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» LymeNet Flash » Questions and Discussion » Medical Questions » NEURO LYME

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Author Topic: NEURO LYME
sonee123
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I havent been confirmed with Lyme yet but i got a call from LLMD office after the tick panel blood test and dr scheduled me for follow up appt and didnt tell me the results which i asked the nurse and she said that the dr usually schedules you if he has found something wrong.

I have been feeling sick!! Mostly i have neurological symptoms. Feeling of something rushing up on my head through my bloodstream that makes everything worst! My vision, my ears, feeling of dizziness, headaches. That feeling is really scary.

I can actually feel something moving up my head and staying there and making all of my symptoms worst. I have severe tingling and numbness throughout my body. It feels like i have alot of mucus built up in my ears throat and chest.

I get cold chills with sudden fevers which make my lay on the bed for hours! About two months ago every joint in my body has started clicking. Now i have acid reflex all the time and i am always constipated. For the past few months ive noticed my neurological symptoms get worst before my period a week or two.

Each day brings a new symptoms that i dont recognize. Sometimes it feels as though this is it...it's going to take me with it. [Frown] I just recently got engaged and started my life and this is the last thing i expected. A sickness which i am physically appear fine but internally my body keeps loosing to it and the beast is winning. Please let me know if someone gets such symptoms.

For me i have to wear head cap or keep my head warm and stay warm because cold makes everything worst. Please let me know if these are the symptoms of lyme...i dont have the appt til next week.

[ 02-17-2009, 09:13 AM: Message edited by: sonee123 ]

--------------------
May God Bless you, answer your prayers, relieve you of your pain and make you stronger than what you are today. Ameen.

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bettyg
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sonee,

please break up your entire solid block text into short paragraphs for us neuro lyme folks to be able to read and comprehend. we'd like to be able to help you if you help us back! see my guidelines below ok! thx [Smile]


Betty's POSTING GUIDELINES . many of us have neuro lyme where we can NOT read long solid block text and be able to comprehend and read it as is.

please edit your post by CLICKING PAPER/PENCIL ICON to right of your name. that opens up BOTH subject line and body text.

now please break up your WORDY SENTENCES into one sentence paragraphs. Then hit ENTER KEY ``TWICE`` after each paragraph; we need that space for comprehension.

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steve1906
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Hi Sonee123,

I feel like i'm within your body!!! What I mean is you have every symptom I have except
( constipated And the ear problems).

Talk about cold, I've been cold - very cold since March of 2007. I shiver, chills etc all day.

I'm not going to repeat everything you said but my God we are a lot alike. I've been a member of this site for some time now,

and I never seen anyone that close to my symptoms as you.

You can PM me anytime you wish and we can maybe help each other and also everyone here.

Hang in there [Smile]

I'm so sorry your so sick, (LYME sucks)

How long have you been feeling this way?
Steve

--------------------
Everything I say is just my opinion!

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JaimieB
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Hey Sonee,

You and I are alot of like too! I notice my neuro problems are really bad about a week before my period. Not to mention my heart paps.

I too havent been confirmed yet either but after reading everything I have, I cannot see how I dont have it.

I wish you the best of luck! We all will get through this!!

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JaimieB
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Hey Sonee,

You and I are alot of like too! I notice my neuro problems are really bad about a week before my period. Not to mention my heart paps.

I too havent been confirmed yet either but after reading everything I have, I cannot see how I dont have it.

I wish you the best of luck! We all will get through this!!

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sonee123
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I have had these symptoms on and off for about 5-6 years now i think. When i had the first "attack" it lasted for few months with strong neuro symptoms and then gradually it got better with minor tingling and numbness left. I went to neuro ENT all said to go home,nothing wrong with u. Then in winter 2006 i had another episode with severe neuro symptoms and within few months everything calmed down again. Now i had another one in September and this one is here to stay. It's been 5 months now and each day brings a new symptom.

--------------------
May God Bless you, answer your prayers, relieve you of your pain and make you stronger than what you are today. Ameen.

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HollyM
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These sound like symptoms of lyme, it can effect any place in the body so there are a wide rage of symptoms.

Just know that if you do have lyme (very probable) that you are not alone.

It sucks and is hard, but stay positive that you will get better.

Lymenet is a great resource for you, you are not alone!

Hang in there!

