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Rehabilitation Strategies

Rehabilitation Strategies

December 8, 2021 | By Mari Wagner Davis, RN ACM

The staff at IAES is proud to present an informational blog written by our wonderful Support Services Coordinator, Mari Wagner Davis. Mari is instrumental in helping AE Warriors, their families and caregivers receive the information and services necessary to optimize their diagnosis, care, and recovery. She is a mighty warrior herself and developed strategies that have not only greatly helped her but have also aided hundreds of others on their AE path forward. We hope you find the information and story to follow, helpful!


My name is Mari Davis, and I am the Support Services Coordinator with the International Autoimmune Encephalitis Society. I was diagnosed with limbic encephalitis almost 5 years ago after having seizures at work. After being diagnosed with AE, I received plasmapheresis, IVIG and steroids. Due to ongoing seizure issues, I remain on seizure medications, and I continue to have memory issues.

After my initial diagnosis and treatment, I had a brief inpatient rehabilitation stay and then was able to move back to our home and transition to a day rehabilitation program. I was, also, able to complete a cognitive rehabilitation computer program. As time went on, it became apparent to me that there was little known about what rehabilitation services may be best for AE patients like me and those with other forms of AE. We all differ greatly in our AE recovery and rehabilitation but many of us have similar issues. I began to question and investigate what services could help to provide the best possible outcomes and help those with AE reach their maximum potential over time.  For example, I have noticed that I have improved greatly in some areas and not so much in other areas.   I have memory issues and have issues with divided attention. I find it difficult to multi-task. Although inpatient and outpatient rehabilitation services ended, I have continued to work on making progress in the areas that I struggle with. With my background and work as a nurse case manager coupled with my own diagnosis of AE, I have been on a quest to find ways to better outcomes not only for myself but all those with AE. Although inpatient and outpatient rehab is wonderful, for me, it has not been AE specific enough.

Many of the areas that I have made the greatest amount of progress on are by developing methods and strategies that I have come up with myself and with the help of others and may be beneficial for those with AE. Realizing and accepting that I have a memory issue has made me become more organized. I have had to develop adaptive strategies for myself. Many of these ideas were not taught during rehab. In the following paragraphs, I will outline strategies that have greatly helped me.

When I plan meals and go food shopping, I save and write my grocery list and organize it by meal versus simply making a list of random items needed at home.  Before I started doing this, I would forget what I had planned on making and because of this I became confused and frustrated.  When I plan to make a meal, I will leave something out on the counter to remind myself of what I planned to make. It is a visual reminder of the meal I plan for that day. Another visual reminder strategy I use is to leave the light on that goes to the laundry area in our home. This visual cue helps me to remember that ‘light on’ means laundry being done. I then remember to go and check on the laundry’s progress. Another visual reminder cue I find useful is to leave my medication bottles on the counter and use a pill organizer. This makes it easier and ensures that I take my medications and keep track of when a med refill is needed. I feel what is out of sight is out of mind. Visual cues have been a very big help for me in overcoming memory issues.

Another way this strategy has been useful is to keep a calendar on my refrigerator. I note events on the calendar and keep this same event calendar on my cell phone. I then utilize the various alarm features and different sounds on my phone for specific events. Having the calendar on the fridge is a visual reminder for me but also lets my husband know what I have planned for certain days. One small thing I do is to call him when I leave the house and call him when I arrive where I am going. This gives him a sense of comfort knowing that I remembered the planned event, have arrived on time, and once home, have gotten there safely. I, also, use phone alarms for my medications. I find this especially useful in the evenings when I may have other activities going on or am tired.  My phone can be useful for directions, typing notes regarding things that I want to accomplish both routine and nonroutine. List making has become paramount for me. For many without AE remembering what needs to be done daily, weekly, and monthly may be easy. For me making a list either on paper or on my phone and then checking off the items once they are done has been a great strategy.  For many of us it can be easy to become frustrated or depressed when we acknowledge or need to deal with memory issues. It can be exhausting. Making lists and checking items off not only assures that things get done but it also gives us a sense of accomplishment and we can then see progress being made. For me, I feel more positive and successful in my rehabilitation.  

When I was discharged from rehab to home, I had no schedule. I slept quite a bit, which is necessary for our recuperation and recovery. And many of us still need to sleep, nap and rest more than we previously did. But I was left with no structure or schedule. I had previously been very busy with work, family, and friends. I felt at a loss.  I no longer had the daily structure I had loved and thrived on before. Trying to develop a new routine can be helpful. It provides structure and can help an individual by giving purpose. For those wanting to and able to return to work this provides a good transition strategy between recovery and returning to work. Simply giving yourself a daily timetable of things to get accomplished can be a mental boost. Of course, at times we need to recognize and pay attention to our brains and bodies and know the daily routines may need to change due to treatments, etc.

Another issue I have realized is that after acquired brain injury, rest is important. It is as important as working on the issues or deficits that remain difficult for us. Most of us need additional rest. At the end of a day, I will find that if I lay down on the couch watching TV, I will fall asleep. If I get up early, I may need a nap during the day. I may need breaks if I am working on something that is cognitively challenging. Giving myself the time to rest, will allow me to be more successful in the things that I am working on.

Exercise can also help in recovery. But it needs to be added to one’s schedule carefully and as tolerated. Exercise can be scheduled into the day at a time that will work with other planned activities. It may take time to come up with a daily routine and individuals with acquired brain injury may need help in initially making a schedule. But developing daily routines for those of us with AE can help our recovery both mentally and physically.

Many of us diagnosed with AE are not able to drive a car or any vehicle for many reasons but the main one being we have had seizures. In many countries we must prove we are seizure free for a certain period of time before our driver’s license can be reinstated or we may need to take a special type of drivers test or class to be able to drive. In my case, I took a special driver’s test with the DMV (Department of Motor Vehicles). The instructor was trained to work with individuals with disabilities and taught me a lot about safe driving. Although I did not pass the driving test the first time, I did the second time, by utilizing what he taught me. I am probably a safer driver now than I was before AE. One of the things the instructor taught me included waiting a bit once the light turns green in case someone is running the red light. This simple act would allow me to avoid getting hit by a car going through the light. I now leave more space between my car and the car in front of me. If there is a reason the car in front of me stops or is stuck in traffic, leaving additional space allows me a way to move into the next lane. I am cautious about my speed and leave additional time to get to where I am going. Prior to AE I used landmarks such as buildings to help when going someplace. Due to my memory issues and the fact that places change, landmarks are moved, etc., I now utilize my phone’s navigation apps versus trying to remember directions. And I check directions prior to leaving home so I am more confident in how to get to a location. Being able to drive once again and utilizing different direction strategies has allowed me some independence and given me confidence in what I can accomplish.

Having a new disability can be difficult to accept. I am not the same person I was before AE. I have seen a psychologist since I was discharged home. I have struggled with grieving the loss of the old me and accepting who I am today. With time and work I can say I have made progress; I now have much more appreciation for other people, I am not in such a hurry that I do not see what may be going on with others around me. I realize that some of my relationships where those of convenience, and I know how much it can mean to people to take a small amount of time to acknowledge them and spend some time with them. I can say that working with a professional around the issues of grief and adaptation can be helpful. I will say recovery after autoimmune encephalitis is a marathon not a sprint. Additional research about the stages of recovery after a diagnosis of autoimmune encephalitis is needed to help provide the services that can help both the individual and the family.

Utilizing some of the strategies I came up with has helped ensure progress in my recovery. It has helped boost my moral. Developing visual cues, trying to schedule my day, exercising when I can, getting adequate rest, learning new driving strategies, and seeing a psychologist have been extremely useful in allowing me to become the new me! 

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Become an Advocate by sharing your story. It may result in accurate diagnosis for someone suffering right now who is yet to be correctly identified. Submit your story with two photos to



International Autoimmune Encephalitis Society (IAES), home of the AEWarrior®, is the only Family/Patient-centered organization that assists members from getting a diagnosis through to recovery and the many challenges experienced in their journey. Your donations are greatly appreciated and are the direct result of IAES’ ability to develop the first product in the world to address the needs of patients, Autoimmune Encephalitis Trivia Playing Cards. Every dollar raised allows us to raise awareness and personally help Patients, Families, and Caregivers through their Journey with AE to ensure that the best outcomes can be reached. Your contribution to our mission will help save lives and improve the quality of life for those impacted by AE. 

