Benefits for Clinicians

A Brain SPECT Imaging 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 toxicity, potential areas of seizure activity, or past brain trauma.
• Potential seizure activity, in many cases more accurately seen by SPECT than standard EEG, especially in the areas of the medial temporal lobe.
• Targeted areas for treatment, such as overactive basal ganglia or anterior cingulate gyrus (seen on anxiety and OCD spectrum disorders), or an underactive temporal lobe (seen in seizure disorders and trauma).
• Specific effects of medication on the brain to help guide us in adjusting dosages or augmenting treatment. Often patients report that SSRIs are helpful but also cause decreased motivation or memory problems, seen as decreased prefrontal or temporal lobe activity on SPECT.
• Changes in brain function with treatment, improved or worsened. A SPECT scan captures the brain at the time of injection and outside the imaging camera, which gives SPECT several significant advantages over fMRI. Most notably, we are able to sedate people after they have been injected so that they can lie still for the scan, which is often difficult for hyperactive or autistic children or demented adults (motion artifact ruins the scan in all clinical imaging techniques).
• 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).
• Help us to avoid prescribing treatments that make the problem worse, such as unnecessarily stimulating an already overactive brain or calming an underactive one.
• Help to evaluate risk for dementia – the brain starts to change long before people show symptoms. There is usually a loss of 30% of hippocampal tissue before symptoms occur. Using autopsy data in 54 patients Bonte4 reported that brain SPECT had a positive predictive value for Alzheimer’s disease of 92%.
• Help to differentiate between types of dementia. Early in the disease, Alzheimer’s disease, frontal temporal lobe dementia, Lewy body dementia and multi-infarct dementia each have their own patterns.
• Show patients how treatments have impacted (improved or worsened) brain function.
• Help clinicians understand the rationale for using certain medications (such as anticonvulsants to stabilize temporal lobe function or calm areas of marked hyperactivity, or stimulants to enhance decreased prefrontal perfusion, or SSRIs to calm basal ganglia and anterior cingulate hyperactivity).
• Identify specific areas of the brain affected by trauma, better target treatment, and help deal with insurance, legal and rehabilitation issues.
• Identify factors contributing to relapse in those recovering from substance abuse, eating disorders, or sexual addiction.
• Useful in determining if further adjustment of medication is needed. Scans of patients on medication will reveal areas of the brain still overactive or underactive. Pictures are powerful…
• Allow patients to see a physical representation of their problems that is accurate and reliable and helps to increase compliance. It can influence a patient’s willingness and ability to accept and adhere to the treatment program.
• Help to develop a deeper understanding of the problem, resulting in less shame, guilt, stigma, and self-loathing. This can promote self-forgiveness, often the first step in healing. Patients can see that their problems are, at least in part, medical and physical.
• Help families understand when things such as permanent brain damage from an injury will not get better, so that they can better accept the condition and plan accordingly.
• Show substance abusers the damage they have done to their brains, thus helping their denial, provide them with motivation in treatment, and support perseverance in their sobriety.
• Help motivate abusive spouses to follow medication protocols by showing that there are physical abnormalities contributing to their problems.
• Is useful for cancer patients suffering with a “chemotherapy toxic brain.” It gives them insight into their cognitive struggles and also helps their doctors see the neurophysiologic and emotional effects of having cancer and its treatment.
• Help take modern psychopharmacology from mystery and unknown consequences to reality and more predictable outcomes.
• Allows patients to understand why specific treatments are indicated, which medication are likely to be most helpful, and what other interventions may be indicated.