There are 2 components to treating GDD: i) removing the Gd, and ii) treating the host response.
Removing the Gd is the most obvious and straightforward, so treatment begins with focusing on that. Patients basically fall into two groups: 1) those relatively easy to treat, and 2) those that are challenging. In group 1, the largest subgroup are patients who have received only linear agents and are beyond 1 year after the most recent GBCA administration. In those patients often just a regimen designed to remove Gd may be sufficient. In group 2, the 3 largest subgroups are: a) those who have received the most recent GBCA within 6 months, b) those who have received macrocyclic agents, and c) those who are a + b.
There are essentially 3 methods that are the most effective, and use an FDA approved drug:
1. Standard, Ca-DTPA followed by Zn-DTPA the next day. Variations are the frequency of this protocol, and 1 - 4 week intervals have all been used and successful.
2. Gentle chelation. Zn-DTPA-only method. This should follow the same 1-4 week interval, but can also be used more than once per week.
3. Aggressive chelation. Ca-DTPA-only method. Ca-DTPA removes from 2 to 4 times more Gd than Zn-DTPA. It is my opinion that the amount of Gd that re-enters the blood stream following chelation is a principle component of the Flare. This strategy may be best for patients with GSC who have undergone multiple GBCA administrations, and want to get Gd out of their body. Some patients in group 1 can also try this. This approach is the most likely to induce a Flare reaction.
Managing the Host Response
This is presently a work in progress. This has to be addressed in group 2 patients.The first two strategies below are currently utilized by our group:
1. Gentle chelation with Zn-DTPA-only. See above.
2. Flare ReAction Medication Envelope (FRAME). Currently this strategy is proprietary as we tweak it. It essentially uses two very common strategies that have been used to manage allergic and other host immune system reaction. It is essentially a combination of a Hypersensitivity protocol (used routinely in Radiology to ward off adverse reactions, also used in Oncology, and likely all other specialties where drugs are used that have an appreciable incidence of allergic reactions, with the number of administrations numbering in the hundreds of thousands) and a steroid taper pack (used for a variety of allergic reactions, inflammations, and migraine, again with the number of administrations in the hundreds of thousands). So essentially we have combined two extremely common methods to deal with allergic and host reactions, and use it as an envelope around chelation. FRAME is designed to mitigate the Flare, but also is useful for managing the primary disease of GDD.
3. Autoimmune treatment. Cytokines are a main component of GDD. In patients who have not responded sufficiently to 5 rounds of chelation, treatment of autoimmune disease will be either added in or substituted for chelation. On a patient by patient basis this may occur earlier than the 6th chelation session. Initially low toxicity safe agents will be used, LDN is one of them. Other nonaggressive integrative approaches will also be considered, eg: supplements, supplement infusions, sauna, hyperbaric oxygen.
4. Autoimmune disease treatment- aggressive. See upcoming blog on Disease-Modifying Anti-Rheumatic Drugs (DMARDS). Very expensive, and I will need clinical evidence before using the most targeted and expensive drugs. For example the two drugs that target the most important cytokines involved in GDD will cost approximately $3,500/month (Humira targeting TNF being one). I cannot justify this expense without evidence that it achieves the desired goal safely, quickly and completely.
5. Immunosuppressive drugs. Cyclosporine. Other more aggressive drugs in this category include methotrexate and rapamycin.
6. Other treatment. We are open to other treatments, which may be aggressive, but we require definite proof of method of action and evidence of success.
My intention at present is to stop at pt 3 above.
Our general interval for chelation/host response treatment is every 3 weeks. This can be modified.