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steve1906
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Hi Sonee,

My symptoms started about 2-3 year ago. In February of 08 is when everything went nuts.

I had every test under the sun they all came back petty much okay.

My brain MRI did came back with a lot of white matter. One doctor was thinking MS but they all said no in the end.

Was on Teracycline 1,000mg per/day 4 months.

Here's what i'm on now> started on 1-5-09
1000mg of clarithromycin
400mg of hydroxychloroquine

What can say some of my problems did clear up with the meds. But the one thing I can't live with is this dame cold and Tingling, burning
Feeling like my whole body is shaking most of the time.

Here are some of what I still have going on after 5 months of meds.

Very cold and chilled all the time.
Tingling, burning
Feels like my whole body is shaking most of the time.
Sweats
Upset stomach
Diarrhea
Chest pain - Heart palpitations -not so bad the last couple of weeks

Pain on my right side under my ribcage (2 years) they all kinds of test never found anything wrong.

Joint pain
Headache - not to bad the last couple of weeks

Eyes/Vision: double, blurry, increased floaters, light sensitivity

difficulty in thinking

Forgetfuiness, short term memory
going to wrong places

Mood swings
Can't sleep

This list is really short from before I started meds.

I never got worst when starting treatment. At least I don't think I did.

Steve [Smile]

--------------------
Everything I say is just my opinion!

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bettyg
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sonee, thx for breaking up your post.

sounds like me especially the COLD!!

click on my newbie package links below; read thru table of contents, and then look for ALL THE SYMPTOMS LISTS I HAVE; some are 150 plus symptoms!!


some are broken down by body parts; good luck; follow instructions on the 1st page of my newbie package ok! [Smile]

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steve1906
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--------------------
Everything I say is just my opinion!

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Dawnee
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I don't have a whole lot of time right now.. but wanted to let you know that I have had every single one of your symptoms before being diagnosed (plus a lot more to be honest) and now I'm doing SO much better after almost a year of abx.
The neuro symptoms are so scary I know. The body tingling was horrible, I had all over muscle twitches...the fullness in the ears, a weird warm rushing up my neck and into my scalp, tremor, chills, flu like symptoms.... too many for me to name. But I guess I would say I'm about 80% better now!
Keep your chin up, don't freak out or stress (just makes it worse!). You'll get through it.
One day at a time for now!

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Dawnee
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I don't have a whole lot of time right now.. but wanted to let you know that I have had every single one of your symptoms before being diagnosed (plus a lot more to be honest) and now I'm doing SO much better after almost a year of abx.
The neuro symptoms are so scary I know. The body tingling was horrible, I had all over muscle twitches...the fullness in the ears, a weird warm rushing up my neck and into my scalp, tremor, chills, flu like symptoms.... too many for me to name. But I guess I would say I'm about 80% better now!
Keep your chin up, don't freak out or stress (just makes it worse!). You'll get through it.
One day at a time for now!

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Keebler
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-

With thanks to BettyG for breaking up the text making it easier to read for those who have neurolyme.
------


http://www.ilads.org/goldings.html


Controversies in Neuroborreliosis
**********************************

Audrey Stein Goldings, M.D.

Updated October, 2002


The objectives of this article are to cover issues related to Lyme disease that are not even-handedly addressed in the current literature. It will:


Present a practical approach for making the diagnosis of neuroborreliosis,

Explore the other side of the post-Lyme syndrome (i.e. the likelihood of chronic ongoing infection),

Discuss the relationship between MS and Lyme,

Critique the current regimens published for treating neuroborreliosis, and

Present my own approach which may differ from some leading authorities.


``Anyone who, in discussion, relies upon authority uses not his understanding but rather his memory.''
--Leonardo da Vinci, Notebooks (c. 1500)


It is hoped this data will provide the reader with a broader understanding of neuroborreliosis so that he or she may better use current and evolving knowledge for clinical decision making.


I. NEUROBORRELIOSIS: MAKING THE DIAGNOSIS


Because of difficulties in making the diagnosis of neuroborreliosis, the physician will need a familiarity with the most common forms of presentations, which will be emphasized.


The following points will help evaluate the patient for neuroborreliosis:


For most patients, systemic features of disease coexist with, or predate, neurologic manifestations.

