When To Start Treatment
Immunomodulatory therapy should be started if patients are unable to walk independently for 10m . Evidence on treatment efficacy in patients who can still walk independently is limited, but treatment should be considered, especially if these patients display rapidly progressive weakness or other severe symptoms such as autonomic dysfunction, bulbar failure or respiratory insufficiency,,. Clinical trials have demonstrated a treatment effect for intravenous immunoglobulin when started within 2 weeks of the onset of weakness and for plasma exchange when started within 4 weeks,. Beyond these time periods, evidence on efficacy is lacking.
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.
A Negative Lyme Disease Test Does Not Rule Out The Disease
OK everyone, Ill admit it. I spend a lot of time listening to internet radio shows. I enjoy them and really do learn a lot. I especially like the shows that have chat rooms where I get the opportunity to interact with people from all over the world.
Well, within the past week Ive encountered two women on two different internet chat rooms who may have Lyme Disease. Before you start thinking, Oh, those Lyme disease patients see it everywhere, in both instances the women said that they had been tested for Lyme . When I asked them if it could be Lyme, they both adamantly stated, No, the test came back negativeI dont have it.
This belief is so very prevalent. It seems to stem from the faulty thinking that if doctors are choosing to use the tests then the tests must be viable. As a culture we dont question doctors . So, as I seem to be doing often these days, I then explained to the women about the lack of sensitivity in the commonly used Lyme disease testits at 46%. for a test to be considered accurate the sensitivity rate needs to be at 95% or better. For contrast the test for AIDS is 99.5% sensitive. I didnt expound on the topic. Im hoping I gave them food for thought. I mean, the test will be false negative half the time. Therefore the diagnosis has to be made clinically by a doctor .
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Diagnosis And Treatment Of Guillain
Virtual Mentor.
Guillain-Barre syndrome is a group of autoimmune conditions consisting of demyelinating and acute axonal degenerating forms of disease. GBS is sometimes known as Landry’s ascending paralysis, French polio, acute idiopathic polyneuritis, or acute idiopathic polyradiculoneuritis. The disease is named for Georges Guillain and Jean Alexandre Barre, who discovered the characteristic feature of the diseaseincreased level of protein in cerebrospinal fluid with normal cell countin 1916. Interestingly, however, the French physician Jean Landry had described the condition in 1859, a half-century earlier .
Resources On Managing Lyme Disease
If you are looking for more information on lyme disease or have a specific question, our information specialists are available business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9am to 8pm ET.
Additionally, we encourage you to reach out to Lyme disease support groups and nonprofits, including:
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Insufficient Response To Treatment
About 40% of patients treated with standard doses of plasma exchange or IVIg do not improve in the first 4 weeks following treatment,. Such disease progression does not imply that the treatment is ineffective, as progression might have been worse without therapy. Clinicians may consider repeating the treatment or changing to an alternative treatment, but at present no evidence exists that this approach will improve the outcome,. A clinical trial investigating the effect of administering a second IVIg dose is ongoing.
Could Lyme Disease Be Another Infection Associated With The Onset Of Guillain
Guillain-Barre Syndrome is a life-threatening illness in which the body’s immune system attacks the peripheral nervous system. It’s characterized by a rapid onset of muscle weakness which can lead to respiratory distress and death. The initial symptoms are typically tingling and weakness in the feet and legs. The exact cause is unknown, but GBS is usually preceded by an infectious illness such as a respiratory infection or stomach flu. While many infections have been associated with GBS, Borrelia burgdorferi, the pathogen causing Lyme disease, has rarely been connected with the syndrome. According to a study by Patel and colleagues, only four cases have been reported in the literature.
However, in their case study Clinical association: Lyme disease and Guillain-Barre Syndrome, the authors highlight Borrelia burgdorferi as an important antecedent infection associated with the development of GBS, and describe a 31-year-old man diagnosed with both Lyme disease and GBS. The case raises the question: Could Lyme disease be an underrecognized infectious disease triggering or contributing to the onset of Guillain-Barre Syndrome?
The exam revealed decreased sensation to pinprick with a distal to proximal gradient up to proximal thigh, according to Patel from SUNY Upstate Medical University, Syracuse, New York. Other significant findings were 4/5 weakness in all extremities along with areflexia in biceps, triceps, patellar and achilles.
