Benefits for Physicians and Mental Health Clinicians
WHAT A SPECT scan can show
Areas of the brain implicated in specific problems such as the prefrontal cortex (executive function) and the medial temporal lobes (long term memory storage).
Unexpected findings that may be contributing to the presenting problem(s) such as brain toxicity or past brain trauma.
Potential, and sometimes unsuspected, seizure activity, sespecially in the areas of the medial temporal lobe; in many cases it is more accurately seen by SPECT than standard EEG.
Targeted areas for treatment such as overactive basal ganglia or anterior cingulate gyrus (seen in anxiety and OCD spectrum disorders), an underactive temporal lobe (seen in seizure disorders and trauma) or underactive frontal lobes (seen in ADD and brain trauma).
Specific effects of medication on the brain to help guide us in adjusting dosages or augmenting treatment. Often times, patients report that SSRIs are helpful, but also cause decreased motivation or memory problems; seen on SPECT as decreased prefrontal or temporal lobe activity.
Improved (or worsened) changes in brain function from treatment.
A SPECT scan can provide explanations for refractory symptoms and help clinicians ask better and more targeted questions (e.g. about toxic exposure, brain injuries, anoxia, inflammation, or infections that patients may have denied or forgotten).
A SPECT scan can help to evaluate the risk for dementia, because the brain starts to change long before people show symptoms-usually a 30% loss of hippocampal tissue before symtoms occur. Using autopsy data in 54 patients, Bonte et al., reported that brain SPECT had a positive predictive value for Alzheimer’s disease of 92%.2
A SPECT scan can also help to differentiate between types of dementia. In the early stages, Alzheimer’s disease, frontal temporal lobe dementia, Lewy body dementia, and multi-infarct dementia each have their own patterns, although patients may have similar looking symptoms.
A SPECT scan helps clinicians understand the rationale for using certain medications, such as anticonvulsants to stabilize temporal lobe function or calm areas of marked hyperactivity, stimulants to enhance decreased prefrontal perfusion, or SSRIs to calm basal ganglia and anterior cingulate hyperactivity.
A SPECT scan can help us to avoid prescribing incorrect treatments that make problems worse, such as unnecessarily stimulating an already overactive brain or calming an underactive one.
A SPECT scan is also useful in determining if further adjustment of medication is needed. Scans of patients on medication can reveal if areas of the brain are still overactive or underactive.
A SPECT scan can identify specific areas of the brain affected by injury and trauma, target treatment more precisely, and help deal with insurance, legal, and rehabilitation issues by providing evidence of brain function problems.
A SPECT scan can often identify factors contributing to relapse in those recovering from substance abuse, eating disorders, or sexual addiction. For example: the patient may have suffered an injury to the prefrontal cortex or temporal lobes and have overactivity in the anterior cingulate gyrus, basal ganglia, limbic system, or prefrontal cortex; each of which could indicate co-morbid disorders requiring treatment.