Anaplasmosis Leading To Neurological Symptoms Of Trigeminal Neuralgia
Anaplasmosis, formerly called human granulocytic anaplasmosis is a co-infection from a tick that typically causes acute disease. In their article, “Trigeminal Neuralgia As the Principal Manifestation of Anaplasmosis: A Case Report,” LeDonne and colleagues described human granulocytic anaplasmosis in an 80-year-old woman with neurological symptoms.
According to the authors, the woman experienced a sudden onset of severe, lancinating headache in the distribution of the fth cranial nerve bilaterally.¹ She had been treated for Lyme disease two months earlier following a tick bite and a rash on her torso. She had since been bitten by a non-engorged tick.
Her neurologic exam was felt to be consistent with a diagnosis of trigeminal neuralgia. Trigeminal neuralgia is a type of chronic pain that affects your face. It causes extreme, sudden burning or shock-like pain. It usually affects one side of the face.²
The patients mother had a history of trigeminal neuralgia. The doctors did not see any evidence of Lyme disease.
However, anaplasmosis and ehrlichiosis can both develop over a shorter timeframe and without a noticeable rash, making these infections a more likely explanation of the patients signs and symptoms, wrote the authors.
They added, To conrm the suspected diagnosis, a tick-borne disease panel was ordered and was positive for Anaplasma phagocytophilum DNA by PCR.
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.
Lyme Disease: The Great Imitator
Stage I of Lyme disease usually begins three days to one month after a tick bite with erythema migrans in approximately 50 percent of affected patients. The lesions average 15 centimeters in diameter, although some may be larger. The lesion is asymptomatic in two-thirds of affected patients and may cause itching or burning in the remaining third. The lesion usually fades in three to four weeks. In over one-half of untreated patients, multiple secondary lesions may develop within a few days of the primary lesion which are smaller, lack central induration, and may appear anywhere on the body, but generally spare the soles and palms. Additionally, the patient may manifest the following flu-lke symptoms which are associated with the skin lesion: polyarthralgia, myalgia, fatigue, headache, stiff neck, sore throat, fever, chills and lymphadenopathy. Approximately 10 percent will have nausea, vomiting, and right upper quadrant pain suggestive of hepatitis. Later, in Stage I, conjunctivitis, urticaria, and/or a malar rash may develop.
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What Causes Trigeminal Neuralgia
Many causes of trigeminal neuralgia are unknown . Known causes may include:
- Vascular problems
- Lesions that may irritate trigeminal nerve roots along the pons
- Inflammatory disorders
- Antispasmodic agents such as baclofen and tizanidine
- Other medications:
- Pimozide , a dopamine receptor antagonist, was more effective than carbamazepine in one trial but is seldom used for TN because it has many potentially serious side effects
- Topical lidocaine is given by intraoral application for pain reduction
- Tocainide is an antiarrhythmic drug that was found to be as effective as carbamazepine in one trial
- Botulinum toxin injections may be beneficial for patients with medically refractory TN, although data are limited
Patients with trigeminal neuralgia may also have accompanying depression and may require antidepressant therapy.
Patients who do not respond to medical treatments may require surgery to treat trigeminal neuralgia. The types of surgeries include:
- Microvascular decompression for TN caused by compression of the trigeminal nerve root
- Ablative procedures
- Rhizotomy with radiofrequency thermocoagulation, mechanical balloon compression, or chemical injection
- Peripheral neurectomy and nerve block
Transcranial magnetic stimulation has been investigated as a treatment for TN and while results appear promising, more investigation is needed.
Getting The Right Diagnosis
My mother insisted that I see the chief of infectious diseases at a prominent hospital in Boston. So, on July 13, 2017, roughly seven months after this all started, we met with him, and he agreed that something unexpected was wrong.
He felt it could be the onset of multiple sclerosis or another autoimmune disease. He said he wanted to draw blood and run as many tests as possible for different infections, autoimmune markers, and signs of inflammation. He also said he would run another Lyme disease test, called a Lyme C6 Peptide. His experience dictated that the test was more reliable than I’d already had.
One week later, he called with the results: Everything was negative or normal, except the Lyme disease test, which was positive. I was thrilled at first, as he said a three-week course of the antibiotic doxycycline would cure me. He called in the prescription, and I started it the next day.
I had no idea what to expect from treatment. I soon learned that tick-borne infections cause your symptoms to become much worse during treatment. When you take antibiotics, an enormous number of infectious organisms die off, which causes an inflammatory response in your body.
So, at the end of the course of antibiotics, my pain was much worse than it had been. My facial numbness had turned into full-blown trigeminal neuralgia . I couldn’t chew food or speak comfortably because my facial and dental nerves were inflamed. Then, all of my body pain worsened.
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Acupuncture And Other Integrative Medicine Treatments
Acupuncture involves insertion of thin needles along the trigger points to provide pain relief. Some people with trigeminal neuralgia report that acupuncture helps reduce intensity and/or frequency of flare-ups.
