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The surgery that ignites the imagination: antidepressant remote control | Israel today

2021-12-19T21:48:12.424Z


It sounds like science fiction, but last week it happened in the country: a special pacemaker, which affects the transmission of electricity to the brain and mood, was implanted in a sufferer of depression • Watch a peek at the surgery that gives hope to patients


The excitement at the Ichilov Government-Municipal Hospital in Tel Aviv was evident in the operating room among the surgeons, the psychiatrist who exceptionally accompanied his patient and also the patient, who had high hopes for the innovative surgery that would save her from the deep and persistent depression she suffers from. Have so far succeeded in front of him.

The pacemaker transplant surgery that treats depression and suicide prevention // Reporter: Ran Reznik, Photo: Moshe Ben Simhon

The innovative operation, performed about a week ago, was one of the first in the country in which a special pacemaker (vagal pacemaker) was implanted in the patient's neck area, to which an electrical conductor connected to the central nerve (vagus nerve) is attached. It is the nerve that connects the body to the brain, and through it electrical currents are transmitted to nerve cells that secrete various substances in the brain that are known to help treat depression. Towards the end of the operation, the psychiatrist accompanying the patient was asked to check in real time via a laptop whether the electrode connected to the pacemaker works and performs the desired conductivity, which should reach the patient's brain and affect it in the treatment of depression.

"Israel Today" was invited to document and photograph the innovative surgery performed under general anesthesia by Dr. Ido Strauss, director of the functional neurosurgery unit at the Ichilov Neurosurgical Division, with senior surgeon Dr. Gad Lotan.

The entire operation was accompanied by Dr. Kfir Pepper, director of the Open Psychiatric Department and the Unit for Advanced Treatment at the Lev Hasharon Government Psychiatric Hospital in Pardesiya.

Dr. Kfir Pepper, Photo: Gideon Markovich

The innovative surgery was performed using one of the medical technologies nominated to be added to the state health basket in 2022, and the drug basket committee has already rated it with a high score ahead of the final discussions to be held by the end of the month.

The innovative surgery is intended for patients with depression who can no longer be treated with all the existing drugs, including electroconvulsive therapies, some of which are already after many suicide attempts - and according to the doctors, for these patients it is a life-saving treatment.

As revealed in October 2020 in "Israel Today", in an unprecedented move, about ten psychiatrists, among the senior in Israel, all psychiatric hospital directors and department heads, already addressed the Drug Basket Committee demanding the introduction of the innovative technology for treating depression.

However, the basket committee decided about a year ago not to put it in the basket and it was resubmitted to the basket of 2022. According to estimates by psychiatrists in Israel, the treatment is intended for about 50 patients suffering from depression per year, estimated at NIS 90,000 per operation and a total annual budget of about five million NIS per year.

Revolutionary looking

To date, about ten such surgeries have taken place in Israel, at Ichilov and at the Sheba Government Hospital in Tel Hashomer, and their funding has been through patients' private insurance or with special approvals from the HMO Exceptions Committees.

Most patients have already seen a very large improvement in their condition after many years of deep depression.

Among most senior psychiatrists in Israel, surgery is part of a revolution in treating mental illness as a disease caused by a brain disorder, and life-saving treatments can be used in new ways that can cure patients who until now had no means of cure or even alleviate their condition.

The special pacemaker, Photo: Gideon Markovich

The innovative surgery is also rated as the most important and critical technology for basket addition in the field of psychiatry by the Mental Health Division of the Ministry of Health. In a document submitted to the Drug Basket Committee, Dr. Tal Bergman-Levy, director of the Mental Health Division, wrote that "it is necessary to prioritize advanced technologies for resistant end-patients before including additional drugs. The division treats these patients as patients with 'orphan disease' of psychiatry, and therefore the surgery was ranked as the first priority for inclusion in the basket in 2022. "

