Getting Ready For My DBS Surgery

It is now less than two weeks away from my Deep Brain Stimulation (DBS) surgery to deal with my treatment-resistant depression.  I had my first pre-surgery appointment today to prepare for it.  For the most part, the appointment was uneventful and just covered things that I had already done, but there are some items of interest that I can report on.

The appointment started out with some more psychiatric scales testing to set a baseline before I get the surgery that we can compare against as my mood improves, or not, over the next year.  They are the same scales as I did for my Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS), so I can also compare how my mood is doing now against the last time I had the scales at my 12 month follow-up.  All of the tests that I did while I was undergoing the MRgFUS study showed that I was suffering from severe depression.  The first test that we did was the Hamilton Rating Scale for Depression (HAM-D).  At my 12 month follow-up, I received a score of 25 on this test.  Today 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).  At my 12 month follow-up I received a score of 38.  Today I received a score of 44.  Scores of greater than 34 indicate severe depression.  So, my depression is getting worse according to this test.  Finally I did the Beck Depression Inventory (BDI).  At my 12 month follow-up my score was 39.  Today my score was 41.  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.

Next I signed the consent forms indicating that I was willing to take part in this study.  There was nothing much to report on this as I had already read the consent a few months ago.  There is one thing of interest though that I neglected to mention in any of my previous blog posts.  After I have had the device implanted for 6 months a blinded section of the trial will occur. The purpose of the trial is to give a better understanding of the possible benefits the DBS is having on my symptoms. The DBS will be turned off for 1 week. Then, I will be randomly assigned to have the DBS turned OFF for 2 weeks and then ON for 2 weeks, or the opposite order.  I will be seen each week and they will test my mood to see if having it turned OFF or ON has an effect.  I will not know if the device is turned OFF or ON, so I cannot influence the results.

After signing the consent, I had a functional MRI, or fMRI, performed.  This is done in an MRI machine whose magnet is rated at 3 Teslas (a unit of measurement for magnets).  Usually MRI machines are rated at 1.5 Teslas, so it is twice as strong as a usual machine.  One of the reasons that they are doing the fMRI testing on a 3 Tesla MRI machine is that they want to prove that the DBS device is safe to use in 3 Tesla machines.  They already know that it is safe to use in 1.5 Tesla machines, but they want to prove the same result for 3 Tesla machines.  The tests that they have done show that the DBS device should heat up by no more than 1 degree Celsius in a 3 Tesla machine, but they have to do human trials, so I will be one of the test subjects.  Hopefully nothing goes wrong!

While performing the fMRI they also want to get some information about how the brain works in people that haven't had a DBS device implanted versus those that have.  Thus, I did some quizzes while in the MRI machine and they could tell how my brain was working while I was doing it.  The first quiz involved showing me a series of pictures of beer and asking my how much I was craving alcohol followed by a series of random pictures and asking me the same question.  They repeated this many times with pictures of beer and random pictures.  The purpose of this was to get an idea of the reward pathways in the brain.  They will repeat the test 3 times after I have the surgery.  The next quiz involved showing me a face of a person with a particular emotion and then having to pick out the face of someone with a similar emotion from a set of two pictures.  They would also show me a shape and then I would have to pick out a similar shape from a set of two pictures.  This is just to see how the brain works in people without a DBS device inserted versus those that have.  Again this will be repeated 3 times after I have had the surgery.

To close off this blog I'd like to post a video about getting DBS for depression that I have been thinking a lot about lately.  The first line of this video is very meaningful to me.

 As you're lying on the table you're wondering how you got to the point where holes drilled in your head sounds like a good idea.

This is what I wonder.

I Have A Date Part 2

As readers of my blog will be aware, I have been suffering from treatment resistant Major Depressive Disorder (MDD) for about a decade now.  In November of 2018 I attempted to cure this disease my having Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS).  This was a scalpel-free surgery in which they used extremely strong ultrasound waves to create a lesion in part of my brain that they believe is controlling my depression and thereby reduce my depressive thoughts.  This was part of a year-long study looking at the effectiveness of MRgFUS.  Unfortunately, this surgery did not help me and my depression has continued over the past year.

Thus, as I mentioned in my last two blog posts, I have been considering getting Deep Brain Stimulation (DBS) performed.  DBS is a much more invasive procedure which involves drilling two holes in my skull and having electrodes implanted in my brain.  The electrodes are connected by wire to a pacemaker-like device which will be placed under my skin just below my right collarbone.  For more information on the pros and cons of doing DBS versus doing MRgFUS you can see my previous blog post.  Having DBS performed would also be part of a year-long study on the effectiveness of DBS.

This week I had an appointment with the study psychiatrist Dr. Peter Giaccobe and the neurosurgery resident involved in the study Dr. Benjamin Davidson.  The purpose of this appointment was to determine if I qualified for the study.  The study neurosurgeon, Dr. Nir Lipsman had already given his approval, so I just needed the approval of the psychiatrist to proceed.  The appointment went well and Dr. Giaccobe thought that I was a good candidate.

Hence, today I received an email from Dr. Davidson that they would like to perform the operation on February 5 of this year.  That is a little less than a month away.  Having a date set is both exciting, because I am potentially close to getting better, and also anxiety-inducing, as this is a very invasive and scary surgery to have performed.  However, with all of the things that I have tried (CBT therapy, ECT, rTMS, MRgFUS, and over 50 different kinds of medications) I feel that this really is my last hope.  I need to try it.  I must be patient, however, as seeing positive results from the surgery can take a couple of years or more in some people.

Dr. Davidson also said that the target of the surgery in my case would be the subcallosal cingulate, also known as Brodmann area 25.  This is the area that most people who receive DBS for MDD have targeted.  There was a chance that they would target the medial forebrain bundle (MFB) as they are also targeting that area as part of their study but they decided not to do that for me.  It is a little more reassuring that with me they are targeting the area that they have the most data on and with which they have the most experience.

For more information on DBS you can view the following video, which I have posted in the past.  It gives a good introduction.



Over the next month I will be undergoing several tests and scans to make sure that there are no problems, but if nothing comes up, I will be going under the drill on February 5.