Both central nervous and peripheral nervous system involvement is frequent with Lyme disease and typically occur together.


Laboratory data may or may not confirm the diagnosis, and other disease in the differential diagnosis must be evaluated thoroughly in cases where diagnostic ncertainty exists.


Although history of exposure to B. burgdorferi should be sought, for various reasons, patients may not remember a history of a tick bite, or the pathognomonic rash particularly if the disease is presenting years after the exposure.


Early on, personality changes, psychiatric symptoms, or cognitive manifestations may be the first, and occasionally the only, symptoms that the patient or family is aware of.


CLINICAL DESCRIPTIONS OF NEUROBORRELIOSIS
******************************************


CENTRAL NERVOUS SYSTEM INVOLVEMENT

Meningismus with normal CSF
Lymphocytic Meningitis
Meningoencephalomyelitis
Subacute Encephalopathy (SAE)
PERIPHERAL NERVOUS SYSTEM INVOLVEMENT


Cranial Neuropathy
Painful Radiculitis
Distal Neuropathy
Plexopathy
Myositis
Polymyalgia Rheumatica


CENTRAL NERVOUS SYSTEM


MENINGISMUS

Patients may present with headache and stiff neck without evidence of CSF inflammation.


Since early CNS seeding has been described, as well as culture positivity during latent disease without concurrent CNS inflammatory changes, these symptoms probably indicate active infection.


Stiff neck might alternatively be due to axonal degenerative changes of the cervical paraspinal musculature, but there should be other evidence of a more widespread neuropathy when this is the case.


LYMPHOCYTIC MENINGITIS

Lymphocytic Meningitis may appear to be indistinguishable from aseptic meningitis during early-disseminated disease (weeks to months after inoculation with B. burgdorferi).


Most patients will have headaches that will fluctuate in intensity. Associated features may include a cranial neuropathy in about one-third.


Low-grade encephalopathy is present in up to one-half, with mild memory concentration deficits, mood changes, and sleep disturbance.


MENINGOENCEPHALOMYELITIS

Rarely, focal parenchymal CNS lesions occur.

The MRI may show punctate white matter lesions best seen on T2-weighted images; larger lesions occur infrequently.


One brain biopsy showed increased numbers of microglia cells, rare spirochetes, and minimal inflammation. Transverse myelitis, movement disorders (extrapyramidal cerebellar, chorea and myoclonus), and hemiparesis can occur.


PSYCHIATRIC DISORDERS

Psychosis, mood swings (mild or bipolar), profound personality changes, depression, anorexia nervosa, obsessive-compulsive disorder, and panic attacks may occur. CSF may be normal.


SUBACUTE ENCEPHALOPATHY (SAE)

The most common chronic CNS manifestation is a SAE, characterized by memory problems and depression.

Many patients (or their families) will complain of their excessive daytime sleepiness and extreme irritability.

These patients generally come to the office disorganized (despite a supreme effort to be organized), unable to give a coherent history.


They will bring copious notes, which are invariably in the wrong order.

Most patients will complain of fatigue, and about one-half have headaches.

Coincident polyneuropathy is very common with spinal or radicular pain, or distal paresthesias.

Quantifiable deficits in memory, learning and retrieval, attention and concentration, perceptual-motor skills, and problem solving are common.

MMPI testing generally shows a stable psychological pattern without significant psychopathology, similar to other medically ill patients.


ADDITIONAL CNS TESTING:
**********************


NEGATIVE TEST RESULTS DO NOT RULE OUT THE DIAGNOSIS OF NEUROBORRELIOSIS


Confirmation by CSF CULTURE is seldom practical because the organism is very fastidious, present in small numbers, takes a long time to grow out, and may undergo changes to forms which cannot be cultured easily.


CSF ANTIBODY TITERS may be present but are inconsistent and therefore their absence does not rule out CNS infection. The MRI is seldom abnormal and the findings, when present, are not specific for Lyme.


CSF PCR (test for spirochetal DNA) is a useful tool, but at present, because the capture of DNA is inconsistent, a few questions still need to be addressed.


OLIGLOCLONAL BANDS AND IGG INDEX -- Looking for evidence of an intrathecal immune response may be helpful, but it is not specific.

As a rule, oligoclonal bands and an elevated IgG index are not present in North American Lyme disease and their presence should suggest other diseases.