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For those interested in face masks, clothing, mugs, and other merchandise, check out our AE Warrior Store!  This online shop was born out of the desire for the AE patient to express their personal pride in fighting such a traumatic disease and the natural desire to spread awareness. Join our AE family and help us continue our mission to support patients, families and caregivers while they walk this difficult journey.  

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Be a part of the solution by supporting IAES with a donation today.





5 Ways to Answer “How Can I Help”

November 10, 2021 |  By Michelle Seitzer of Caregiving Advice

A message from IAES Blog staff:

In the US, Thanksgiving Day and week are upon us. And we have much to be thankful for. For those within the AE community, we cannot thank all those that care for us, in any capacity, enough! As we round out Caregiver Awareness month and head into a holiday season of joy, peace, and grace, may we all continue to be aware and be thankful for all we have been given. 

Michelle Seitzer founder of Caregiving Advice has graciously offered to let us share her article regarding ways to help those that care for us the most. We hope you find this as informative as we have!

She offers wonderful tips, and many ways caregivers can be cared for!!!


Want to help a caregiver whose life is busy, busy, busy? Here’s how!

During this week’s Coffee Chat—our brand new virtual support group that takes place Mondays at 11ET on Instagram Live—we talked about what kind of help is actually helpful for caregivers, and why it’s so hard to get it.

We first posted this article in February 2020, right before the world shut down. How times have changed since then! But the advice we shared here? It hasn’t changed at all. Caregivers still need help. Caregivers still want help. But caregivers get a little triggered by kind offers from well-meaning people—and here’s the main reason why.

Because it feels like more work.

When caregivers hear these age-old phrases—“How can I help?” or “Let me know if I can do anything!”—our initial internal reaction is STRESS. Because the thought of coming up with helpful tasks feels like extra work, and extra work is something no caregiver wants. We want someone to lighten our load, not add to it!

Now don’t misunderstand: We are generally thankful for the offers. We appreciate that you see our need for help and want to provide it. But we need you to make it a little easier for us. And sometimes, we just need a little more time to think about it! As caregivers, we need to say that. “Thanks for your offer, can I get back to you with some ideas? And can you check in with me in a week if I forget?”

So caregivers, next time someone asks you *THE QUESTION,* refer to these 5 simple suggestions. And if you’re reading this as a person who wants to help a caregiver, thank you for your willingness; we hope you find these ideas helpful!

#1: Bring us a meal.

An oldie but a goodie: make us a meal! Or make a couple of meals for me to stack in my freezer, or send gift cards for GrubHub, UberEATS, or our favorite local pizzeria. Planning meals is often the last thing we want to squeeze into our busy day, which leads to lots of unhealthy dinners like frozen pizzas—or even worse, skipping meals altogether.

#2: Come visit us.

Offer to sit with our caree for a few hours while I run errands. Don’t feel comfortable with that? Just stop by for a visit when I’m there (if we’re all up for visitors that day)! Caregiving can be extremely lonely, so it’s a huge help to see friendly faces and welcome visitors! It’s equally as refreshing to have someone take over so I can get a few items checked off my to-do list.

#3: Fill our (gas) tanks.

If you really want to do something of monetary value for us, a gas gift card is always appreciated! There’s a lot of driving involved in caregiving, and it adds up. And financial pressures add to our already heavy caregiving load.

#4: Bring us groceries (treats included).

With online shopping now available in almost all areas—and with a variety of pick-up, drive-up or delivery options—this is an easy way to help that makes a HUGE difference!

Think of how much work it is to grocery shop…

It starts with planning: thinking about meals and snacks, then assessing what you need, taking note of what you’ve run out of, and jotting it down.

Then you have to figure out when to go, and depending on your caregiving situation, this can be a logistical challenge. Who can stay with your caree, if they need supervision? Or do you bring the person along, which comes with its own challenges? Some caregivers opt to shop at night when a spouse, partner, or child can stay home with the person you care for—but that often means shopping on tired legs and with a weary mind.

Now that you’ve figured out when to go, you have to drive there, go inside, fill your cart, empty your cart on the belt, load the bags in your cart, bring them out to your car, load them in your car, drive home, bring the bags into the house, then put the groceries away.

And then, of course, make a list of the things you forgot, because that inevitably happens, right?!

When you break down all the steps, you realize how much work is involved—and why it would be SUCH a help for someone to step in on this necessary life activity. (It also makes the case for paying the nominal delivery fee for those services, if you ask me!)

#5: Update others for us.

Offer to update others when something big happens. This one is a little tricky in terms of privacy, but it can still be super helpful.

The key word here is “offer.” Never give updates on my caregiving life without checking with me first. But if you know something big just happened (new diagnosis, a fall, change of living situation or school depending on age, a death or similar big loss/change in the family, etc.), ask me if I could help with letting others know.

Who are those “others?” Those are the people who would love to hear the latest on my caree but don’t necessarily need to hear it from me directly—i.e. my pastor, neighbors, boss/coworkers, friends I haven’t talked to in a while, to name a few.

It’s emotionally exhausting to repeat the same information — especially bad news — over and over again, so having someone offer to take on that task provides a huge sense of relief.


And there you have it! Five simple ways to help a caregiver whose life is busy, busy, busy. Pass this on to others who are looking for ways they can help, and let us know if you’d add anything to this list by commenting below. 


Click here or the image below to subscribe to our mailing list:

Your generous Donations allow IAES to continue our important work and save lives! 


Become an Advocate by sharing your story. It may result in accurate diagnosis for someone suffering right now who is yet to be correctly identified. Submit your story with two photos to



International Autoimmune Encephalitis Society (IAES), home of the AEWarrior®, is the only Family/Patient-centered organization that assists members from getting a diagnosis through to recovery and the many challenges experienced in their journey. Your donations are greatly appreciated and are the direct result of IAES’ ability to develop the first product in the world to address the needs of patients, Autoimmune Encephalitis Trivia Playing Cards. Every dollar raised allows us to raise awareness and personally help Patients, Families, and Caregivers through their Journey with AE to ensure that the best outcomes can be reached. Your contribution to our mission will help save lives and improve the quality of life for those impacted by AE. 

For those interested in face masks, clothing, mugs, and other merchandise, check out our AE Warrior Store!  This online shop was born out of the desire for the AE patient to express their personal pride in fighting such a traumatic disease and the natural desire to spread awareness. Join our AE family and help us continue our mission to support patients, families and caregivers while they walk this difficult journey.  


Be a part of the solution by supporting IAES with a donation today.




Caregiver’s guide to self care & avoiding caregiver burnout

November 10, 2021 |  By the SingleCare Team; medically reviewed by Gerardo Sison, Pharm.D.

November is Caregiver Awareness month! The staff and members of IAES celebrate, love, depend on and, at times, could not get by without those that have cared for us! To say we appreciate you is an understatement. So, this month we celebrate ALL of you wholeheartedly!

Thank you all!

We are honored to share with you a wonderful article by The SingleCare Team and thank them for allowing us this opportunity!


Learn risk factors, signs of burnout, and how to reduce the danger of caregiver burnout

A caregiver is anyone who assumes a significant level of responsibility for another person. This could be a family member, friend, or home healthcare worker. Caregivers demonstrate selflessness, commitment, and duty every day. But they also take on emotional and physical burdens that can become overwhelming.

What is caregiver burnout?

Caregiver burnout is a state of total exhaustion brought about by the emotional, physical, and mental toll of assuming responsibility for another person’s needs.

How does caregiver burnout start?

In most cases, caregiver burnout begins with emotional exhaustion. The stress and burden of providing for someone’s critical needs can exhaust a person’s ability to cope. Emotions like anger, sadness, and fear can be harder to control than usual.

Physical exhaustion often follows. Caregiving often requires new physical demands and usually leads to a reduction in other physical activities like exercise. One person may feel lethargic because they no longer go on their morning walk. Another person may have sore muscles because they have to bathe and clothe someone else, or sleep somewhere unfamiliar.

The combination of emotional and physical exhaustion can lead to mental exhaustion. A caregiver may begin making simple mistakes like forgetting appointments or leaving a key ingredient out of a favorite recipe. Restful sleep may be difficult, and a caregiver may lack motivation for social interaction. This is when exhaustion has reached the burnout stage.

