Category: Lyme Signs, Symptoms, & Diagnosis
Does Lyme disease cause a peripheral neuropathy?
Yes, patients with Lyme disease may develop "peripheral neuropathy" -- a dysfunction of the nerves that transmit electrical signals between the body's periphery and the spinal cord and brain. Common symptoms of Lyme-related neuropathy include multi-site "neuropathic pain" (described as a "burning" or "stabbing" sensation), spinal or radicular pain, distal paresthesias (e.g., numbness, tingling), sensory loss, weakness and hyporeflexia. [Logigian et al, "Chronic Neurologic Manifestations of Lyme Disease," NEJM, 1990]. These symptoms are often caused by malfunctioning of small "A-delta fibers" and "C fibers" that carry pain and temperature signals. Pathology of the small nerve fibers can also disrupt autonomic functions such as heart rate, blood pressure, and gastrointestinal functions. Involvement of the cranial nerves can lead to blurry vision, double vision, facial droop, loss of balance, or tinnitus (ringing in the ears).
The precise mechanisms by which these nerve fibers are damaged in Lyme disease remains a subject of active investigation. Some possibilities include: direct assault on the nerve fibers by spirochetes during periods of active infection; immune-mediated damage to the nerve fibers or their protective myelin sheaths by the hostís own innate (killer T-cell mediated) or adaptive (memory B- or T-cell mediated) immune system; or production of antibodies with accumulation of immune-complexes that disrupt the small vessels that supply oxygen and nutrients to the metabolically-active peripheral nerves.
The symptoms and immune-mediated mechanisms of peripheral neuropathy are not specific to Lyme disease, and must be understood within the broader clinical picture. Other disorders that might be considered, based on the history and presentation, may include: diabetes, vitamin deficiency, accumulation of endogenous toxins (e.g. uremia due to renal failure) or exogenous toxins (e.g. heavy metals such as lead, mercury or arsenic) or paraneoplastic disorders or Collagen Vascular diseases/autoimmune diseases (Sjogrens, Systemic Lupus), or other infectious or inflammatory processes such as HIV or hepatitis. Additional studies such as body fluid analysis, nerve conduction studies and peripheral nerve biopsy can be utilized to inform the diagnosis and treatment of a peripheral neuropathy. Additionally, neurocognitive testing may be ordered to help clarify the underlying diagnosis.
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