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#25 freezeup

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Posted 23 October 2019 - 03:15 PM

T

 

Totally irrelevent. The right VLPFC cortex that is active in depersonalisation works as a switch to other regions in the prefrontal cortex. We know that from basic research of different areas in the prefrontal cortex and functional studies of depersonalisation disorder. To inhibit the right VLPFC with rTMS will stop all inhibitions of emotions by the all areas of prefrontal cortex, including those areas that works though the opioid system. To inhibit the right VLPFC reduces depersonalisation with 45% on average -especially emotional numbing -but not dissociation.

 

The study with lamotrigine only mentions a reduction of 30% in 56% of those who tried. On this forum i would say that the response rate in lower among those who have tried. 

 

Its a solution that could possibly work. I'm not sure why you're so against people trying lamictal, and in every other thread saying it wont work for them. Its worked for me after having chronic DP/DR for 9 years. Glutamate is a highy understated neurotransmitter that I feel for people with drug induced DP/DR is to blame. Hyper-vigilance,dissociation,OCD and depression are all correlated with glutamate dysfunction. Lamotrigine inhibits glutamate thus bringing back a balance to the brain. 

Besides, any of this is just us bullshitting with hypotheticals. None of us have any idea why this is going on. The only real treatment is to try everything remotely viable and hope that it works. 



#26 Mayer-Gross

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Posted 23 October 2019 - 03:37 PM

T

 

 I'm not sure why you're so against people trying lamictal, and in every other thread saying it wont work for them. Its worked for me after having chronic DP/DR for 9 years. 

 

I have never spoken against the use of lamotrigine. I have just stated that only 50% have a response to it and the average reduction in symptoms it is around 30% in the response group. That is not to speak against it. I have tried up a dose of 500.mg without effect and never claimed that it wouldn't worked for others. 



#27 teal

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Posted 23 October 2019 - 06:46 PM

The cost of neuronavigation for rTMS is; . "We note that the cost of our set-up is much lower than many commercial systems in the market (<$5000 vs $50,000). Our results also showed that the tracking performance of the system was on a par with other high-end commercial systems"

 

https://www.ncbi.nlm...les/PMC5738908/

 

 

Alrighty then. That's good news. So even at the high-end it's affordable. 

 

 

Localisation with the use of neuronavigation will also increase the cost for the patient with 500-700 euros- that is a cost 95% of patients can avoid because they don't need for location. rTMS is also relatively new on the private european market. From around 2017

 

 You need neuronavigation for disorders that are very atypical for the normal rTMS clinic right now and are regarded as "off-label" because of the small trails done. 

 

From your writings I knew the stuff about OCD and depression where you don't need neuronavigation for rTMS and so forth. The gist of my message was that it's achievable for someone to make an investment pay off. If someone got neuronavigated rTMS for DPDR in Europe, they'd be close to having a monopoly, and if they'd charge a premium, I wouldn't mind.

 

Doctor Kelley, with her private practice in Arizona, is able to offer her patients effective rTMS, according to the thread you linked to. If it's feasible for her ... I see Smart TMS has clinics in London, Birmingham, Manchester, Bristol and Havant. And they're soon opening a new clinic in Holborn. So it looks like their business is going well, well indeed. They write that «Studies show that DPD could affect one person in every 50 in the UK», so they know there are patients out there. They should have one clinic which specializes in DPDR, one of their five clinics in England. If each clinic has a high level of autonomy, one could get in touch with each of the five in sequence, explaining the high potential for neuronavigated rTMS, the feasibility of it, and that patients from Europe would flock there if everything went dandy.

 

What we need is at least one clinic willing to invest, and at least one researcher willing to give guidance, or become some sort of commercial partner.

 

Localisation with the use of neuronavigation will also increase the cost for the patient with 500-700 euros- that is a cost 95% of patients can avoid because they don't need for location.

 

700 euros for extra time spent is cheap. They don't have to spend extra time on all conditions, it's just to not use the neuronavigation machine when they've got a patient with say OCD or depression. That's no problem. 

 

Will you open our brains too with a russian doctor 

 

Yes. Yes, I would!

 

The number I dug up was slapdash, quick and dirty. I googled and pasted in a flash. But yeah, I would trust a Russian research institution to do neuronavigated rTMS—if the people there seemed skilled, trustworthy and wanting to learn more about DPDR. But Nigerian? Nope! 



#28 Mayer-Gross

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Posted 23 October 2019 - 07:21 PM

Teal

I have written to a clinic that has neuronavigation and among their founders are university researchers who have done several trials with rTMS with publications .They treat 13.conditions with rTMS.  A professor has replied me that they are looking into the disorder and they are likely waiting for the publication of the french trail. I wish you good luck with your very interesting ideas .Have a nice trip to Russia.



#29 teal

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Posted 05 December 2019 - 04:14 PM

Have a nice trip to Russia.

 

 
'Yes, yes I would' was an ironic answer to your snarky comment. You drew a picture of some doc Nick Riviera crossed with Bernie Madoff. It gave me a laugh, but it isn't necessarily what you'd find at a foreign research clinic, nor is Russia at the top of the priority list. The Russian clinic was chosen at random from a long PubMed list of researchers with access to neuronavigation and rTMS, because you wrote it was all but impossible to get treatment, even if you had a million bucks at your disposal. 
 
What it takes is the will of an existing clinic to invest some fifty grand, plus the assistance of researchers. It's not a chimera. It's not impossible. My approach is to get everything on the table, and then adjust or dismiss options afterwards, instead of dismissing everything first. Sure, sure. I've seen private clinics where the docs wear Rolexes and offer experimental, ineffective and overpriced treatment.
 
I think the mentioned DPDR foundation could play a key role in working with the British rTMS clinics, lobbying for neuronavigation and cooperation with experienced researchers. Impossible is nothing. 





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