If caregiver burnout is not addressed, it can lead to caregiver depression—a dangerous situation for the caregiver and the person to whom they are giving care. Depression is often characterized by feelings of worthlessness, sadness, or irritation, which can sometimes lead to chronic negative thoughts of hurting themselves or others.

If you or a loved one is experiencing severe depression or suicidal thoughts and behaviors, seek help from a healthcare provider or emergency room immediately. You can also call the National Suicide Prevention Lifeline at 800-273-TALK (8255).

Why is caregiving so exhausting?

Caregiving is exhausting because of the time and energy it requires. When someone you love can’t entirely fend for themselves, you want to help them. But when you are preparing meals, sorting out their financial situation, or helping them use the bathroom, you are using up energy and hours normally devoted to your own well-being.

In the end, the exhaustion often comes from losing the ability to do things that you enjoy and that make you, you.

What are the risk factors of caregiver burnout?

Not all caregivers get caregiver burnout. But among those that do, researchers have identified certain risk factors that seem to make caregivers more likely to suffer from burnout. Not everyone who has these risk factors will experience burnout, and people who don’t have any of these factors may experience burnout anyway.

Still, it is worth reviewing these risk factors and being aware of any that apply to you.

  • Physically demanding tasks (i.e., lifting someone out of a bathtub)
  • Taking care of someone that has severe behavior problems (i.e., dementia), not only physical ones
  • Financial difficulties
  • Living with the person you’re caring for
  • Lacking friends or a support network
  • A high percentage of time or long duration spent as a caretaker
  • History of substance abuse

What are the signs of caregiver burnout?

Certain signs may indicate total exhaustion or caregiver burnout. If you are a caregiver or know someone who is a caregiver, look for the following signs.

  • Feeling overwhelmed
  • Feeling constantly worried
  • Not getting enough sleep, or sleeping too much
  • Gaining or losing weight
  • Feeling angry at the person you’re caring for
  • Feeling easily irritated
  • Avoiding friends and family
  • Feeling sad or hopeless
  • Having frequent body pains, such as headaches
  • Increasing the use of alcohol, drugs, or prescription medications
  • Getting sick more often

Caregivers experiencing any of these symptoms should speak to their doctor.

Measuring caregiver stress and burnout

The Zarit Burden Interview is the most widely used diagnostic tool for identifying caregiver burden.

To determine whether you are experiencing excessive caregiver stress, consider taking this Caregiver Health Self Assessment Questionnaire that was developed by the American Medical Association.

How to avoid caregiver burnout

You now have an understanding of what caregiver burnout is, how to recognize it, and who is most likely to get it. Here are 12 proven methods of avoiding burnout.

1. Make sure you get breaks for yourself

There’s no “pause button” for caretaking. Every caregiver may have felt the urge to simply walk away, but they understand that doing so could be catastrophic for the person who is relying on them. You don’t want to let it get to that point.

That’s why implementing breaks into your daily routine is so important. Short breaks can have a hugely positive impact on your mental outlook.

In some cases, the person you are taking care of can manage on their own for a few hours, so you can get away. Others may at least be able to entertain themselves safely while you are in another room.

If you are helping someone who needs constant supervision, you’ll have to be proactive about scheduling breaks. This could mean drafting a neighbor, friend, or family member to help periodically. Or it could mean hiring a home healthcare worker to stop in a few days per week.

We’ve already learned that a high percentage of time spent as a caregiver is a risk factor for burnout. Do everything you can to ensure you have time to yourself to relax and recharge. It’s the best thing for you and for the person you’re caring for.

2. Use tools that make sharing updates simpler

A primary caregiver isn’t only a healthcare worker, they’re a reporter, too. Close family and friends will expect updates on topics like symptoms, prognosis, how their medication is working, what the person is eating, and more.

Individual calls or emails are nice, but time-consuming. When a caregiver isn’t able to provide updates as often as they’d like, they can feel guilty about it which adds to their burden.

Tools like CaringBridge, PostHope, or MyLifeLine make communication easier. These sites let you post updates simultaneously—with controls to protect your loved one’s privacy.

A single update shared with everyone also reduces the risk of miscommunication. Everyone will have the same information, so they don’t feel left out.

3. Use online resources

Every caregiver should have a device with internet access. Critical advice and important resources can often be just a few clicks away.

One of many examples is Eldercare Locator. This free resource site, produced by the U.S. Department of Health and Human Services, has a clean, readable design and trustworthy links. In just a few clicks, you can connect with insurance, transportation, and home care resources.

Many other online resources for caregivers are worth consulting, such as online support groups and local home health organizations.

4. Join a support group

Participating in a support group is one of the best ways that a caregiver can use their limited free time. Caregiving can be isolating and frustrating. On the most basic level, a support group reminds caregivers that there are others facing the same challenges.

But on a deeper level, a support group can help provide guidance that’s based on experience. And a caregiver can feel the satisfaction and catharsis of helping others by sharing their successes and failures with other like-minded individuals.

Bonding over these shared experiences often leads to friendship. As supportive as family and friends can be, they can only sympathize with what you’re going through. A fellow caregiver can share the burden and support you, like a coworker or teammate.

5. Take a self-assessment test regularly

Caregiver burnout doesn’t happen all at once. Emotional, physical, and mental exhaustion accumulates over time.

You stand a better chance of avoiding burnout if you track benchmarks in your mental health. Taking a self-assessment test regularly (say, once a month) will give you a clearer view of how well you are coping.

Self-assessments ask basic questions about your feelings and your physical health. They shouldn’t take more than 10 to 15 minutes. We recommend the Caregiver Health Self Assessment Questionnaire, which was developed by the American Medical Association.

This small-time investment could save you the consequences of burnout.

6. Maintain positive relationships with other friends and family

When a loved one is going through a health crisis, everyone wants to help. Sometimes the best help is the simplest: Reaching out to a friend or family member.

Caregivers need a sense of normalcy that can often be obtained by going on a walk with a former coworker, having brunch with old friends, or enjoying a night at the bowling alley.

Friends and family may feel that they have to do extra, or they may feel hesitant about trying to contact you. Try to maintain a schedule with friends and family members, either by having a phone call every few months or arranging lunch meetups once a week.

7. Set boundaries

One of the biggest changes when you become a caregiver is making decisions for someone else. And the people who also love that person may not always agree with the decisions you make.

You can’t make everyone happy, and being second guessed adds to your burden. Family and friends who want to provide help may do so in a way that interrupts your routine.

So set clear boundaries about things like who should attend doctor visits, when people should visit, and the types of assistance you actually need.

8. Set health goals for yourself, including mental health

The emotional burden of caregiving can cause you to neglect your physical and mental health.

Positive behaviors like exercise and meditation become important when you are under emotional strain. They are an effective way to calm your racing thoughts.

Give yourself achievable goals for activities like these. Phone apps can help by providing daily reminders and preset programs that last 10 to 30 minutes.

9. Set realistic goals for your caregiving and ask for help when you need it

Too many caregiving situations start in crisis mode and stay there. That’s a sure path to caregiver burnout.

Early on, work with your doctor to identify a realistic level of caretaking. Think about your loved one’s current and future needs and whether you will be able to provide them.

For example, someone with a progressive, debilitating disease may be able to function normally now, but what happens when they need help getting in and out of the bathtub?

What types of care are you comfortable giving? Could you give shots, or monitor IV drips? What about driving to pick up medications or necessities like groceries with them in the car?

Think about what will go into caretaking in your unique situation, and set realistic goals for what you can do.

Overextending yourself can lead to burnout (or a dangerous situation) for the person you’re caring for.

10. Talk to a professional, including a therapist or social worker

Becoming a caregiver is a time of stress and even shock. These are times when talk therapy can be extremely comforting and critical to our ability to cope.

Family and friends can be a sounding board, but they also have a close relationship with the person you’re caring for. That makes it hard to honestly discuss feelings of shame, guilt, or anger—feelings that are common and valid.

Speaking to a third party gives you the freedom to express yourself, put certain feelings out into the open, and work on strategies for coping with them.

11. Be realistic about your loved one’s disease

Another reason to seek advice from a third party is to be able to honestly discuss your loved one’s path to recovery—or their lack of one.

For dementia patients, sadly, there is no cure. And doctors can’t say for sure how fast the disease will take hold.

