Involvement of the Central and Peripheral Nervous System

As more becomes known about the possible long-term effects of neurological Lyme disease, also known as Lyme neuroborreliosis, it is important that both the general public and medical professionals are made more aware of this disease.

The organisms that cause Lyme disease in Europe include at least three species within the bacterial genus Borrelia. These are Borrelia burgdorferi sensu stricto, Borrelia garinii and Borrelia afzelii.

The clinical features may vary according to genospecies: B. garinii tends to cause a classic picture of neuroborreliosis as described below whereas B. afzelii tends to cause skin lesions and less specific neurological symptoms which may be more difficult to diagnose.

Any part of the nervous system may become affected giving a wide range of possible neurological and psychiatric symptoms and signs. Lyme disease has been called “The New Great Imitator” because, like syphilis (also a spirochaete) it may affect many parts of the body including the skin, nervous system, heart, joints and eyes (although transmission of the disease is different from syphilis).

LDA has produced a detailed booklet Lyme Neuroborreliosis which is available as a pdf to download. This web version has been arranged to fit onto two double-sided sheets of A4 paper for easier home printing.

What is the Role of the Health Professional?

Because of the diverse clinical features of Lyme neuroborreliosis, health professionals from many disciplines need to be aware of and consider this infection in their differential diagnosis. Otherwise, the crucial diagnosis of Lyme disease may be missed. The symptoms that develop may mimic other disorders. They can occur in any person at any age, including children.

If left untreated, there is a high risk that the patient will start suffering a range of debilitating symptoms. The sooner the infection is treated, the better the chances of a full recovery. Therefore it is essential that patients are correctly diagnosed and offered the right treatments as soon as possible.

Symptoms that affect the Nervous system

Neuro-psychiatric symptoms tend to develop after early signs and symptoms of the infection have occurred, although they may be the earliest and/or only signs, possibly occurring as early as one week after infection. Whilst this stage, termed early Lyme neuroborreliosis (< 6 months) can be painful and debilitating, it may not progress to late Lyme neuroborreliosis if properly treated.

After what is often a flu-like start to the infection, patients may develop arthritic, cardiac or early neurological problems. Neurological problems may include:

  • Meningitis – inflammation of the brain’s enveloping membrane, though neck stiffness may be minimal or absent.
  • Painful radiculitis – inflammation of the nerve roots.
  • Cranial neuritis – inflammation of the cranial nerves.

This combination of meningitis, painful radiculitis and cranial neuritis is known as Bannwarth’s Syndrome.

  • Encephalopathy – cognitive inefficiency.
  • Myelitis – inflammation of the spinal cord.
  • Encephalitis – inflammation within the brain.
  • Encephalomyelitis – inflammation of the brain and spinal cord.
  • Peripheral neuropathy – particularly small fibre damage.

Lyme associated neurological symptoms may include:

  • Facial palsy/weakness (Facial nerve palsy = VII cranial nerve palsy).
  • Headache/neckache.
  • Double vision (VI cranial nerve palsy and III cranial nerve palsy).
  • Sensory disturbances – eg parasthesia, resulting in tingling, numbness and pain, often in a dermatomal distribution.
  • Dizziness, tinnitus and vertigo.
  • Excessive sensitivity to noise or light.
  • Shoulder droop
  • Debilitating fatigue.
  • Suspected gastrointestinal motility disturbances
  • urinary problems eg retention or incontinence

At any time after infection, symptoms affecting a person’s thinking, memory and ability to process information may appear. These symptoms, known as cognitive symptoms are listed in detail below.

Disorders of the nervous system are a common feature of late Lyme disease.

As noted, neuro-psychiatric symptoms that mimic other neurological and psychiatric disorders may develop at any stage of untreated or undertreated disease.

Main symptoms indicating nervous system involvement

Symptoms of cognitive loss such as:

  • Memory impairment or loss.
  • Slowed processing of information.
  • Word-finding problems with reduced verbal fluency.
  • Dyslexia and problems dealing with numbers.
  • Visual/spatial processing impairment (losing things, getting lost, disorganisation)
  • Poor abstract reasoning
  • Losses in fields of attention/executive functions such as inability to maintain divided or sustained attention
  • Poor auditory and mental tracking and scanning (loss in ability to follow daily affairs, which is complicated by persistent distractibility)

Neurological symptoms and signs including:

  • Headaches.
  • Neuralgia/neuropathic pain, ie pain which may have a pricking/stinging quality, with excessive sensitivity to light touch or pressure.
  • Cranial nerve disorders: facial palsy (sometimes involving both sides of the face), double vision, drooping eyelid (ptosis), numbness pain and tingling of the face, hearing loss, dizziness and tinnitus.
  • Seizures.
  • Autonomic dysfunction – problems in regulation of pulse and blood pressure eg POTS (postural orthostatic tachycardia syndrome).
  • States that mimic other defined neurological disorders such as Parkinson’s disease, MS, Bell’s palsy, stroke, ALS, Motor Neurone Disease.
  • In children, indications of neurological involvement include behaviour changes, learning difficulties and headaches.

Some patients have developed Lyme-related psychiatric symptoms:

  • Psychoses including hallucinations and delusions.
  • Emotional lability: rapid mood swings, episodes of rage, crying, reduced impulse control.
  • Depression.
  • Suicidal thoughts and behaviour.
  • Anxiety/Panic attacks.
  • Mood swings that may mimic bipolar disorder (manic-depression).
  • Obsessive-compulsive disorder (OCD).
  • Sleep Disorders.
  • An Attention deficit/hyperactivity disorder (ADD/ADHD)-like syndrome.
  • Autism-like syndrome.
  • Delirium.
  • A progressive dementia.

Patients may also be wrongly diagnosed with hypochondrial and somatoform disorders as well as ME (Myalgic Encephalitis) and CFS (Chronic Fatigue Syndrome), if they are perceived as having medically unexplained symptoms.

References:

All references are available on request from Lyme Disease Action.

Further Sources of Information
Why psychologists need to know about Lyme