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.
Examples Of Neurological Symptoms From Anxiety
It could be argued that anxiety itself is a neurological symptom. After all, anxiety can change neurotransmitter levels in the brain causing them to send unusual signals to the rest of your body. And although anxiety causes no known neurological damage, it still creates symptoms such as:
These symptoms of anxiety may vary in severity and prevalence depending on the person, but often mirror what those with an actual neurological disorder may experience.
Making Connections To Clarify Diagnosis
Chronic Lyme disease shares many symptoms with other chronic illnesses. This is especially true of Lyme neuroborreliosis and chronic neuroinflammatory illnesses such as multiple sclerosis, Alzheimers disease, amyotrophic lateral sclerosis , Parkinsons disease, and traumatic brain injury.
Not surprisingly, new sophisticated methods of microbial detection are showing potential links between these neuroinflammatory illnesses and many of the microbes associated with chronic Lyme disease.
For instance, both mycoplasma and chlamydia have been closely linked to multiple sclerosis. Mycoplasma, borrelia, and chlamydia have been associated with demyelination. Parkinsons and ALS have been linked to borrelia and other microbes commonly associated with Lyme disease. Borrelia and other stealth pathogens have been found in the brains of patients who died of Alzheimers disease.
The connections go well beyond Lyme disease microbes. Two recent studies are shedding new light on how closely disruptions in the microbiome are linked to neuroinflammation. One, published in Frontiers of Aging Neuroscience, evaluated the presence of microbes in the autopsied brains of deceased Alzheimers patients. The other, published in Scientific Reports, evaluated the presence of microbes in the autopsied brains of people who had died of multiple sclerosis.
So what does restore well-being? Therapy that comprehensively addresses chronic immune dysfunction and widespread disruption of the microbiome.
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Lyme Is Not The Only Threat
As mentioned earlier in this article, there is another group of borrelia that causes a disease that is similar to, but biologically distinct from, Lyme. This disease, called Tick-Borne Relapsing Fever or TBRF, is often characterized by fevers that wax and wane every few days. However, many patients never experience relapsing fevers or any fevers at all. Like those of Lyme and other tick-borne diseases, TBRF symptoms can often go undetected or be mistaken for other conditions, which can give the disease time to develop into neurological symptoms.
So, as with Lyme, it is crucial to get an early and accurate diagnosis of TBRF. Be aware that TBRF will not show up on a Lyme test the test must be designed to test for TBRF borrelia in order to show accurate results. If symptoms are Lyme-like but test results are negative, doctors should consider the possibility of TBRF.
Cognitive Neurological And Psychological Symptoms
Lyme disease can cause cognitive, neurological, and, in some cases, psychological symptoms. It can affect the central, cranial, and peripheral nervous systems.
When the bacteria affect the nervous systems, it can cause neurological symptoms. They :
- Central nervous system: This may cause sensitivity to light, issues with vision, stiff neck, fever, or headache.
- Cranial nervous system: This may cause facial palsy, which is drooping facial features on one or both sides of the face.
- Peripheral nervous system: This may cause tingling or numbness, a sharp, shooting pain, and weakness in the arms or legs.
The symptoms can often resemble those of other disorders, which could lead to misdiagnosis.
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What Lyme Disease Does To Your Brain
is a bacterial infection that you catch when an infected deer tick bites you. The first symptoms can appear within a few days or weeks. They include a target-shaped , , fever, , , and . Often, doctors promptly recognize and treat Lyme disease with antibiotics. But when treatment is delayed, the infection can spread to other areas, including the nerves, liver and eyes. It can also spread to the central nervous systemthe brain and spinal cordand cause the following problems.
Get Tested And Treated Early
Studies acknowledge that up to 30% of patients go on to suffer further Lyme symptoms even after treatment, sometimes called Post-Treatment Lyme Disease Syndrome . One of the biggest risk factors for this condition is delayed treatment.
Research is finally, if slowly, catching up to the reality that letting Lyme disease slip through the cracks of insufficient diagnostic testing causes real suffering for patients. IGeneX is at the forefront of solving this problem, offering more sensitive and accurate testing for Lyme disease and other tick-borne diseases that can cause mental health problems when left untreated. Learn more today.
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The Unfortunate Connection Between Lyme Disease And Mental Illness
Carol has been a patient of mine for over five years. We have walked through some of the most difficult times in her life as she dealt with her failing marriage and then divorce, a move, significant career changes, undiagnosed medical issues, and co-parenting teenagers.
Yet during our discussions, there was an undercurrent of, I dont feel right. Her feelings were understandable given her life circumstances. But when life settled down, her complaints of pain, stress, fogginess, anxiety, and depression intensified. One medical doctor after the other ran tests with no conclusive diagnosis so she was labeled psychosomatic.