Acceptance can be the hardest part of dealing with certain diseases. We want to believe our loved ones will beat the odds. Thinking realistically about what the future holds can help us balance our hopes with the practical requirements of home care.

12. Develop coping strategies that work for you

Every caregiving situation is different and so is every caregiver.

Some people may decide to take time for solitary walks before deciding that what they really want is to join a support group.

Coping on a daily basis can be a real challenge. Try to identify the stressful parts of your day and how you could alleviate that stress. Maybe you’d benefit from getting housekeeping help or a meal delivery service. It doesn’t have to be forever, but keeping your head above water for the health of you and the person you’re caring for has to be the top priority.

Self-care is part of caregiving

Caregiving can be a shock to the system. Our instinct is to help our loved one, no matter the cost to ourselves. But as the days, weeks, and months go by, we run out of energy.

The most important thing for caregivers to remember is this: Successful caregiving includes caring for yourself.


Click here or the image below to subscribe to our mailing list:

Your generous Donations allow IAES to continue our important work and save lives! 


Become an Advocate by sharing your story. It may result in accurate diagnosis for someone suffering right now who is yet to be correctly identified. Submit your story with two photos to



International Autoimmune Encephalitis Society (IAES), home of the AEWarrior®, is the only Family/Patient-centered organization that assists members from getting a diagnosis through to recovery and the many challenges experienced in their journey. Your donations are greatly appreciated and are the direct result of IAES’ ability to develop the first product in the world to address the needs of patients, Autoimmune Encephalitis Trivia Playing Cards. Every dollar raised allows us to raise awareness and personally help Patients, Families, and Caregivers through their Journey with AE to ensure that the best outcomes can be reached. Your contribution to our mission will help save lives and improve the quality of life for those impacted by AE. 

For those interested in face masks, clothing, mugs, and other merchandise, check out our AE Warrior Store!  This online shop was born out of the desire for the AE patient to express their personal pride in fighting such a traumatic disease and the natural desire to spread awareness. Join our AE family and help us continue our mission to support patients, families and caregivers while they walk this difficult journey.  


Be a part of the solution by supporting IAES with a donation today.




Memory Strategies: Helping You Remember

August 25, 2021 | From the Speech Pathology Services at the University of Washington Medical Center

We are grateful for the permission to re-publish this article from the University of Washington Medical Center.


This article explains the 4 types of memory. It also gives strategies to help you remember things if your memory is impaired.

What is memory?

Injury or illness can affect your memory.

Memory is the ability to learn, store, and retrieveinformation. New or increasing problems withany or all of these 3 stages of memory oftenoccur after a traumatic brain injury, stroke, braintumor, multiple sclerosis, or other kind of injury or illness that affects your nervous system.

Some memory problems may also occur as part of normal aging, when manypeople have more trouble retrieving new information.


Types of Memory

  • Long-term (remote): memory for old, well-learned information that has been rehearsed (used) over time, such as the name of a childhood pet,memories of vacations, or where you went to high Long-termmemory tends to remain after injury or illness.
  • Short-term (recent): memory for new things that took place a fewminutes, hours, or days ago, such as what you had for breakfast or what you did yesterday. Short-term memory tends to be the most affected after People who have had brain injuries may have problems withattention span, storing memories, thinking quickly, and learning easily. These memory problems make it hard to understand and save short-term memories so that they can be rehearsed and stored in long-term memory.
  • Immediate (working): memory for information that is current, that youusually keep track of mentally, such as a phone number you look up, directions someone just gave you, or keeping track of numbers in your head when you add or subtract.
  • Prospective: the ability to remember to do something in the future, such as taking a medicine, going to an appointment, or following through on an assignment or project.

Strategies to Help Improve Your Memory

A medicine organizing tool can help you remember when yo take your medicines.

Your speech therapist can help you with strategies to help you remember new information. There are 2 maintypes of strategies to help your memory: internal reminders and external reminders.

Internal Reminders

  • Rehearsal: retelling yourself information you just learned, or restating it out loud in your own words.
  • Repetition: saying the same information over and over, either silently or out loud.
  • Clarification: asking others to repeat or rephrase information.
  • Chunking: grouping items to reduce the number of items to remember, such as grouping 7-digit phonenumbers into 2 chunks, one with 3 numbers and the other with 4 numbers.
  • Rhyming: making a rhyme out of important information.
  • Acronyms or alphabet cueing: creating a letter for each word you want to remember, or vice versa. One example is using the sentence “Every Good Boy Does Fine” to remember that the notes E, G, B, D, and Fare on the lines of a treble staff in music.
  • Imagery (also called visualization): creating pictures of the information in your mind.
  • Association: linking old information or habits with the new, such as taking your medicine at the same time that you brush your teeth.
  • Personal meaning: making the new information meaningful or emotionally important to you in some way.

External Reminders

  • Using a paper or electronic calendar or day planner.
  • Setting timers or alarms to remind you to do something.
  • Using written reminders such as to-do lists, shopping lists, and project outlines.
  • Recording new information with a voice recorder.
  • Using a medicine organizing tool, such as a MediSet.
  • Creating specific, permanent places for important One example is putting your keys, wallet, and cellphone in the same place every time you get home.
Your questions are important. Call your doctor or healthcare provider if you have questions or concerns.

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        Become an Advocate by sharing your story. It may result in accurate diagnosis for someone suffering right now who is yet to be correctly identified. Submit your story with two photos to     International Autoimmune Encephalitis Society (IAES), home of the AEWarrior®, is the only Family/Patient-centered organization that assists members from getting a diagnosis through to recovery and the many challenges experienced in their journey. Your donations are greatly appreciated and are the direct result of IAES’ ability to develop the first product in the world to address the needs of patients, Autoimmune Encephalitis Trivia Playing Cards. Every dollar raised allows us to raise awareness and personally help Patients, Families, and Caregivers through their Journey with AE to ensure that the best outcomes can be reached. Your contribution to our mission will help save lives and improve the quality of life for those impacted by AE.  For those interested in face masks, clothing, mugs, and other merchandise, check out our AE Warrior Store!  This online shop was born out of the desire for the AE patient to express their personal pride in fighting such a traumatic disease and the natural desire to spread awareness. Join our AE family and help us continue our mission to support patients, families and caregivers while they walk this difficult journey.    

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IAES’ President Shares Proactive Steps to Take Regarding the COVID-19 Virus

Hello AE Family,

IAES takes pride in keeping our community up-to-date with the latest news in the field of autoimmune neurology and topics that directly impact our lives.  Our motto, “Education is Power” continues to ring true as education does help to steer the best outcomes. Our motto is particularly appropriate in regard to the COVID-19 Virus.

Information about the COVID-19 continues to dominate world news and likely will for some time to come.   We have prepared a flyer of the preventive measures you can take as recommended by the guidance from the Centers for Disease Control and Prevention (CDC).  You can print out and post this flyer at home, school, doctor’s offices, work, place of worship, or anywhere in your community. In addition, we have created an ‘info meme’ that can be easily and widely shared on social media platforms. International Autoimmune Encephalitis Society continues to monitor the situation with the AE community in mind.


Download Flyer


The severity of illness or how many people will fall ill from COVID-19 is unknown. However, you are at higher risk if you are immunocompromised due to the immune suppressant medications used in the treatment of autoimmune encephalitis. IAES encourages you to stay informed by following updates from the CDC and/or your local health department. The likelihood of getting COVID-19 depends on where you live in the world and may change quickly.

COVID-19 is a novel virus, and there is still much we have yet to learn. One fact we do know is that an infected person can be a carrier, capable of spreading the virus to others for several days before they begin to show symptoms or know they are sick. Each infected person has the ability to pass the virus on to 2 or 3 people. Implement these hygiene practices now to avoid getting sick. Because there is no way of knowing who a carrier might be, assume you may come in contact with someone who is and institute these preventive hygiene practices and pro-active planning steps right now.

In addition to your advocacy of spreading COVID-19 preventative awareness and implementing the recommended hygiene habits the CDC recommends, plan and prepare ahead should you need to self-quarantine. If a member of your household becomes sick, all family members will have to self-quarantine for 14 days. Because the AE patient’s immune system is compromised, this also means that it takes AE patients longer to fight off a virus and the self-quarantine length may extend beyond the mentioned 14 days. Make sure you have enough food, water, other basic supplies on hand should you need to remain at home for 14 days. Find out if your pharmacy delivers and make sure you will have enough of your medications on hand. Contact your doctor should you have a fever, cough or shortness of breath.


