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.
Why Would I Need To See A Neurologist For My Eye
Neurologists specialize in disorders and diseases that affect the brain and the nervous system. Since the eyes can be affected by some of these conditions, doctors who specialize in neurology may be needed to diagnose and treat certain visual conditions. Some ophthalmologists specialize in neurology and eye issues, but for most eye conditions involving the brain, a neurologist would be needed to make the diagnosis.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
The Different Types Of Doctors Who Can Test For Lyme Disease
Lyme disease is a tick-borne infectious disease caused by a group of spiral-shaped bacteria we now refer to as Lyme borreliae. This includes, but is not limited to, Borrelia burgdorferi. It is treatable with antibiotics, but in order to have the best chance at full recovery, its crucial to get your disease diagnosed and treated as soon as possible. That means finding the right doctor.
But what kind of doctor tests for Lyme disease? You may be wondering if you need to see a specific kind of physician to get the right test and treatment. The answer can depend on your particular situation.
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Symptoms That Should Lead To Clarification Of Lyme Neuroborreliosis
Radiculitis of the spinal nerves : initially severe, nocturnal, radicular or segmentally distributed pain, persisting without treatment for weeks, later development of paresis > paraesthesia
Radiculitis of the cranial nerves IIXII : facial nerve paresis most frequent , bilateral in about one third ocular muscle paresis . Very rare : paresis of the oculomotor and trochlear nerves, optic neuritis, papilloedema, hearing loss, dizziness , paresis of the hypoglossal nerve
Meningitis : headache, meningism, photophobia, nausea, vomiting, fatigue, emotional instability rarely chronic
Neuritis of the peripheral nerves , probably only in the context of acrodermatitis chronica atrophicans/axonal polyneuropathy with predominantly sensory symptoms
Encephalitis , : paresis, speech and language disorders, coordination disorders, occasional epileptic seizures rarely organic brain syndrome with lack of concentration, loss of consciousness and hallucinations
Myelitis : transverse sensory dysfunction, central and peripheral paresis, voiding disorders often in association with encephalitis
Borrelia-induced cerebral vasculitis: rare, mainly ischemic events in different areas of the bloodstream with corresponding neurological symptoms
Borrelia-induced myositis: extremely rare ,
How Is Lyme Disease Diagnosed
Some Lyme disease diagnoses are straightforward and no specific tests are needed. If you remember that you were bitten by a tick while hiking and see the characteristic bulls eye rash, a doctor will probably prescribe antibiotics without any additional tests.
But sometimes people have no idea that theyve been bitten by a tick. Ticks usually only stick around for a few days before dropping off to look for a new host. In the weeks and months following a bite, a person might develop symptoms that could be confused with another condition.
Some people are misdiagnosed with chronic fatigue syndrome, arthritis, Crohns disease, or a variety of other ailments. To know for sure, a doctor will usually order a blood test that looks for the antibodies produced by the bodys immune system to fight the bacterial infection.
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Do I Need To See An Infectious Disease Specialist To Get Tested For Lyme Disease
No, you do not need to see an infectious disease specialist.
As noted above, any type of physician should be able to order the correct diagnostic tests, interpret your test results, and provide antibiotics to treat Lyme disease. This is especially true the earlier the disease is caught.
In fact, American Lyme Disease Foundation points out that waiting for an appointment with an infectious disease or other type of specialist can actually delay your diagnosis and treatment. If you were bitten by a tick, notice symptoms of Lyme disease, or believe youre at risk for Lyme or another tick-borne disease, its important that you make an appointment with a doctor immediately even if its your primary care physician.
That said, there are plenty of reasons why you may want to consult with, or get a second opinion from, someone with specific experience with Lyme disease. In other words, you may want to make an appointment with a Lyme-literate doctor . Read on to learn more.
Internal Medicine & Primary Care Located In Frederick Md
Lyme disease is an unpleasant condition spread by the bite of the deer tick, and without expert assessment, it can be hard to diagnose. Usha Sivakumar, MD, MBBS, is a highly experienced physician at SivIMed Internal Medicine and Primary Care in Frederick, Maryland, who specializes in the diagnosis and treatment of Lyme disease. Call the clinic now if youre concerned you have the infection or book an appointment online.
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What Kind Of Doctor Tests For Lyme Disease
In fact, any kind of doctor can test you for Lyme disease. However, that doesnt mean its a good idea to have your dermatologist or podiatrist order the diagnostic tests. Many people simply see their family physician or primary care doctor to get diagnosed and treated for Lyme.
There are also doctors who specialize in Lyme disease and other tick-borne illnesses, called Lyme-literate doctors, who you may want to consult instead more on that a little later in this article.
Finally, there are other types of specialists you may or may not need to consult with depending on the duration and severity of your symptoms.
For example, many patients wonder if they need to see an infectious disease specialist.
