Lyme Disease of the Nervous System

Introduction

Lyme Disease of the nervous system is not uncommon in the endemic areas for this tick-borne bacterial disease.

Lyme-disease is an infectious disease caused by a bacteria by name borrelia burgdorferi and few other borrelia species, so it is also called as borreliosis. The involvement of the nervous system is called as neuroborreliosis too.

What causes it?

It is transmitted to human beings through the bites certain ticks called as hard ticks. The bacteria is a type of spirochete. This disease is also called as zoonoosis (infectious disease acquired from an animal to human beings).

Clinical Manifestations

In the early stage a characteristic skin rash called as erythema chronicum migrans may be seen. Patients can also have non specific flu like symptoms with fever headache, body ache etc. If this condition is not treated at this level some patients will go onto develop later stages (chronic-lyme-disease) and it can involve multiple organs like joints, heart, bones, nervous system etc, of course not necessarily all these involvements in the same patient.

Patients with nervous system involvement can present with varieties of manifestations including;

• Neuropsychiatric manifestations (e.g. depression, psychosis etc)
• Cranial nerve palsies (e.g. 7th nerve palsy causing facial drooping)
• Brain parenchymal involvement causing stroke or MS like presentation with limb weakness, sensory loss
• Spinal cord or spinal nerve root involvement
• Peripheral nerve involvement etc

Diagnosis

A brain MRI scan (or a brain CT scan), spinal fluid analysis, blood tests, EMG & NCS are some of the tests commonly employed and the decision for the tests are done on case to case basis.

Spinal fluid may show meningitis picture. Both blood & spinal fluid may reveal high titers of antibodies to lyme bacteria. IgM type antibody indicates recent infection. A PCR test may help in detecting the DNA of the bacteria.

Treatment

Antibiotics are necessary and chosen usually from intravenous or intramuscular ceftriaxone, doxycycline, amoxicillin, erythromycin etc depending upon the stage & severity of the disease, age, pregnancy status etc.

Avoiding tick bites when you go to an endemic area is the best thing to do if it is possible.

A pediatric and/or adult neurologist is frequently involved in the care of patients with Lyme disease of the nervous system.



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