I live in the state of Oregon in the U.S.A. The first two cases of COVID-19 were announced last weekend and are located 15 minutes from my home. The Nursing facility in Washington State that was so badly impacted that is being reported daily on national news is a few hours away. While I was stocking up at the supermarket for supplies the other day, seeing the bare shelves, I felt an eerie feeling of being involved in the beginning of an impending community health crisis.

The woman who helped me at the Deli Counter shared a story of how her friend, who was a second-tier transportation bus driver for the Nursing Home that had been so hard hit had been instructed to self-quarantine and it was not being reported on the news. I realized that there was a true possibility that my husband, son and I may have to self-quarantine at some point during this virus outbreak and we do not have any family support.

As I drove home with my car laden with groceries, I started thinking about staying home for two weeks without back up support. We have lived in the same house for 30 years, and this past year our next-door neighbor, who we loved dearly, moved away and our neighbors directly across the street sold their house. Both neighbors had been a wonderful support to us and us to them over the years and I mourned the loss.

However, we had started to get to know the young couple across the street and we were already lending each other a helping hand. She has a home business as a massage therapist and a 14-month-old daughter. They were at high risk, I realized. There is a couple in their 80’s two doors up from us and they have no family. They are at high risk. Our new neighbor next door, a bachelor and Uber driver is high risk. Another neighbor of ours is a mailman and his wife works at the local elementary school. They are at high risk. The couple next door on our other side are in their late sixties and he has health concerns. They are at high risk. Next to them is a couple whose sons are grown, married and parents now, empty nesters who are not high risk. I realized that the first 8 houses on our block have 6 high-risk households. If I have concerns, they must too. I thought we need to create a neighborhood support network. We will be the best possible back up system for each other and everyone’s concerns can vanish. That’s exactly what I did.

One by one I contacted my neighbors and explained my idea. If one of us became ill, we would have to self-quarantine. Other neighbors in the support network could drop off supplies and meals and pick up prescriptions or whatever was needed for that household. We could all chip in and help where and when we could. We would become our own best built-in back-up system.

The smiles, relief, and enthusiasm everyone greeted the idea with did not surprise me. We needed each other, and it would be a great way to get to know our new neighbors. I opened a text message group with everyone included and typed up a telephone directory. Using a plastic protective sleeve, I included the IAES preventative health measures COVID-19 flyer back to back with the directory.  I texted the ‘Neighborhood Support Network’ group to let my neighbors know I would leave their telephone list by their front door. My phone started pinging away as my message was read and I got the chance to visit with all of my neighbors as they greeted me upon my arrival. We laughed and joked and shared stories with each other. Everyone was so excited about the idea and grateful to live among such supportive neighbors.

I feel safer tonight. I know that if one of my neighbors gets sick or just needs a helping hand, they will text or call. Everyone was ‘all in’ and ready to do their part to support the whole. We are going to be just fine on SW Parkview Loop in Beaverton, Oregon. We plan on keeping our network as a permanent network solution too. There is a silver lining in everything I thought. My life just became richer. I hope you do the same in your neighborhood. We are #StrongerTogether.

With Fondness for you all,

Tabitha Orth


International Autoimmune Encephalitis Society

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KETO Diet: What is it? Who is it for? And why?

January-28-2020 | Daria Muir, M.D.

It is important that we all stay well informed. When a person receives a diagnosis of autoimmune encephalitis, they want to do whatever they can to improve their health. Some will reach for what appears to them to be a positive action and decide to change their diet. This can have very negative unintended consequences. To ensure your safety, and in IAES’ commitment to providing accurate information to assist you in being well informed on your road to recovery, today I’m going to give you a simple explanation about the Keto Diet.

What is it?


KETO is a diet that excludes carbohydrates completely. Basically, you eat just proteins and fats. Carbohydrates are the main fuel generator for the body (and especially the brain). They transform into glucose (the fuel). By switching to the KETO diet, one leaves the body without the fuel source. So, the body learns to turn other stuff into fuel. In this case, mainly fat. But also, the muscles. That’s what we call “putting the body into a state ok Ketosis). Is this good? Is it bad? For some people it is good. For some it is bad. For some it is an unnecessary risk, meaning there is no proof whatsoever that it helps, but there is proof that it can do some damage.

Who is a candidate for the Keto Diet?


Keto diet is recommended in a small number of diseases:

– severe Epilepsy, irresponsive to golden standard medication (being more efficient in children);

– Glucose Transporter Type 1 Deficiency Syndrome (a genetical disease that does not allow the body to produce GluT1 , so the brain does not get glucose- fuel. The ONLY treatment in this situation is keto diet!);

– it is also used by some nutritionists with patients that need to lose weight.

!!!! It needs to be assessed, recommended and monitored by a doctor!!!


There is no proof that the KETO Diet works in Autoimmune Encephalitis. (It can be recommended in severe Epilepsy post-Acquired Brain Injury in AE, but it does not treat AE, it treats the Epilepsy resulted from a brain injury from AE. As you know by now, Epilepsy and Seizures are not the same things. In AE we may have seizures, due to brain swelling and antibodies attacking our healthy brain cell. This is why we need immunosuppressant/ immunomodulatory treatment to control the disease.

Epilepsy is a disease resulted from the brain being injured and scarred.

Epilepsy can happen in AE but having seizures does not mean you have Epilepsy! Your doctor needs to asses that and tell you that you acquired Epilepsy!

Why? And why not the KETO Diet?


Now that you understand who an appropriate candidate for the Keto Diet would be, let’s discuss what can happen if you try the diet on your own without discussing it with your doctor.

Why does the Keto Diet need to be recommended by your doctor and monitored all the time?


Because it can be dangerous! Yes, it can be.

For diabetics. Also, people with kidney disease or who take medication that increases the risk of Kidney disease. For example, It can lead to major weight loss, below the normal BMI, that can endanger hormonal balance. It can increase pressure on the liver and kidney and eventually eats up your muscles too. The body can enter into ketosis (dangerous for some people).

KETO Diet is not easy, not harmless, not for anybody and not proven effective in AE.


Your doctor needs to assess and recommend that for you or for your child because it can be dangerous and can cause harm. If you have the conditions stated at point 2, then you might benefit from a very well supervised KETO Diet. Always ask your doctor! And please, don’t recommend it to other people, because it can harm them! Our concern is your safety and sharing accurate information for your best overall health.


Ketogenic Diet and Epilepsy: What We Know So Far

Ketogenic Diet in Patients with GLUT1 Deficiency Syndrome 

Ketogenic Diet 


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When Your Brain is on Fire

January-22-2020 | Carolyn Keating, PennNeuroKnow

Imagine you’re a bright twenty-something with a new job and a new relationship.  Everything seems to be going your way until you start becoming paranoid and acting erratically.  Then come the hallucinations and seizures.  You’re admitted to a hospital where you’re (incorrectly) diagnosed with a psychiatric disorder.  You swing from violence into a state of immobility and stupor.  And perhaps even scarier?  You don’t remember any of it.  Sound like a nightmare?  Well, it actually happened to Susannah Calahan, who details her terrifying story first-hand in her 2012 book Brain on Fire: My Month of Madness.

What caused these frightening symptoms?  The answer was a disease that had only been discovered a few years earlier (right here at Penn!): NMDAR encephalitis.  There are four main phases of the disorder.  In the prodromal phase, many but not all patients experience a flu-like illness for up to 3 weeks.  The psychotic phase is accompanied by delusions, auditory and visual hallucinations, depression, paranoia, agitation, and insomnia.  At this stage, most patients are taken to the hospital, where around 40% are misdiagnosed as having a psychiatric disorder like schizophrenia.  As this phase progresses, seizures are very common (although they can occur at any time throughout the illness), as well as involuntary muscle movements like lip-smacking or grimacing, catatonia (muscular rigidity and mental stupor), impaired attention, and memory loss.  The next phase is unresponsiveness, which includes symptoms like the inability to speak, loss of voluntary movement, and sometimes abnormal muscle contractions that cause involuntary writhing movements.  The last phase is the hyperkinetic phase and is characterized by instability of involuntary bodily functions such as breathing, blood pressure, heartbeat, and temperature.  Many patients who breathe too slowly often need to be placed on a ventilator at this stage. The decline to ventilator support can progress very rapidly after several weeks in the psychotic stage, and ultimately patients can be hospitalized for several months with the disease1–3.