References:
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What Was The Culprit For This Guillain Barre Syndrome
Case Presentation: A 22-year-old female was admitted with a 5-day history of bilateral lower extremity weakness. She received influenza vaccination five weeks prior to the presentation. The patient progressed rapidly over days to quadriplegia and respiratory failure requiring intubation and mechanical ventilation. The cerebrospinal fluid analysis showed albuminocytological dissociation, and nerve conduction studies revealed an acute inflammatory demyelinating polyneuropathy. GBS was diagnosed, and she was treated with intravenous immunoglobulin and later had plasmapheresis sessions following minimal recovery. Lyme serology was positive, but the CSF Lyme PCR was negative for which she was started on Ceftriaxone. She made a gradual recovery over the next ten weeks to a near full functional status.
In our patient, since the CSF Lyme PCR was negative, Neuroborreliosis was unlikely though antecedent Lyme disease leading to GBS could not be ruled out. She likely had post-influenza vaccination GBS.
To cite this abstract:
WHAT WAS THE CULPRIT FOR THIS GUILLAIN BARRE SYNDROME -LYME DISEASE OR THE FLU VACCINE?.
Abstract published at SHM Converge 2021.
People Left To Suffer And Die Because Of Ignorance
After speaking with her a feeling of deep sadness came over me. Our conversation made me think of all the other patients in upstate New York and elsewhere who have been misdiagnosed or left undiagnosed. And I thought of all the people with negative Lyme tests who are adamant they dont have it and clinging to the idea of whatever their doctor suspects it to be. And they take it as gospel. The whole situation is overwhelming to me.
It really makes me wonder just how many people out there right now in severe pain and suffering terribly actually have Lyme. The woman I mentioned above was in the chat room looking for alternative ideas to cope with the pain . There are so many people like her truly suffering and if the doctors understood that the tests arent reliable, maybe theyd have sent this poor woman to a Lyme specialist. I really dont know. But something has to be done. This country needs Lyme education both for the doctors and the general public.
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What Is Lyme Disease
Lyme disease is a bacterial infection transmitted to humans by the bite of certain black-legged ticks, although fewer than 50 percent of all Lyme disease patients recall a tick bite.
Typical symptoms include fever, headache, and fatigue. Lyme disease can also lead to neurological symptoms, including loss of function in arms and legs. According to experts, standard diagnostic methods fail to discover as many as 40 percent of cases of Lyme disease.
At times, Lyme disease is misdiagnosed as amyotrophic lateral sclerosis or multiple sclerosis.
Most cases of Lyme disease can be treated successfully with antibiotics over several weeks. While some people with long-term Lyme disease take antibiotics over an extended course of time, most physicians do not consider it to be a chronic infection.
According to published medical literature, many individuals diagnosed as having chronic Lyme disease demonstrate no evidence of prior infection. In fact, only 37 percent of patients in one referral center had current or previous infection with B. burgdorferi as the explanation for their symptoms.
There are reports that hyperbaric oxygen and bee venom have been effective for some in treating symptoms of the disease. A number people with chronic Lyme disease have traveled abroad for expensive, unauthorized stem cell therapies.
Box 3 Erasmus Gbs Respiratory Insufficiency Score
The Erasmus GuillainBarré syndrome Respiratory Insufficiency Score calculates the probability that a patient with GBS will require mechanical ventilation within 1 week of assessment and is based on three key measures. Each measure is categorized and assigned an individual score the sum of these scores gives an overall EGRIS for that patient . An EGRIS of 02 indicates a low risk of mechanical intervention , 34 indicates an intermediate risk of mechanical intervention and 5 indicates a high risk of mechanical intervention . This model is based on a Dutch population of patients with GBS and has not yet been validated internationally. Therefore, it may not be applicable in other age groups or populations. An online resource that automatically calculates the EGRIS for a patient based on answers to a series of questions has been made available by the International GBS Outcome Study consortium . The Medical Research Council sum score is the sum of the score on the MRC scale for: muscle weakness of bilateral shoulder abduction elbow flexion wrist extension hip flexion knee extension and ankle dorsiflexion. A higher MRC sum score denotes increased disability, up to a maximum score of 60.
Table 2
NA, not applicable. Adapted with permission from ref., Wiley-VCH.
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Ignorant Primary Care Doctors
So one of the problems is that most primary care doctors rely on these faulty tests, treating them as if theyre good, accurate tests. Doctors will tell you that you dont have Lyme disease because the test was negative. This maddens me. Are they unaware and completely ignorant of the fact that its a useless test? This boggles my mind. And so this insistence on solely using tests for a Lyme diagnosis then gets transferred to patients who cling to their misdiagnoses because Lyme has been ruled out by a test oh, yeah, a test that is as flimsy as flipping a coin .
