Greg Widseth, a 47-year old Polk County attorney, was suddenly hit by a rare disease after seemingly feeling fine. The disease, discovered by Mayo Clinic specialists, prompted his immune system to attack his brain cells, resulting in as many as 60 seizures a day.
According to the article in the Star Tribune, prior to seeking help at Mayo Clinic, Widseth said neurologists near his home had no idea what to do for him after standard anti-seizure drugs failed to stop the lightning jolting his brain. Widseth's wife, Nan, called her sister in Rochester for help, whose neighbor happened to be Dr. Jeffrey Britton, a Mayo neurologist specializing in autoimmune encephalitis. Britton and his colleague, Dr. Andrew McKeon, a neuroimmunologist, agreed to see Widseth within a few days.
Special blood and spinal fluid tests developed by Mayo Medical Laboratories confirmed that Widseth had antibodies known to target certain brain cells. That prompted a round of immunosuppressant drugs that had him feeling nearly normal in just four days. According to Dr. Britton, patients who don’t get prompt immunosuppressant therapy can suffer serious memory problems or permanent seizures.
As stated in the article, scientists discovered in the 1960s that patients with some types of cancer can develop autoimmune disorders that attack the central nervous system. The immune system sends antibodies to attack the cancer, but sometimes they “cross-react” with normal brain cells, leading to neurological diseases, Britton explained.
Mayo Clinic researchers started seeing patients who had nerve diseases without the underlying cancers, and it occurred to them that the patient’s antibodies might be to blame. In the past decade, Mayo has been a leader in identifying harmful antibodies, Britton said.
While some patients have a fever shortly before the onset of their illness, possibly indicating an infection that set off the immune system, at least half the people seen don’t have an obvious trigger that can be pinpointed, according to Britton. “So we don’t know right now what sets it off.”
Dr. Sean Pittock, director of the Neuroimmunology Laboratory and the Center for MS and Autoimmune Neurology, set up the nation’s first autoimmune neurology clinic at Mayo in 2006. He said technological advances in the past decade have led to “an explosion” in the identification of antibodies that trigger neurological disorders. Autoimmune responses have been identified as the cause behind a variety of diseases, including dementia, epilepsy, encephalopathy, and some eye diseases and movement disorders, Pittock said.
Mayo patients with suspected autoimmune neurological diseases undergo special blood and spinal fluid tests to detect abnormal antibodies, which can lead to a search for cancers. Other tests, such as cognitive exams or electroencephalograms, help establish a baseline for their particular diseases. Immunosuppressant therapy is then prescribed, and the patients are retested for any improvement.
“With these types of conditions … we can sometimes stop the autoimmune inflammatory process and in fact in many cases, completely reverse the process,” Pittock said. “So it’s a very exciting area.”
Last April, Mayo published the results of a trial evaluating patients with presumed autoimmune epilepsy in the journal Neurology. Now the idea is spreading to other neurological diseases. Autoimmune spinal cord disease and autoimmune vision problems “have also been revolutionized by Mayo labs,” Pittock said. Now, Pittock said, researchers are exploring autoimmune disorders that cause serious, painful gastrointestinal disease. “Remember, the gut has 100 million neurons,” he said.
Since his diagnosis, Widseth has been able to stay on the job and said he’s grateful he got to Mayo before much damage was done.