Mapping the Brain
By
JAMI KUNZER
The
Northwest Herald
Diane
Venn peeks around the
corner at her son lying on a table, his head strapped into a scan
machine. Weeks earlier, she had given him an ultimatum: Go to jail
or get some help. Eighteen-year-old Robert Venn had stolen money.
He was impatient, moody, impulsive, irritable. He wanted to feel
better. “I really do think we’re onto something with
this,” his mother whispers as she peers into a nearby computer
screen. A three-dimensional image of Robert’s brain glows in the
dark, cold room. His forehead fastened down by Velcro beneath the
scanner, Robert’s blanket-covered legs poke out from the
machine. His tall, lanky body lies still. Nervous, he coughs
occasionally, swallows hard. The scanner buzzes with a steady hum.
The relatively new nuclear technology called SPECT – Single
Photon Emission Computerized Tomography – displays an image of
the blood flowing through the brain. A radioactive material is
injected into the patient to better display activity. Areas of
increased blood flow take up more radioactive tracer than areas
where blood flow is lower. Diane sought the technology after the
family doctor diagnosed Robert with attention deficit disorder.
She read book after book, looked for anything to help her son. The
hunt brought her from Indianapolis to
McHenry.
•
• •
Only
a few neurologists use SPECT. Robert Kohn, a neurologist and
psychiatrist with New Perspectives Lab in McHenry, is one of
them. He
believes that the visual images of brain activity created through
SPECT allow him to better diagnose and treat patients. It is a
maverick opinion in his field. Doubters say the technology is not
advanced enough to work accurately. Still, Kohn moved his
family and his practice last January to McHenry from Chicago to open a
$500,000 SPECT lab
and attract new patients. He has served about 100 patients since then, but receives few
local referrals. “What
I’m doing is extremely controversial,” Kohn said. “Hardly
anybody does it.” Most of his patients drive or fly in from
outside the state after finding Kohn’s name on the short list of
doctors who do SPECT imaging. Along with attention deficit disorder,
the device is used to analyze and possibly treat patients with
autism, bipolar depression, anxiety, obsessive-compulsive
disorder, epilepsy, post-traumatic stress disorder, migraines and
common headaches, stroke, multiple sclerosis and Parkinson’s
disease. It dates from the 1960s but only
recently has become advanced and affordable enough to be put into
use. “It’s
sort of like the Wizard of Oz, working behind this great big
screen,” Kohn explained. “People want to see themselves on
it.” He picked up a heavy plastic model of a brain, split in
half. “These parts are involved with attention,” he said,
pointing to various sections of the model. Using a color scale, the
SPECT shows areas of blood flow. The scale ranges from black to
red, with red representing the highest activity. Those areas with
too much blood flow work too fast, triggering hyperactivity.
Those with too little blood flow signal damaged areas, Kohn said.
Kohn held up a picture of a heroin addict’s brain. Areas of
limited blood flow and activity show up like craters in the
brain. “It looks like a moth got into his brain and chewed it
up,” he said. Patients come to Kohn for many reasons: to become
more involved in their treatment, to see proof, to find answers. “Some
of it is wishful thinking,” Kohn said. “They just didn’t
like what they heard before.”
•
• •
Diane
came to Kohn’s office because she felt like she had hit dead
ends with other doctors. She wanted to know exactly what was wrong
with her son and whether he was taking the correct medication.
Robert always was an introvert, she says as she awaits her
first-born in an office of cool colors filled with the faint sound
of classical music. He was hyperactive, kind of in his own world.
He didn’t like to be cuddled or touched as a child, and he still
doesn’t.
“The
older he got, the more impatient he got,” she says after once
again checking in on him. His grandmother died and he held it all
inside. Two years later, he fought with his father. When asked why
he was mad, he told his parents that he never got to say good-bye
to his grandmother. He went through grief counseling. Years later,
he took an entrance exam for a preparatory school. A psychologist
examined him and determined that he had a learning disability. He
was put on the stimulant Aterol to help him focus and concentrate.
He became lethargic, suffered from suicidal tendencies and
depression. He impulsively took money from family and friends.
Then he’d feel guilty. He struggled to keep up with schoolwork.
Once, he cried in the shower because he failed to finish his
homework. “He
has good intentions, but it falls by the wayside,” Diane says,
tears filling her eyes. “We keep plunging further and further
into self-destruction. It’s disrupting the whole family. ”She
thinks the SPECT will let her and Robert see exactly what’s
working and what’s not working in his brain. “Most doctors
just stick him on Ritalin or Aterol and away you go,” she said.
“I feel they’re just making it worse. All parents hate to see
their kids suffer, and I watched it and felt guilty.”
•
• •
Kohn
will not rely on Robert’s SPECT scan alone. As with all
patients, he looked at Robert’s history, and talked to him and
to his mother. SPECT is just one part of the process, he
stressed.“ Suppose that was a brake on your car, you’d look at
the brake pads,” he said. “I like to look and see what’s
going on in the brain as part of the picture.” Using the scans,
he sometimes switches a patient’s medication or therapy.
Determining whether the SPECT scan has helped is subjective and
difficult. Kohn has yet to scan a patient again to determine if
the changes improved blood flow and activity in the brain. But he
said many of his patients say they feel better because they feel
more in control of their own therapy. Still, critics say the SPECT
scans are not clear enough to be used in diagnosis. Other more
advanced procedures are better, but more expensive and not readily
available to patients, said Philip McCullough, a professor of
psychiatry and behavioral science at Northwestern University and
medical director with Family Services.
Advanced scans that produce clearer pictures of the brain with
similar technology are used mainly for research, he said.“ A
trained psychologist can spend some time with a patient and
usually have a good idea pretty quickly as to what the diagnosis
is and the treatment is,” McCullough said. He said he worries
more about cuts in insurance coverage for those with psychological
illnesses than keeping up with technology.
“Our
real problem isn’t being able to diagnose,” he said. “Our
real problem is being able to treat people accurately, give them
enough visits and the medication they need.” The $1,000 SPECT
scans typically are not covered by insurance. But Kohn said he
works with family doctors by giving them the scan results. They
then can change the patient’s treatment to ensure that the cost
is covered by the family’s insurance.
•
• •
The
expense and the five-hour drive are worth it, Diane says as Robert
walks into Kohn’s office shortly after his first scan. Robert
slouches in a chair, rests his hand on his forehead and tells his
mother his head hurts. “I don’t like that,” he says,
furrowing his eyebrows. “It’s kind of a dizzy feeling. I’m
claustrophobic.” Robert already felt stressed on the drive to
McHenry, and the two must return the next day for another scan.
Based on the results, Kohn acknowledges that Robert has attention
deficit disorder but recommends a change in medication. He will
take his stimulant in combination with an antidepressant and
anticonvulsant. The new medication should help his moods and
impulsiveness, while the last round of drugs may have contributed
to Robert’s tendencies toward bipolar depression, the doctor
explains. “It’s been a learning experience for the entire
family because we understand why now,” Diane says. But it could
take months before the family sees any results. For now, Robert is
tired and frustrated as he rubs his forehead after the procedure.
“I have some anger problems, and I’d like to get control of
them,” he admits to Kohn. “We’ll get some sleep,” his
mother responds. “Tomorrow will be a better day.”
Reprinted
with the permission of The Northwest Herald
