Lyme disease and neuropathy
The neurologic manifestations of lyme disease
To see whether post-treatment Lyme disease syndrome (PTLDS), which is characterized by fatigue, cognitive complaints, and generalized pain after Lyme disease treatment, is linked to small fiber neuropathy (SFN), which manifests as autonomic and sensory dysfunction.
Subjects with PTLDS were tested in this single-center retrospective analysis. To evaluate SFN, seriousness of dysautonomia, and cerebral blood flow disturbances, skin biopsies for epidermal nerve fiber density (ENFD), sweat gland nerve fiber density (SGNFD), and functional autonomic testing (deep breathing, Valsalva maneuver, and tilt test) were performed. Transcranial Doppler was used to measure heart rate, end tidal CO2, blood pressure, and cerebral blood flow velocity (CBFv) from the middle cerebral artery.
The study looked at 10 people, 5 women and 5 men, with an average age of 51.3 14.7 years and a BMI of 27.6 7.3. Many of the participants tested positive for Lyme disease according to CDC guidelines. Both ten participants had at least one irregular skin biopsy. In 9 participants, abnormal ENFD was discovered, abnormal SGNFD was discovered in 5 participants, and both abnormal ENFD and SGNFD were discovered in 4 participants. Seven participants had parasympathetic impairment, and all had mild to moderate sympathetic adrenergic failure. Both ten participants had abnormal total CBFv scores. Seven participants had abnormally low orthostatic CBFv, and three more had abnormally low supine CBFv.
A warning in the last stages of lyme disease
In 36 percent of late Lyme disease patients, peripheral nerve dysfunction was found. 14 of the 36 patients examined had severe limb paresthesias. Thirteen of them had neurophysiologic signs of peripheral neuropathy, yet the majority of them had regular neurologic tests. In 11 of the 12 cases, repeat testing after treatment revealed rapid progress. We conclude that late Lyme disease neuropathy, which is distinct from the infrequent peripheral nerve syndromes previously identified in this illness, is normal. Intermittent paresthesias without major deficits on clinical review characterize this neuropathy, which is reversible with antibiotic therapy. Neurophysiologic testing is a valuable diagnostic method as well as a significant indicator of patient response.
How to know if you have lyme disease
Lyme disease cases have been gradually increasing over the last 30 years, but diagnosis can be difficult. Patients with Lyme disease, if left untreated, may experience neurological symptoms, including those associated with peripheral neuropathy.
For more than six months, Francis Bean, DPM, has been experiencing neurological symptoms in his lower extremities. When they appear, he experiences tingling in his hallux, numbness in his heels, and hypersensitivity to temperature and touch, resulting in a painful burning feeling. On paper, these sound like signs of diabetic peripheral neuropathy, a disorder Bean is familiar with as a podiatrist.
Lyme borreliosis, also known as Lyme disease, is a multisystem infectious disease caused by the spirochete Borrelia burgdorferi (Bb), which is almost exclusively transmitted by tick bites in the United States.
1.2 Despite the fact that cases are concentrated mainly in small geographic areas where the tick is endemic, Lyme disease is the most frequently recorded vector-borne infection in the world, and reported cases have been steadily increasing over the last 30 years. 3.4
One man’s experience with lyme disease
In a paper on the study released online in JAMA Neurology on April 11, the findings of a small study of people with tingling pain in their hands and feet contributed to evidence that so-called prediabetes is more detrimental to motor nerves than previously thought.
The study of patients with small fiber neuropathy, according to Johns Hopkins neurologists, revealed unexplained degradation over the entire length of sensory nerve fibers, rather than only at the longest ends first, which defies traditional wisdom on how nerves deteriorate.
The investigators discovered that generalized damage occurs in those with prediabetes, and that the precursor disorder could be less benign than most clinicians realize, over the course of the three-year analysis of the 62 participants, 13 of whom had prediabetes.
“I liken small fiber neuropathy to the canary in the coal mine,” says senior author Michael Polydefkis, M.D., professor of neurology and director of the Cutaneous Nerve Lab at Johns Hopkins University School of Medicine. “It indicates the start of nerve damage, which eventually includes other forms of nerve fibers, becomes more visible, and has a significant impact on people’s quality of life. The findings of this new research highlight the urgent need for further screening and intervention for those who have the disease.”