The Chronic Lyme Disease Controversy
Chronic Lyme disease is a poorly defined term that describes the attribution of various atypical syndromes to protracted Borrelia burgdorferi infection. These syndromes are atypical for Lyme disease in their lack of the objective clinical abnormalities that are well-recognized in Lyme disease and, in many cases, the absence of serologic evidence of Lyme disease as well as the absence of plausible exposure to the infection. The syndromes usually diagnosed as CLD include chronic pain, fatigue, neurocognitive, and behavioral symptoms, as well as various alternative medical diagnosesmost commonly neurologic and rheumatologic diseases. Perhaps the most recognized and contentious facet of this debate is whether it is effective, appropriate, or even acceptable to treat patients with protracted antibiotic courses based on a clinical diagnosis of CLD.
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Routine Laboratory Parameters In Blood
In the routine laboratory, patients with Lyme neuroborreliosis have normal or slightly elevated values for ESR, CRP, leukocytes and transaminases that indicate a systemic infection ). When diagnosing Lyme neuroborreliosis, the routine laboratory results only play a role in differential diagnosis.
Routine lab parameters for patients with early or late manifestations of Lyme neuroborreliosis
Support/financing Of The Guideline
This guideline was created without the influence or financial support of sponsors.
The funds required to create and to translate this guideline were provided by the Society for Promotion of Quality Assurance in Medical Laboratories , Düsseldorf.
Travel expenses were provided by the respective expert medical societies.
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The Confusing Terminology Of Chronic Lyme Disease
The mere name chronic Lyme disease is in itself a source of confusion. Lyme disease, in conventional use, specifically describes infection with the tick-borne spirochete B burgdorferi sensu lato. The diagnosis chronic Lyme disease, by incorporating that terminology, connotes a similar degree of microbiologic specificity the addition of the word chronic further implies that there is some distinction between chronic Lyme disease and other manifestations of the infection. This distinction in itself is problematic because several manifestations of Lyme disease may indeed present subacutely or chronically, including Lyme arthritis, acrodermatitis chronicum atrophicans, borrelial lymphocytoma, and late Lyme encephalopathy.
Chronic Lyme disease, however, has no clinical definition and is not characterized by any objective clinical findings. The only published attempt to define CLD provisionally produced a description too broad to distinguish CLD from myriad other medical conditions, and the case definition did not mention evidence of B burgdorferi infection . The absence of a definition makes it impossible to investigate whether a patient population with putative CLD has evidence of infection with B burgdorferi this would seem to be a basic requirement to include a syndrome within the term Lyme disease. It stands to reason that it is impossible to even posit a well-designed antibiotic trial when the study population is undefined.
What Kinds Of Neurological Problems Are Caused By Lyme Disease
Typically, three main neurological complications develop in people with untreated Lyme disease.
- Cranial neuropathy: If the infection affects nerves of the face, some patients might experience cranial neuropathyor dysfunction of the peripheral nervescausing drooping or swelling. The most common form of cranial neuropathy is Bells palsy, which is muscle drooping on one side of the face.
- Meningitis: If the bacterial infection reaches the meninges, or the tissue lining the brain and spinal column, it may cause inflammation and tissue damage. Patients with meningitis are likely to experience fevers, headache, fatigue, and stiff neck.
- Radiculoneuritis: If the bacterial infection reaches the nerve root, or the part of the nerve cells that attaches to the central nervous system , it can cause severe pain, numbness, and other abnormal sensations.
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What Are The Symptoms Of Lyme Disease
If you’re bitten by an infected deer tick you’ll first see a skin rash, which appears in a bulls eye pattern around the area of the tick bite. If the rash is not detected and the infection is not treated, symptoms of Lyme disease will appear within a few weeks.
The initial symptoms may seem like the flu and could include fever, lymph-node inflammation, fatigue, aches, and headaches. If left untreated, the bacteria can, in a few weeks or months, spread to the heart, bones, and nervous system.
If the infection spreads to those organs, patients might experience pain, weakness, headaches, memory problems, pinkeye, joint pain and swelling, or rapid heartbeat. And if the infection is never treated, it can lead to such joint problems as arthritis and neurological problems such as memory loss.
Biological Explanations For Chronic Lyme Disease
Several arguments have been made to support the biological plausibility of CLD and to justify its treatment with lengthy courses of antibiotics. One is that B burgdorferilocalizes intracellularly in the infected host, and that the antibiotics typically chosen to treat it do not penetrate cells effectively. Aside from the fact that B burgdorferi predominantly occupies the extracellular matrix, the antibiotics currently recommended to treat Lyme disease are well-established to treat a variety of intracellular infections. For example, doxycycline and azithromycin are first-line drugs for the treatment of Mycoplasma, Chlamydia, and Legionella, and doxycycline is the drug of choice for Rickettsia and related species. Ceftriaxone is effective against Salmonella and Neisseria, both of which are predominantly intracellular amoxicillin is effective against Listeria.