But that didnt make sense given that fact that she was consistent in therapy, did what was asked, and had significant improvements in several areas of her life. Something else seemed to be wrong. Finally, she found a doctor who tested her for Lyme disease, and she was properly diagnosed.
What is Lyme Disease? Lyme disease is aninfectious diseasecaused by abacteriaand spread byticks resulting in a suppression of the immune system. It can develop into a chronic multisystemic illness affecting the nervous system causing neurologic and psychiatric symptoms. These symptoms can mimic paranoia, dementia, schizophrenia, bipolar, panic attacks, depression, eating disorders, and obsessive-compulsive behaviors.
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.
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Treatment Of Chronic Lyme Disease
Damage to the peripheral and autonomic nervous system is common in late-stage Lyme disease. Numbness, tingling, burning and nerve pain experienced in peripheral neuropathy and radiculitis require effective treatment of the involved infections. Therapies directed at decreasing the inflammatory response by the immune system and repair of the damaged nerves is also part of the strategy when treating symptoms associated with chronic neurological Lyme disease.
Neuropathy is one of the most debilitating and challenging to treat symptoms of chronic neurological Lyme disease. Intravenous immunoglobulin therapy can be useful at reversing any form of neuropathy including CIDP caused by Lyme disease. The biggest hurdle in using IVIG as a therapy is the expense , so insurance coverage of this therapy is typically necessary. Often, criteria for health insurance approval is a positive nerve conduction study and a biopsy demonstrating small fiber neuropathy. Treatments are usually once per month, and it can take 6-18 months to see results.
Other therapies can also be helpful in treating the untoward neurological effects of Lyme disease. Work with a Lyme-literate doctor to determine the most effective therapies for the infection and subsequent immune-mediated inflammatory response that is causing your symptoms.
What Are Neurologic Manifestations Of Lyme Disease
Neurologic involvement, also known as Lyme neuroborreliosis, is reported in 5-20% of cases. In the United States, cranial neuropathy is the most common manifestation of early neurologic Lyme disease. Other manifestations include meningitis and encephalopathy.
Cranial neuropathies, especially facial nerve palsy , develop in approximately 3% of Lyme disease patients. In endemic areas, Lyme disease is the most commonly identified cause of acquired facial palsy, especially in children. Headache, absence of previous herpetic lesions, and meningeal symptoms are noted in most pediatric Lyme disease patients with facial palsy.
When meningitis is involved, symptoms usually occur 2-10 weeks following infection. Headache, neck pain or stiffness, and photophobia typically indicate meningeal irritation. The headache of Lyme disease typically is described as waxing and waning, and the severity varies from mild to severe, even in patients with frank meningitis. Persistent headache alone is a rare presentation of Lyme disease but should be considered in patients in endemic areas during summertime.
Borrelia encephalopathy most commonly manifests as a mild confusional state accompanied by disturbances in memory, concentration, mood, sleep, personality, and/or language occurring months to years after the infection. Depression and irritability are also common.
Feder HM Jr. Lyme disease in children. Infect Dis Clin North Am. 2008 Jun. 22:315-26, vii. .
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What Are The Symptoms Of Lyme Disease
The list of possible symptoms is long, and symptoms can affect every part of the body. The following are the most common symptoms of Lyme disease. But symptoms are slightly different for each person.
The primary symptom is a red rash that:
Can appear several days after infection, or not at all
Can last up to several weeks
Can be very small or grow very large , and may resemble a “bulls-eye”
Can mimic such skin problems as hives, eczema, sunburn, poison ivy, and flea bites
Can itch or feel hot, or may not be felt at all
Can disappear and return several weeks later
Several days or weeks after a bite from an infected tick, you may have flu-like symptoms such as the following:
Weeks to months after the bite, the following symptoms may develop:
Neurological symptoms, including inflammation of the nervous system and weakness and paralysis of the facial muscles
Heart problems, including inflammation of the heart and problems with heart rate
Eye problems, including inflammation
Months to a few years after a bite, the following symptoms may include:
Inflammation of the joints
Neurological symptoms including numbness in the extremities, tingling and pain, and difficulties with speech, memory, and concentration
Treatment Of Acute Neuroborreliosis
In acute Lyme neuroborreliosis, treatment needs to be directed at the bacterial infection. Administering the antibiotic ceftriaxone intravenously for 14 days has proven to be effective at treating the bacteria in the central nervous system. Blood levels of oral antibiotics or herbal formulas may not reach high enough concentrations to treat central nervous system infections effectively.