Meditation, wellness clinics and lifestyle modification programs are also options for those looking for more natural trigeminal neuralgia treatments or a supplemental treatment after surgery.
How Is Trigeminal Neuralgia Diagnosed
Idiopathic trigeminal neuralgia is a clinical diagnosis and often no testing is required after the healthcare professional takes a history of the situation and performs a physical examination which should be normal.
It is important to remember that the neurologic exam must be normal. There are two specific areas to test. There can be no muscle weakness V3 is responsible for chewing and there can be no jaw or facial weakness found. The corneal reflex controlled by V1 must be present. When the cornea or covering of the eye is touched, the eye blinks in response. If these two findings are not normal, the search should begin for an inflammatory or compression cause of the trigeminal nerve. Some clinicians may order an MRI to help diagnose other conditions that may cause trigeminal neuralgia.
The International Headache Society has established 5 criteria for making the diagnosis and includes the following:
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What Is Neurologic Lyme Disease
Neurologic symptoms of Lyme disease occur when the Lyme disease bacteria affect the peripheral or central nervous systems.
- Cranial nerve involvement: When the cranial nerves are affected, facial palsy can occur on one or both sides of the face.
- Peripheral nerve involvement: When the peripheral nerves are affected, patients can develop radiculoneuropathy which can cause numbness, tingling, shooting pain, or weakness in the arms or legs.
- Central nervous system involvement: When the central nervous system is affected, Lyme meningitis can cause fever, headache, sensitivity to light, and stiff neck.
Out of every 100 patients whose cases are reported to CDC, 9 have facial palsy, 4 have radiculopathy, and 3 have meningitis or encephalitis. Because of reporting practices, this statistic may overestimate how often these manifestations are seen by clinicians.
Epidemiology Including Risk Factors And Primary Prevention
TN is a rare disease. Epidemiological studies showed that approximately 4 to 28.9/100,000 persons worldwide experience TN.1,4,5,6
In the United States, there are approximately 15,000 new cases each year.5,6 Classic TN accounts for 80% of cases, secondary TN 15% and idiopathic TN 5-10%.30,31
Females are 1.5 times more likely to have trigeminal neuralgia.2,5,6
The disease can appear at any age, however it is rare in children and it occurs after age 40 in more than 90% of cases, with peak age between 52-58 years for the classical type and 30-35 years for the symptomatic form of TN.2,3
Familial cases, though rare, have also been reported.28,29
Preliminary data for risk factors has hypothesized that hypertension and migraines may be risk factors for developing TN.32,33,34
No methods for primary prevention have been proposed.
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Cutting Edge Concepts And Practice
Voltage gated potassium channel openers are being examined as potential therapeutic agents for TN pain.26 There is also some preliminary data that the development of selective sodium channel blockers for the Nav1.7 sodium receptor may prove more beneficial than carbamazepine or oxcarbmazepine.30More randomized controlled studies on botulinum toxin in the treatment of TN are needed to prove efficacy, though preliminary reports are promising.39
Research conducted on Schwann cell activation has identified two signaling pathways including NGF-trkA and BDNF-trkB as key in promoting myelin repair mechanisms after trigeminal nerve injury and can be further targeted in the future to develop novel methods of treating TN.44
There are reports of deep brain stimulation, electric stimulation of structures deep in the brain by an implanted pacemaker, successfully treating post-herpetic TN.27 Additionally, use of peripheral nerve stimulation is gaining favor in some pain and neurosurgical circles.
Patient Identification And Data Abstraction
We queried the electronic medical records to identify 2 cohorts of patients: those with a positive 2-tiered Lyme disease serologic test result and those tested for Lyme disease during a compatible illness . For the first cohort, we reviewed the electronic medical records to determine whether each patient had a clinical presentation compatible with active Lyme disease documented within 1 month of when the diagnostic test was obtained. We abstracted testing results, information about their clinical presentation, documentation of an alternative diagnosis, and documentation of tick exposure in a Lyme disease endemic state.
Workflow used to conduct electronic medical record queries. Abbreviations: CPT-4, Current Procedure Terminology 4 ICD-9, International Classification of Diseases, Ninth Revision IgG, immunoglobulin G IgM, immunoglobulin M.
To identify each cohort we performed queries of the Duke electronic medical records. Our search terms identified inpatients and outpatients of all ages tested at Duke-affiliated laboratories. We excluded patients from both cohorts without available electronic medical records to review. All patients were tested using the Meridian Premier Lyme EIA kit . Specimens reactive by this kit were then tested by Western blot using the Trinity Biotech B. burgdorferi IgG and IgM MarBlot Strip Test systems .
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After She Was Bitten By A Tick Katie Wood Had Debilitating Pain And Fatigue For Months Until She Was Finally Diagnosed With Lyme Disease
Health.com Editorial TeamHealthDaniel More, MD
The walk was short-lived. My son’s friend stumbled over a tree root, prompting us to return to our home. But our time outside was long enough to pose an unexpected risk.