What Mimics Bell’s Palsy
mimic Bell’s palsy
. Considering this, can Bell’s Palsy be misdiagnosed?
Interestingly, we found that 10.9% of patients misdiagnosed with Bell’s palsy went on to receive a diagnosis of GBS on 90-day follow-up. GBS encompasses multiple heterogeneous immune-mediated neuropathies, generally presenting with progressive and symmetric motor weakness and loss of deep tendon reflexes.
Beside above, what is the difference between facial palsy and Bell’s palsy? Essentially, Bell’s palsy is a diagnosis of exclusion.If none of the known causes can be confirmed, then the facial palsy is considered idiopathic, i.e. from unclear or undetermined causes. In other words, if the causes of your facial palsy cannot be determined and confirmed, the diagnosis will be Bell’s palsy.
Herein, can Bell Palsy be a sign of something else?
Facial paralysisSigns and symptoms of Bell’s palsy come on suddenly and may include: Rapid onset of mild weakness to total paralysis on one side of your face occurring within hours to days. Facial droop and difficulty making facial expressions, such as closing your eye or smiling. Drooling.
Can Bell’s Palsy be caused by stress?
Under Pressure: Bell’s palsy triggered by stress. Stress can lead to disease in the body. Bell’s palsy is a disruption of function of the cranial nerve. The cranial nerve controls facial movement.
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How To Diagnose Gbs
In the absence of sufficiently sensitive and specific disease biomarkers, the diagnosis of GBS is based on clinical history and examination, and is supported by ancillary investigations such as CSF examination and electrodiagnostic studies. The two most commonly used sets of diagnostic criteria for GBS were developed by the National Institute of Neurological Disorders and Stroke in 1978 , and the Brighton Collaboration in 2011 . Both sets of criteria were designed to investigate the epidemiological association between GBS and vaccinations but have since been used in other clinical studies and trials. We consider the NINDS criteria to be more suited to the clinician as they present the clinical features of typical and atypical forms of GBS, although the criteria from the Brighton Collaboration are also important, widely used, and can help the clinician to classify cases with GBS or MFS according to diagnostic certainty. Various differential diagnoses must also be kept in mind when GBS is suspected, and some symptoms should raise suspicion of alternative diagnoses . The role of ancillary investigations in confirming a GBS diagnosis is described in more detail in the following section.
Lyme Mystery Illness Or Slow
One of the women I encountered was told she had a slow-progressing form of Guillain-Barre . Before I was diagnosed, because of all of my neurological complications, I thought I may have Guillain-Barre. The symptoms sound so familiar :
- Acute or sub acute onset
- 50 60% of cases occur days or weeks after a viral or bacterial infection, such as a sore throat, the flu, or diarrhea.
- Surgery, childbirth or vaccinations may trigger the syndrome
- Pain in spine and limbs
- Reflexes such as knee jerks are lost
- Weakness and tingling sensation in legs, possibly spreading to upper body and arms
- Weakness in breathing, swallowing and the muscles used to cough
- In extreme cases, paralysis
Yes, I had all of those symptoms . And this woman I chatted with also had severe fatigue and peripheral neuropathy. I couldnt help but question her diagnosis. Then I learned that she lived in Upstate New York. I was in shock , as most Lyme patients know, and most of the general public understand that upstate New York is a hotbed for Lyme Disease. Im not saying she was misdiagnosed , but Guillain-Barre is extremely rare. And in her area Lyme disease is very common.
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When To Admit To The Icu
Reasons to admit patients to the intensive care unit include the following: evolving respiratory distress with imminent respiratory insufficiency, severe autonomic cardiovascular dysfunction , severe swallowing dysfunction or diminished cough reflex, and rapid progression of weakness,. A state of imminent respiratory insufficiency is defined as clinical signs of respiratory distress, including breathlessness at rest or during talking, inability to count to 15 in a single breath, use of accessory respiratory muscles, increased respiratory or heart rate, vital capacity < 1520ml/kg or < 1l, or abnormal arterial blood gas or pulse oximetry measurements.
As up to 22% of patients with GBS require mechanical ventilation within the first week of admission, patients at risk of respiratory failure must be identified as early as possible. The Erasmus GBS Respiratory Insufficiency Score prognostic tool was developed for this purpose and calculates the probability that a patient will require ventilation within 1 week of assessment .
Risk factors for prolonged mechanical ventilation include the inability to lift the arms from the bed at 1 week after intubation, and an axonal subtype or unexcitable nerves in electrophysiological studies. Early tracheostomy should be considered in patients who have these risk factors.