My name is Cherie Marvel.
I'm an associate professor in the departments of Neurology and Psychiatry at
Johns Hopkins University School of Medicine.
My background is in cognitive neuroscience and I'm trained to use
brain imaging methods and cognitive testing to study how the brain functions
when it's undergoing different cognitive processes.
I think the major limitation is that there's no, there's no test,
there's no diagnostic test that you can order, um,
through your clinician and, and just take it and say, oh yeah, that's it.
That's, that's, we know it is, or it isn't, it's not binary.
It's really quite subtle.
So people can talk about their symptoms and they have complaints.
They can even take some cognitive tests,
but the cognitive tests still might look pretty normal because that person
might, for example,
might be a really high functioning even when they're not feeling well.
So that's the major limitations.
There's no good way to just be definitive about a diagnosis.
Brain fog is, uh, it's a general term.
It's a great term cuz I think it really sounds like what it feels like that your
brain's in a fog, you know, so it's, um,
a cognitive difficulties that could be your brain just feels like it's moving
slowly. It makes it harder to remember things and to, um,
to put things in order to multitask.
This difficulty with thinking and concentrating is one of the most common
complaints from people with Lyme disease.
And the cognitive deficits of brain fog can often be too subtle for standard
diagnostic tests to uncover.
So we can use different types of brain imaging to get more of a quantitative
objective measure of what's happening in the brain.
And we can look at it two ways. We can kind of look at the,
the structure of the brain,
but we can also look at how the brain's functioning over time using functional
mri.
We're essentially associating the brain activity with their performance
on the task.
And we're trying to see is everything working normally or someone activating
kind of unusual areas,
or are they compensating in some way if they're unable to do the task?
Does that brain look different from people who can do that task successfully?
You can think of it like a video showing which brain regions are activated when
being asked to recall by associating brain activity with the patient's
performance on the test.
It allows for better understanding of how the brain is processing information.
DTI is diffusion tensor imaging,
and that is something we use to look at the integrity of the white
matter. We're seeing brain changes associated with Lyme disease.
I think that's important because it shows that this is biological,
it's not psychosomatic. We were not hypothesizing in any way, um,
that some of these changes are actually associated with better outcomes.
The novel finding for us,
we found that there are white matter changes,
especially early on in the infection.
People who have a lot of those changes actually end up having the better
outcomes six to 12 months down the road. So on the one hand,
we think about white matter changes as being damaged or pathologic
in some way,
but it turns out if you don't have whatever it is that we're seeing with these
white matter changes, if you don't have that, then you're,
you're worse off in terms of your outcome.
And that was really surprising to us because they're typically thought of as
pathology. Now we're rethinking that a bit. Whatever we're detecting, um,
in our scans, it must be some form of, uh,
an appropriate response to an earlier response to
Lyme disease.
Dr. Marvel's fMRI and FTI study builds upon previously published
neuroimaging studies that use PET imaging to identify brain inflammation in Lyme
disease patients.
The significance of the findings are that these cognitive complaints that people
often have in the clinic can be verified. They're, they're something real,
that this is a,
a biological change in the brain and it's something that we can measure and we
can see that goes above and beyond, you know,
just subjective descriptions from the patient. And I think that's, you know,
significant not only from a scientific standpoint,
but also in terms of validating, uh, the concerns of the patients.
So the next step in the research is really to, we're just,
we are planning to do more work with these brain imaging methods and combine
them with, you know,
other blood markers and cerebral spinal fluid markers 'cause we wanna
understand more what these changes are about. We're trying to find out, um,
what causes them and,
and how they might be associated with damage or repair and what is
it about them that may, that when they happen,
they're related to better outcomes down the road.
We really wanna understand that if we can exploit that in some way,
if we can tap into that, um, we might be able to, um,
help with bringing that kind of information into the clinic.
This sort of information might tell us down the road how that person's going to
do and we can perhaps, um,
have some forms of treatment early on for those types of individuals who don't
look like they're gonna return to health as quickly as the other other group
might.
Maybe that we've kind of stumbled on something that might have common overlap.
Uh, for example, long haul covid, chronic fatigue syndrome.
If we were to apply these same methods to those diseases,
we might see some underlying, um, mechanisms that are, uh,
common to what we're seeing in Lyme disease.