeks and months, Rachael continued to slowly but steadily regain cognitive function and motor skills.
Rachael returned to Penn State in fall 2021 to resume her studies. In December, she spent a week in the UR Medicine Neuro-ICU, this time to be re-united with and shadow the physicians, nurses, advanced practice providers, and staff who cared for her during her long stay at Strong Memorial Hospital. She is currently preparing to take her MCATs, considering neurology as a specialty, and her experience may bring her back to the University of Rochester as a medical student.
“When someone is with you as long as Rachael, you become attached and they become a part of your family, especially when that person is young and has their whole life ahead of them,” said Roberts. “Every member of our team was committed to getting her through this devastating illness, and to see how far the remarkable young woman has come and what lies ahead has been a wonderful experience.”