New York Times Article: When Lyme invades the brain and spinal system

Please note: This article is over 15 years old, but I found it quite interesting and wanted to share this on my blog. I was recently told I have spinal stenosis (my Lyme arthritis symptoms are worsening 2 years and 6 months later) and I came across this article under the search "Lyme and Spinal Stenosis" 

Personal Health; When Lyme invades the brain and spinal system.

By Jane E. Brody
Published: February 15, 1995

A YOUNG woman, whose doctor declined to identify her, thought she was going crazy. Suddenly, this once perfectly healthy college freshman developed severe anxiety, panic attacks, insomnia and loss of appetite.

A doctor and a psychologist at her college's health service recommended rest for what they thought were problems in adjusting to being away from home. Forced to take a medical leave, she underwent an extensive examination that showed no abnormalities except one: evidence in her spinal fluid of infection by the spirochete Borrelia burgdorferi, which causes Lyme disease. Only then did she recall having had a circular rash characteristic of Lyme disease months earlier, followed by a brief bout of headaches and unusual fatigue. At the time, she did not take these symptoms seriously and did not seek medical attention.

The young woman's case is among dozens reported in which the Lyme spirochete was the apparent cause of a wide range of psychiatric and neurological problems. Three months after receiving a six-week course of intravenous antibiotics to eradicate the spirochete, the woman felt better. But a year later more therapy was needed when the anxiety and panic attacks returned, along with musical hallucinations, deja vu experiences and obsessional thoughts.

Although such extreme cases are rare, neurological problems resulting from Lyme disease are more common than realized by most doctors, who tend to look for the more characteristic arthritic conditions associated with the disease. Nervous System Attack

When Lyme disease is promptly recognized and properly treated, the overwhelming majority of patients recover uneventfully. But often the initial sign of a bite by a Lyme-infected tick, a red circular rash that clears in the center, is not recognized. Only when more severe symptoms develop weeks or months later are a diagnosis and treatment pursued.

Meanwhile, within weeks of entering the body, the spirochete, a bacterium that resembles the organism that causes syphilis, can invade the brain and spinal cord. At first, patients may develop meningitis, encephalitis or problems like pain or loss of sensation stemming from an attack on the nerves that emanate from the brain or spinal cord. But as with syphilis, months or years may pass before the late signs of a neurological infection appear.

Once inside the central nervous system, the organism can wreak all kinds of havoc, from memory problems, moodiness and depression to hallucinations, panic attacks, paranoia, manic depression, seizures and even dementia. Memory problems are the most common sign of a brain infection. When the organism invades spinal nerves, patients may develop numbness and tingling in fingers and toes and pain radiating to the front of the body.

In rare cases, the spirochete may mount an attack on the protective sheath of nerves, resulting in spastic muscle weakness in the extremities that resembles multiple sclerosis, said Dr. Allen C. Steere of Tufts-New England Medical Center in Boston. Dr. Steere first recognized Lyme disease as a distinct disorder in 1975 and soon realized that it could cause neurological problems.

Dr. Brian Fallon, a psychiatrist at the State Psychiatric Institute in New York, recently reviewed the neuropsychiatric aspects of Lyme disease in The American Journal of Psychiatry, in the hope of prompting his colleagues to consider the possibility of this infection when examining patients who might have been exposed to Lyme-infected ticks.

In Europe, where the disease is called borreliosis, patients commonly develop neuropsychiatric symptoms after being infected by the same spirochete that causes Lyme disease, Dr. Fallon said. But in this country, arthritic symptoms are most common and many doctors still do not appreciate the threat to the nervous system.

Dr. Fallon said that up to 40 percent of patients with Lyme disease developed some involvement of the nervous system affecting either the extremities or the central nervous system. He told of a 47-year-old man who experienced depression and memory problems as his main signs of Lyme disease, symptoms that responded well to intravenous antibiotics. The symptoms recurred five months later, but he was not treated a second time. He developed a type of dementia that required hospitalization and died a few years later. An autopsy found Lyme spirochetes in a degenerated part of his brain.

Children can also develop a neurological form of Lyme disease that often shows up as behavioral or emotional disturbances. Such children may become moody, lose interest in play and do poorly in school. Among 16 children in Westchester County, N.Y., who contracted Lyme disease, 15 whose infections were identified and treated within the first month were doing very well, Dr. Fallon said. But one child, in whom the disease was not diagnosed until four months after he was thought to have been infected, has suffered for five years with arthritis, headaches, depression and memory problems.

Studies by Dr. Steere and others of patients with neurological signs of Lyme disease have revealed inadequate blood flow through particular areas of the brain. Dr. Steere also said that after an attack of Lyme disease, patients might develop pain or fatigue syndromes that resemble fibromyalgia or chronic fatigue syndrome. Diagnosis Problems

To be sure, extreme incapacitating effects of a Lyme infection are rare. But even the more subtle effects like depressed mood, memory problems and word-finding difficulties can be devastating to those who are afflicted.

Such patients commonly receive the wrong diagnosis or inappropriate treatment. Often they are shunted from one doctor to another. In addition to blood tests for antibodies to the spirochete, diagnosis of neurological Lyme disease may require a spinal tap, an electroencephalogram (EEG), magnetic resonance imaging (M.R.I.), standard neuropsychological tests (for example, for memory, word association and depression) and a carefully taken health history.

Even after a correct diagnosis is made and a long course of intravenous antibiotics is administered, the organism may not be eradicated from its sanctuary in the brain. Repeated courses of this costly therapy are typically needed, but many insurance companies balk at paying for them because the treatments are still considered experimental.

Sometimes the treatment itself can cause a flare-up of Lyme disease, producing both physical and neuropsychiatric symptoms. But most often, when the presence of a Lyme infection can be established, treatment with intravenous antibiotics for four to six weeks results in a distinct improvement. But Dr. Steere, who uses ceftriaxone, which is sold as Rocephin, noted that patients typically must wait three to six months to see signs of gradual improvement and may never recover 100 percent.