THE PERIPHERAL NERVOUS SYSTEM

Cranial neuropathy, painful radiculitis, distal neuropathy, and plexopathy are seen and generally reflect different clinical presentations of mononeuritis multiplex (polyneuropathy).

Bell's Palsy occurs in almost 11% of all Lyme patients and is bilateral in up to 1/3.

Therefore, a bilateral Bell's Palsy is very suspicious for Lyme in an endemic area.


Painful radiculitis or cranial neuropathy can be seen with meningitis but also with normal CSF due to axonal neuropathy.

Myositis may occur with Lyme as well as polymyalgia rheumatica.


Symptoms of chronic involvement of the peripheral nervous system in a series of patients with chronic neurologic manifestations of Lyme disease developed a median of 16 months after the onset of infection, while CNS involvement began a median of 26 months after the onset of disease.


PERIPHERAL NERVOUS SYSTEM TESTING

Electrophysiological testing may show evidence of a mild peripheral neuropathy.

Axonal degeneration and perivascular inflammatory infiltrates are noted on pathological specimens.


CHRONIC NEUROBORRELIOSIS
**************************


THE MOST COMMON PRESENTATION IS SAE, POLYNEUROPATHY, AND ARTHRITIS


Most typically, patients present with SAE, most often combined with polyneuropathy.

Brief episodes of arthritis, primarily involving the knees, generally predate the symptoms and may persist after onset of neurological abnormalities.


The TRIAD OF SAE, POLYNEUROPATHY, AND ARTHRITIS IS HIGHLY SUSPICIOUS FOR NEUROBORRELIOSIS.


Since serologies may be contradictory or negative, the physician will have to settle for treating if clinical suspicion is strong enough and assess whether the patient has ``possible'' or ``probable'' neuroborreliosis.


Vigilant attempts to rule out other disorders should be undertaken.


Screening should be done for collagen vascular disease, other infections, cancer, metabolic or endocrinological disturbances, etc. when a definite diagnosis cannot be made.


II. CURRENT MEDICAL MYTHOLOGY
*********************************


``YOU HAVE FIBROMYALGIA. YOU MIGHT HAVE HAD LYME DISEASE IN THE FIRST PLACE, AND EVEN IF YOU DID, YOU WERE GIVEN ENOUGH ANTIBIOTICS. RETREATMENT WILL NOT HELP.''


PERSISTENT INFECTION VERSUS POST-LYME SYNDROME
********************************************


Many patients are sent home with antidepressants, muscle relaxers, but no antibiotics from doctors' offices because they have symptoms of fibromyalgia.


Pictures similar, or identical, to fibromyalgia may be part of the constellation of symptoms of Lyme; it may occur more rarely as an isolated symptom, or surface after what would otherwise be considered successful treatment.


Symptoms of fibromyalgia due to Lyme disease have not been cured with short-term oral or intravenous antibiotics, so some argue fibromyalgia is not due to active infection.


I would question whether those particular antibiotic regimens were adequate to eliminate the infection, rather than assume the patient has developed ``Post-Lyme Syndrome'' (some yet to be defined immunologically triggered disorder).


THE SCOPE OF THE PROBLEM

Bujak et al. evaluated patients a mean of almost five years after treatment.

15% of these patients had symptoms of fatigue and arthralgia.

Almost one-half met criteria for fibromyalgia or chronic fatigue syndrome.


Fibromyalgia is thought to be a variant of the chronic fatigue syndrome.

Of note, nearly all patients continued to complain of memory loss or concentration difficulties.

One quarter had objective evidence of cognitive impairment, and 15% manifested depression.


SYMPTOMS OF FIBROMYALGIA AND CHRONIC FATIGUE SYNDROME IN LYME DISEASE MAY BE ATTENUATED FORMS OR CHRONIC MANIFESTATIONS OF THE FLU-LIKE SYMPTOMS ASSOCIATED WITH EARLY DISSEMINATION


All physicians experienced with treating Lyme disease have had patients who present with a recurrence of flu-like symptoms, months to years after they have completed the usual antibiotic course of therapy, oral or intravenous, and re-exposure had not occurred.


These patients describe their flu-like symptoms as identical to their early-disseminated stage of Lyme disease.


The flu-like symptoms may reoccur following what appears to be a trivial stressor, such as an uncomplicated viral URI.

