To Treat or Not to Treat:  Understanding the Impacts on Mental Health

2023 TBF Preventative Research Grant - In Honor Of The Yezzi Family

David Altschul has been an endovascular neurosurgeon for nine years. He’s also an indefatigable researcher, specifically in new approaches in endo-vascular neurology, treatment techniques and disparity research. His focus on treatment approaches is reflected in the project which The Bee Foundation has funded as one of the three 2023 grant awards for research into innovative approaches to detection, prevention, and treatment.

Altschul’s research, inspired by a recent discussion among high-level clinical researchers at a Washington DC conference, centers around the awareness that more needs to be understood about the mental health impacts of a brain aneurysm diagnosis. With more patients getting MRAs, and more un-ruptured aneurysms thus being discovered, the question is gaining in criticality.

When determining whether or not to treat an aneurysm once detected, Altschul says, a physician usually follows the generally established guidelines, which are focused on eliminating the risk of ruptureand bleeding. Under those guidelines, there are many aneurysms that don’t get treated. But should that be the only element that is factored into the decision? Altshul’s experience has shown him that for a patient, simply discovering that they have a brain aneurysm is essentially life changing. Suddenly, people have to question how they conduct their whole lives. Do they have to stop their normal activities? Can they continue playing tennis, travelling, driving long distances? Is this or that going to cause a rupture?

They become scared of doing things they have simply taken for granted. As health care physicians, Altschul muses, we rarely consider the thoughts of the patients. How does the decision to treat – or not to treat – the aneurysm affect them?

For many, having the aneurysm treated might allay a lot of those concerns, and thus the focus of Altschul’s research. Is the patient going to be better off, or worse, with one decision or the other? Can we create patient centered metrics that reflect these thoughts and feelings? And how do we factor that into the treatment decision?

Altschul is planning to enroll 120 patients with newly discovered aneurysms into his study. The first step will be to give them a standardized questionnaire, developed by Altschul’s team, that covers aspects of mental health – depression and anxiety – that have not previously been asked. The patients will be split into two groups – treated and non-treated – and followed up in 6 month, 1 year and 2 year intervals to provide a long-term view of the impacts of treatment. Altschul’s hope is that the research will help to create a standard so that this patient-centered metric is factored into future aneurysm trials. 

Essentially, says Altschul, it’s part of the bigger picture and the longer conversation – How can we do a better job? Considering the mental health of aneurysm patients is clearly a key part of the picture.

Names/Titles of Team Members:

Principal investigator: David Altschul, MD Department of Neurosurgery, Montefiore Medical Center,
Research Fellow: Muhammed Amir Essibayi, MD Department of Neurosurgery, Montefiore Medical Center,