Treatment For The Neurological Complications Of Lyme Disease
Review question
Are antibiotics effective for the treatment of Lyme disease affecting the nervous system?
Background
In humans, a bacterium called Borrelia burgdorferi causes Lyme disease. People become infected when bitten by ticks carrying the bacterium. The person may experience symptoms in the joints, skin, muscles, and nervous system , the brain, and the spinal cord). Without antibiotic treatment, neurological Lyme disease either may resolve or cause long-term problems. Neurological Lyme disease differs between Europe and the United States, probably because of differences in B. burgdorferi. Limited information exists about which antibiotics are better for the treatment of neurological Lyme disease.
Study characteristics
Key results and quality of the evidence
The seven studies were too different for their results to be combined, so we analyzed them individually.
None of the studies provided clear evidence that one antibiotic was better than another. One study failed to find evidence that a second and longer treatment with an oral antibiotic offered any extra benefit following initial intravenous treatment with ceftriaxone. As none of the other studies used a dummy treatment , the extra benefit offered by antibiotic treatment over recovery that occurs naturally is unknown. In general, the treatment was tolerated well, although the quality of adverse event reporting in most studies appeared to be low.
The evidence is current to October 2016.
Diagnostic Tests For Lyme Disease
The diagnosis of Lyme disease should be based on a history of tick exposure, epidemiology, clinical signs and symptoms at different stages of the disease , and the use of serologic tests. Early Lyme disease in a patient with erythema migrans is virtually 100% specific and more sensitive than serology. Adults at risk for tick-borne disease who develop persistent âsummer fluâ symptoms should increase the clinical suspicion of tick-borne illnesses, such as Lyme disease.
A definitive diagnosis of LNB requires evidence of possible exposure, signs and symptoms of nervous system disease, and supportive laboratory data. Because LNB frequently has clinical overlap with other medical illnesses, there are many obstacles and pitfalls to securing the diagnosis with laboratory confirmation. B burgdorferi can be identified by direct microscopy in tissue biopsies, electron microscopy, and by culture, but these methodologies are not readily available. Polymerase chain reaction for clinical samples has had a low sensitivity for blood and CSF in Lyme disease but has been useful on synovial fluid specimens in patients with Lyme arthritis.,
Evaluation Of Immune Mediators From Culture Supernatants
The concentrations of cytokines and chemokines present in the culture supernatants from rhesus DRG were quantified using the MILLIPLEX MAP Non-Human Primate Cytokine Magnetic Bead Panel – Premixed 23 Plex, PCYTMG-40 K-PX23 Cytokine-Chemokine Array kit following the manufacturers instructions. The analytes detected by this panel are: G-CSF, GM-CSF, IFN-, IL-10, IL-12/23 , IL-13, IL-15, IL-17, IL-18, IL-1ra, IL-1, IL-2, IL-4, IL-5, IL-6, IL-8, CCL2, CCL3, CCL4, TGF-, TNF-, VEGF and sCD40L. The concentrations of cytokines and chemokines present in the culture supernatants from HSC cultures described above were quantified using the MILLIPLEX Human Cytokine/Chemokine – Premixed 14 Plex, MPXHCYTO60KPMX14 Cytokine-Chemokine Array kit following the manufacturers instructions. The analytes detected by this panel are: GM-CSF, IFN-, IL-10, IL-12 , IL-13, IL-1, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, CCL2 and TNF-. The multiplex plate was read using a Bio-Plex 200 Suspension Array Luminex System .
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Stem Cell Therapy To Treat Symptoms
Regenerative stem cell therapy has shown great success in healing the nervous system. Transplanted stem cells placed in the brain and spinal cord travel to the damaged areas of your body, signaling them to heal.
Not only can your body begin to heal itself with stem cell regeneration, but other treatments are also enhanced. It is like extra support in fighting chronic infections and diseases that affect your immune system, like Lyme disease.
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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How Can I Prevent Lyme Disease
While walking in green spaces, consider wearing clothing that covers your skin to make it more difficult for ticks to access a suitable place to bite.
Use insect repellent such as DEET and consider wearing light coloured clothing so that you can easily spot ticks and brush them off.
After spending time outside, check yourself, your clothing, your pets and others for ticks. Remove any attached tick as soon as you find it using a tick-removal tool or fine-tipped tweezers.
More information can be found on the NHS website.
The idea of being bitten by a tick can be daunting. It is important to know that with the right precautions and by being tick aware you can help to protect yourself and your family from tick bites.
Remember that advice and treatment is readily available through the NHS. So, if you think you have been bitten by a tick and have symptoms, contact your GP and accept the treatment that is offered to you.