Patients may be able to ``contain'' their symptoms without specific antimicrobial therapy, but many will have to resume antibiotics.


These patients complain of having to go to bed due to excessive fatigue or hypersomnolence.

They cannot think straight, their muscles and joints ache, and they may have a low-grade fever.


Do these symptoms sound like a ``fibromyalgia-like syndrome'' or ``acute fatigue syndrome?''

Prior medical experience suggests reactivation of infection.

Despite what may appear to have been a previous ``cure,'' relapse of symptoms in this context would appear to be due to failure to eradicate the infection and with reactivation after a period of dormancy.


Reoccurrence of symptoms due to immunologically triggered disease, INDEPENDENT of persistent infection seems unlikely.


In reality, DISTINCTIONS BETWEEN FLU-LIKE SYNDROME, FIBROMYALGIA, AND CHRONIC FATIGUE BLUR.

It seems more logical to postulate that fibromyalgia and chronic fatigue syndrome, when seen with Lyme disease, may be attenuated forms of chronic manifestations of earlier flu-like symptoms associated with early dissemination.

[page 2]


III. THE ASSOCIATION BETWEEN MULTIPLE
SCLEROSIS AND LYME DISEASE:

THREE DIFFERENT SCENARIOS


1) LYME CAN LOOK LIKE MS BUT SYMPTOMS AND PATHOLOGY RESIDE OUTSIDE THE CENTRAL NERVOUS SYSTEM

Lyme may present as a MS-like illness, but on many occasions the pathology is not actually in the CNS.


Since chronic Lyme symptoms often are predominantly shifting, vague, behavioral-psychological, psychiatric, and, as mentioned, neurological, they are likely to conjure up the diagnosis of MS in patients and physician alike.


However, the existence of pathology outside the CNS should rule out the diagnosis of MS.

Some of the vague symptoms that can be mistaken for MS include those that are better attributed to peripheral nervous system damage, as part of the mononeuritis multiplex that may occur.


This might cause numbness, tingling, facial weakness, diplopia, etc.

The diagnosis of MS cannot be made in the absence of CNS symptoms and signs.

MRI and CSF findings would also help support the diagnosis of MS.

In addition, a significant CSF pleocytosis may occur with Lyme disease, which should not be present with MS.


2) OTHER LYME PATIENTS DO HAVE CNS LESIONS, BUT THESE ARE GENERALLY DISTINCTLY DIFFERENT, CLINICALLY, AND PATHOLOGICALLY FROM MS


Patients can have CNS lesions in the brain or spinal cord with Lyme disease.

The European literature includes many more cases than the American for encephalomyelitis, strokes, etc.

In those cases where there is focal involvement of the brain or spinal cord, it may be more difficult to distinguish neuroborreliosis from MS.

Again, a brisk CSF pleocytosis would help diagnose Lyme and the specific aforementioned test for CNS Lyme antibodies.

Simultaneous appearance of peripheral nervous system abnormalities or arthritis should suggest the diagnosis of Lyme.


3) ANOTHER GROUP OF PATIENTS HAS MULTIPLE SCLEROSIS AND LYME


There are some patients who have a clear-cut preexisting history of MS before the onset of Lyme disease.

The Lyme appears to accelerate their clinical course.

For others, it appears to be the initiating infection that triggers the MS.

These patients are most likely genetically predisposed to MS and the Lyme bacteria exerts its major effect by ``turning on'' immunologically directed CNS injury.


It is not uncommon to get a history of the onset of an exacerbation of MS related to infections, so Lyme exacerbating MS would be expected.


HLA Class II molecules determine the intensity of the immune response to pathogenic foreign or self-antigens.


With MS, the HLA-DR4 DQw8 haplotype has been associated with chronic progressive MS and the HLA-DR2 DQw6 haplotype has been associated with susceptibility to both chronic progressive and relapsing or remitting MS.


It is possible that in genetically predisposed patients of certain HLA types that infection by Lyme bacteria would cause a high production of cytokines that would mediate the demyelination and destruction of oligodendrocytes.


Most recently, researchers are studying positive outcomes when antibiotics that are most useful in treating Lyme disease are used to treat ``MS.''


IV. WHAT'S WRONG WITH ``CURRENT GUIDELINES FOR TREATMENT'' OF NEUROBORRELIOSIS?


First, read the fine print.


