Neurologic Complications Of Hiv
HIV affects the nervous system in a variety of ways and can do so either directly by the virus itself or indirectly through opportunistic infections or dysregulated inflammatory reactions. Direct effects the virus has on the nervous system include cognitive disorders causing memory loss, sensory neuropathy causing pain in the hands and/or feet) spinal cord disease causing difficulty walking, meningitis causing headaches, muscle wasting causing weakness and/or muscle pain. Sometimes HIV can be the cause of strokes or seizures, as well.
The Role Of Coinfections
Ticks carry more diseases than just Lyme and TBRF, and its not uncommon for patients to be infected with more than one type of disease-causing bacteria.
Common coinfections such as Babesiosis and Bartonellosis can not only cause neurological and psychiatric symptoms of their own, but they can also complicate the diagnostic process, delaying proper diagnosis and treatment all of which increase the risk of developing emotional, behavioral, or cognitive problems from the infection.
Imaging In Lyme Neuroborreliosis
There is limited knowledge of structural and functional changes in LNB with quantitative MRI techniques. Three studies have reported structural changes, and no difference between the patients and controls was found . However, these studies included a limited number of subjects and controls , so they probably lacked power to show subtle changes. Functional studies have been conducted with PET and with SPECT . These studies reported regional hypoactivity and hypoperfusion, but were hampered by heterogeneous study populations with non-specific symptoms and included individuals with uncertain diagnoses. Larger, prospectively conducted case-control studies are needed to learn more about imaging abnormalities in LNB.
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Posttreatment Lyme Disease Syndrome
Posttreatment Lyme disease syndrome has been defined as the presence of any of: widespread musculoskeletal pain, cognitive complaints, radicular pain, paresthesias, or dysesthesias interfering with function within 6 months after initial diagnosis and treatment and persist for at least 6 months . The symptoms overlap extensively with those of Lyme encephalopathy, differing primarily by the requirement that encephalopathy occur in patients with active extraneurologic infection, whereas PTLDS patients have already been appropriately diagnosed with and treated for Lyme disease. Such symptoms are often present immediately after treatmentas they may be following treatment of other infectionsand usually resolve over time. PTLDS is diagnosed when symptoms persist for 6 or more months.
Encephalitis Myelitis Or Encephalomyelitis
This refers to infection or inflammation of the brain , spinal cord , or both and can relate to a variety of viruses or bacteria, including herpes simplex virus, West Nile Virus, enterovirus, Eastern equine encephalitis virus, cytomegalovirus, Listeria monocytogenes, mycoplasma, influenza virus, or varicella zoster virus , to name a few. In addition to infectious causes, autoimmunity is an important cause of encephalomyelitis whose approach differs from infectious encephalomyelitis. Acute disseminated encephalomyelitis is an example of this.
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Can Lyme Disease Cause Neurological Problems
Lyme disease can wreak havoc on the entire body and every system within it, including the nervous system. The nervous system is a communication pathway that is made up of the brain and spinal cord. Another part, the peripheral nervous system, has nerves that extend to other parts of the body from the spine.
When this system becomes affected by Lyme disease, certain health issues can arise that affect more than just the brain the nervous system is, after all, essentially in charge of a persons movement, balance, senses, thought processes, and awareness. Unfortunately, the borrelia bacteria that causes Lyme also has the ability to cross the blood-brain barrier, which means it can get directly into the brain and cause issues with neurological health.
The reason why the nervous system can be so strongly affected by Lyme disease is because the borrelia bacteria is able to travel through the bloodstream throughout the entire body. It makes its way to joints, tissues, and the nervous system, and camps out wherever it can to survive in its new host.
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Lyme Symptoms: Nervous System Inflammation
byJennifer Crystalon April 26, 2021
We patients must remember that Lyme is an inflammatory disease. Flare-ups often involve increased inflammation.
Last week I had an incredibly busy schedule: I did research, had several long conversations over Zoom, taught a class, and wrote a lot. The work required a good amount of mental energy, or spoons. I also happened to have a physically busy week, running around doing errands and going to doctors appointments, as well as meeting friends for socially distanced walks.
But what Lyme patients need to do and what we want to do dont always match up.
By Thursday evening, my brain felt as if it was filling with cotton, a pressure I remember well from my acute days with Lyme disease, ehrlichiosis, and babesiosis. This should have been my cue to stop and rest. What I really needed to do was darken the lights, put on some soft music, and relax. But what Lyme patients need to do and what we want to do dont always match up. In this case, I wanted to relax by watching a favorite show, something Id been looking forward to as a reward all week. And so I watched.
Horowitz, Richard I., MD. How Can I Get Better? An Action Plan for Treating Resistant Lyme & Chronic Disease. New York: St. Martins Press, 2017 .
