Well, I had my appointment with the study psychiatrist, Dr. Anthony Levitt today. It was a very interesting meeting that we had. He reviewed my history and agreed that some form of neuromodulation was required in my case. Therefore, he approved me for both Deep Brain Stimulation (DBS) and Focused Ultrasound Surgery (FUS). That is good news. It means that I can move on to the next step of meeting with the neurosurgeon, Dr. Nir Lipsman. I already have that scheduled for next Wednesday, October 10. There is just one small condition that I have to meet before any surgery can be performed. I recently developed a low thyroid (hypothyroidism) and have been taking medication to control that. He needs to see a lab report of a blood test where my thyroid is in the right range before I can have the surgery. I am going for a blood test next week and hopefully my medication is working and my thyroid is no longer an issue.
He also gave me a lot to think about with respect to the decision to do either DBS or FUS. I had been leaning toward doing DBS since that procedure has been around longer, they know how to perform it and they have data to back it up. It also has the advantage that they aren't making permanent changes to your brain and can adjust the settings on the device to get the desired result. FUS on the other hand has only been performed on a small number of patients for depression and they are still studying to see how safe and effective it is.
Dr. Levitt, however, said that while using ultrasound to create a lesion in the brain is a new procedure, the idea of creating a lesion in the brain to treat depression is not new. They have been doing it for 60 years. It's just that in the past they would create the lesion by drilling a hole in the skull and inserting an instrument into the brain to create a lesion at the desired location. So, the theory behind the work is not new, just the method of creating the lesion. He also said that while with FUS the changes that they make to the brain are permanent, they do it in such a way as they know whether it will cause permanent damage or not. They use the ultrasound to heat up a volume of brain 1 millimetre cubed to the point that the cells are inactive, but not dead. They then check on how the patient is doing and if he/she notices any changes. If everything is okay then they heat it up to a higher temperature to kill the brain cells. Thus, there is minimal chance of brain damage causing side effects.
Another thing to consider is that I have some Obsessive-Compulsive Disorder (OCD) symptoms. He said that based upon the prior work with creating lesions in the brain they know that it works for people with OCD. DBS on the other hand, isn't quite as well studied for OCD. It should work, but they don't really have the data.
He did say that with FUS patients typically have a headache for about a week. One patient had headaches for 3 months and another one has had headaches for 4 months and they haven't gone away. The headaches aren't a result of the lesions being created, but of the device that they must bolt your head into to keep it immobile for the duration of the surgery.
So, now I am less sure about which way to go. DBS has the inherent risks associated with drilling holes in your head and sticking electrodes in your brain, but has been studied more and they have the data to back it up. FUS on the other hand doesn't require them to open up my head and can be done safely so there is minimal chance of brain damage side effects, but this particular technique hasn't been used very much.
He's given me a lot to think about. I'm going to be spending the upcoming Thanksgiving weekend pondering all of this and coming up with more questions to ask the neurosurgeon on Wednesday.
No comments:
Post a Comment