Pans/pandas And Lyme Disease
PANDAS an acronym for pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. It was first recognized in 1998 and characterized by a group of neurological symptoms following a strep infection. In PANDAS, the antibodies formed against strep also attack neuronal receptors in the brain leading to repetitive behavior, decreased concentration, decreased social engagement, aggression/rage, anxiety, insomnia, and phobias.
In the past 20 years since PANDAS was first recognized, other infections were identified as causing anti-neuronal antibodies that produce similar symptoms. In one study, 60% of patients with late-stage Lyme disease tested positive for anti-neuronal antibodies. Other published research has identified a protein on Borrelia that has a similar structure as strep, suggesting antibodies similar to strep can be triggered by Lyme disease and manifest similarly to PANDAS.
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How Lyme Disease Can Affect The Entire Body
Holtorf Medical Group
Lyme disease can affect any organ or system within the body, including the immune system, brain, nervous system, heart, and gut. Most cases of Lyme disease in the U.S. are caused by a corkscrew-shaped spirochete called Borrelia burgdorferi. This organism has a unique way of evading the human immune system starting as early as when the tick bite occurs and has learned to survive in the human body even when aggressive treatment attacks are mounted against it.
Personal Health When Lyme Invades The Brain And Spinal System
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A YOUNG woman, whose doctor declined to identify her, thought she was going crazy. Suddenly, this once perfectly healthy college freshman developed severe anxiety, panic attacks, insomnia and loss of appetite.
A doctor and a psychologist at her college’s health service recommended rest for what they thought were problems in adjusting to being away from home. Forced to take a medical leave, she underwent an extensive examination that showed no abnormalities except one: evidence in her spinal fluid of infection by the spirochete Borrelia burgdorferi, which causes Lyme disease. Only then did she recall having had a circular rash characteristic of Lyme disease months earlier, followed by a brief bout of headaches and unusual fatigue. At the time, she did not take these symptoms seriously and did not seek medical attention.
The young woman’s case is among dozens reported in which the Lyme spirochete was the apparent cause of a wide range of psychiatric and neurological problems. Three months after receiving a six-week course of intravenous antibiotics to eradicate the spirochete, the woman felt better. But a year later more therapy was needed when the anxiety and panic attacks returned, along with musical hallucinations, deja vu experiences and obsessional thoughts.
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Should I Get Tested By The Nhs Or A Privately Funded Laboratory Is There A Difference
If patients have a recent tick exposure but no bulls eye rash, guidance to NHS doctors in England is to take a blood sample and send it for testing at an NHS or UKHSA laboratory.
The tests work by looking for antibodies that a person infected with Lyme disease would produce.
The antibodies take some time to reach levels that can be detected,therefore, tests carried out within the first 4 weeks of infection may be negative and may need to be repeated on a fresh blood sample taken 4 to 6 weeks after the first test.
We recommend people exercise caution with private tests and speak to their NHS doctor for advice before spending money on private tests or treatments, as some private laboratories and clinics offer tests and treatments for Lyme disease which may not be supported by scientific evidence.
Diagnostic tests done outside the NHS may also produce false positives where the test shows positive for Lyme disease when the patient doesnt actually have it. Our advice is to seek help through the NHS.
Analysis Of The Evidence
When Lyme borreliosis affects the nervous system, it typically presents with all or part of a triadmeningitis, cranial neuritis, and radiculoneuritis parenchymal inflammation of the brain or spinal cord mild radiculoneuropathy presenting as a more diffuse, predominantly sensory peripheral neuropathy or encephalopathy . Most well performed studies have focused on , the group in which the diagnosis is most clear-cut and treatment response is most straightforward to assess.
Parenchymal CNS involvement is quite rare, and studies of treatment of these individuals have largely been anecdotal . Similarly, only a limited number of small studies have addressed or all are Class III or IV.
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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.
Evaluation Of Apoptosis By In Situ Tunel Assay
Cells contained in chamber slides were labeled for NeuN by immunofluorescence staining as described above. Slides were then fixed with 2% PFA, washed three times with PBS by rinsing the slides in PBS and holding them in PBS for two minutes between washes. Slides were then subjected to the TUNEL-ApopTagPlus fluorescein in situ apoptosis assay as per the manufacturers instructions. Slides were then mounted as described above and stored at 4°C in the dark until viewed. The percentage of apoptotic neurons from ten fields was evaluated from each chamber area by counting the total number of NeuN-positive cells from each of the chamber areas, followed by the percentage of cells that showed co-localization of both the TUNEL signal and NeuN expression. All counts were made by viewing slides under a fixed magnification of 63X using the confocal microscope. Cultures were also stained with S-100 prior to doing the TUNEL assay as described above to detect apoptotic satellite glial cells.