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Does Lyme Disease Affect The Brain And Nervous System
Lyme disease affects the nervous system. This statement is both accurate and terrifying since, for many of us, damage to the brain is the most feared consequence of disease. However, when it comes to Lyme disease, much of this fear is misplaced. Lyme disease can affect the lining of the brain, a disorder known as meningitis. Other than causing fever and bad headaches, this form of meningitis is remarkably benign nobody has ever died of it, and it has rarely if ever caused significant damage to any patients brain. On extremely rare occasions, the infection can involve the brain or spinal cord, disorders that are now extraordinarily rare. Other patients can develop inflammation of various nerves, e.g., the nerves that control the muscles on one side of the face this might occur in about 5% of untreated individuals. Other nerves can be affected, but even less frequently.
When considering these disorders, it is essential to recognize some key facts. First, the infection is highly responsive to antibiotics. Second, if the facial nerve has been severely damaged, there may be some residual weakness after treatment. However it is extraordinarily rare for there to be any permanent damage to the brain itself.
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Chronic Lyme And Mental Health
The CDC lists having a chronic disease as a risk factor for developing mental illness. This underscores the reality that even for patients who do not develop neurological Lyme disease, the experience of Lyme disease alone can cause or exacerbate mental health problems like depression, anxiety, and others listed above.
Getting diagnosed and treated for Lyme disease can be stressful and exhausting, especially the longer this process takes which, for many, can be several years. Patients often must deal with conflicting or inaccurate diagnoses, lack of support from health care professionals, and exorbitant medical bills, all while battling physically and mentally debilitating symptoms with no end in sight. This experience can lead to a drastic reduction in quality of life that creates the perfect conditions for mental illness.
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Whats The Difference Between Neurologic Lyme Disease And Ms
Olga Syritsyna, MD
Hearing the words you have Lyme disease or you have MS can be quite unsettling. And to complicate matters, when Lyme disease affects the central nervous system, the symptoms can be very similar to MS. So it can be hard to tell the difference to the untrained eye. Many doctors are generalists and not specially trained to diagnose either disease. Dr. Olga Syritsyna is a neurologist with subspecialty training in neurologic Lyme disease and MS.
What is neurologic Lyme disease?First, lets start with defining Lyme disease. Its a seasonal tick-borne infection caused by the borrelia burgdorferi bacteria that can affect multiple organs and systems in the body. Its named after Lyme, CT, where it was first identified in 1975. In about 15 percent of cases, Lyme disease affects the central nervous system. When it does, it is known as neurologic Lyme disease. Sometimes, people who think they may have Lyme disease find out they have MS . Lyme disease as an infection can act to trigger MS attacks. This is why being seen by a neurologist specially trained to know the differences is key.
Why choose Stony Brook for diagnosis and treatment of neurologic Lyme disease?For neurologic Lyme disease, Stony Brook has extensive experience in detecting antibodies to the borrelia burgdorferi bacteria that is carried by ticks and can affect the central nervous system. We do frequent lumbar punctures and perform a variety of tests on cerebrospinal fluid.
Conflict Of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer, NM, and handling editor declared their shared affiliation, and the handling editor states that the process nevertheless met the standards of a fair and objective review.
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How Is It Treated
Facial palsy is treated with oral antibiotics and Lyme meningitis/radiculoneuritis can either be treated with oral or intravenous antibiotics, depending on severity . Most people with Lyme disease respond well to antibiotics and fully recover. Varying degrees of permanent nervous system damage may develop in people who do not receive treatment in the early stages of illness and who develop late-stage Lyme disease.
Should You See A Neurologist For Lyme Disease
A neurologist is a specialized medical professional who deals with all neurological disorders. When a person is suffering from neurological complications of Lyme disease, it may seem as though seeing a neurologist may help. But in truth, any doctor can test and diagnose you with Lyme disease, regardless of your symptoms.
It might be appropriate to see a neurologist for Lyme disease if you are only experiencing neurological symptoms however, if you have any other symptoms of the infection, you should see your general practitioner first.
The neurological symptoms of Lyme disease can be difficult to cope with, but the good news it that Lyme disease can be treated. The best way to address any neurological symptoms is see your doctor so they can direct you to the right specialist or assist in getting you diagnosed with Lyme disease so treatment can begin.
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Treating Neurological Lyme Disease
Though neurological and psychiatric symptoms can be reduced with antibiotic treatment, emotional and cognitive problems arising from late-stage or chronic Lyme often call for a broader range of interventions. This includes lifestyle changes in such areas as diet, exercise, and environment.
Again, its worth reiterating that the longer an infection goes undetected, the harder it is to treat, and the more likely it is that symptoms will require multi-pronged, multi-system interventions besides antibiotics alone.
