Dig Deeper – Neurological Aspects of Lyme Disease

Underdiagnosis of neuropsychiatric Lyme disease in children and adults

Abstract:

Lyme disease is a tick-borne illness caused by the spirochete Borrelia burgdorferi. Reported throughout the United States, the greatest incidence of Lyme disease occurs in certain areas, such as the Northeast, the upper Midwest, and the Pacific Coastal states. It has been dubbed “The ‘New Great Imitator” because, like another spirochetal illness neurosyphilis—the original Great Imitator, Lyme disease has a vast array of multisystem manifestations, including neuropsychiatric ones. Failure to recognize Lyme disease early in its course can result in the development of a chronic illness that is only temporarily or partially responsive to antibiotic therapy. The goal of this article is to present the typical and atypical manifestations of Lyme disease in children and adults in order to help the clinician more rapidly unmask the correct diagnosis behind the puzzling presentations of some patients.

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A controlled study of cognitive deficits in children with chronic Lyme disease

Abstract:

Although neurologic Lyme disease is known to cause cognitive dysfunction in adults, little is known about its long-term sequelae in children. Twenty children with a history of new-onset cognitive complaints after Lyme disease were compared with 20 matched healthy control subjects. Each child was assessed with measures of cognition and psychopathology.

Children with Lyme disease had significantly more cognitive and psychiatric disturbances. Cognitive deficits were still found after controlling for anxiety, depression, and fatigue. Lyme disease in children may be accompanied by long-term neuropsychiatric disturbances, resulting in psychosocial and academic impairments. Areas for further study are discussed.

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Neurologic complications of Lyme disease, dilemmas in diagnosis and treatment

Abstract:

There is not much doubt about the neurological manifestations of acute Lyme disease – headache, neck rigidity, facial nerve palsy, peripheral pain, numbness, and weakness.

But more than 20 years after Lyme disease was first linked to the tick-borne spirochete Borrelia burgdorferi, there is considerable doubt about chronic syndromes attributed to borreliosis. Ambiguities in testing and overlaps in symptoms and in timing complicate diagnosis.

As the AAN practice parameters for diagnosing patients with nervous system Lyme disease state: Highly rigorous and restrictive criteria should be required to establish a general cause-and-effect linkage between a given neurologic syndrome and B. burgdorferi infection. On the other hand, a slightly less restrictive basis may be appropriate for diagnosing an individual patient in whom failure to treat a probable, but not definite, infection might have significant adverse consequences (Neurology 1996;46(3):619-627).

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Psychiatric illness in chronic Lyme disease

Abstract:

After adjusting for age and sex, axis I psychiatric disorders were more common in CLD patients than in comparison patients , but personality disorders were not. Patients with CLD had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain than comparison patients. All psychological factors except personality disorders were related to level of functioning. A predictive model based on these psychological variables was confirmed. Fibromyalgia was diagnosed in 46.8% of CLD patients.

Conclusion. Psychiatric comorbidity and other psychological factors distinguished CLD patients from other patients commonly seen in Lyme disease referral centers, and were related to poor functional outcomes.

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Panic attacks may reveal previously unsuspected chronic disseminated Lyme disease

Abstract:

The author describes the histories of three patients with panic-like episodes that turned out to be related to underlying, previously unsuspected tick-borne diseases. Each woman experienced symptoms that are not usual in panic disorder but are typical of neurological Lyme disease, including exquisite sensitivity to light, touch, and sounds, joint pain often in combination with cognitive changes including mental fogginess and loss of recent memory, and some degree of bizarre, shifting, and often excruciating neurological pain. Because these symptoms are atypical of primary panic disorder, they were very helpful in alerting the clinician to suspect an underlying physical illness.

In each case, the results of testing revealed positive hallmarks of disseminated Lyme and other tick-borne diseases, including Lyme borreliosis caused by the spirochete, Borrelia burgdorferi, babesiosis, and ehrlichiosis. Since beginning treatment with intensive doses of appropriate antimicrobial medications for their tick-borne infections, all three patients have become free of panic attacks. Treatment of their infections by a specialist in Lyme disease allowed one of the women to discontinue anti-anxiety medication completely and another to reduce the dose of medication to occasional use only. The third patient is no longer anxious but her depression is resolving more slowly despite the ongoing use of an antidepressant. Two of the patients have also needed ongoing medication for pain and other symptoms of late-stage, neurological Lyme disease.

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BellsPalsy and Positive Association with Lyme Disease Infection – 1

Abstract:

Background: A variety of microorganisms have been shown to cause peripheral facial nerve palsy (PFNP) and/or aseptic meningitis in children. Clinical findings and history may help to predict the specific etiology of these entities.

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BellsPalsy and Positive Association with Lyme disease Infection – 2

Abstract:

To determine how often Slovenian children with acute peripheral facial palsy are infected with Borrelia burgdorferi sensu lato, 52 patients with peripheral facial palsy were included in this prospective clinical study. According to case definitions, the diagnosis of Lyme borreliosis was established in 56% of those patients. The diagnosis was confirmed in 41%, probable in 28%, and possible in 31% of patients.

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Neurologic Lyme disease and Aggression

Abstract:

Summary: The link between Lyme neuroborreliosis (LN) and aggression is reviewed from multiple perspectives. Cases are presented and discussed. It appears Lyme disease (LD) and other related tick-borne diseases contribute towards causing human aggression and violence. Greater attention to this area has the potential of reducing crime and saving lives. Narrow and restrictive opinions on the diagnosis and treatment of Lyme disease can contribute to the increased consequences of late stage disease, which includes aggression and violence associated with Lyme disease and other related tick-borne diseases.

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Neurologic Lyme disease, psychiatric aspects and brain pathology case studies

Abstract:

Lyme disease, the leading vector-borne disease in the United States may present with psychiatric features. Consider the following [3] cases. Each of the people in these cases was eventually diagnosed with Lyme disease, but not before having been symptomatic for at least a year….

The goal of this article is to alert clinicians to the neurologic and psychiatric aspects of Lyme disease and to briefly address the neuropathology and different treatment strategies.

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Brain scan assessments of post-treatment neurologic Lyme disease

Abstract:

To determine whether patients with a history of well-characterized Lyme disease and persistent cognitive deficit show abnormalities in global or topographic distributions of regional cerebral blood flow (rCBF) or cerebral metabolic rate (rCMR).

Conclusions: Patients with persistent Lyme encephalopathy have objectively quantifiable topographic abnormalities in functional brain activity. These CBF and CMR reductions were observed in all measurement conditions. Future research should address whether this pattern is also seen in acute neurologic Lyme disease.

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Loss of Libido – Sexual Function and Lyme Disease

Abstract:

Purpose: The primary aim was to carry out a pilot study to compare the loss of sexual libido between a group of Lyme disease patients and a group of matched controls. The secondary aim was to evaluate whether loss of libido in Lyme disease patients is associated with urinary bladder detrusor dysfunction.

Conclusions: This pilot study suggested an association between Lyme disease and loss of libido. Moreover, this loss of libido did not seem to be associated with urinary bladder detrusor dysfunction. Given these results, we recommend further studies to confirm the association.

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