Invasion of the Brain Snatchers!

By Mark Filidei, DO

When patients present with anxiety, depression, attention problems, fuzzy thinking, irritability, insomnia, or other issues, most traditional psychiatrists simply dole out prescription medications to try to treat these problems. But these issues are just symptoms, and using a Band-Aid to mask symptoms without investigating and addressing their underlying causes will never work. Clinicians need to think like detectives and look at symptoms as clues to the real culprit.

Let’s look at two case studies.

Case Study #1

Joe was 65 years old when he came to see me with his wife Rita (not their real names) for couples counseling. Rita complained that Joe was “not himself anymore.”  He had abruptly changed two years earlier and started making very poor decisions. Rita was unhappy and wondered what had happened to the man she had married.

The traditional treatment route would have been to give Joe medication, such as Provigil, for his fuzzy thinking. But was it really cognitive impairment, the onset of Alzheimer’s, or something else?

Case Study #2

I met with 7-year-old Tyler (not his real name) and his mother, who complained about her son’s severe behavioral issues, filthy mouth, and extreme anger. Tyler had threatened to kill people, talked about violent acts, and had his parents worried that he would grow up to be a murderer. His mom was afraid Tyler would get kicked out of school and felt ashamed that she was raising a “sociopath.”

In traditional psychiatric care, Tyler may have been prescribed one or more drugs—such as stimulants, anticonvulsants, or antipsychotics—in an attempt to change his behavior. But were these medications the right answers to his problems?

Root Causes of Psychiatric Symptoms

At Amen Clinics, our brain imaging work has shown that many common “psychiatric” symptoms are actually related to biological causes. On brain SPECT scans, we often see evidence of encephalopathy (any abnormal condition of the structure or function of brain tissues) or encephalitis (inflammation of the brain).

Once again, abnormal brain scan results are often symptoms of another problem, clues that something else is in the body isn’t functioning optimally. In general, causes of encephalopathy fall into the following four categories:

• Metabolic: sleep apnea, hormone imbalances, allergies/food reactions, anemia, etc.
• Infections: Lyme disease, Epstein-Barr virus (EBV), cytomegalovirus (CMV), toxoplasmosis, etc.
• Toxins: mold, mercury, drugs, solvents, etc.
• Trauma: Concussions or traumatic brain injuries (TBIs)

To determine which one (or more than one) of these is causing the brain to look unhealthy, clinicians can perform specific lab tests, and they need to ask more probing questions.

Lab Workup for Encephalopathy

There are numerous lab tests available that can provide valuable information for the clinician. A lab workup for toxic encephalopathy may include the following:

• Toxic metal: hair analysis, 6-hour urine provocation test
• Hormones: serum, 24-hour urine collection test, saliva cortisol
• Gastrointestinal (GI) dysbiosis: organic acid urine test, comprehensive stool analysis
• Obstructive sleep apnea (OSA): natural oximetry, attended sleep study
• Biotoxin illness: urine mycotoxins, serum transforming growth factor-beta-1 (TGFB-1), melanocyte-stimulating hormone (MSH), C3a, C4a, vasoactive intestinal polypeptide (VIP)
• Infections: Lyme disease: Western Blot (WB) and C6 Lyme ELISA; CMV; EBV—confirm with polymerase chain reaction (PCR); Human Herpesvirus-6 (HHV-6); Parvovirus B-19; syphilis: rapid plasma reagin (RPR); mycoplasma; Chlamydia pneumoniae; strep: antistreptolysin O (ASO) and anti-DNase B; West Nile virus (WNV); Candida antibodies; toxoplasma gondii antibodies: immunoglobulin G (IgG) and immunoglobulin M (IgM)
• Neuroautoimmune panels
• Additional tests: C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibodies (ANA), homocysteine, thyroid-stimulating hormone (TSH), free thyroxine 4 (FT4), free thyroxine 3 (FT3), Reverse Triiodothyronine (RT3), thyroid antibodies: thyroid peroxidase (TPO) and antithyroid antibodies (ATA)

Although these tests can offer critical data, they are only one portion of a comprehensive diagnostic process. Delving into a patient’s clinical history helps complete the picture.

Clinical History Questions

When encephalopathy is noted on brain scans, it should prompt you to ask patients a series of questions, including:

• Have you ever lived in a home with mold exposure or water leaks?
• Have you ever been bitten by a tick? (Note that more than half of all people with Lyme disease do not recall being bitten by a tick or developing a rash.)
• Have you ever been diagnosed with mononucleosis?
• Have you ever been tested for obstructive sleep apnea?
• Have you engaged in significant foreign travel?
• Are you routinely exposed to toxins at work or in the environment?
• Do you have amalgam fillings?
• What is your vaccination history?

Combining the clues gleaned from the patient’s clinical history with the lab test results and the patterns seen on brain scans, the clinician can close in on what’s causing a patient’s symptoms. Let’s look at what the lab tests and clinical history questions revealed about our two case studies.

Case Study #1: Joe

Joe’s lab results showed off-scale high levels for toxoplasma IgG and IgM antibodies, as well as low testosterone levels. No amount of Provigil would have treated these issues.  In taking his clinical history, I discovered that the couple had gotten a cat a few years earlier, and Joe was tasked with changing the kitty litter. This is where he might have come in contact with toxoplasma gondii, a single-celled parasite that is often carried in cats and shed in their feces. With hormone replacement therapy (HRT), treatment for toxoplasmosis, and instructions to always wear gloves when changing the kitty litter, he is doing much better. His wife says she feels like she’s got her husband back.

Case Study #2: Tyler

Tyler, the 7-year-old’s lab tests showed abnormal results in his nutritional and metabolic panel. In particular, he had increased urinary excretion of 3-(3-hydroxyphenyl) 3-hydroxypropionic acid (HPHPA), an abnormal phenylalanine metabolite of Clostridium spp. found in the GI tract. Research in Nutritional Neuroscience shows that HPHPA has been found in higher concentrations in children with autism and also in people with psychosis related to schizophrenia. By enhancing Tyler’s gut health, it helped calm his aggressive behavior, and his mother was no longer afraid he would grow up to be a murderer.

In summary, clinicians must think of symptoms as clues to a deeper biological problem. Similarly, brain SPECT scans, lab tests, and a patient’s clinical history are other clues that help solve the mystery and lead to an accurate diagnosis and effective treatment plan.

About the Author: Mark Filidei, DO, Amen Clinics Orange County, CA

Dr. Mark Filidei is an Internal Medicine physician and is the Director of Integrative/Functional Medicine for Amen Clinics. Functional Medicine incorporates the latest developments in systems biology, genetics, and a deep understanding of human physiology to address complex medical and mental health issues. Dr. Filidei’s approach is to find the root cause of a person’s health problems including metabolic, genetic, and environmental factors, and to treat those problems in as natural a way as possible by using targeted nutritional supplements, correcting hormone and metabolic imbalances, improving lifestyle and diet, and detecting and treating toxin exposure and infections like mold and Lyme disease.