What does NMDAR encephalitis actually mean?  This disease is an autoimmune disorder, meaning the body’s immune system mistakenly attacks its own healthy cells.  Normally the body identifies foreign substances by making something called an antibody that recognizes a unique part of the invader, thus targeting it for attack and destruction.  In NMDA encephalitis though, the immune system attacks the brain (that’s where to term encephalitis comes from), specifically a type of neurotransmitter receptor called an NMDA receptor (NMDAR).  These receptors bind the neurotransmitter glutamate, and play an important role in learning, memory, cognition, and behavior.  In fact, the symptoms of NMDAR encephalitis resemble those caused by drugs such as ketamine or PCP that prevent the activation of NMDARs.  For instance, at low doses ketamine and PCP cause paranoia, false perceptions, and impaired attention (like the early stages of NMDAR encephalitis), and at higher doses these drugs cause psychosis, agitation, memory and motor disturbances, and eventually unresponsiveness, catatonia, and coma2.  Several mechanisms have been proposed to explain the symptoms caused by antibodies targeting the NMDAR, but most of the evidence seems to support the idea that the receptors get removed from the cell surface and internalized.  For instance, experiments in the laboratory demonstrate that when animal neurons grown in a dish are exposed to patients’ anti-NMDAR antibodies, the number of NMDARs on the cell surface decreases as the amount of antibodies increase.  When the antibodies are removed, the number of NMDAR receptors on the cell surface returns to baseline within 4 days1.

It’s easy to remove antibodies in a dish, but how do doctors get the body to stop producing antibodies against itself?  Step one is identifying what triggers antibody production in the first case.  Interestingly, NMDAR encephalitis predominantly affects women, and ovarian teratomas (a type of tumor made up of multiple types of tissues, which can include nervous system tissue) are responsible for 50% of cases in young women2.  In patients who have some sort of tumor, removal improves symptoms in 75% of cases.  Interestingly, herpes simplex virus can also cause encephalitis (inflammation of the brain), and about 20% of these patients also develop antibodies against NMDAR2.  Treatment consists of immunotherapy: corticosteroids, IV infusion of immunoglobulins, and/or plasma exchange1, however patients with a viral trigger tend to be less responsive to treatment than those with a teratoma trigger or the 50% of patients with an unknown trigger2.  Once treatments begin improvements in symptoms start within a few weeks, though return to baseline functioning can take up to three years.  Rehabilitation is required for many patients after they leave the hospital.  Deficits in attention, memory, and executive function may linger for years, but luckily over 75% of patients with the disease recover to at or near baseline neurological functioning1.

Doctors and scientists hope to develop new treatments involving immunotherapy combined with small molecules that are able to access the brain to directly combat the effects of anti-NMDAR antibodies, ideally leading to faster control of symptoms and shorter recovery time2.  A brand new animal model of the disease was just described last week that will hopefully lead to more discoveries about how the disease is triggered and potential new therapies4.  And with increased awareness of autoimmune disorders against the brain, doctors will be able to more quickly correctly diagnose patients with this illness and get them the treatment they need.


  1. Venkatesan, A. & Adatia, K. Anti-NMDA-Receptor Encephalitis: From Bench to Clinic. ACS Chem. Neurosci. 8, 2586–2595 (2017).
  2. Dalmau, J. NMDA receptor encephalitis and other antibody-mediated disorders of the synapse: The 2016 Cotzias Lecture. Neurology 87, 2471–2482 (2016).
  3. Dalmau, J. et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 7, 1091–1098 (2008).
  4. Jones, B. E. et al. Anti-NMDA receptor encephalitis in mice induced by active immunization with conformationally-stabilized holoreceptors. bioRxiv 467902 (2018). doi:10.1101/467902

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Travel Tips for the AE Warrior

December-18-2019 | Mari Wagner Davis, RN

Last Summer my husband and I traveled to Italy to celebrate our 25th wedding anniversary. Not only was it special because it was our 25th anniversary, but special because we had survived 2 years after my seizures and diagnosis with autoimmune encephalitis.  My husband has learned a variety of tricks to help me feel more comfortable in any environment. Traveling overseas, was something we hadn’t done since I got sick.

I found the following tips helpful and wanted to share them:


  1. If you haven’t traveled at all since you were diagnosed, consider doing a weekend stay close to home, to help identify any issues like finding the room, remembering which floor you are on) ahead of time.

2. Bring your insurance cards with you, physician’s phone number and important medical records(I had mine copied to a computer disc).


3. Make sure you have reservations and confirm them, keep a folder where you can write down confirmation numbers.


4. Provide your family members with your itinerary, including phone numbers.


5. Identify how to get medical help in countries where you do not speak the language.


6. Consider using a travel agent that specializes in planning trips for people with disabilities.


7. Plan on addressing jet lag before you leave. Try to adjust your sleep schedule a couple of hours to the time zone you will be in.


8. Adjust scheduling your medication schedule as close as you can to the time zone you are traveling to a week or so before you leave.


9. While flying try not to sleep too much especially if you will be arriving in the evening.


10. Set your watch to local time so you do not get confused.


11. Drink plenty of fluids.


12. Daylight can reset your internal clock, be aware that you may need to nap to adjust to the different time zone.


13, One trick I have found helpful in hotel rooms is to leave the bathroom light on, so I can find it in the middle of the night.


14. Finally, be flexible and have a sense of humor!


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How does Sleep Affect the Blood-brain Barrier?

December-11-2019 | Sarah Reitz, PennNeuroKnow

Autoimmune encephalitis (AE) is the name for a group of conditions that occur when the body’s immune system mistakes its own healthy brain cells for invaders, leading to brain inflammation that ultimately triggers a number of other symptoms. Normally, the body’s immune system has only limited access to the brain, as it is protected by the blood-brain barrier (BBB). When this barrier is healthy, it can prevent an immune system attack by blocking immune cells and antibodies targeting brain cells from actually entering the brain. Like any fortress, however, the BBB isn’t completely impenetrable. Given that AE symptoms occur when immune cells or antibodies manage to cross the BBB, researchers think that the weakening of this barrier plays a critical role in AE and may even be a target for future therapies to reduce or prevent AE symptoms. But what causes the BBB to weaken, allowing cells, antibodies, and other molecules to invade the brain?


The blood-brain barrier: gatekeeper of the brain

Before discussing how the BBB becomes impaired, we need to understand how the healthy BBB functions. The BBB is often referred to as a “gateway”, made up of tightly joined endothelial cells that surround the blood vessels in the brain and spinal cord1. Outside of the brain, the endothelial cells lining blood vessels have small spaces between them, allowing for the exchange of substances between the blood and the surrounding tissue. However, the endothelial cells of the BBB are connected to each other by proteins called tight junction proteins, which squeeze the cells tightly together, blocking larger cells and molecules from freely flowing between the blood supply and the brain (Figure 1).

Figure 1: The blood-brain barrier is made up of endothelial cells that are tightly connected to each other by tight junction proteins (purple). These tight connections prevent unwanted substances from traveling between the blood and the brain. Different types of transporter proteins (yellow & blue) shuttle only certain types of molecules between the blood and brain.

The BBB is selectively permeable, meaning it allows only certain substances to enter and leave the brain. One way that molecules can cross the BBB is by endocytosis, a process where the endothelial cells uses its cell membrane to take in a molecule on one side (say, the side facing the blood) and pass it through to the other side (facing the brain) where it is released1. The endothelial cells of the BBB also express a variety of transporter proteins, which actively move molecules between the blood and the brain (Figure 1). Additionally, small, fat-soluble molecules can cross the BBB without any help from endocytosis or transporter proteins, giving the brain access to important nutrients and energy sources1.

BBB permeability changes across the day

The permeability of the BBB is not always the same, however. Research has shown that its permeability actually changes depending on the time of day2. Like many cells in the body, BBB cells are controlled by circadian rhythms, biological processes that cycle roughly every 24 hours. These rhythms are driven by a molecular “clock” within each cell, and cells across the body are synchronized by the “master clock” located in the brain.

