MS and Lyme disease

Last fall was diagnosed with disseminatated Lyme.  Lyme carditis and CNS.  AFter 3 weeks rocefin (sp?) 4 weeks oral, symptoms improve.  Relapse of symptoms 6 months later.  Speech difficulty, hyperacusis, fatigue, etc.  CSF showed 5 oligoclonal bands.  EVP showed abnormal VEP.  No lyme in CSF.  normal brain MRI, normal cervical MRI.

Prior to lyme, have had muscle cramping in legs, jaw spasms, and hands "freezing in position".  

Still have all of the above, some balance problems, fatigue, sleep disturbances - too many oddities to mention.

Question:  
1)  Could all of this be related to Lyme, the bands and the abnormal VEP,
2)  or did Lyme "wake a sleeping giant"?
3)  Can one be diagnosed with MS without lesions, or am I somewhere in between - where the optic nueritis was the first event and the second is yet to come?

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.  The symptoms you describe can all be due to lyme disease, but you should pursue a full multiple sclerosis (MS) workup (if not already done).  Lyme disease can cause optic neuritis (which causes abnormal visual evoked potential (VEP)).  Central nervous system (CNS) lyme disease can also produce some oligoclonal bands (these are over-represented proteins in the CSF, usually antibodies against specific proteins, that can be associated with multiple sclerosis, infections (such as Lyme disease) and vasculitis (not MS specific)). Your normal MRI of the brain and cervical spine argues against MS, but I would make sure your test was done with contrast and saggital flair (a sequence on the MRI that is best for viewing MS lesions).  I would also make sure your LP (lumbar puncture) included a Tourtelotte panel, but again this can also be positive in other diseases such as infetions, vasculitis,etc.  You should also consider a SPECT scan of your brain to evaluate for vasocontrictive disease that can have a wide array of clinical manifestations such as parathesisas, cognitive and psychiatric disturbances.  Given your symptoms, you will likley require another month of IV Rocephin (ceftriaxone).  Some people require 12-18 months of treatments of various antibiotics before they improve completely.  You should discuss this with your neurologist.
I hope this has been helpful.