Interview of Eric Ott and Dr Black of Cedar Sinai

November 14, 2006

The MRI Scan gives us the black and white picture, it doesn’t give us a diagnosis but it gives us some possibilities so the most likely possibility of what that represents is a tumor that has originated in the brain itself;; and we call it aglimoa or an astrocytoma. We divide these into sort of low grade and high grade tumorsThe appearance of this is low grade, but we cannot be sure of that. So we don’t know how long it’s been there, but it’s probably enlarged over time and the fact that you are now having more seizures and more difficult to control, suggests that it may have changed recently - that it may have gotten a little larger. So, the best thing to do in my opinion at this point is to do a biopsy so that you get a diagnosis. I think going in to try to surgically remove that area,even if some people may advocate that, I think would be very risky for you; and the risk benefit ratio, I don’t think, would be worth it.

Eric: Are you saying longterm? After the biopsy?

Dr. Black: I wouldn’t recommend doing a big operation at this point. What I would recommend is doing a biopsy and getting a diagnosis. And if this turns out to be a low grade tumor or a high grade tumor, we can subtype it based on its molecular profile , based on the biopsy, and we can recommend some treatment; and that treatment could be chemotherapy with temerolor radiation or a combination or both of those things. Or it may be just observation and not doing either. But I think the next step for you would be to get the biopsy.

Eric: Are there other things that we could do for a diagnosis? I just want to get your opinion.

Dr. Black There are scans (??) - PET scans, nuclear medicine - all those things would be fine; but again, with the MRI scan, since I’m about 85% predictive of what it is based on the MRI scan, if we had a MR Spec or a PET scan or a nuclear medicine scan, then that goes up to maybe 89% predictive. It’s not like you go from 85 to 99% in predictive.

Eric: But how would you do the biopsy in the best way …(Interference) ??? Is it there a spec to be able to help you map it out… ?

Dr. Black: About 15 years ago - when we look back and look at all those studies-Iactually published some studies on that - It may be somewhat predictive if we found an area that had a lot of activity to go along with the biopsy, but in general probably not - on a practical basis,it is probably not predictive.

Eric: Where would you go in looking at it now?

Dr. Black: I would pick the safest location. Because, you know, draped over the surface of this are a lot of blood vessels, so the risk of a biopsy is really a risk of getting an injury to one of those vessels that could cause a hemorrhage, or blood clot, or a stroke. So we try to make sure that we get an adequate sample …

Eric: Based on those statistics, what would the risk be of those things?

Dr. Black: Probably 3%.