On November 19 it was exactly one year since I had the Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) for my Treatment Resistant Depression. Thus over the last couple of weeks I had a couple of days filled with appointments at Toronto's Sunnybrook Hospital to complete the 12 month follow up and to discuss next steps.
The first day of appointments started off with an MRI scan of my brain so that they could see what has happened to the lesions that the surgery created. This was followed by psychiatric scales testing to determine if there has been any improvement in my depression since the surgery was performed last year. As I wrote back when I originally did the psychiatric scales, all of the tests that I did at the time of my surgery showed that I was suffering from severe depression. The first test that we did was the Hamilton Rating Scale for Depression (HAM-D). Originally when I had my surgery, I received a score of 25 on this test. This week I also received a score of 25, so there was no change with this score. Scores of greater than or equal to 23 indicate a very severe depression. The second test that I did was the Montgomery–Åsberg Depression Rating Scale (MADRS). Originally when I had my surgery, I received a score of 36 on this test. This week I received a score of 38. Scores of greater than 34 indicate severe depression. So, my depression is getting slightly worse according to this test. Finally I did the Beck Depression Inventory (BDI). Originally when I had my surgery, I received a score of 36 on this test. This week, my score was 39 Scores of greater than or equal to 29 indicate severe depression. Thus, I am also getting slightly worse according to this test. Overall, my scores seem to indicate that my depression is getting slightly worse.
After the psychiatric scales, we did some neuropsychological testing. These tests are meant to determine if I have had any negative effects from the surgery that may be affecting my memory or cognitive abilities. They were mostly simple, yet difficult, tests in which I had to remember words or sort shapes or do other simple tasks that measured my memory and cognitive abilities. I didn't have too much trouble with any of them except for a new one that was added to this follow up appointment. In this test I was given a letter and had to list as many words as possible that start with that letter. It seems easy, but I had a really difficult time with it. I don't know if it is an effect of the surgery or simply because I hadn't had lunch yet.
On my second day of appointments I started off by meeting with a neurpsychologist who asked me some general, open-ended questions about the positive and negative effects that I have experienced since the surgery. It was a pretty quick interview because I haven't noticed any changes, positive or negative, since the surgery.
Next came the most important appointment of the 12 month follow up. I met with the neurosurgeon, Dr. Nir Lipsman to discuss possible next steps. In particular, whether or not I am a candidate for Deep Brain Stimulation (DBS) which involves having a couple of holes drilled into my head and electrodes inserted into my brain. I wrote in a previous blog post that they were looking at doing DBS in the medial forebrain bundle (MFB). The MFB is a part of the brain's reward system and is involved in the integration of reward and pleasure, so it seems like a good place to target. Recently, in Germany, they did a study targeting this area of the brain and 4 out of the 5 participants noticed an improvement after 7 days and they were able to maintain that improvement. After discussing the surgery with Dr. Lipsman however, it seems that they are not only targeting the MFB, but also targeting an area of the brain called the subgenual cingulate cortex, also known as Brodman area 25. This area of the brain has been targeted much more commonly and is the area that is usually targeted when doing DBS. The team of doctors will decide which area to target when they decide if I am approved for surgery. Before approving me for surgery however, Dr. Lipsman wants me to meet with the study psychiatrist Dr. Peter Giaccobe. I have to get his approval before I can proceed with the surgery. So, if I am approved, I might be able to have the surgery sometime in January or February.
Finally, to wrap up the 12 month follow up I had a PET scan done of my brain so that they can see how it is functioning.
Overall, I am very disappointed that the MRgFUS was not successful, but am hopeful that I can have the DBS surgery and that will provide me with some relief.
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