What do these rhythms mean for BBB permeability though? Interestingly, research in both flies and mice shows that the amount of hormones, inflammatory proteins, and other molecules that cross from the blood into the brain fluctuates across the day, with peak BBB permeability occurring at night2.

Sleep loss impairs BBB function

Circadian rhythms aren’t the only daily process that affects the integrity of the BBB. Sleep—or more appropriately, lack of sleep—is also known to affect the BBB’s protection of the brain. This relationship between sleep and the BBB is increasingly important as sleep restriction becomes more and more common in our modern society.

Sleep loss is also highly relevant to the AE community. One study found that 73% of AE patients surveyed reported sleep disturbances, including gasping/snoring and insomnia. Even further, patients with AE had decreased total sleep time and increased fragmentation of sleep compared to people without AE3. But how exactly does sleep loss affect the BBB?

Figure 2: After periods of sleep loss, the blood-brain barrier is negatively affected in many ways (left). Inflammatory signaling caused by TNFα and IL-6 increases, leading to the breakdown of tight junction proteins (purple). This causes gaps between endothelial cells, allowing unwanted immune cells and antibodies to enter the brain. After sleep loss, the endothelial cells also make fewer of the transporter proteins (blue and yellow) that are required to shuttle necessary molecules between the brain and blood.

Multiple studies have now shown that sleep restriction weakens the BBB. One reason is due to the increase in inflammatory signaling that results from extended periods of wakefulness. Increases in inflammatory proteins, like TNFα and IL-6, are known to break down the tight junction proteins that keep the endothelial cells tightly joined together2 (Figure 2). Sleep-deprived mice and rats showed decreased numbers of tight junction proteins, leading to increased BBB permeability.

In addition to weakened tight junctions between endothelial cells, sleep loss also increases permeability by enhancing the rate of endocytosis across the BBB2, meaning that the endothelial cells shuttle more molecules from the blood into the brain. Relevant to AE, this increased permeability means that more immune cells and antibodies can enter the brain after sleep loss compared to after a full night’s sleep.

While these results are a bit frightening, there is good news. All of the damage to the BBB caused by sleep loss returns to normal after getting enough sleep! One study found that even an extra 1-2 hours of sleep following sleep loss restored BBB function in most brain areas4. Given even more time to sleep, the BBB throughout the brain returned to normal function5. These results suggest that treating the sleep disorders commonly associated with AE may help strengthen the BBB, increasing the brain’s protection against the immune system’s cells and antibodies and improving long-term outcomes for patients.

The BBB as a treatment target

Given that AE is caused by immune cells and antibodies infiltrating and attacking the brain, researchers are now looking at the BBB as a potential therapeutic target1. Treatments that strengthen the BBB will hopefully reduce the number of immune cells and antibodies that make it into the brain, and may also increase the effectiveness of some AE medications, such as anti-inflammatory drugs or immune-suppressants. Because these AE medications are specifically designed to cross a healthy BBB and access the brain, strengthening a weakened BBB will protect against molecules that aren’t supposed to be in the brain, while still allowing the necessary medication in.

The known circadian effects on BBB permeability can also be used in determining when to give medication that needs to cross the BBB. Medication can be given at the time of day when BBB permeability is highest to increase the amount of drug that makes it into the brain. In fact, this has already been studied with anti-seizure medication in epilepsy. For instance, in both flies and humans, when medication was given at night during peak BBB permeability, it was most effective at controlling seizures6,7.

This new strategy of “chronotherapeutic” dosing schedules has the potential to improve the efficacy of medication in many diseases. By administering drugs when it is easiest for them to enter the brain, doctors may be able to see results at lower doses of the drug, potentially reducing the risk of harmful side effects. As we continue to learn more about the BBB, scientists may identify even more ways to improve BBB health in the many disease states where it is compromised.

Free Download for BBB Handout


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Image References:  Figure 1 and 2 created with


  1. Platt MP, Agalliu D, Cutforth T (2017) Hello from the other side: How autoantibodies circumvent the blood-brain barrier in autoimmune encephalitis. Front. Immunol. 8:442. doi: 10.3389/fimmu.2017.00442
  2. Cuddapah VA, Zhang SL, Sehgal A (2019) Regulation of the blood-brain barrier by circadian rhythms and sleep. Trends Neurosci 42(7):500-510. doi: 10.1016/j.tins.2019.05.001
  3. Blattner MS, de Bruin GS, Bucelli RC, Day GS (2019) Sleep disturbances are common in patients with autoimmune encephalitis. J Neurol 266(4):1007-1015. doi: 10.1007/s00415-019-09230-2
  4. Gomex-Gonzalez B, et al. (2013) Rem sleep loss and recovery regulates blood-brain barrier function. Curr. Neurovasc. Res. 10, 197-207
  5. He J, Hsuchou H, He Y, Kastin AJ, Wang Y, &Pan W (2014) Sleep restriction impairs blood-brain barrier function. J Neurosci 34(44)14697-14706. doi: 10.1523/jneurosci.2111-14.2014
  6. Zhang SL, Yue Z, Arnold DM, Artiushin G, Sehgal A (2018) A circadian clock in the blood-brain barrier regulates xenobiotic efflux. Cell 173(1):130-139. doi: 10.1016/j.cell.2018.02.017
  7. Yegnanarayan R, et al. (2006) Chronotherapeutic dose schedule of phenytoin and carbamazepine in epoleptic patients. Chronobiol. Int 23, 1035-1046




Caregiver Stress and Burnout. Tips for Regaining Your Energy, Optimism, and Hope

September 18, 2019 | Melinda Smith, M.A.

The demands of care giving can be overwhelming, especially if you feel that you’re in over your head or have little control over the situation. If the stress of care-giving is left unchecked, it can take a toll on your health,
relationships, and state of mind eventually leading to caregiver burnout. And when you’re burned out, it’s tough to do anything, let alone look after someone else. That’s why taking
care of yourself isn’t a luxury, it’s a necessity. There are plenty of things you can do to rein
in the stress of care-giving and regain a sense of balance, joy, and hope in your life.

What is caregiver burnout?

Caregiver burnout is a state of emotional, mental, and physical exhaustion caused by the
prolonged and overwhelming stress of care-giving. While caring for a loved one can be very rewarding, it also involves many stressors. And since care-giving is often a long-term challenge, the stress it generates can be particularly damaging. You may face years or even decades of care-giving responsibilities. It can be particularly disheartening when there’s no hope that your family member will get better or if, despite your best efforts, their condition is gradually deteriorating.

If you don’t get the physical and emotional support you need, the stress of care-giving can leave you vulnerable to a wide range of problems, including depression, anxiety, and eventually burnout. And when you get to that point, both you and the person you’re caring for suffer. That’s why managing the stress levels in your life is just as important as making sure your family member gets to their doctor’s appointment or takes their medication on
time. No matter how stressful your care-giving responsibilities or how bleak your situation seems, there are plenty of things you can do to ease your stress levels, avoid caregiver burnout, and start to feel positive and hopeful again.

Signs and symptoms of caregiver stress and burnout

By learning to recognize the signs of caregiver stress, you can take steps to deal with the problem and prevent burnout. Or if you recognize that you’ve already hit your breaking point, you can take action right away. Once you burn out, care-giving is no longer a healthy option for either you or the person you’re caring for, so it’s important to watch for the warning signs.

Common signs and symptoms of caregiver stress

  • Anxiety, depression, irritability
  • Feeling tired and run down
  • Difficulty sleeping
  • Overreacting to minor nuisances
  • New or worsening health problems
  • Trouble concentrating
  • Feeling increasingly resentful
  • Drinking, smoking, or eating more
  • Neglecting responsibilities
  • Cutting back on leisure activities

Common signs and symptoms of caregiver burnout

  • You have much less energy than you once had
  • It seems like you catch every cold or bout of flu that’s going around
  • You’re constantly exhausted, even after sleeping or taking a break
  • You neglect your own needs, either because you’re too busy or you don’t care anymore
  • Your life revolves around care-giving, but it gives you little satisfaction
  • You have trouble relaxing, even when help is available
  • You’re increasingly impatient and irritable with the person you’re caring for
  • You feel helpless and hopeless

While caring for a loved one will never be stress-free, the following tips can help you to lighten the load, avoid the symptoms of caregiver burnout, and find more balance in your life.

