48. Looking at the brain with Eboni Cornish

The role of SPECT scanning in tick-borne illness.

Episode 48 with Dr. Eboni Cornish, on the Looking at Lyme podcast.

Dr. Cornish is an integrative functional physician working at the Amen Clinics. She was introduced to chronic Lyme disease when working with a patient who was not cured by a short course of antibiotics. The patient, a landscaper who presented with a bullseye rash followed by ongoing Lyme symptoms, had been labeled as a “drug seeking” patient. This caused Dr. Cornish to ask the question, “Who in the world drug-seeks antibiotics?” After joining a medical practice in a Lyme endemic area, Dr. Cornish learned about the International Lyme and Associated Diseases Society (ILADS), and eventually became a Board member.

MRI, CT and SPECT scans

While CT and MRI scans of the brain examine the function and anatomy, Dr. Cornish explains that a SPECT scan, a single photon emission computerized tomography scan, looks at brain activity and blood flow. She explains that areas of the brain that have less blood flow or activity appear almost like “holes” on a SPECT scan. These changes can be caused by toxins, head injury, Alzheimer’s, Lyme disease and other infections.

“Another change you might note (on SPECT scans) is when there’s a lot of activity in the brain, and I’ve seen those changes when patients are having what you call a ‘die-off’ reaction, a Herxheimer reaction, whereby the underlying infection is being treated…you will definitely see changes, because the first pattern it may be scalloping, toxic appearing, and then afterwards (after treatment)…we’ll see more of a calm, symmetric brain activity.”

Dr. Eboni Cornish

SPECT scans and Lyme disease

Although SPECT scans alone are not diagnostic of Lyme disease, scans can be used to figure out what questions to ask. Dr. Cornish looks for areas of inflammation and “scattered early activity”. Later in the disease process, the activity may be less scattered and may take on a scalloped appearance with decreased blood flow, indicating brain inflammation. The scan, along with a physical exam and detailed patient history help a physician determine differential diagnoses. Dr. Cornish notes that brain inflammation can be caused by a number of toxins such as mold, Lyme, and other tick-borne infections. 

“A lot of my patients get dismissed by traditional medicine, and even by their family members. They’re diagnosed as just a psychiatric patient…all these different diagnoses that you provide to patients when you don’t know the root cause of their illness. So when you’re looking at SPECT scanning, and you see these abnormalities…it makes parents and patients and family members feel more supported, and they realize, ‘Wait, it’s in my head, but it’s not ALL in my head.’”

Dr. Eboni Cornish

SPECT changes with treatment

In her practice, Dr. Cornish has noted decreased activity in basal ganglia and frontal lobes, the areas for excitement and executive functioning. She has also seen increased activity in the brain in certain areas during treatment due to a die-off or Herxheimer reaction. Fortunately, patients’ SPECT scans that have a scalloped appearance often return to a healthier looking SPECT scan after they’ve been treated for Lyme disease.

Shining a light on brain symptoms

Dr. Cornish points out that, for patients who are experiencing brain symptoms of Lyme disease, a SPECT scan can be helpful in understanding the root cause. Patients with symptoms such as depression, anxiety and psychiatric symptoms such as psychosis, are sometimes dismissed with a psychiatric diagnosis, without considering the root cause of their symptoms. Dr. Cornish notes that changes in the basal ganglia, which include fight or flight responses, can be seen on a SPECT scan. Knowing that certain symptoms relate to changes in their SPECT scan can help patients and their families feel more supported.

 “Over time, you’ll start hearing people complain of this ‘wired but tired’ response because that stress hormone, the cortisol, becomes too high, and if your body is only focussing on stress, it has the inability to focus on healing.”

