Lyme and Motor Neurone Disease (MND) known as Lou Gehrig’s disease or Amyotrophic lateral sclerosis (ALS) in some countries
Immunologic reactivity against Borrelia burgdorferi in patients with motor neuron disease. Arch Neurol. 1990 May;47(5):586-94. Halperin JJ, Kaplan GP, Brazinsky S, Tsai TF, Cheng T, Ironside A, Wu P, Delfiner J, Golightly M, Brown RH, Dattwlyer RJ, Luft, BJ Department of Neurology, State University of New York, Stony Brook 11794.
Abstract: Of 19 unselected patients with the diagnosis of amyotrophic lateral sclerosis (ALS) living in Suffolk County, New York (an area of high Lyme disease prevalence), 9 had serologic evidence of exposure to Borrelia burgdorferi; 4 of 38 matched controls were seropositive. Eight of 9 seropositive patients were male (8 of 12 male patients vs 2 of 24 controls). Rates of seropositivity were lower among patients with ALS from nonendemic areas. All patients had typical ALS; none had typical Lyme disease. Cerebrospinal fluid was examined in 24 ALS patients--3 (all with severe bulbar involvement) appeared to have intrathecal synthesis of anti-B burgdorferi antibody. Following therapy with antibiotics, 3 patients with predominantly lower motor neuron abnormalities appeared to improve, 3 with severe bulbar dysfunction deteriorated rapidly, and all others appeared unaffected. There appears to be a statistically significant association between ALS and immunoreactivity to B burgdorferi, at least among men living in hyperendemic areas. PMID: 2334308 [PubMed - indexed for MEDLINE]
Abstract: Of 19 unselected patients with the diagnosis of amyotrophic lateral sclerosis (ALS) living in Suffolk County, New York (an area of high Lyme disease prevalence), 9 had serologic evidence of exposure to Borrelia burgdorferi; 4 of 38 matched controls were seropositive. Eight of 9 seropositive patients were male (8 of 12 male patients vs 2 of 24 controls). Rates of seropositivity were lower among patients with ALS from nonendemic areas. All patients had typical ALS; none had typical Lyme disease. Cerebrospinal fluid was examined in 24 ALS patients--3 (all with severe bulbar involvement) appeared to have intrathecal synthesis of anti-B burgdorferi antibody. Following therapy with antibiotics, 3 patients with predominantly lower motor neuron abnormalities appeared to improve, 3 with severe bulbar dysfunction deteriorated rapidly, and all others appeared unaffected. There appears to be a statistically significant association between ALS and immunoreactivity to B burgdorferi, at least among men living in hyperendemic areas. PMID: 2334308 [PubMed - indexed for MEDLINE]
Lyme borreliosis associated with complete flaccid paraplegia. J Infect. 1994 Mar;28(2):181-4. Salonen R, Rinne JO, Halonen P, Puusa A, Marttila R, Viljanen MK. Department of Neurology, University of Turku, Finland.
Abstract: We report the case of a patient with concomitant Lyme borreliosis and acute paraplegia. The paraplegia was complete, flaccid and of upper motor neurone type. The diagnosis of borreliosis was based on the detection of large amounts of IgM and IgG borrelia antibodies in the acute phase serum and on the complete disappearance of IgM antibody during the review period. IgG borrelia antibodies were also detected in the CSF, but leakage of antibodies from the blood to the intrathecal space could not be ruled out. Lymphocytosis and increased total protein concentration in the CSF were signs compatible with neuroborreliosis. Ceftriaxone therapy effected dramatic recovery of the patient. This case suggests that borreliosis should be considered a possible cause of acute flaccid paraplegia. PMID: 8034998 [PubMed - indexed for MEDLINE]
Abstract: We report the case of a patient with concomitant Lyme borreliosis and acute paraplegia. The paraplegia was complete, flaccid and of upper motor neurone type. The diagnosis of borreliosis was based on the detection of large amounts of IgM and IgG borrelia antibodies in the acute phase serum and on the complete disappearance of IgM antibody during the review period. IgG borrelia antibodies were also detected in the CSF, but leakage of antibodies from the blood to the intrathecal space could not be ruled out. Lymphocytosis and increased total protein concentration in the CSF were signs compatible with neuroborreliosis. Ceftriaxone therapy effected dramatic recovery of the patient. This case suggests that borreliosis should be considered a possible cause of acute flaccid paraplegia. PMID: 8034998 [PubMed - indexed for MEDLINE]