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Peripheral Nervous System Manifestations
Peripheral nervous system manifestations of LNB are variable and may range from mild-to-severe intermittent sensory symptoms to a typical constant dermatomal painful radiculitis. The latter is a prominent feature of European LNB but is less commonly recognized in the United States. Approximately 85% of European disease presents with Bannwarth syndrome, a painful lymphocytic meningoradiculitis with or without paresis. The pain is frequently sharp, may display nocturnal exacerbations, and may last weeks to months. The European presentations are further confounded by a lower incidence of recognized erythema migrans. In the absence of a compressive etiology, Bannwarth syndrome may be a unique clinical hallmark of B garinii LNB. This form of LNB is rarely seen in North American LNB., Enhancement of spinal nerve roots has been observed on postcontrast T1-weighted sequences in the lower spinal cord and cauda equina more than in cervical cord and roots associated with a lymphocytic meningitis.
North American LNB usually presents as a subacute meningitis within weeks to months of an antecedent untreated erythema migrans rash. Unilateral more than bilateral cranial nerve palsy occurs frequently. The seventh cranial nerve is most frequently involved . Lyme disease is an infrequent cause of isolated facial palsy in patients without constitutional symptoms or additional neurologic findings. However, in endemic areas, it may be responsible for â¥25% of new-onset Bell palsy.,
Fig 4.
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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Neurological And Psychiatric Issues Associated With Lyme Disease And Tbrf
Home » Tick Talk » Neurological and Psychiatric Issues Associated with Lyme Disease and TBRF
Chronic illness often has significant impacts on mental health, and Lyme disease is no different. With the accuracy and sensitivity of todays recommended Lyme testing still so lacking, many Lyme patients have to wait too long to get accurate diagnoses and treatment. To compound this problem, many patients with Lyme-like symptoms are not even tested for the similar, but biologically distinct, Tick-Borne Relapsing Fever . That gives infections time to spread throughout the body and cause neurological and psychiatric symptoms.
This article will outline the direct and indirect effects that Borreliosis both Lyme disease and TBRF can have on mental health, including how and why untreated Lyme can develop into neurological Lyme disease.
Improve The Health Of Your Microbiome
The microbiome is the sum of all the microbes that inhabit the body, including normal flora that typically causes no harm as well as potential disease-causing pathogens, says Dr. Rawls. The microbiome is vast and more complex than anyone could have ever imagined. Though the science of this expansive micro-ecosystem continues to advance, research like that found in the Journal of Medicinal Food suggests a sea of possibilities for how the gut and brain interact with one another.
The main mode of communication? Its the vagus nerve, which gives and receives information from your gut, via a two-way, or bidirectional, throughway called the gut-brain axis. Additionally, the vagus nerve facilitates the production of relaxing chemicals like serotonin and GABA in the brain, slows breathing, reduces heart rate and blood pressure, , and promotes healing.
Gut bacteria can impact the vagus nerve because the microbes stimulate nerve impulses that send signals to the brain, affecting such functions as sleep, reactivity to stress, cognition, and more. When the gut flora is healthy, theres a more harmonious relationship among the types of signals being sent along the lengthy cranial nerve. However, the persistent symptoms of Lyme disease can fuel chronic stress, altering your bodys normal microbial load and, along with it, the signals they send.
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Growth And Preparation Of Live Spirochetes
B. burgdorferi B31 clone 5A19 spirochetes, passage 1 to 3 were grown to late logarithmic phase under microaerophilic conditions in Barbour Stoenner-Kelly medium, supplemented with 6% rabbit serum and antibiotics . Spirochetes were pelleted at 2000 × g for 30 minutes at room temperature. At the end of the run the rotor was left to coast without breaking so as to minimize damage to the live spirochetes. The culture was washed using sterile phosphate buffered saline and resuspended in the working medium at the desired density.
Human Schwann Cell Cultures
Cryopreserved human Schwann cell cultures obtained from ScienCell Inc., , were revived in tissue culture flasks coated with poly-L-lysine as per the manufacturers instructions and maintained in the supplied Schwann cell medium consisting of basal medium, 5% FBS, 1% Schwann cell growth supplement and 1 x antibiotic mixture of penicillin/streptomycin. Several aliquots of the above-revived culture were frozen back as per the manufacturers instructions and thawed and revived as needed for experiments. Cultures that were 80% confluent were trypsinized and re-seeded onto poly-L-lysine chamber slides containing two wells at a seeding density of 1 × 104 cells per well, as recommended by ScienCell Inc., after which they were maintained in SCM for three days prior to commencing experiments. Extra wells were seeded to evaluate final cell count prior to incubation with live B. burgdorferi at the desired multiplicity of infection . Duplicate wells were seeded for each condition for each of the two experiments, set up using different passage-two stocks. Both basal media and Schwann cell supplement were supplied by the manufacturer and their composition is proprietary. HSC maintained on poly-L-lysine-coated chamber slides were used for the evaluation of phenotypic markers and secreted immune mediators using a Human 23-plex Cytokine-Chemokine Array kit described below.
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