SPECT can be helpful in understanding and treating aggressive behavior. I have found a consistent triad of SPECT findings common in children, teenagers and adults who exhibit aggressive behavior. These findings include:
When these three findings are present it is often helpful to intervene with anticonvulsant medication to stabilize temporal lobe abnormalities and decrease violent thoughts, a serotonergic agent to help decrease anterior cingulate activity and improve cognitive flexibility, and sometimes a psychostimulant to activate prefrontal cortex activity and enhance impulse control.
As the population ages, the incidence of dementia in the world will become an even more common problem and take up an even larger percentage of the health care budget. With the advent of new medications that slow the course of some dementing processes, diagnostic tools that help in the early differential diagnosis of dementia is essential.
The SPECT pattern for Alzheimer's Disease is typically bilateral hypoperfusion in the parietal and temporal regions of the brain with frontal lobe hypoperfusion occurring later in the illness.
Multi-infarct dementia is characterized by multiple areas of decreased perfusion. HIV dementia is typically seen by decreased patchy uptake across the cortex. Frontal lobe dementias (as the name indicates) are often characterized by very poor frontal lobe perfusion.
Psuedodementia (another condition, such as depression, that clinically appears like dementia) will not have a typical dementia pattern and may be more like a depression pattern.
This is perhaps the most important section of this atlas. It shows actual images of treatment, the before and after SPECT images of our patients who have experienced significant benefit from treatment. This section highlights that in many cases the brain can be healed or optimized to produce greater function and subsequently a healthier, happier life.
SPECT can be helpful in evaluating the effects of drugs and alcohol on the brain. On 3D surface images several substances of abuse appear to show consistent patterns. For example, cocaine and methamphetamine abuse appear as multiple small holes across the cortical surface; heroin abuse appears as marked decreased activity across the whole cortical surface; heavy marijuana abuse shows decreased activity in the temporal lobes bilaterally and heavy alcohol abuse shows marked decreased activity throughout the brain. These findings tend to improve with abstinence, although long term use has been associated with continued SPECT deficits seen years after abstinence. SPECT can be helpful in several ways in drug and alcohol abuse. First, 3D surface SPECT images of drug and alcohol abusers can be used in drug prevention education. Second, SPECT studies can help break though the denial that often accompanies substance abuse. When one is faced with their own abnormal cerebral perfusion it is hard to remain in denial. Third, SPECT may help evaluate if there is an underlying neuropsychiatric condition that needs treatment.
Studying the effects of drugs and alcohol on the brain has clearly been one of the most informative and fascinating parts of my work. I had a sense growing up that drugs and alcohol weren't helpful to my overall health. I might add, this notion was helped along by getting drunk on a six pack of Michelob and half a bottle of champagne when I was sixteen years old - I was sick for three days. After that, I've been lucky enough to stay away from drugs and alcohol. After doing this work there's no way you could get me to do marijuana, heroin, cocaine, methamphetamine, LSD, PCP, inhalants or any more than a glass or two of wine or beer. These substances damage the patterns in your brain, and without your brain you are not you.
There is really quite a bit of scientific literature on the physiological effects of drugs and alcohol on the brain. SPECT has demonstrated a number of abnormalities in substance abusers in brain areas known to be involved in behavior, such as the frontal and temporal lobes. There are some SPECT similarities and differences between the damage we see caused by the different substances of abuse. I'll discuss the differences in drug abuse patterns below. There tends to be several similarities seen among classes of abused drugs. The most common similarity among drug and alcohol abusers is that the brain has an overall toxic look to it. In general, the SPECT studies look less active, more shriveled, and overall less healthy. A "scalloping effect" is common amongst drug abusing brains. Normal brain patterns show smooth activity across the cortical surface. Scalloping is a wavy, rough sea-like look on the brain's surface. I also see this pattern in patients who have been exposed to toxic fumes or oxygen deprivation. My research assistant says that the drug brains she has seen look like someone poured acid on the brain. Not a pretty site.