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How Is Lyme Disease Treated
Your healthcare provider will figure out the best treatment for you based on:
How old you are
Lyme disease in the earliest stage is usually treated with antibiotics for 2 to 3 weeks.
Treatment will also be considered based on these and other factors:
If you are bitten by a tick that tests positive for the bacteria that causes Lyme disease
If you are bitten by a tick and have any of the symptoms
If you are bitten by a tick and are pregnant
If you are bitten by a tick and live in a high-risk area
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.
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Strategies For Managing Nerve Pain
1. Reduce Your Microbial Burden
When youre dealing with Lyme disease and co-infections, its not always easy to pinpoint which stealth pathogen is affecting your nervous system. In fact, its most reasonable to recognize that all sneaky microbes are capable of disrupting immune function and causing it to go awry.
When your bodys microbial burden becomes too great, your microbiome becomes imbalanced, driving inflammation and aggravating neuropathy. Thus, at the top of the priority list is decreasing the infectious load to normalize and calm the immune system.
When youre looking for natural solutions to lessen the impact of stealth pathogens, herbal therapy can play a critical role. Not only do herbs have antimicrobial properties, but they are anti-inflammatory and contain antioxidants as well.
Moreover, herbs dont disrupt the delicate balance of the microbiome like synthetics medications do. Some of my favorite herbs with antimicrobial and immunomodulating properties to keep in mind include:
2. Use Medications Cautiously
When it comes to neuropathy, the reality is that sometimes you need some extra support to get your pain levels to a tolerable level. There are a variety of over-the-counter and prescription medications that may be useful from time to time.
However, the value of medications is limited to short term management of symptoms because of cumulative side effects. The list of medications commonly recommended by healthcare providers includes:
Invite More Calm Into Your Life
Since stress is a powerful immune system disruptor, finding more calm is key to restoring immune health and resolving symptoms of neurological Lyme. One of the best tools to fight stress is getting optimal sleep. Without it, your immune functions are disrupted, and healing is compromised.
Sleep is especially important for recovery from neuroinflammatory illnesses. Studies have shown that even one night of compromised sleep in healthy people is associated with accumulation of beta amyloid in the brain, a hallmark of Alzheimers disease.
Your goal: At least 8 hours of good sleep a night, including 4 hours of deep sleep. Practicing good sleep hygiene can help you hit the mark that includes keeping a regular bedtime, and limiting light, computer screens, and stimulation in the evening.
What happens during the day is also key to drifting off at night. Finding additional ways to de-stress, getting regular low-intensity exercise, and practicing meditation a couple of times during the day promotes good sleep onset and better quality sleep at night.
Early on, when neuroinflammation is pronounced and the nervous system is very agitated, sleep medications may be indicated. But use them intermittently, and stick to the lowest dose possible.
Acupuncture can be beneficial for reducing pain and restoring normal energy pathways in the body. It is also helpful for restoring normal sleep.
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Pots Constipation And Lyme Disease
POTS stands for postural orthostatic tachycardia syndrome which means the heart rate will increase when someone changes position, from laying or sitting to standing. POTS is very common in late-stage Lyme disease since the autonomic nervous system does not maintain tone in blood vessels causing a drop in blood pressure. When the blood pressure drops, the heart rate has to increase to stabilize blood pressure. Mast cell activation syndrome is another common cause of POTS and MCAS is frequently seen as a consequence of Lyme disease.
Another common symptom associated with autonomic nervous system dysfunction is constipation. Termed gastroparesis, constipation can happen when the nerve that signals intestinal muscular contraction become damaged by the bacteria and the resulting immune response.
What Is Lyme Disease Brain Fog
Brain fog due to Lyme disease is complex, and it has to do with inflammation.
Lyme disease infections can inflame blood vessels in the brain, inflame nerve roots from the brain to the spinal cord, and erode the myelin sheath that protects nerves. It can disrupt thought processes, concentration, speech, and memory.
There are two kinds, Type 1 and Type 2 Brain Fog. You can have one or both categories at the same time.
Type 1 brain fog makes you feel like your brain is clouded or foggy. Its caused by a buildup of inflammatory chemicals, like cytokine, mold, yeast, and other toxins.
Type 2 brain fog is characterized by an inability to think temporarily: confusion, poor attention, short-term memory issues, and lack of organization.
A Lyme specialist can assess you for which type of brain fog you have and develop a treatment plan for fixing it. Fixing type 2 will also fix type 1.
To do this, you must decrease inflammation and take steps to eliminate infections. Both must be done with the help of a Lyme literate specialist. Together, you can implement a treatment plan that includes the right therapies, like the ones listed below.
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