LDA/Columbia 2011
Scientific Conference

Hyatt Penns Landing

Philadelphia, PA

October 1-2, 2011

Category:  Lyme overlap with other Diseases

How does one distinguish between Multiple Sclerosis and neurologic Lyme Disease?

Multiple Sclerosis and Lyme Disease may have similar clinical and neuroimaging manifestations. Further, MS patients can get superimposed Lyme Disease - a concomitant infection which might make the MS worse by triggering an exacerbation. Similar to MS, infection with the agent of Lyme Disease can cause a progressive encephalomyelitis characterized by para- or tetraspastic pareses with gait difficulties, ataxia, bladder dysfunction, visual disorders, impaired hearing. Other manifestations of encephalomyelitis might include lateral nystagmus, intention tremors, dysarthric speech, seizures, facial palsies, retrobulbar neuritis, mild cognitive disorders (though rare dementia-like manifestations may occur). MS and Lyme Disease may cause brain and spinal MRI hyperintense lesions. Lyme Disease however more often causes a CSF pleocytosis and elevated protein. In Lyme Disease, evoked potential studies are generally but not always normal. MS patients do not have extra-neural features, as one may often find in patients with neurologic Lyme Disease (arthralgias, arthritis, myalgias, erythema migrans, carditis). Generally with MS, the laboratory studies reveal "abnormal evoked potentials (50%), CSF oligoclonal bands (90-95%), intrathecal IgG production (70-90%), and CSF myelin basic protein." (Coyle, 1992, Seminars in Neurology). If one finds intrathecal production of antibodies against Borrelia burgdorferi in the CSF, then the diagnosis of Lyme encephalomyelitis is confirmed. If one finds elevated myelin basic protein and oligoclonal bands and no signs of intrathecal Lyme antibody production, then the diagnosis of MS is much more likey. A case of a man with an MS-like illness that ultimately proved to be Lyme Disease responsive to antibiotics is described in the following citation: Psychiatric Clinics of North America, v21: 693-703, 1998)

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