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CHAPTER 16 - IMAGES OF TREATMENT
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Hope for Healing
This is perhaps the most important section of this atlas. It shows actual images of
treatment, the before and after SPECT images of our patients who have experienced
significant benefit from treatment. This section highlights that in many cases the brain
can be healed or optimized to produce greater function and subsequently a healthier,
happier life.
The opening case history is one that was listed in a previous section. It is such an
important and instructive case study that it warrants repeating.
A 35-year-old man who had been living on the street was brought for evaluation by his
mother. He had previously been diagnosed on many occassions with paranoid schizophrenia,
but refused medication. His SPECT study revealed marked overall decreased activity
throughout the cerebral cortex. Being able to see his own brain activity, represented by
the 3D surface SPECT study above, was helpful for him. He agreed to take his medication
under his mother's supervision. One month later, after significant clinical
improvement on 4 mg of risperidone a day a repeat SPECT study was performed which showed
improved overall cerebral perfusion. Being able to see the before and after SPECT studies
side by side on the imaging computer monitor again was very encouraging to the patient and
helped significantly with compliance.
Paranoid Schizophrenia
Before and After Risperdal
Suicidal, Rage
Before and After Anafranil
Bob, a 48 year old married system analyst, came to see me because he had a problems with
holding grudges, "getting stuck" into loops of negative thinking patterns,
obsessive thoughts, moodiness, irritability, periodic intense suicidal thoughts and
problems with anger control. "I am the anger broker of the valley," he reported
during the initial session. His wife also reported episodes where Bob would often become
upset about something, be unable to shift away from the thoughts which were upsetting him,
lose control and exhibit aggressive behavior such as breaking furniture or putting holes
in the walls. Bob had a childhood history of oppositional behavior (by the report of his
mother). As part of his evaluation a brain SPECT study done which showed marked increased
uptake in his cingulate gyrus. I started him on Anafranil (clomipramine), which has been
used in patients with obsessive thinking. Over two months of treatment the dose of
Anafranil was increased to 225 mg. a day. Bob and his family noted a marked positive
response. He was less irritable, markedly less aggressive, more flexible and happier. He
reported that he was more effective in interpersonal relationships, especially with his
children.
After three years of continued clinical improvement on the same dose of clomipramine (2
brief trials at lowering the dosage caused a resumption of symptoms) a follow up brain
SPECT study was ordered to evaluate brain activity subsequent to treatment. The follow up
SPECT study revealed a marked normalization of brain activity.
Anger, ADD
B/A Depakote and Adderall
Mark, a 52 year old married accountant, sought help for problems with concentration,
focus, follow through and severe temper problems. He had become physically aggressive on
several occassions with his wife. He tended to take things in a negative way and struggled
with his memory. Often, for little reason he would explode and then feel very guilty about
his behavior a short while later. He had longstanding school problems, despite getting an
MBA degree. After his initial evaluation he was diagnosed with attention deficit disorder
and a SPECT was ordered to rule out temporal lobe dysfunction. The SPECT study showed
marked overall decreased activity, especially in the prefrontal cortex and temporal lobes.
He was placed on a combination of Adderall (for ADD) and Depakote (for temper). He had a
very positive response to medication. He and his wife reported that he was more focused,
better able to follow through on tasks, less irritable and in much better control of his
temper. After three years of continued clinical improvement on the same dose of Depakote
and Adderall a follow up brain SPECT study was ordered to evaluate brain activity
subsequent to treatment. The follow up SPECT study revealed a marked normalization of
brain activity.
PTSD, Depression and Anxiety
Before and After St. John's Wort and EMDR
Linda was 26 years old when she first came to see me. She had a history of 2 prior violent
rapes (age 15 & 22), a physically abusive love relationship, along with experiencing
the deaths of 8 friends (age 14-16). Her symptoms were depression, anxiety, worrying and
drug use. Her baseline SPECT study showed marked overactivity in the cingulate (problems
shifting attention), basal ganglia (anxiety) and limbic areas (depression and mood
dyscontrol). After 4 psychotherapy sessions with EMDR (a specific treatment technique for
traumatic events) and 1 month of St. John's Wort (900 milligrams a day) Linda felt
significantly better. When we repeated her SPECT study there was marked normalization of
activity in all 3 areas.
Attention Deficit Disorder
Before and After Adderall
Attention Deficit Disorder
Before and After Dexedrine
Conduct Disorder
Before and After Tegretol/Clonidine
Memory, Anger, ADD
B/A Adderall and Depakote
Russ had serious problems with unresponsive ADD symptoms, anger outbursts and memory
problems. Here is his SPECT study before and 1 year after treatment with Adderall and
Depakote.
Asperger's Syndrome
B/A Zyprexa
Tim, age 12, was diagnosed with Asperger's Syndrome. He had problems with repetitive
behaviors and very poor social skills. In addition, he was rigid in his thinking and had
frequently temper outbursts. His baseline SPECT study revealed marked increased patchy
uptake throughout his cerebral cortex. Zyprexa had an overall calming effect on his brain
and significantly improved his temper and cognitive inflexibility.
Severe Head Trauma
B/A Adderall
Randy, age 17, sustained a severe blow to the left side of his head. He had a subdural
bleed over his left parietal lobe and subsequently developed temper problems, school
problems, speech and coordination problems. This scan series was performed on and off
Adderall. Note the marked overall improvement from Adderall, giving him more access to
brain function.
Anger/Severe ODD
B/A Risperdal
Mark, a 14 y/o male, was evaluated for anger outbursts and constant defiant behavior.
Psychotherapy and parent training were ineffective. Depakote, Ritalin, Dexedrine and
Wellbutrin were also ineffective. Prozac made him much more aggressive. A SPECT study
revealed marked hyperfrontality and he was placed on Risperdal. He had a dramatic
response. He was more compliant, happier and less aggressive. Two follow up studies were
performed a month and 6 months later, which revealed progressive calming of the
hyperfrontality.
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