And back to the exciting surgery in Ichilov: Dr. Strauss, one of the most prominent neurosurgeons in the country, told "Israel Today" that functional neurosurgery is a branch of neurosurgery that deals with surgical treatment of neurological diseases, such as Parkinson's, epilepsy and other neuropsychiatric diseases that affect other neuropathic systems. Central. This is one of the most advanced fields in medicine today, and the guiding principle for us is to try to regulate the abnormal activity in the neural networks in the brain to improve its function. Technological developments in recent years allow us to do this in a variety of minimally-invasive methods, such as implantation of state-of-the-art neurotransmitters, which allow for precise stimulation of specific areas of the brain. These innovative treatments offer the possibility of improving the health status of patients, and improving the quality of life of them and their families. "

Dr. Pepper explained to "Israel Today" that "during the operation I verified with the neurosurgeon and the technician the normal activity of the pacemaker, but the full operation takes place in the pacemaker clinic as part of the advanced treatment unit at Lev Hasharon Hospital.

After that, meetings are held every two weeks for the purpose of calibrating the device and fully adjusting it to the needs of the treatment, and within about two months, the intensity and frequency of the treatment are reached.

The calibration itself is actually a simple operation performed using a dedicated laptop found at the doctor.

The patient attaches a kind of wand to the chest in the pacemaker area, the pacemaker communicates with the computer, and programming is performed on the operating intensity and frequency, which is determined according to various clinical parameters. "

Dr. Strauss, Photo: Gideon Markovich

Dr. Pepper was recently invited to lecture on the innovative surgery by the Department of Psychiatry at Albert Einstein University in New York, and said, “The message he returned in the lecture is that one must speak boldly about the risk of untreated major depression. It is a disease that kills both because of the suicide that accompanies it and because of physical illnesses that develop or are not treated. "We already have quite a few new tools to help these patients, so the public's awareness, ability to talk about depression and the promotion and budgeting of mental health centers and research institutions are of great importance."

The patient who underwent the surgery, Tamar (pseudonym), in her 50s, told Israel Today that "I have been suffering from depression and an eating disorder (anorexia) since my 20s, but the last decade is the most challenging. I have not experienced episodes. "I was very short and very significant of major depression and I had already been hospitalized in five psychiatric hospitalizations. I tried many types of medication, underwent dozens of electric shock treatments and was treated with a ketamine drug, which did not help me."

"I went to a gloomy place"

She added that "it is important to note that I have a warm and loving family, a few good friends I did not shy away from and a dedicated psychologist who accompanies me. Of the pacemaker implant I arrived almost hopeless, and thanks to the encouragement and support of my dear and dear Dr. Kfir Pepper I agreed to go through this procedure and give another chance. I hope that the pacemaker will be able to give me back because in my experience I went to a dark, gloomy place, with no present and no future, very sad and empty. "

Dr. Yoav Domani, director of the psychiatric department and the unit for advanced treatment of depression at Sheba Government Hospital in Tel Hashomer, accompanies five patients who underwent surgery at Sheba to implant the innovative pacemaker. .

In such situations the innovative surgery can bring a ray of hope.

An example of this is a patient who underwent surgery four months ago and no longer suffers from depression.

In a letter he wrote he stated that he felt ‘a radical change in mood and functioning’.

"This treatment should be treated as a lifesaver."

Activating the pacemaker using the tablet, Photo: Gideon Markovich

About a week ago, the heads of psychiatry in Israel, Dr. Zvi Fischel, chairman of the National Mental Health Council in the Ministry of Health, and Prof. Yuval Melamed, chairman of the Psychiatric Association of the Medical Association, warned members of the basket committee that "Israeli psychiatry suffers from many years of discrimination. And it is clear from the basket committee's discussions that there is no attentive ear to the plight of psychiatric patients and there is insufficient understanding that psychiatric disorders 'reside' in the brain.

"Psychiatric distress is great and psychiatric illnesses are responsible for most of the disabilities in the world. When we talk about depression, it is a serious and life-threatening illness, and now there are treatments through direct or indirect brain stimulation ... The areas where there is discrimination can continue to be named. "It is time to correct distortions of decades, and you have the duty and the right to be the ones to bring the psychiatric patients back in line with the rest of the citizens of the country."

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Source: israelhayom

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