MS & Lyme

    
      Re: MS & Lyme
    


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Posted by ccf neuro M.D. on August 29, 1997 at 19:19:20:

In Reply to: MS & Lyme posted by Nancy on August 28, 1997 at 09:23:02:
  Recently my daughter has been diagnosed as possibly having MS.  She has had a spinal tap and we are awating results.  My question is - - I know that Lyme Disease can have similar symptoms as MS.  What is the major difference in symptoms and what is the test for Lyme.  I'm still hoping that the spinal tap tells us it is not MS.  Her first MRI, when we thought she had a stroke showed nothing.  Her last MRI said that her spine was not inflamed and the doctor said that was very good news!  The reason I am asking about Lyme is they have, on numerous occasions this summer, seen many ticks on their children and dog.  She, however does not remember any on her.  
  Any information you can give me will be appreciated.
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Nancy,
The diagnosis of multiple sclerosis is often challenging, insofar as while many different tests may be supportive of it, the diagnosis is most often made by clinical history and physical examination evidence of multiple attacks of brain or spinal cord malfunction causing neurologic symptoms (such as numbness, weakness/paralysis, double vision, facial paralysis, difficulty walking and speaking etc.) separated in both space (in other words, different areas of the brain or spinal cord being involved in each attack), and time (in other words, symptoms should go away completely or almost completely, or at least significantly improve, between attacks, rather than progress all at once).  On MRI scans, M.S. most often produces evidence of so-called "spots" on the brain or spinal cord, indicative of areas where the MYELIN, or insulation coating of nerve fibers, has been damaged or destroyed by inflammation, hence M.S. being called a DEmyelinating disease. Unfortunately, other diseases can cause such demyelination as well, and until the clinical features of M.S. occur (often over months to years), one can never be completely certain that it is M.S., although it is by far the most frequent cause of demyelinating disease in the barin and spinal cord. Diseases that sometimes imitate M.S. include sarcoidosis, cerebral vasculitis, arteriovenous malformations, Lyme disease, lupus, and some other rare diseases. Lyme disease specifically is caused by a bacteria called Borriella burgdorfera, and is transmitted to humans by the bite of a certain tick (Ixodes damnii). Often but not always, a RING-shaped area of redness appears at the bite location, and spreads, and other ring shaped areas may form elsewhere. The second stage of the disease occurs only in some people (and may be the first stage in those that never get the rash), and consists of brain and sometimes heart symptoms. Brain symptoms most often consist of meningitis-like symptoms (stiff neck, headache, light sensitivity) and/or so-called cranial nerve palsies, where nerves that come out from the brain on their way to the face, eyes, throat and other parts of the head, get inflammed. Sometimes stroke-like symptoms occur, however, if deeper parts of the brain are affected. Typically if unrecognized and untreated, this phase of the illness will "burn out" over months to a year or so, and then the third stage may set in, which is a persistent ARTHRITIS that can affect many joints. Blood tests and spinal fluid tests are available to diagnose the disease, but there is NO 100% accurate test for Lyme disease (or M.S.). Spinal fluid analysis often reveals certain abnormal proteins that support a diagnosis of M.S. There is also another test called a visual evoked potential sometimes used to support a diagnosis of M.S., as it often affects thge optic nerves, which are responsible for vision (causing optic neuritis, where temporary blindness or dim vision occurs in one eye).
Because a diagnosis of M.S. has long term implications (and often insurance coverage and employment implications), physicians are highly reluctant to diagnose it until they are CERTAIN that OTHER causes of demyelinating disease and M.S. imitators have been excluded. Once the diagnosis is made or strongly suspected, however, there are some new treatments for it that actually do favorably alter the long term course of the disease, although they do not cure it (much like antiinflammatory drugs like ibuprofen help arthritis a great deal, but do not cure it). Treatments are also available for individual flareups of the disease.
I hope this information answers some of your questions and helps you to better understand your daughter's situation. Information provided on the neurology forum is intended for general medical informational purposes only. The actual diagnosis of and treatment of any particular condition you (your daughter in this case) may have should be strictly in conjunction with the patient's treating physician(s(. The Cleveland Clinic is the home of the Mellen Center, the world's largest institute devoted entirely to the diagnosis and treatment of multiple sclerosis and related disorders. If your daughter would be interested in obtaining asecond opinion there, the number is 1-800-223-2273--- ask to be connected to MELLEN CENTER appointments (separate from general neurology appointments). I would suggest Dr. Richard Rudick, Rip Kinkle, Jeff Cohen, or Richard Ransahoff in particular. Good Luck!!