Dr. Eboni Cornish

Mast cells and the deep limbic system

The deep limbic system integrates gait sensory information, sets emotional tone, changes in memory, sense of smell, and activates the autonomic nervous system (ANS). When the ANS is activated, patients experience a fight or flight response. Dr. Cornish explains that mast cells within the deep limbic system release histamine and over 50 other chemicals, which can lead to anxiety, insomnia, multiple chemical sensitivity, autonomic dysfunction, or allergies. Changes in SPECT scans often co-relate to symptoms of mast cell activation that a patient is experiencing.

Cortisol imbalance and healing

Dr. Cornish explains to our listeners that when we experience excess and prolonged release of the stress hormone cortisol, our bodies in turn are not in a state of healing. She notes that this phenomenon leaves many patients in a “wired but tired” state and may eventually lead to imbalances in many areas of the body. 

Autoimmunity blood tests

One of the other diagnostic tools that Dr. Cornish uses is a set of metabolic blood tests called the Cunningham panel. She explains that in conditions such as PANS and PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus), infection causes an immune response against brain cells, leading to brain inflammation and subsequent brain symptoms. Researchers have discovered that certain antibodies are associated with specific symptoms such as mood changes or OCD. A specific antibody called CaM kinase II can become abnormal due to infection. Dr. Cornish notes that pre and post treatment tests can help determine the effectiveness of treatment of not only Strep, but other infections as well. 

“Patients who have those neurological manifestations of Lyme disease also have more activity…in that limbic system. So when patients go through programs like DNRS (Dynamic Neural Retraining System)…one of their major goals is to calm that limbic system, calm that fight or flight response, which is one of the ways it improves mast cell activity…autonomic dysfunction, multiple chemical sensitivities and anxiety…first I’ll get their brain scan and it will look toxic…after they do those programs, it calms down, and you see less activity.”

Dr. Eboni Cornish

Detoxing the brain

Dr. Cornish discusses some of her preferred methods for clearing toxins from the brain. She has found treatment with IV glutathione and B vitamins to be helpful. She has also seen patients who present with mold toxicity, chronic infections, head trauma and post concussion syndrome often have something called cranial cervical syndrome. Dr. Cornish has found that the flow of cerebrospinal fluid may be improved by cranial cervical manipulation, resulting in improved release of toxins from the brain.

Calming limbic activity in the brain

Dr. Cornish has also seen positive changes in SPECT scan results after limbic system retraining such as the Dynamic Neural Retraining System, or DNRS. She explains that patients with neurological manifestations of Lyme disease also have more activity in the limbic areas of the brain. As the limbic system calms, mast cell activity is also affected, leading to reduction in symptoms associated with autonomic dysfunction. These include physical symptoms relating to heart rate and blood pressure changes and other symptoms such as anxiety or multiple chemical sensitivity.

“One of the many problems with toxoplasma is its impact on the central nervous system. So, studies have shown that patients who have this parasite also suffer from things like schizophrenia or psychosis, and when you treat a patient for the parasite, surprisingly enough, those neurological symptoms also improve.”

Dr. Eboni Cornish

Toxoplasma and compromised immune system

Another infection that Dr. Cornish screens patients for is toxoplasma. She notes that toxoplasma gondii can be found worldwide, and becomes more problematic when a person’s immune system is attacked or compromised. This parasite can be found in many animals and can show up in cat-litter boxes or in contaminated meat, and has also been found in ticks. Dr. Cornish explains that toxoplasma affects the central nervous system and can cause symptoms of schizophrenia or psychosis. Fortunately, when patients are treated for the parasite, these neurological symptoms improve. Dr. Cornish also notes patients with blood tests that indicate chronic infection (IgG) can still be experiencing active infection and need to be treated. 

Emerging research

Dr. Cornish reflects on some of the more recent research into tick-borne illnesses. She is excited about Dr. Zhang’s research around persistence of Lyme disease and emerging treatments. She is also following research about treatments such as Methylene blue, in combination with antibiotics, for the treatment of Bartonella as well as the use of various herbal treatments for tick-borne illness. Thank you Dr. Cornish for explaining SPECT scans to us, and for all of the work you are doing in the area of tick-borne illnesses!

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