It is interesting to note that recommendations for treatment in the medical literature may carry provisos in small print that can easily be overlooked but are instrumental to understanding how important individualization of therapy is at the current time.


For instance, in the past and in small print, Dr. Alan Steere has written, ``treatment failures have occurred in all these regimens, and retreatment may be necessary; the duration of therapy is based on clinical response, and the appropriate duration of therapy with late neurological abnormalities may be longer than two weeks.''


A more recent article written by Rahn and Malawista states ``these guidelines are to be modified by new findings.


It should always be applied with close attention to the clinical course of individual patients.''


Dr. Katzel surveyed several Lyme Borreliosis conferences, including international ones. He finds a trend towards the use of antibiotics for longer periods than previously described and lack of standardization of care worldwide.


50% of physicians responding considered using antibiotics for time periods greater than one year in symptomatic seropositive patients, with almost as many extending therapy up to one and a half years when necessary.


THE CASE FOR PERSISTENT INFECTION

Studies have shown that Lyme bacteria can be an intracellular pathogen and may evade the normal host immune response.


The causative spirochete, B. burgdorferi, for instance, may persist within fibroblasts and survive at least 14 days of exposure to ceftriaxone.


In addition, B. burgdorferi has been cultured from CSF more than a half year after a standard regimen of IV antibiotics, according to Preac-Mursic.


Logigian and Steere looked at patients with chronic neuroborreliosis, evaluating them six months after two weeks of IV ceftriaxone.


Over one-half of the patients had already been treated with therapy that was thought appropriate for their stage of illness, yet the illness progressed.


The majority of patients studied had subacute encephalopathy and polyneuropathy.

Most had persistent fatigue, and almost one-half had headaches.


One-third of these patients had to stop working or had to go part-time, underscoring the disability that may be seen with Lyme disease on an individual and societal level.


After therapy, two-thirds of patients improved markedly, but seldom completely. Twenty-two percent improved but then relapsed, and fifteen percent had no change in their condition.


This study suggests that additional antibiotics greatly helped the majority with neuroborreliosis but they were insufficient to cause long lasting remission in those patients who subsequently relapsed.


Persistent residual or irreversible disease may explain the fifteen percent who had no change in their condition.


For those clinicians who have had extensive experience with chronic neuroborreliosis, more recent recommendations suggesting that a regime of only 20 to 28 days or even 6 weeks of intravenous antibiotics is sufficient for cure proved contrary to clinical experience.


That brief dosing does not appear to prevent relapse or improve long-term outcome dramatically in many cases.


Perhaps, as recent information has instructed, that is because the immune system does not begin to repair itself until the beginning of the fourth month of antibiotic treatment.


A trial of prolonged use of oral antibiotics seems more reasonable in many cases, given these circumstances.


Antibiotics used for chronic neuroborreliosis should be able to penetrate the blood-brain barrier, express activity against intracellular organisms, and assure good intraphagocytic penetration.


It is anticipated that the microbe during late disease has achieved maximal adaptation to its host environment. Also, because of the long generation time of the organism, lengthier therapy is warranted.


V. WE DON'T HAVE ALL THE ANSWERS BUT HERE'S WHAT IS RECOMMENDED


If a patient has meningitis or appears acutely ill, particularly with possible arrhythmia, admit him or her to the hospital for intravenous antibiotics and observation.


Generally, however, in patients with stable late disease, oral antibiotics can be tried first.


The majority of patients will have some improvement or gradual resolution of encephalopathic symptoms with a better energy level.


After a six-week trial of appropriate antibiotics, the patient is re-evaluated.


If there is no Herxheimer response or some clinical improvement during this interval, it is worrisome, and the physician needs to be concerned about:

1) misdiagnosis,
2) noncompliance,
and/or 3) permanent end organ damage.


These possibilities should be addressed with the patient before proceeding with intravenous antibiotics since they may not be maximally beneficial either


Over the long haul, whether intravenous antibiotics are used for two weeks or longer, with chronic refractory disease, ultimately other methods are necessary.


A lengthier use of oral antibiotics seems more logical than intravenous antibiotics for some patients.

Unfortunately, there are no current tests that adequately measure disease activity with neuroborreliosis in all patients.


