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Neurology (Expert Forum)
Lyme/MS Diagnostics-- docs want SPECT, maybe Lumbar puncture.....
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Lyme/MS Diagnostics-- docs want SPECT, maybe Lumbar puncture.....
by Camile__0, Dec 05, 1998 12:00AM
Thank you for your reponses to my questions a month or so ago. I hope you may be able to shed a little light again, if you have the time....
Recapping what I've shared previously: I have had neurological symptoms of fatigue, weakness, minor motor disturbance, mild cognative dissodences (sp), tingling in extremeties, hormone problems (demonstrated by lactating, flushing-body temp. regulatory problems), and low-grade fevers that come and go accompanied by glandular swelling.
My MRI showed no focal lesions, but activity showed generalized minimal ischemic demylination in the periventricular region.
No acute viral infection (at least not EBV, HSV1 or 2, CMV, Hep, HIV)
My first Lyme titer was .67, my second, a month later was .90 (borderline). Western Blot analysis was "highly reactive".
Because of my demographics-- 27 white female, Scot-Irish decent, as well as some symptoms I had just prior to onset of neuro symptoms (maculopaples across buttocks, examthem across belly), my doctor wants to rule out MS as a differential diagnosis before proceeding with IV antibiotics.
He has requested that I go in for a SPECT scan, to supplement the MRI information, as he claims is extremely helpful in coming to an acceptable diagnostic conclusion. He says latest research shows SPECT brain-glucose processing patterns are different in Lyme and MS, but MRI lesions may be different or the same. I am very hesitant to proceed with this test, because of the requirement of IV radioactive glucose. I would like to know how long the test has been around and any long term effects that may have been observed to date if any. Wouldn't a lumbar puncture wouldn't be able to differentiate between the two just as effectively? What are the risks associated with that proceedure?
Surely the neurologists at Cleveland have encountered similar situations-- a patient with MS/Lyme type symptoms fitting the average MS demographic, but testing positive for Lyme. What would your standard protocols be in insuring accurate diagnosis?
Dear Camille:
Sorry for the delay in getting to your post, it has been really packed and busy lately. Sorry to hear about your problem. PLEASE DO NOT GET THE SPECT FOR THIS DIAGNOSIS. Should I repeat myself... Do not get the spect. First, I would get an LP and have the fluid checked for oligoclonal bands, tourtelletts. kappa chains, and also PCR for the organism for lyme disease, Borrelia burgdorferi. If it is lyme disease, the CSF will show increase in lymphocytes and positive PCR. If it is MS, it will show oligoclonal bands, positive kappa chains, CSF synthesis of antibodies, increased protein etc. At this point, it is a no brainer and treatment is by protocol. If your neurologist refuses, then see another neurologist. The SPECT studies are only preliminary data and this has not yet been accepted as fact by the MS doctors around the country. Let us know if we can help, you can call 1-800-CCF-Care. Best of luck.
Sincerely,
CCF Neuro[P] MD, RPS