Motor neuron disease recovery associated with IV ceftriaxone and anti-Babesia therapy. Acta Neurol Scand. 2007 Feb;115(2):129-31. Harvey WT, Martz D. Rocky Mountain Chronic Disease Specialists, L.L.C., North Circle Drive, Colorado Springs, CO 80909, USA. wth928@aol.com
Abstract: This report summarizes what we believe to be the first verifiable case of a significant and progressive motor neuron disease (MND) consistent with amyotrophic lateral sclerosis that resolved during treatment with i.v. ceftriaxone plus oral atovaquone and mefloquine. The rationale for use of these antibiotics was (i) positive testing for Borrelia burgdorferi and (ii) red blood cell ring forms consistent with Babesia species infection. The patient has continued to be free of MND signs and symptoms for 15 months, although some symptoms consistent with disseminated Borreliosis remain. PMID:17212618 [PubMed - indexed for MEDLINE]
Abstract: This report summarizes what we believe to be the first verifiable case of a significant and progressive motor neuron disease (MND) consistent with amyotrophic lateral sclerosis that resolved during treatment with i.v. ceftriaxone plus oral atovaquone and mefloquine. The rationale for use of these antibiotics was (i) positive testing for Borrelia burgdorferi and (ii) red blood cell ring forms consistent with Babesia species infection. The patient has continued to be free of MND signs and symptoms for 15 months, although some symptoms consistent with disseminated Borreliosis remain. PMID:17212618 [PubMed - indexed for MEDLINE]
Motor neuron disease features in a patient with neuroborreliosis and a cervical anterior horn lesion. Acta Clin Belg. 2009 May-Jun;64(3):225-7. De Cauwer H, Declerck S, De Smet J, Matthyssen P, Pelzers E, Eykens L, Lagrou K. Department of Neurology, Klina Regional Hospital, Brasschaat, Belgium. harald.de.cauwer@klina.be
Abstract: A variety of neurological syndromes has been described in neuroborreliosis: cranial nerve palsies, radiculopathy, axonal neuropathy, stroke, parkinsonism, transverse myelitis, supranuclear palsy, Guillain-Barré syndrome, ... We report a case of neuroborreliosis with cervical myelitis presenting clinically as a lower motor neuron syndrome of the upper and lower limbs with proximal and distal pareses and atrophies as well as bulbar dysarthria and dysphagia. During the course of the disease the patient developed the clinical picture of a meningoencephalitis. After initiating ceftriaxone treatment the patient showed a complete recovery. In endemic regions for Lyme disease, in all neurological syndromes neuroborreliosis has to be excluded. PMID: 19670562 [PubMed - indexed for MEDLINE]
Abstract: A variety of neurological syndromes has been described in neuroborreliosis: cranial nerve palsies, radiculopathy, axonal neuropathy, stroke, parkinsonism, transverse myelitis, supranuclear palsy, Guillain-Barré syndrome, ... We report a case of neuroborreliosis with cervical myelitis presenting clinically as a lower motor neuron syndrome of the upper and lower limbs with proximal and distal pareses and atrophies as well as bulbar dysarthria and dysphagia. During the course of the disease the patient developed the clinical picture of a meningoencephalitis. After initiating ceftriaxone treatment the patient showed a complete recovery. In endemic regions for Lyme disease, in all neurological syndromes neuroborreliosis has to be excluded. PMID: 19670562 [PubMed - indexed for MEDLINE]
Generalised motor neuron disease as an unusual manifestation of Borrelia burgdorferi infection J Neurol Neurosurg Psychiatry. 1997 August; 63(2): 257–258. PMCID: PMC2169663
B HEMMER, F GLOCKER, R KAISER, C LUCKING, and G DEUSCHL
Introduction: Lyme borreliosis is a well known multisystem disease caused by the spirochete Borrelia burgdorferi and can produce a wide array of neurological abnormalities in humans. The most frequent are meningitis, cranial neuritis, and painful radiculoneuritis. Other clinical manifestations include chronic encephalomyelitis, spastic paraplegia, and axonal polyneuropathy. Our report concerns what we think to be the first case of a patient with upper and lower motor neuron disease and Borrelia burgdorferi infection of the CNS. A causal relation is strongly supported by an evaluation of the Borrelia burgdorferi specific antibody index and the patient’s favourable response to medical treatment.... To continue reading - download full article at this Link