We are sorely in need of a test similar to the CSF VDRL for syphilis that would give us a measure of disease activity.


Culture negativity or disappearance of a specific immune response in the serum or CSF has not been useful at this time to establish cure. CSF antibodies may persist for years after otherwise successful treatment.


Particularly in the CNS, judging response of therapy is problematic because pathological changes may incompletely or, at least, very slowly reverse.


Any clinical improvement would be expected to occur in a delayed fashion after therapy is given.


Likewise, one would expect neuropathy related to axonal degeneration to remit slowly and/or incompletely.


Formal neuropsychiatric testing is of value in documenting pathology and following the patient.


It also helps delineate what the patient can and cannot do.

It also can help to define the disease for the patient, family, insurer, and the employer.


The patient needs to be told that his or her symptoms should remit slowly and incompletely, when on antibiotic treatment.

This is particularly important when the symptoms have been chronic.


VI. IN SUMMARY
****************


The premise of this approach to diagnosing and treating neuroborreliosis needs to be reinforced.


There is no current laboratory test that makes or breaks the diagnosis of neuroborreliosis.


It is a clinical diagnosis substantiated by laboratory data when possible.

Fortunately, the majority of cases are fairly uniform in their lack of uniformity, and other diagnoses are easily ruled out.


In situations where the physician simply cannot achieve diagnostic certainty, he or she should notify the patient that the diagnosis is ``possible'' or ``probable'' neuroborreliosis.


This has been done previously with MS (i.e., possible, probable, and definite MS), another disease where laboratory testing does not make the diagnosis in and of itself.


There is no perfect current laboratory test to monitor success of therapy, and this is critically needed.


Until better testing is available, assessing progress, or lack thereof, will largely be determined with clinical acumen.


The infection is difficult to eradicate and may require long-term treatment.

The spirochete, particularly in later stages, becomes well adapted to survival within its host environment.


There are some patients that we may not be able to cure, but will be able to palliate with currently available antibiotics.


Although immunopathogenic factors may play a crucial role in disease presentation, the presence of chronic infection appears necessary to perpetuate the process and play a causative role in persistence of immunologically triggered symptoms.


There is no Diagnostic and Statistic Psychiatry Manual (DSM IV) category for ``antibiotic seeking behavior.''


It is common for physicians who are unable to explain patients' symptoms or effect their cure to ascribe a psychiatric cause to their malady.


This is easily done with Lyme since objective findings may be subtle or non-existent.

Because neuropsychiatric symptoms may pre-dominate, it is easy in some patients to attribute their symptoms to depression or secondary gain.


These patients do not in any other way seek other medication that would be associated with habituation or addiction (i.e., pain medicine).


Many patients suffer unfairly at the hands of physicians who refuse to make the diagnosis because blood tests are either contradictory or negative.


``Lyme bashing,'' for instance, referring to Lyme disease as ``yuppie flu,'' is demeaning.


The ``just say no'' attitude of certain physicians towards Lyme patients who request retreatment with antibiotics should not be condoned in the face of continuing experience with this potentially chronically disabling infectious disease.


Audrey Stein Goldings, MD is a private practice neurologist in Dallas.


She is member of ILADS and a founding member of the Board of Directors.


-

Posts: 48021 | From Tree House | Registered: Jul 2007  |  IP: Logged | Report this post to a Moderator
Leelee
Frequent Contributor (1K+ posts)
Member # 19112

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Hi Keebler,

Great information again!

I have one question, please.

What is MMPI testing?

Thanks,

Leelee

--------------------
The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. Martin Luther King,Jr

Posts: 1573 | From Maryland | Registered: Feb 2009  |  IP: Logged | Report this post to a Moderator
steve1906
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Hi Leelee,

Take a look at this web-site...

http://deltabravo.net/custody/mmpi-info.php

Steve [Smile]

--------------------
Everything I say is just my opinion!

Posts: 3529 | From Massachusetts Boston Area | Registered: Jul 2008  |  IP: Logged | Report this post to a Moderator
Leelee
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Member # 19112

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Thank you, Steve.

Very informative link. I was never even aware such a thing existed.

Leelee

--------------------
The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. Martin Luther King,Jr

Posts: 1573 | From Maryland | Registered: Feb 2009  |  IP: Logged | Report this post to a Moderator
   

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