Neuroimaging of Lyme Disease | Cherie Marvel, Ph.D.

Why It Matters

If early brain‑imaging can predict chronic Lyme outcomes, clinicians could intervene sooner, reducing long‑term disability and informing treatment strategies across infectious diseases.

Key Takeaways

• White‑matter fMRI activation predicts better recovery in Lyme patients.
• Early post‑treatment scans show heightened brain activity in responders.
• PTLD patients exhibit reduced activation, correlating with persistent symptoms.
• Blood biomarkers are being integrated with imaging for Lyme diagnostics.
• Longitudinal research required to validate neuroimaging as prognostic tool.

Summary

Dr. Cherie Marvel, an associate professor at Johns Hopkins, presented her latest neuroimaging work on Lyme disease, emphasizing brain‑based changes and emerging blood‑marker data. The talk linked her expertise in cognitive neuroscience, functional MRI, and brain stimulation to the understudied neurological sequelae of both acute and post‑treatment Lyme disease (PTLD).\n\nAcross three studies, functional MRI revealed unexpected white‑matter activation patterns. In a small cohort of PTLD patients, higher white‑matter signal correlated with lower self‑reported symptom scores, while acute Lyme patients showed robust activation shortly after antibiotic treatment that predicted a return to health six months later. Conversely, those who remained symptomatic exhibited minimal activation, suggesting a failure to mount the protective neural response. The research also began pairing these imaging findings with blood biomarkers to create a multimodal disease profile.\n\nMarvel highlighted specific data points: a scatter plot where increased MRI signal aligned with better SF‑36 health scores, and a segmentation analysis confirming that over 75% of the identified activations resided in white matter rather than gray matter. She noted the difficulty of recruiting participants—often fewer than 20 per study—and stressed that 10‑20% of treated Lyme patients progress to chronic PTLD, a condition with no established cure.\n\nThe implications are clear: early neuroimaging could serve as a prognostic tool, identifying patients at risk for chronic neurological symptoms and enabling targeted interventions before deficits become entrenched. However, the findings remain preliminary; larger, longitudinal cohorts are needed to validate white‑matter activation as a reliable biomarker and to integrate blood‑based markers for a comprehensive diagnostic framework applicable to Lyme, HIV, and long‑COVID contexts.

Original Description

Neuroimaging of Lyme Disease | Cherie Marvel, Ph.D. (3/18/26) #neuroimaging #johnshopkins #lymedisease https://www.hopkinsmedicine.org/neurology-neurosurgery/research/jhu-nimh/seminar-series