SPECT Brain Imaging in Chronic Lyme Disease
Donta, Sam T. MD*; Noto, Richard B. MD†; Vento, John A. MD‡
Abstract
Objectives: Lyme disease is an infectious disease that
frequently involves the central nervous system, leading to cognitive
and/or mood dysfunction. The basis for these symptoms remains to be
defined but may be the result of a vasculitis or metabolic abnormality
secondary to the infection. SPECT scans of the brain might provide an
objective measure of abnormalities present in patients with otherwise
difficult to objectify clinical findings. The objective of this study
was to determine the frequency, location, and severity of abnormalities
in SPECT scans of the brain of patients with chronic Lyme disease.
Methods: A total of 183 individuals who met the
clinical definition of chronic Lyme disease underwent SPECT scanning of
the brain using 99mTc and standard nuclear imagine
techniques. Abnormalities of perfusion to affected areas of the brain
were defined as mild, moderate, or severe.
Results: Of all patients, 75% demonstrated
abnormalities in perfusion to various areas of the brain, most notably
the frontal, temporal, and parietal lobes. Patients considered to be
seropositive and those considered seronegative had similar rates, types,
and severity of perfusion defects. Abnormalities of MRI of the brain
were seen in 14% of patients. Treatment with antibiotics, especially
those with intracellular-penetrating activity, resulted in resolution or
improvement of abnormalities in 70% of patients over a 1- to 2-year
period.
Conclusions: Brain SPECT scans are abnormal in most
patients with chronic Lyme disease, and these scans can be used to
provide objective evidence in support of the clinical diagnosis. The use
of certain antibiotic regimens seems to provide improvement in both
clinical status and SPECT scans.
