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Ask the Experts


How does one distinguish between multiple sclerosis and neurologic Lyme Disease?

Answered by: Brian Fallon

Lyme Encephalomyelitis, which can look a lot like MS, is rare in the United States.

Nevertheless, there may be patients with LE in the US who appear to have MS. The white matter MRI hyperintensities in Lyme disease tend to be smaller than would be typical in MS. It is also uncommon to have oligoclonal bands in the CSF of patients with Lyme disease while this is commonly seen in MS patients.

If the Bb Lyme Index is positive in the CSF/serum comparison or if the CSF PCR is positive, then the diagnosis of Lyme encephalomyelitis is made.

At times when a patient may have a positive serologic test for Lyme disease and a reasonable exposure history to a Lyme endemic area and a clinical and MRI profile typical of MS, physicians may consider a trial of IV antibiotic therapy to see if there is a resolution or improvement of the hyperintense lesions on the MRI scan.

Patients may have MS and not Lyme. Patients may have MS and Lyme together by chance and the two are unrelated. Or patients may have Lyme and not MS.

Most cases of MS are not related to Lyme disease and so patients should make sure they consult with a neurologist to take advantage of the many helpful treatments now available for patients with MS.