Chapter 13: My Brain Scans; Inside Active View

I have been off clonazepam for 15 days.  I am still taking extra Neurontin for the anxiety, I am more irritable, but I am sleeping well.  I visualize my brain healing, and I am starting to get excited about being able to start the last part of my medication treatment plan.  As soon as the anxiety calms down I will begin taking Wellbutrin.  It is important for me to wait until the anxiety calms.  The 100 milligrams of Luvox I am taking per day is helping to calm the increased activity in the deep limbic system.  The 1200 milligrams of Neurontin per day is helping calm the anxiety in the basal ganglia.  Wellbutrin will help increase the activity in my prefrontal cortex.

Here are SPECT scans of a healthy brain when it is active.  This is a 3D Active rendering, looking at the most active 15% of the brain where fluid (Ceretec) injected into an artery reached the tissues.  A normal scan shows increased fluid in the tissues of the cerebellum, with all else being relatively quiet.  Pictures are from the Amen Clinic.
                                    

                                    

                   Here are my SPECT 3D Active rendering scans after rest:  R=rest.

These are my SPECT 3D Active rendering scans after concentration:  C=concentration

                           

                                                                           

My SPECT Study Findings Report from the Amen Clinic is 4 pages long.  Here is a brief overview of what was found on my scans.  The most significant finding is decreased activity bilaterally (both sides) of the temporal lobes on the rest and concentration studies. 

Decreased activity was found in the following areas:

• Bilateral inferior orbital prefrontal cortex, worse at rest.
• Bilateral parietal lobes, worse at rest.
• Medial parietal lobe, on both studies.
• Left and medial dorsal prefrontal cortex, at rest.
• Bilateral occipital lobes, at rest.
• Anterior medial prefrontal cortex pole, on both studies.
• Internal cerebellar activity, worse at rest.

Increased activity was found in the following areas:

• Thalamo-limbic system, worse on concentration.  The basal ganglia are a group of large nuclei that partially surround the thalamus.
• Anterior cingulate gyrus, on both studies.

Below are pictures of the anatomy of the brain.  PFC=prefrontal cortex; FC=frontal cortex; TL=temporal lobe; PL=parietal lobe; OL=occipital lobe; BG=basal ganglia; ACG=anterior cingulated gyrus; PCG=posterior cingulate gyrus; R=right; L=left.  These photos were included in my notebook from the Amen Clinic.

                                                              

I am not well yet, but I am making progress toward feeling better.  Having SPECT scans done did not cure anything, but they gave my psychiatrist at the Amen Clinic more information which helped him write a treatment plan that is working for me!

Chapter 11: My Brain Scans; Outside Surface View

Getting off the drug clonazepam is brutal! Clonazepam is the generic name for Klonopin, and is in the benzodiazepine family of drugs.  They are sometimes called benzos for short.  The last time I lowered the dose it brought me down to .03125 of my original dose of .50 at night.  This time the withdrawal symptoms did not subside in 2-3 days, they persisted. 

After having a headache, slight nausea, a strange dizzy feeling, and increased anxiety for a week, I increased the dosage of Neurontin.  I am now taking 300 mg of Neurontin three times a day and 600 mg before bed. The main side effect of Neurontin (for me) is a dizzy feeling; so I am just more dizzy now.  Increasing the dose of Neurontin has decreased the anxiety, and the other withdrawal symptoms as well.

The supplements recommended by the doctor at the Amen Clinic are also helping.  (Refer to Chapter 10 for more details)  I take Restful Sleep and Neuro PS at night and they have helped me continue to sleep well.  Adding the extra Neurontin capsule at night also helps me sleep. Taking Brain Vitale in the morning seems to help with anxiety.  Luvox, Neurontin, and the supplements are making the withdrawal tolerable.  I would hate to do it without them!

I am hoping in the next two weeks the side effects of Neurontin will be over, and the clonazepam withdrawal symptoms will have stopped.  If this happens, I am going to stop taking clonazepam.  I am anticipating a spike in anxiety when I do this.  If this happens I can increase the dosage of Neurontin again. 

Being addicted to clonazepam gives me more compassion for anyone addicted to anything!  I want to get off clonazepam because it is causing scalloping on my brain. This scalloping shows I am not getting the blood flow I need in those areas.  It is hard to remember the reasons to quit when I feel sick day after day and know if I took a little clonazepam I would begin to feel better.  It is a hard place to be.

