Neuroborreliosis (Neuro Lyme) interpreted as multiple sclerosis by MRI

From: https://ugeskriftet.dk/videnskab/neuroborreliose-tolket-som-multipel-sklerose-ved-mr-skanning

Machine translated from Danish (might contain errors):

A Danish review of 431 patients with neuroborreliosis from 2017 showed that the mean incidence of Lyme neuroborreliosis (LNB) was 4.7 per 100,000 inhabitants per year on Funen. The most common clinical symptoms were painful radiculitis (66%), cranial nerve palsy (43%) and headache (28%). The study showed an unchanged delay from symptom onset to diagnosis over 20 years. Confirmatory diagnosis of LNB requires neurologic symptoms consistent with LNB, lymphocytic pleocytosis in the cerebrospinal fluid, and intrathecal Borrelia burgdorferi-specific immunoglobulin (Ig) G and/or IgM antibody synthesis.

Multiple sclerosis (MS) is diagnosed after a symptom that increases over hours to days and lasts for several weeks, after which it usually slowly disappears. These symptoms usually occur in younger adults and are typically related to optic neuritis, cerebellar syndrome, spinal cord syndrome or brainstem syndrome. Thus, the symptom must be localized in the central nervous system (CNS) and last for at least 24 hours, and the patient must not be febrile. Such a symptom allows the diagnosis of MS to be made if MRI of the CNS shows dissemination in space and there are oligoclonal bands in the cerebrospinal fluid (CSF).

In this article, we describe a patient who met the criteria for both diagnoses and review MRI scan changes in LNB.

CASE HISTORY

A 27-year-old man, previously healthy, was referred in November 2021 due to increasing headaches. He related the headache to a minor head trauma during a ball game in July 2021. However, the medical history revealed that the headache occurred a week after the head trauma, which was not associated with impaired consciousness. It was also revealed that the patient had attended a survival course a month before, but he did not remember observing any skin changes. He experienced double vision when looking straight ahead, intermittent dizziness, persistent light sensitivity and paresthesias in his fingers, and generally reduced energy levels. Examinations showed latent outward strabismus and restricted inward rotation of the eyes. MRI scan of the cerebrum in April 2022 showed juxtacortical and periventricular lesions (Figure 1).

On suspicion of MS, a spinal fluid examination was performed in May 2022, which showed eight mononuclear cells, elevated IgG index and oligoclonal bands. Finally, a positive intrathecal Borrelia antibody index was found. The patient started treatment with doxycycline 200mg daily for three weeks.At 12-month follow-up, he reported significant improvement in headache and a marked reduction in photosensitivity, but continued impact on quality of life as he often had to be selective in what he could manage.Memory was good, but there was continued difficulty concentrating. Ophthalmologic examination in June 2023 showed completely normal conditions.Control MRI scans showed unchanged conditions in September 2022 and in September 2023.

DISCUSSION

This case history shows that even a very small increase in CSF mononuclear cell count can be seen in LNB. In the above-mentioned Danish study, normal CSF cell counts were found in about 11% of patients with LNB. This delayed treatment time and increased the risk of persistent symptoms. Contributing to the delay in the current patient was the fact that he was part of both the approximately 80% who do not remember a rash and the more than 60% who do not remember ever being bitten by a tick.

A PubMed search found seven case reports describing juxtacortical lesions, periventricular lesions, brainstem lesions and spinal cord lesions in relation to LNB. These changes were associated with the symptoms described above, but also with symptoms of optic neuritis. In one of the articles, the LNB changes were distinguished from MS changes by a special MRI scanning technique.

Demyelinating changes periventricular to the LNB were also found histologically.This supports a secondary autoimmune reaction, which is one of the pathogenetic hypotheses in MS.

Another 15 case reports described MRI scan changes in LNB in the form of cranial nerve involvement, meningoencephalitis, meningoradiculitis, encephalitis, vasculitis and tumor-like changes.

Thus, we conclude that there may be overlap between LNB and MS on MRI, but larger, prospective case-control studies are needed to better elucidate changes in LNB. At the slightest suspicion of LNB, lumbar puncture should be performed, and a normal cell count in the spinal fluid does not rule out LNB.

In Eurasia borrelia garinii frequently infects people. It causes much more rapid and aggressive nervous system symptoms. It tends to invade the nervous system more rapidly than borrelia burgdorferi. If you search the medical literature you will find European case reports of patients who show up in the emergency room with acute Lyme that caused headache, fever, changes of consciousness, seizures and other symptoms of acute encephalitis. In European emergency rooms, many of the doctors know to look for Lyme in the spinal fluid.

I spent some time looking through these case reports when I was worried about my son's facial nerve palsy coming back. I was worried maybe it wasn't just cranial nerve involvement but might instead be some of the things I read about in the European case reports of acute neuroborreliosis. I think some of the people in the case reports had lesions from active infections in their basal ganglia inside of their brains. Several children presented with left-sided weakness as a result. Left-sided facial drooping was just one symptom.

According to my research, in North America, borrelia burgdorferi most commonly invades the meninges, the cranial nerves and the peripheral nerves when it infects the nervous system.

Of course it is still possible for it to make its way into the brain as well. One poor woman who died young of Lyme disease, after having been tick bitten multiple times in her life in the Hudson River Valley in New York, and after having been bed ridden, had her organs autopsied. All of them, including her brain, were riddled with borrelia biofilms. This woman had never been CDC positive on a Western Blot, but LLMDs had treated her because she had a band on her her Western Blot that was borrelia specific. She had very few B cells next to the biofilms but lots of T cells. I think the B cells would be the cells that would make the antibodies that would show up on a Western Blot.

I wonder if this poor Lyme patient would have benefited from an herb that would have anti-biofilm efficacy. The Johns Hopkins studies showed in vitro that some plants deal with biofilms and cysts better than the antibiotics. One study showed in vitro that the combination of baicalin with doxycycline was effective against the biofilms, cysts and active forms of borrelia. Whereas doxycycline all by itself increases biofilm formation and cyst formation.

I think the LLMDs did the best they could with her at the time. It's not their fault that so little business model exists to study borrelia, and the NIH invests little money in it.

Anyway, it goes to show that you can never say never when it comes to borrelia burgdorferia. It can definitely get into the brain and not only into the meninges and cranial nerves. But I think as a general rule, its tendency is not to invade the brain and central nervous system as rapidly and aggressively as borrelia garinii does, even in acute Lyme.

For me, the most reliable test seems to be treating the perceived infection and waiting for the
anticipated effects/results. Does the treatment make me feel sick in a way that can be pointed back to
the infection? Does it cycle? etc......

Looking for "warriors" (antibodies) in a "war" that a body is losing is probably folly.........

Rob

Dr. Klinghardt claims that his Lyme patients usually don't test positive for Lyme until after treatment has begun. Some people "provoke" before they test by taking Samento for three months before the Western Blot.

I agree with the thinking about variable host immune response. I think studies show a continuum. The poor woman whose organs were all riddled with biofilms may have been at one extreme end of the continuum. At the other extreme are the people who carry borrelia asymptomatically.