Has Niaid Looked At The Potential Benefits Of Long
Yes. NIAID has funded three placebo-controlled clinical trials on the efficacy of prolonged antibiotic therapy for treating PTLDS. The published results were subjected to rigorous statistical, editorial, and scientific peer review.
These trials were designed to ensure that several key parameters were addressed:
- The susceptibility of B.burgdorferi to the antibiotics used
- The ability of the antibiotics to both cross the blood-brain barrier and access the central nervous system and to persist at effective levels throughout the course of therapy
- The ability of the antibiotics to kill bacteria living both outside and inside mammalian cells
- The safety and welfare of patients enrolled in the trials
The first clinical trial, which included two multicenter studies, provided no evidence that extended antibiotic treatment is beneficial. In those studies, physicians examined long-term antibiotic therapy in patients with a well-documented history of previous Lyme disease but who reported persistent pain, fatigue, impaired cognitive function, or unexplained numbness. Those symptoms are common among people reporting PTLDS. Patients were treated with 30 days of an intravenous antibiotic followed by 60 days of an oral antibiotic.
In 2016, a clinical trial conducted in the Netherlands also concluded that in patients with persistent symptoms attributed to Lyme disease, longer term treatment with antibiotics did not provide additional benefits compared with shorter term regimens.
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Relationship Of Ptlds And Chronic Lyme Disease To B Burgdorferi Infection
The key questions concerning these 2 entities are whether they truly exist, and if they do, what might the underlying mechanism be? With regard to the existence of PTLDS, 30% or more of patients treated for Lyme disease may report persisting, subjective posttreatment symptoms. However, several controlled trials have shown that identical symptoms are equally common in patients without Lyme disease . The few studies suggesting relatively more frequent subjective symptoms following treated Lyme disease show no increase in corroborating objective abnormalities . Studies of the general population indicate that up to a third of the normal, healthy population experiences the same symptoms to a varying degree , the same frequency as that found in the control populations of Lyme disease posttreatment studies. In the absence of any objective evidence of disease in these treated patients, and given that the identical symptoms are equally prevalent in control individuals, it seems plausible that the entity PTLDS is simply an example of anchoring bias. Patients who have been treated successfully for Lyme disease and subsequently experience common symptoms that they have heard are attributable to PTLDS incorrectly conclude that these nonspecific symptoms are indeed the sequelae of B. burgdorferi infection, perpetuating the notion of this construct.
Key Points For Healthcare Providers
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A Murine Model Of Lyme Disease Demonstrates That Borrelia Burgdorferi Colonizes The Dura Mater And Induces Inflammation In The Central Nervous System
Affiliation Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Visualization, Writing review & editing
Current address: BioLegend, San Diego, California, United States of America
Affiliation Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
- Emilie E. Vomhof-DeKrey,
Roles Investigation, Methodology
Affiliations Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America, Department of Surgery, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
How Does Lyme Affect The Nervous System
Borrelia, the spirochete that causes Lyme disease, can invade the nervous system, creating a condition called Lyme neuroborreliosis.
In the central nervous system, the infection can cause meningitis , and damage various nerves in the brain or brainstem. In the peripheral nervous system, the infection can result in pain that radiates along sensory nerves.
The exact reasons why some patients get better with treatment and other patients remain ill is unclear. The potential mechanisms may include permanent damage from infection, neuroinflammation, autoimmune reactions, or persistent infection.
As Professor Holly Ahern explains, the main problem with research into so-called PTLDS is the absence of an accurate blood test or biomarker. Researchers have no way to determine if persisting infection is the cause of the continuing symptoms.
Dr. Novak and his team set out to find objective measures. We know these patients are suffering. The next question is how do we treat them? says Novak.
The most valuable studies are those that give us a biomarker, something we can measure, so that when we treat them, we can look objectively to see if they get better or not.
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Neurobehavioral Changes Without Cns Infection
The controversy about nervous system Lyme disease actually relates to 3 other disorders often included under the same rubricdisorders that are actually neurobiological but not neurologic . Unfortunately, the inappropriate attribution of these symptoms to nervous system infection immediately terrifies patients, who often become convinced they are suffering from an irreversible and devastating brain disorder.
Lyme Sci: Nerve Damage Shown In Patients With Chronic Lyme Symptoms
Many Lyme disease patients report severe chronic pain, numbness and tingling, even after they have supposedly completed treatment for Lyme disease.
But up until recently, there hasnt been an objective way to measure those symptoms. You had to report them to the doctor, hoping hed take you at your word about what you were feeling.
New research suggests such sensations may be caused by nerve damage. Additional findings show that decreased blood flow in the brain may also be contributing to dysautonomia. Thats dysfunction of the system that regulates bodily functions such as blood pressure, digestion, and sweating.
Now, a groundbreaking study provides quantifiable, physiological reasons for these chronic symptoms that continue to plague a subset of patients despite treatment for Lyme disease.
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