Avoid caregiver burnout by feeling empowered

Feeling powerless is the number one contributor to burnout and depression. And it’s an easy trap to fall into as a caregiver, especially if you feel stuck in a role you didn’t expect or can spend a tremendous amount of energy dwelling on things you can’t change and for helpless to change things for the better. But no matter the situation, you aren’t powerless. This is especially true when it comes to your state of mind. You can’t always get the extra
time, money, or physical assistance you’d like, but you can always get more happiness and hope.

Practice acceptance. When faced with the unfairness of a loved one’s illness or the burden of care-giving, there’s often a need to make sense of the situation and ask “Why?” But you which there are no clear answers. And at the end of the day, you won’t feel any better. Try to avoid the emotional trap of feeling sorry for yourself or searching for someone to blame.

Embrace your caregiving choice. Acknowledge that, despite any resentments or burdens you feel, you have made a conscious choice to provide care. Focus on the positive reasons behind that choice. Perhaps you provide care to repay your parent for the care they gave you growing up. Or maybe it’s because of your values or the example you want to set for your children. These deep, meaningful motivations can help sustain you through difficult

Look for the silver lining. Think about the ways care giving has made you stronger or how it’s brought you closer to the person you’re taking care of or to other family members.

Don’t let care-giving take over your life. Since it’s easier to accept a difficult situation when there are other areas of your life that are rewarding, it’s important not to let caregiving take over your whole existence. Invest in things that give you meaning and purpose whether it’s your family, church, a favorite hobby, or your career.

Focus on the things you can control. You can’t wish for more hours in the day or force your brother to help out more. Rather than stressing out over things you can’t control, focus on how you choose to react to problems.

Celebrate the small victories. If you start to feel discouraged, remind yourself that all your efforts matter. You don’t have to cure your loved one’s illness to make a difference. Don’t underestimate the importance of making your loved one feel more safe, comfortable, and loved!

Get the appreciation you need

Feeling appreciated can go a long way toward not only accepting a stressful situation, but enjoying life more. Studies show that caregivers who feel appreciated experience greater physical and emotional health. Care-giving actually makes them happier and healthier, despite its demands. But what can you do if the person you’re caring for is no longer able to feel or show their appreciation for your time and efforts?

Imagine how your loved one would respond if they were healthy. If they weren’t preoccupied with illness or pain (or disabled by dementia), how would your loved one feel about the love and care you’re giving? Remind yourself that the person would express gratitude if they were able.

Applaud your own efforts. If you’re not getting external validation, find ways to acknowledge and reward yourself. Remind yourself of how much you are helping. If you need something more concrete, try making a list of all the ways your caregiving is making a difference. Refer back to it when you start to feel low.

Talk to a supportive family member or friend. Positive reinforcement doesn’t have to come from the person you’re caring for. When you’re feeling unappreciated, turn to friends and family who will listen to you and acknowledge your efforts.

Ask for care-giving help

Taking on all of the responsibilities of care-giving without regular breaks or assistance is a surefire recipe for caregiver burnout. Don’t try to do it all alone.

Look into respite care. Enlist friends and family who live near you to run errands, bring a hot meal, or watch the patient so you can take a well-deserved break. Volunteers or paid help can also provide in-home services, either occasionally or on a regular basis. Or you can
explore out-of-home respite programs such as adult day care centers and nursing homes.

Speak up. Don’t expect friends and family members to automatically know what you need or how you’re feeling. Be up front about what’s going on with you and the person that you’re caring for. If you have concerns or thoughts about how to improve the situation, express
them, even if you’re unsure of how they’ll be received. Start a dialogue.

Spread the responsibility. Try to get as many family members involved as possible. Even someone who lives far away can help. You may also want to divide up care-giving tasks. One person can take care of medical responsibilities, another with finances and bills, and another with groceries and errands, for example.

Set up a regular check-in. Ask a family member, friend, or volunteer from your church or senior center to call you at a regular time (daily, weekly, or as often as you think you need it). This person can help you spread status updates and coordinate with other family members.

Say “yes” when someone offers assistance. Don’t be shy about accepting help. Let people feel good about supporting you. It’s smart to have a list ready of small tasks that others could easily take care of, such as picking up groceries or driving your loved one to an appointment.

Be willing to relinquish some control. Delegating is one thing, trying to control every aspect of care is another. People will be less likely to help if you micromanage, give orders, or insist on doing things your way.

Give yourself a break

As a busy caregiver, leisure time may seem like an impossible luxury. But you owe it to yourself—as well as to the person you’re caring for—to carve it into your schedule. Give yourself permission to rest and to do things that you enjoy on a daily basis. You will be a better caregiver for it.

There’s a difference between being busy and being productive. If you’re not regularly taking time-off to de-stress and recharge your batteries, you’ll end up accomplishing less in the long run. After a break, you should feel more energetic and focused, so you’ll quickly make up for your relaxation time.

Maintain your personal relationships. Don’t let your friendships get lost in the shuffle of care-giving. These relationships will help sustain you and keep you positive. If it’s difficult to leave the house, invite friends over to visit with you over coffee, tea, or dinner.

Share your feelings. The simple act of expressing what you’re going through can be very cathartic. Sharing your feelings with family or friends won’t make you a burden to others. In fact, most people will be flattered that you trust them enough to confide in them, and it will only strengthen your bond.

Prioritize activities that bring you enjoyment. Make regular time for hobbies that bring you happiness, whether it’s reading, working in the garden, tinkering in your workshop, knitting, playing with the dogs, or watching the game.

Find ways to pamper yourself. Small luxuries can go a long way towards relieving stress and boosting your spirits. Light candles and take a long bath. Ask your spouse for a back rub. Get a manicure. Buy fresh flowers for the house. Whatever makes you feel special.

Make yourself laugh. Laughter is an excellent antidote to stress—and a little goes a long way. Read a funny book, watch a comedy, or call a friend who makes you laugh. And whenever you can, try to find the humor in everyday situations.

Get out of the house. Seek out friends, family, and respite care providers to step in with care-giving so you can have some time away from the home.

Take care of your own health

Think of your body like a car. With the right fuel and proper maintenance, it will run reliably and well. Neglect its upkeep and it will start to give you trouble. Don’t add to the stress of your care-giving situation with avoidable health woes.

Keep on top of your doctor visits. It’s easy to forget about your own health when you’re busy with a loved one’s care. Don’t skip check-ups or medical appointments. You need to be healthy in order to take good care of your family member.

Exercise. When you’re stressed and tired, the last thing you feel like doing is exercising. But you’ll feel better afterwards. Exercise is a powerful stress reliever and mood enhancer. Aim for a minimum of 30 minutes on most days—break it up into three 10-minute sessions if
that’s easier. When you exercise regularly, you’ll also find it boosts your energy level and helps you fight fatigue.

Practice a relaxation technique. A daily relaxation or meditation practice can help you relieve stress and boost feelings of joy and well-being. Try yoga, deep breathing, progressive muscle relaxation, or mindfulness meditation. Even a few minutes in the middle of an overwhelming day can help you feel more centered.

Eat well. Nourish your body with fresh fruit, vegetables, lean protein, and healthy fats such as fish, nuts, and olive oil. Unlike sugar and caffeine—which provide a quick pick-me-up and an even quicker crash—these foods will fuel you with steady energy.

Don’t skimp on sleep. Cutting back on time in bed is counterproductive—at least if your goal is to accomplish more. Most people need more sleep than they think (8 hours is the norm). When you get less, your mood, energy, productivity, and ability to handle stress will suffer.

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Our website is not a substitute for independent professional medical advice. Nothing contained on our website is intended to be used as medical advice. No content is intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice. Although THE INTERNATIONAL AUTOIMMUNE ENCEPHALITIS SOCIETY  provides a great deal of information about AUTOIMMUNE ENCEPHALITIS, all content is provided for informational purposes only. The International Autoimmune Encephalitis Society  cannot provide medical advice.

International Autoimmune Encephalitis Society is a charitable non-profit 501(c)(3) organization founded in 2016 by Tabitha Andrews Orth, Gene Desotell and Anji Hogan-Fesler. Tax ID# 81-3752344. Donations raised directly supports research, patients, families and caregivers impacted by autoimmune encephalitis and to educating healthcare communities around the world. Financial statement will be made available upon request.




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