Another commonly voiced argument is that B burgdorferi assumes a round morphology, variously described as cyst forms,spheroplasts,L-forms, and round bodies. These variants are said to be resistant to antibiotic treatment and require alternative antibiotics and dosing strategies. On close review of the literature there is little evidence that these variants arise in vivo in humans, let alone that they are associated with CLD-like symptom complexes or that they require treatment.
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Lyme Arthritis In Children Can Present Throughout The Year
The studys objective was to evaluate the seasonality of pediatric Lyme disease in three endemic regions in the United States, writes Sundheim. Participants had been treated at 8 different medical centers throughout the Northeast and UpperMidwest. Of the 690 children with Lyme disease, 77 had a single EM lesion, 247 had early disseminated disease, and 366 had arthritis, wrote the authors. Children with early and early-disseminated Lyme disease
Neurological Complications Of Rheumatologic Conditions
Systemic lupus erythematosis , rheumatoid arthritis, Sjogren syndrome, and mixed connective tissue disease are a few of the rheumatologic conditions that can affect the nervous system, and they can do so in a variety of ways. Additionally, many parts of the nervous system can be involved, from the muscle to the peripheral nerve all the way to the cerebral cortex. For instance, some patients can have abnormal blood clotting as a complication of SLE, which can affect the brain. Additionally, these conditions may place patients at risk for opportunistic infections, as mentioned above, usually due to the longstanding immune therapy required to treat these diseases.
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Persistent Symptoms After Treatment For Lyme Disease
It is well-recognized that some patients experience prolonged symptoms during convalescence from Lyme disease, and a subset suffer significant functional impairment., The most common complaints among such patients are arthralgias, myalgias, headache, neck and backache, fatigue, irritability, and cognitive dysfunction .
A working definition was developed to categorize patients with post-Lyme disease symptoms , those patients with persistent clinical symptoms after treatment for Lyme disease, but who lack objective evidence of treatment failure, reinfection, or relapse . PLDS is not strictly speaking a coherent clinical diagnosis its primary value has been to define a patient cohort for further study. Nonetheless, it is worth considering how it conceptually differs from CLD. To meet criteria for PLDS, patients must have unequivocal documentation of appropriately treated Lyme disease, lack objective manifestations of Lyme disease, and have persistent symptoms that cannot be explained by other medical illnesses. Thus, of patients with chronic symptoms that have been attributed to Lyme disease, those meeting criteria for PLDS are those for whom infection with B burgdorferi is most plausible. This makes the studies of PLDS paradigmatic for the understanding of CLD.
When You May Need To See A Specialist
Though a family physician or general practitioner should be able to order the diagnostic tests for Lyme disease, there are some situations in which you may need to see a specialist. For example, untreated or misdiagnosed Lyme can develop into chronic Lyme disease, which can then lead to complications such as arthritic or neurological symptoms. In these cases, patients may need to see the following types of specialists:
- Rheumatologist Chronic joint problems from Lyme disease may need the care of a physician who specializes in rheumatology.
- Neurologist Chronic Lyme can be associated with debilitating neurological symptoms that must be treated by a specialist.
- Infectious disease specialist Again, even though this isnt always necessary, it can be helpful if your symptoms dont go away or become more complex.
- Cardiologist In the event that you develop the rare but dangerous complication known as Lyme carditis, you may need to see a cardiologist and even be fitted with a temporary pacemaker.
However, its important to remember that seeing a specialist for symptoms related to Lyme disease without treating Lyme disease is costly and dangerous. In other words, a rheumatologist or neurologist will not be able to treat your Lyme if no diagnosis has been made. They can simply help treat symptoms that result from chronic or untreated Lyme.
To treat Lyme disease, you must get an accurate diagnosis and be prescribed antibiotics.
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Do Antibiotics Kill Lyme Disease
In acute cases, or when taken prophylactically soon after a bite, antibiotics can be helpful. But Dr. Dane recommends follow-up testing with DNA Connexions and MacTech Imaging. Not everyone bitten by a tick will develop Lyme disease. However, it is becoming more broadly accepted that increased numbers of patients experience treatment failure and end up with long-term, debilitating symptoms. These may include pain, fatigue, and cognitive dysfunction. This is why extra testing is worth the effort.
Long-term antibiotic therapy for treating CLD has negative effects on the immune and venous systems if the antibiotics are given intravenously. But the main disadvantage of this type of treatment is that patients do not get the satisfaction of saying unequivocally that they beat the disease. Even Lyme-literate doctors will say antibiotics help to manage symptoms but do not eliminate the disease. This is true.
Antibiotics place Lyme infections into a dormant state, which of course result in the patient feeling better. The problem is that symptoms return as soon as antibiotics are stopped. Herbals do basically the same thing. The spirochetes go into a cystic formation and cover up with biofilm.
Spirochetes associated with CLD have great anatomical advantage. The way they are built allows them to live easily in viscous areas of the body, such as the mouth. The biofilm that forms over them makes them especially resistant to antibacterial treatments.