The following evening, my husband found a tick attached to my back. He removed the creature as carefully as possible and applied antibiotic ointment.
What I knew then about Lyme disease told me that I would develop a bulls-eye rash or flu-like symptoms if the tick had transmitted the illness to me. Neither of those signs appeared, so I assumed I was OK.
That flawed assumption drastically changed my life.
Measurement Of Treatment Outcomes Including Those That Are Impairment
A multidisciplinary team approach that includes physical and occupational therapy and neuropsychology is indicated. This approach should incorporate consistent use of Cognitive Behavioral Therapy, Graded Exposure Therapy, desensitization techniques. Patient functional changes can be measured with Functional Independent Measurement scores or other functional grading measures.
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Essential Tremor And Parkinsons Disease: How They Differ
A tremor is a condition that occurs when you experience involuntary muscle contraction that causes one to shake or shiver. Many people associate tremors with Parkinsons disease, but they are also caused by a different movement disorder called essential tremor. Essential tremor is said to affect up to 7 million …
What Is The Life Expectancy For Trigeminal Neuralgia
Trigeminal neuralgia is a chronic nerve pain disorder but it does not directly affect life expectancy and patients with the condition can live a normal life span.
However, the pain is so intense for some patients, trigeminal neuralgia has been nicknamed The Suicide Disease due to higher rates of depression, anxiety, and suicidal ideation seen in patients with the disorder. Modern treatments are more effective and patients now fare better than they have in the past. If you have trigeminal neuralgia, tell your doctor if you have worsening depression or anxiety or thoughts of suicide.
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Peripheral Neuropathy Of Sjgrens Syndrome
What is neuropathy?
Neuropathy, which means inflammation and/or damage to the peripheral nerves, can be affect patients with Sjögrens syndrome. Neuropathy can cause various symptoms, from numbness, to coldness in its most severe, neuropathy has been described as burning, lancinating, or feeling like my skin is on fire. Neuropathy can also cause weakness and clumsiness.
How does my doctor diagnose neuropathy?
The first step is to take a careful history and perform a physical examination. The pattern and description of symptoms, which may include pain and weakness, could suggest damage to the peripheral nerves. A neurological examination is crucial in providing objective evidence of peripheral neuropathy. Weakness may be present, which is typically greater in the toes and fingers than in the larger muscle groups of the arms and legs. Your physician may test your reflexes. Typically, a reflex hammer should elicit emphatic lurches of arms and legs. However, patients with neuropathy may not have any reflexes. Your physician may also test your ability to appreciate temperature, a sharp pin, and vibration. If the neurological examination confirms a peripheral neuropathy, then you may have a nerve-conduction test, looking at the integrity of nerves and muscles.
Moving Forward And Preventing Lyme Disease
Lyme disease is often considered to be an invisible illness. Still, to myself and those close to me, the condition is heartbreakingly tangible. Untreated Lyme disease has stolen two and a half years from me. My goal is to reach remission and live a symptom-free life.
I find comfort in taking the proper precautions to protect myself and my family. I’ll still roll in the grass with my kids and go for nature walks. But beforehand, we’ll apply bug spray. And afterward, we’ll do head-to-toe tick checks.
With tick-borne disease, prevention truly is the cure.
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Recognizing The Symptoms Of Lyme Disease
Ticks are countless different bacteria, viruses, and fungi. Getting a bulls-eye rash is like winning the lottery. Many people do not develop it worse, some do not notice the tick bite. That makes diagnosis even more complicated.
Dr. Hubbuch recommended removing and sending an attached tick for tick testing to determine what pathogens it carries. That way, you know what to treat should symptoms appear.
I had no idea that Lyme disease symptoms could be so varied and diverse. For this reason, Lyme is known as the “great imitator,” mimicking symptoms of diseases such as fibromyalgia, MS, and lupus, to name a few.
If you or someone you know has seemingly unrelated symptoms affecting a wide range of bodily processes, ask your healthcare provider for a Lyme disease test. In addition to a bulls-eye rash, according to the CDC, common symptoms of Lyme disease include:
- Fever and chills
- Swollen lymph nodes
However, remember that a negative test does not mean you do not have Lyme disease.
“This is when you need to see someone very well trained in differentiating what could be tick-borne illness from the myriad other things that can cause similar symptoms,” explained Dr. Hubbuch.
Caring For A Loved One With Trigeminal Neuralgia
Although not fatal, trigeminal neuralgia pain and the anxiety it causes can erode the quality of life not only for the person suffering, but for those around them. Understanding the severity of the pain the person is going through and being accommodating are the first steps to caring for a loved one with trigeminal neuralgia. Other steps may include:
- Helping your loved one stay on track with his or her medications and communicating about the success of the treatment.
- Encouraging doctor visits and exploring other treatment options when medications stop working.
- Helping locate and coordinate appointments with doctors who can offer evaluations and second opinions.
It is essential to work closely with experienced and compassionate health care providers who can help find the best therapeutic approach for each person.
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