B HEMMER, F GLOCKER, R KAISER, C LUCKING, and G DEUSCHL
Introduction: Lyme borreliosis is a well known multisystem disease caused by the spirochete Borrelia burgdorferi and can produce a wide array of neurological abnormalities in humans. The most frequent are meningitis, cranial neuritis, and painful radiculoneuritis. Other clinical manifestations include chronic encephalomyelitis, spastic paraplegia, and axonal polyneuropathy. Our report concerns what we think to be the first case of a patient with upper and lower motor neuron disease and Borrelia burgdorferi infection of the CNS. A causal relation is strongly supported by an evaluation of the Borrelia burgdorferi specific antibody index and the patient’s favourable response to medical treatment.... To continue reading - download full article at this Link
CASE REPORT
Lyme disease –induced polyradiculopathy mimicking amyotrophic lateral sclerosis
November 2014, Vol. 124, No. 11 , Pages 859-862 (doi:10.3109/00207454.2013.879582) Ahmet Z. BurakgaziNeuroscience Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USACorrespondence: Ahmet Z. Burakgazi, MD, Carilion Clinic, 3 Riverside Circle, Roanoke, VA 24016, USA. E-mail: drburakgazi@yahoo.com
Importance: To describe a case of predominantly motor polyradiculopathy secondary to Lyme disease that can mimic motor neuron disease and has been rarely reported. Observations: A 64-year-old man presented with a 1-month history of rapidly progressive weakness involving bulbar, upper limb and lower limb muscles. The physical examination showed widespread weakness, atrophy, fasciculation, and brisk reflexes. The initial electrodiagnostic test showed widespread active and chronic denervation findings. The initial physical and electrodiagnostic findings were suggestive of Amyotrophic Lateral Sclerosis (ALS). However, blood serology indicated possible Lyme disease. Thus, the patient was treated with doxycycline. The clinical and electrodiagnostic findings were resolved with the treatment. Conclusion and Relevance: The diagnosis of Lyme disease can be very challenging and it can mimic other neurological disorders such as ALS or Guillain-Barre syndrome (GBS). Careful and detailed examination and investigation are required to confirm the diagnosis and to prevent misleading inaccurate diagnoses.
Read More: http://informahealthcare.com/doi/abs/10.3109/00207454.2013.879582?mobileUi=0
Lyme disease –induced polyradiculopathy mimicking amyotrophic lateral sclerosis
November 2014, Vol. 124, No. 11 , Pages 859-862 (doi:10.3109/00207454.2013.879582) Ahmet Z. BurakgaziNeuroscience Section, Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USACorrespondence: Ahmet Z. Burakgazi, MD, Carilion Clinic, 3 Riverside Circle, Roanoke, VA 24016, USA. E-mail: drburakgazi@yahoo.com
Importance: To describe a case of predominantly motor polyradiculopathy secondary to Lyme disease that can mimic motor neuron disease and has been rarely reported. Observations: A 64-year-old man presented with a 1-month history of rapidly progressive weakness involving bulbar, upper limb and lower limb muscles. The physical examination showed widespread weakness, atrophy, fasciculation, and brisk reflexes. The initial electrodiagnostic test showed widespread active and chronic denervation findings. The initial physical and electrodiagnostic findings were suggestive of Amyotrophic Lateral Sclerosis (ALS). However, blood serology indicated possible Lyme disease. Thus, the patient was treated with doxycycline. The clinical and electrodiagnostic findings were resolved with the treatment. Conclusion and Relevance: The diagnosis of Lyme disease can be very challenging and it can mimic other neurological disorders such as ALS or Guillain-Barre syndrome (GBS). Careful and detailed examination and investigation are required to confirm the diagnosis and to prevent misleading inaccurate diagnoses.
Read More: http://informahealthcare.com/doi/abs/10.3109/00207454.2013.879582?mobileUi=0
A Number of links can be seen at: When ALS is Lyme Page