Here are SPECT scan photos of the outside of a healthy brain.  These are scans of the top down surface and the underside surface of the outside of the brain.  These are 3D Surface renderings, looking at the top 45% of brain perfusion.  (Perfusion means injection of fluid into an artery in order to reach tissues.)  A normal scan shows full, even, symmetrical perfusion.

These are my SPECT brain scans of the outside of the brain during concentration.  The scalloping is circled in white. The scalloping on my brain is mild and should heal after I am off clonazepam. The scalloping holes mean cerebral blood flow and metabolism are poor in these areas.  It does not mean my brain is missing in these scalloping holes. After the scalloping heals my brain will have better functioning capabilities.

These are my SPECT brain scans of the outside of the brain during rest.  The scalloping is circled in white again and you will notice an object has been put in one of holes to show how deep it is.  I think it looks like I put a Mentos candy in my ear and it went to my brain. :)

          

                             

Below are three examples of more severe scalloping and the causes.  These scans are taken from a poster made by Dr. Daniel G. Amen.  They show a 3-D surface view of the brain, acquired by SPECT imaging, looking at cerebral blood flow and metabolism.  I think these scans are fascinating and intriguing!

                                                                                                                                                                 

                                                          

Chapter 9: Three Days At The Amen Clinic

Wednesday morning I had my first SPECT brain scan.  The IV was inserted with ease and I had no bruising later.  The concentration scan is done first and I did an activity to get my brain focused.  The radioactive isotope was put into my IV during the activity.  I did not have any sensation in my body when it was injected.  After the activity I laid down on my back on the scanning machine.  I needed to hold still, but the the time went quickly; it took about 15-20 minutes.  A band was wrapped around my forehead to help me keep my head still.  The scanning machine made a noise, but it wasn't irritating.  Part of the machine went around my head, but I did not feel claustrophobic like I have during an MRI.

Wednesday afternoon I had an appointment with one of the historians.  She had read my intake questionnaire and asked me questions to clarify, or give her more details on my answers.  This was a calm, deliberate process. She gave me plenty of time to add any information to what was included in the questionnaire. She compiled a well written history for the psychiatrist I had an appointment with later in the week.

Thursday morning I had my second SPECT brain scan.  After the IV was in place I was taken to a dim lit room to prepare for the resting scan.  I was asked to let my mind wander or daydream, but not to think about any specific subject, meditate, or fall asleep.  A short time into my resting the isotope was injected.  There was an interesting rug in the room with geometric shapes on it.  I wanted to see how the pattern repeated itself, but I didn't, I kept resting.  There was also a picture of Dr. Amen with information about his work in brain imaging I wanted to look at.  I didn't, I kept resting. After 15-20 minutes, I laid down on the scanning machine for my second scan.

On Thursday afternoon, my husband and I had a delectable seafood lunch at a restaurant called Rusty Pelican.  It is on 2735 West Coast Highway, Newport Beach, CA 92663-4798, (949) 642-3431.  http://www.rustypelican.com/

On Friday afternoon I met with a psychiatrist.  He showed me my brain scans and went over what was found on them.  It was awesome to see the scans!  He showed me rippling, called scalloping, on the surface of my brain.  For me, it is probably caused by taking the drug clonazepam. I have not abused or been exposed to drugs, alcohol, or environmental toxins. I have used this drug for approximately 8-10 years and the Amen Clinic uses it only for short periods of time for severe cases of anxiety.  I am in the process of coming off clonazepam so the scalloping on my brain can heal!

Other Findings:

1. Luvox has been helping calm the activity in my deep limbic system; where depression originates. 
2. There is too much activity in my basal ganglia; causing anxiety. 
3. I have an atypical depression needing to be treated in layers.  This is why I haven't achieved a more complete remission of symptoms in the last year and a half.  The basal ganglia (anxiety) must be calmed down first. 
4. My prefrontal cortex is not functioning effectively.  After the anxiety is calmed down I will need to take a drug to stimulate the prefrontal cortex.  If I take this drug too soon, it will over stimulate the basal ganglia and cause too much anxiety.

I now have an extensive treatment plan giving me hope I can get feeling better!