Tuesday, 7 June 2011

Lyme Disease and Neuropathy

An explanation of how Lyme Disease can also be a cause of neuropathy (for all you people who, through the years, have taken long, energising walks through the woods!)
What all fashionable night walkers are wearing these days!


Lyme Disease and Neuropathy
BY JOHN J. HALPERIN, M.D.


Lyme disease is an infectious illness, caused by a corkscrew-shaped bacterium (belonging to the spirochete group of bacteria) known as Borrelia Burgdorferi. This infection is transmitted almost exclusively by bites of very small, hard-shelled ticks. Although these ticks are found in many locations, in the United States, Lyme disease is found primarily on the eastern seaboard (from Southern Maine to Maryland), in the upper Midwest (in Wisconsin and Minnesota), and, to a lesser extent, in Northern California. Notably, a virtually identical illness has been known in Europe for decades.

Ticks must be attached and feeding for at least a day or two before a person is at risk of becoming infected. The most typical initial sign of infection is an unusual rash, erythema migrans, appearing at the bite site several days to a few weeks after the bite. The rash is typically painless, red and round to oval, enlarging from day to day reflecting the outward migration of bacteria from the site of the bite (hence the name migrans). This may be accompanied by fever, headache and other typical signs of an infection, but not by respiratory or stomach symptoms.

In the first weeks to few months after infection, the bacteria may spread to other parts of the body; common sites include the heart (primarily causing problems with the heart’s electrical conduction system), the nervous system and the joints.

Nervous system involvement results from inflammation of the lining of the brain – “meningitis” – in this case a harmless but uncomfortable illness that will subside even without treatment, but more rapidly if treated with antibiotics. Five to ten percent of patients develop paralysis of one or both sides of the face, which, again, resolves over weeks to months in the vast majority of patients.
Another early neurological symptom is radiculitis. Radiculitis involves inflammation of a nerve or its root and causes symptoms very similar to sciatica and other pinched nerves. The affected nerves control muscles and sensations in specific parts of the body. Patients experience localized weakness, numbness or pain dictated by which nerve is involved.

Other types of neurologic involvement are less common. In people with untreated Lyme disease for longer periods of time, a more widespread involvement of nerves— i.e. a peripheral neuropathy—can occur. This can resemble diffuse neuropathies with numbness, tingling and weakness starting at the most distant parts of the body (fingers and toes), progressing gradually over time.
Although there is a lot of controversy about the treatment of Lyme disease,
2-4 week antibiotic regimens are highly effective, particularly in peripheral neuropathies. Intravenous antibiotics such as ceftriaxone, cefotaxime or high-dose penicillin are highly efficacious. Recent European studies indicate that oral antibiotics such as doxycycline are equally effective. Although Lyme disease can affect peripheral nerves in many different ways, in the vast majority of circumstances, they are reversible. Like virtually every other known bacterial infection, Lyme disease can be treated with antibiotics.

John J. Halperin, M.D. is Professor of Neurology at Mount Sinai School of
Medicine and Medical Director of Neuroscience for Atlantic Health System.


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